Improvement In Peak Flow Research Articles

Composite urinary and sexual outcomes after Rezum: an analysis of predictive factors from an Italian multi-centric study.

The Rezum system is one of the latest minimally invasive surgical treatments for benign prostatic hyperplasia. We retrospectively reviewed all patients who underwent the Rezum treatment in seven different Italian institutions. A successful urinary outcome was defined as: ≥50% improvement in the IPSS <7, improvement in peak flow ≥50% and/or more than 15 ml/s, ≥1-point improvement in the QoL questionnaire and in the absence of perioperative major complications (AUR, transfusion) or postoperative incontinence. A successful sexual outcome was defined as postoperative (latest follow up consultation) antegrade ejaculation or no variation in ejaculatory function and an increase, or stability or max 1 class reduction, in IIEF-5. 262 patients were enrolled with a follow-up period of 11 months (IQR 5-15). No early or late serious adverse events (Clavien III-IV) occurred. Early complications occurred in 39.3% of cases, with 4 cases of clot retention and one case of blood transfusion. Urge incontinence was reported by 6 patients (2.2%). A treatment failure requiring re-intervention occurred in 4 cases (1.5%). The preoperative antegrade ejaculation rate was 56.5%, and after the procedure it increased to 78.2%. The increase of ≥1-point in the QoL was achieved in 92.7% of the cases. Optimal urinary and sexual outcomes were achieved in 52.9% and 87.8%, respectively. In our series, water vapor intraprostatic injections seem to be an effective and safe procedure.

Impact of early pulmonary rehabilitation in postacute COVID Disease: A single-center experience from India – A quasi-experimental study

It was observed that post-COVID patients reported persistent exertional dyspnea, cough, fatigue, or chest pain. About 10%-20% of patients may progress to pulmonary fibrosis. Pulmonary rehabilitation has been proven to be useful in improving effort tolerance and quality of life in chronic respiratory diseases. The objective of this study was to assess the effectiveness of pulmonary rehabilitation in improving 6-min walk distance (6 MWD), peak flow, fatigue, anxiety, and depression in early postacute COVID disease. This quasi-experimental study was conducted during January 2021 to March 2021. The patients who recovered from COVID-19 and having persistent exertional dyspnea and fatigue after 3 weeks of recovery were included in the study. Baseline and postintervention assessment of 6 MWD, Visual Analog Scale for Fatigue (VAS-F), peak flow, and Hamilton rating scales (HAM) scales after 4 weeks were done. Compliance was ensured with weakly telemonitoring. Significant improvement in peak flow, 6 MWD, Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), and VAS-F (P < 0.01) after 4 weeks of pulmonary rehabilitation. Early pulmonary rehabilitation in post-COVID syndrome can contribute to statistically significant improvement in functional and psychological parameters as well as post-COVID fatigue.

Parent-child conflict and physical health trajectories among youth with asthma

ObjectiveTo investigate the role of caregiver- and youth-reports of parent-child conflict on trajectories of asthma-related health outcomes over 2 years. MethodsIn a sample of 193 youth with asthma (42.7% female; M age = 12.78) and their primary caregivers, we used a multi-method and multi-informant approach to assess self-reported parent-child conflict from youth and caregivers at both the daily and global levels at baseline. Next, we annually assessed subjective (i.e., youth self-reported asthma symptoms) and clinical (i.e., peak flow) asthma health outcomes for 2 years. ResultsLatent growth curve models revealed an effect of baseline youth-reported global family conflict on peak flow trajectories such that youth who reported greater parent-child conflict at baseline experienced less of an increase in peak flow over time than youth who reported less parent-child conflict at baseline (standardized β = −0.27, p = .003). ConclusionsYouth with asthma who perceive greater overall conflict with their caregivers experience less improvement in peak flow as they age. The research and clinical implications of these findings are discussed.

What's New in Bipolar TURP for Surgical Management of BPH?

Transurethral resection of the prostate (TURP) is still considered the gold standard for male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), but new methods like bipolar TURP became a real treatment alternative. Bipolar resection presents many option for the effective resection of the prostate: the most similar with m-TURP is represented by the loop resection, then transurethral vaporisation of the prostate (B-TUVP) which is derived from plasmakinetic B-TURP and the enucleation, which is among open prosta tectomy or holmium laser, the first choice of surgical treatment in men with a substantially enlarged prostate and moderate-to-severe LUTS. There was no statistical difference observed between M-TURP and B-TURP in the parameters of surgery time, catheterization time, PSA drop, peak flow improvement (Qmax), occurrence of urinary retention, and IPSS and quality of life (QoL) scores. On the other hand, B-TURP proved to be superior to M-TURP in relation to hospitalization time, blood transfusion rate, post-TURP syndrome, serum sodium rate and lower occurrence of urethral stenosis. when is about the cost of the procedure, a meta-analysis on 24 from the most relevant publications in the last 20 years, revealed that the TURis system demon strates equivalent efficacy versus MTURP, In conclusion, it could be observed nowadays that bipolar-TURP represents a viable alternative to M-TURP in patients with moderate to-severe LUTS secondary to BPO, with similar efficacy but lower peri-operative morbidity.

Urodynamic Changes after Valve Fulguration Alone and Valve Fulguration with Bladder Neck Incision.

Aims:The aim of this study is to compare urodynamic changes after valve fulguration alone and valve fulguration with bladder neck incision (BNI).Settings and Design:A total of 81 patients with posterior urethral valve were treated at our center from July 2010 to July 2016. Patients were randomized into two groups using simple randomization. Forty patients underwent BNI in addition to valve fulguration (Group I), and the remaining 41 patients underwent conventional transurethral valve fulguration (Group II).Subjects and Methods:The exclusion criteria for both the groups were the presence of simultaneous urogenital anomalies, any neurological condition, history of any urethral manipulation, and urinary diversion. Urodynamic changes were compared in both groups postoperatively. All patients were evaluated throughout their follow-up, according to the following protocol: (a) Voiding cystourethrography at 6 weeks after surgery; (b) Renal function test and urine culture at 6 weeks and then 3 monthly; (c) Ultrasound kidney, ureter, and bladder region and urodynamics at 3 and 6 months after surgery and then yearly. Median follow-up period for Group I was 27.5 months (13–72 months) and 14 months (14.5–72 months) for Group II.Statistical Analysis Used:Statistical analysis was done using the Student's t-test for parametric data and Chi-square test for categorical variable. P ≤ 0.05 was considered as statistically significant.Results:The mean age was 7.26 years in Group I and 7.66 years in Group II at the end of follow-up. There was no statistically significant difference found regarding detrusor overactivity (P = 0.68), compliance (P = 0.052), end-filling pressure (P = 0.08), and max Pdet at Qmax (P = 0.08) in the both groups. However, there was a statistically significant difference regarding improvement of peak flow (P = 0.038) and postvoid residue (PVR) (P = 0.045) in Group I in comparison to Group II.Conclusions:Valve ablation with BNI gives statistically significant better urodynamics in voiding phase regarding flow and lesser PVR in comparison to valve ablation.

PP.19.13] POST OCCLUSIVE REACTIVE HYPEREMIC RESPONSE OF SKIN MICROCIRCULATION IN EXTREMELY OBESE HYPERTENSIVE AND NON-HYPERTENSIVE PATIENTS AFTER BARIATRIC SURGERY

Objective: Bariatric surgery is an effective therapeutic method to lose weight and improve metabolism in extremely obese patients. However, little is known about reactivity of skin microcirculation after bariatric surgery. The aim of this study was to assess changes of post occlusive reactive hyperemic (PORH) response in skin microcirculation among extremely obese patients after six months after bariatric surgery. Design and method: Study population consisted of patients with severe obesity who met the eligibility criteria and underwent bariatric surgery (sleeve gastrectomy and Roux-en-Y gastric bypass). Skin blood flow was measured using PeriFlux laser Doppler flowmetry (Periflux System 5000; Perimed, Järfälla/Stockholm, Sweden). Resting flow and PORH were registered before and six months after bariatric surgery. Fast Fourier Transformation of LDF signal of reactive hyperemia was also performed. Data were analyzed in two groups: without (group I) and with hypertension (group II). Statistical analysis was performed with median test. Results: Data from 89 patients (mean age 42.1 ± 11.2 years, 40,4% men) were analyzed. Age and weight loss were similar in group I (n=28) and in group II (n=61). Peak flow increased in group I [44,5 (35,5–64,7) vs 51,2 (33,4–71,6) AU, p < 0,02] after surgery, but it was unchanged in group II [35,0 (24,4–60,4) vs 45,7 (37,1–60,3) AU, p=0,24]. Power of endothelium activity significantly increased and power of neurogenic activity was unchanged in both groups. On the other hand, power of myogenic activity remained unchanged in group I [0,208 (0,144–0,470) vs 0,230 (0,148–0,441) AU2/Hz, p=0,72] and increased in hypertensive subjects [0,190 (0,114–0,257) vs 0,209 (0,162–0,354) AU2/Hz, p=0,001]. Conclusions: Reactivity of skin microcirculation improved in different way in hypertensive and non-hypertensive obese patients after bariatric surgery, but those changes were not associated with improvement of peak flow in patients with hypertension.

Usability of the BLRP model for hydrological applications in arid and semi-arid regions with limited precipitation data

In this study, Hydrological Simulation Program-FORTRAN (HSPF) is used to investigate rainfall-runoff process in Taleghan watershed, northern Iran. Despite the high accuracy of the model, the lack of rainfall data at short time scales (hour and less than hour) restricted implementation of the model especially for long time simulations. Some studies use simple division for daily rainfall disaggregation into the hourly values to provide data requirements of HSPF model. In simple division, each rainfall event is divided into 24 pulse stochastically and the peak flows may not properly being simulated due to the lower rainfall intensities. In this study, random parameter Bartlett–Lewis rectangular pulse (BLRP) model was implemented to disaggregate daily rainfall time series into the hourly values and the results compared with that of simple division. In BLRP model, parameters of the model calibrated against the 1, 24 and 48 h mean, variance, lag1 auto covariance and proportion dry of observed rainfall. The calibrated model was then implemented to disaggregate daily rainfall data into the hourly values. To compare two disaggregation approaches, daily stream flow simulation by HSPF model is initialized in 2 scenarios by applying the hourly rainfall data resulted from two disaggregation methods. The results indicated that while using the simple division method leads to the underestimation of peak flows, using the BLRP model improved peak flow simulations. This study indicated usability of the BLRP model for rainfall disaggregation in arid and semi-arid regions with limited fine scale precipitation data availability.

School Environmental Intervention to Reduce Particulate Pollutant Exposures for Children with Asthma

Home-based interventions to improve indoor air quality have demonstrated benefits for asthma morbidity, yet little is known about the effect of environmental interventions in the school setting. We piloted the feasibility and effectiveness of a classroom-based air cleaner intervention to reduce particulate pollutants in classrooms of children with asthma. In this pilot randomized controlled trial, we assessed the effect of air cleaners on indoor air particulate pollutant concentrations in 18 classrooms (9 control, 9 intervention) in 3 urban elementary schools. We enrolled 25 children with asthma (13 control, 12 intervention) aged 6 to 10 years. Classroom air pollutant measurements and spirometry were completed once before and twice after randomization. Asthma symptoms were surveyed every 3 months. Baseline classroom levels of fine particulate matter (particulate matter with diameter of <2.5 μm [PM2.5]) and black carbon (BC) were 6.3 and 0.41 μg/m3, respectively. When comparing the intervention to the control group, classroom PM2.5 levels were reduced by 49% and 42% and BC levels were reduced by 58% and 55% in the first and second follow-up periods, respectively (P < .05 for all comparisons). When comparing the children randomized to intervention and control classrooms, there was a modest improvement in peak flow, but no significant changes in forced expiratory volume in 1 second (FEV1) and asthma symptoms. In this pilot study, a classroom-based air cleaner intervention led to significant reductions in PM2.5 and BC. Future large-scale studies should comprehensively evaluate the effect of school-based environmental interventions on pediatric asthma morbidity.

A randomized, controlled, crossover study in patients with mild and moderate asthma undergoing treatment with traditional Chinese acupuncture

OBJECTIVES:This study sought to verify the effects of acupuncture as an adjuvant treatment for the control of asthma.METHODS:This was a randomized, controlled, crossover trial conducted at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A total of 74 patients with mild/moderate, persistent asthma were randomized into two therapeutic groups: Group A – 31 patients underwent 10 real weekly acupuncture sessions, followed by a 3-week washout period and 10 sham weekly acupuncture sessions; and Group B - 43 patients underwent 10 sham weekly acupuncture sessions, followed by a 3-week washout period and 10 real weekly acupuncture sessions. Patients used short- and long-acting β-2 agonists and inhaled corticosteroids when necessary. Prior to treatment and after each period of 10 treatment sessions, the patients were evaluated for spirometry, induced sputum cell count, exhaled nitric oxide (NO) and with the Short Form 36 (SF-36) and Questionnaire on Quality of Life-Asthma (QQLA) questionnaires. Daily peak flow and symptom diaries were registered. The level of significance adopted was 5% (α=0.05).RESULTS:In Group B, after real acupuncture, there was a decrease in eosinophils (p=0.035) and neutrophils (p=0.047), an increase in macrophages (p=0.001) and an improvement in peak flow (p=0.01). After sham acupuncture treatment, patients experienced less coughing (p=0.037), wheezing (p=0.013) and dyspnea (p=0.014); similarly, after real acupuncture, patients reported less coughing (p=0.040), wheezing (p=0.012), dyspnea (p<0.001) and nocturnal awakening episodes (p=0.009). In Group A, there was less use of rescue medication (p=0.043). After the sham procedure, patients in Group A experienced less coughing (p=0.007), wheezing (p=0.037), dyspnea (p<0.001) and use of rescue medication (p<0.001) and after real acupuncture, these patients showed improvements in functional capacity (p=0.004), physical aspects (p=0.002), general health status (p<0.001) and vitality (p=0.019). Sham acupuncture also led to significant differences in symptoms, but these were not different from those seen with real acupuncture. Spirometry and exhaled NO levels did not show a difference between sham and real acupuncture treatment. In addition, no significant difference was demonstrated between treatments regarding the quality of life evaluation.CONCLUSION:Real and sham acupuncture have different effects and outcomes on asthma control. The crossover approach was not effective in this study because both interventions led to improvement of asthma symptoms, quality of life and inflammatory cell counts. Thus, sham acupuncture cannot serve as a placebo in trials with acupuncture as the main intervention for asthma.

Early results and complications of prostatic arterial embolization for benign prostatic hyperplasia.

To review current knowledge on clinical outcomes and peri-operative complications of prostatic arterial embolization (PAE) in patients treated for lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). A systematic review of the literature published from January 2008 to January 2015 was performed on PubMed/MEDLINE. Fifty-seven articles were identified, and four were selected for inclusion in this review. Only one randomized clinical trial compared transurethral resection of the prostate (TURP) to PAE. At 3months after the procedure, mean IPSS reduction from baseline ranged from 7.2 to 15.6 points. Mean urine peak-flow improvement ranged from +3.21ml/s to +9.5ml/s. When compared to TURP, PAE was associated with a significantly lower IPSS reduction 1 and 3months after the procedure. A trend toward similar symptoms improvement was however reported without statistical significance from 6 to 24months. Major complications were rare with one bladder partial necrosis due to non-selective embolization. Mild adverse events occurred in 10% of the patients and included transient hyperthermia, hematuria, rectal bleeding, painful urination or acute urinary retention. Further comparative studies are mandatory to assess post-operative rates of complications, especially acute urinary retention, after PAE and standard procedures. Early reports suggest that PAE may be a promising procedure for the treatment of patients with LUTS due to BPO. However, the low level of evidence and short follow-up of published reports preclude any firm conclusion on its mid-term efficiency. Further clinical trials are warranted before any use in clinical practice.

Impact of antibiotics on acute exacerbations of COPD

BackgroundMost patients with an exacerbation of chronic obstructive pulmonary disease (COPD) are treated with antibiotics. However the value of their use remains uncertain. Some controlled trials of antibiotics have shown benefit while others have not. This study was conducted in order to help resolve the issues surrounding the value of antibiotic therapy for exacerbations of COPD. Patients and methodsOne hundred subjects were recruited from patients with type 1 exacerbation of COPD referred to the outpatient clinics of Assiut and Al-Azhar University hospitals for treatment of COPD exacerbation from April 2013 to October 2014. Patients were divided into two groups, placebo and antibiotic group. Each group contain 50 patients, the placebo group received (bronchodilators, corticosteroids), the treatment group received bronchodilators, corticosteroids, and 10day course of antibiotics. ResultsThe frequency of individual symptoms was significantly different before and after treatment in antibiotic and placebo-treated groups. Lung function studies showed no significant difference in both antibiotic-treated and placebo groups. Peak flow data increased in antibiotic treated group and in placebo treated group without statistical significance (p=0.205, paired t-test). However, this increase in PEFR occurs significantly more rapid and in shorter duration in antibiotic-treated group than placebo group (15±3days versus 18±5days) p=0.001. The success rate was higher in antibiotic-treated exacerbations while failure with deterioration was higher in placebo-treated group. When exacerbations without deterioration were considered, antibiotic-treated exacerbations showed more rapid improvement in symptoms than those with placebo treated group (13±7days versus 16±6days) p=0.02. ConclusionsIn conclusion, this study has clearly shown that in type 1 exacerbations of COPD, antibiotic therapy, significantly results in decrease in duration of treatment, success rate and more rapid improvement in peak flow.

Treatment of asthma exacerbations with the human-powered nebuliser: a randomised parallel-group clinical trial.

Background:Nebulisers aid the treatment of respiratory diseases, including asthma, but they require electricity and are often cost-prohibitive for low- and middle-income countries.Aims:The aim of this study was to compare a low-cost, human-powered nebuliser compressor with an electric nebuliser compressor for the treatment of mild to moderate asthma exacerbations in adults and children.Methods:This was a non-blinded, parallel-group, equivalence study, with 110 subjects between 6 and 65 years of age, conducted in the emergency department of a district hospital in Ilopango, El Salvador. Participants were assigned by random allocation to receive a 2.5-mg dose of salbutamol from the experimental human-powered nebuliser or the electric nebuliser control. All assigned participants completed treatment and were included in analysis. The study was not blinded as this was clinically unfeasible; however, data analysis was blinded.Results:The mean improvement in peak flow of the experimental and control groups was 37.5 (95% confidence interval (CI) 26.7–48.2) l/min and 38.7 (95% CI, 26.1–51.3) l/min, respectively, with a mean difference of 1.3 (95% CI, −15.1 to 17.7) l/min. The mean improvement in percent-expected peak flow for the experimental and control groups was 12.3% (95% CI, 9.1–15.5%) and 13.8% (95% CI, 9.8–17.9%), respectively, with a mean difference of 1.5% (95% CI, −3.6 to 6.6%).Conclusions:The human-powered nebuliser compressor is equivalent to a standard nebuliser compressor for the treatment of mild-to-moderate asthma. (Funded by the Opus Dean’s Fund, Marquette University College of Engineering; ClinicalTrials.gov NCT01795742.)

Cochrane Review: Dietary marine fatty acids (fish oil) for asthma in adults and children

AbstractBackgroundEpidemiological studies suggest that a diet high in marine fatty acids (fish oil) may have beneficial effects on inflammatory conditions such as rheumatoid arthritis and possibly asthma.Objectives(1) To determine the effect of marine n‐3 fatty acid (fish oil) supplementation in asthma. (2) To determine the effect of a diet high in fish oil in asthma.Search strategyWe searched the Cochrane Airways Group Specialised Register. We also searched bibliographies of retrieved trials and contacted fish oil manufacturers. Searches were current as of May 2010.Selection criteriaWe included randomised controlled trials in patients with asthma more than two years of age. The study duration had to be in excess of four weeks. Double blind trials were preferred, but we also reviewed single‐blind and open trials for possible inclusion.All four reviewers read each paper, blind to its identity. Decisions concerning inclusion were made by simple majority. We all performed quality assessment independently.Data collection and analysisThe only comparison possible was between marine n‐3 fatty acid supplementation and placebo. There were insufficient trials to examine dietary manipulation alone.Main resultsNine randomised controlled trials conducted between 1986 and 2001 satisfied the inclusion criteria. Seven were of parallel design and two were cross‐over studies. Eight compared fish oil with placebo whilst one compared high dose versus low dose marine n‐3 fatty acid supplementation. Two studies were conducted in children, whilst the remaining seven studies were conducted in adults. None of the included studies reported asthma exacerbations, health status or hospital admissions.There was no consistent effect on any of the analysable outcomes: FEV1, peak flow rate, asthma symptoms, asthma medication use or bronchial hyper reactivity. One of the studies performed in children which combined dietary manipulation with fish oil supplementation showed improved peak flow and reduced asthma medication use. There were no adverse events associated with fish oil supplements.Authors' conclusionsThere is little evidence to recommend that people with asthma supplement or modify their dietary intake of marine n‐3 fatty acids (fish oil) in order to improve their asthma control. Equally, there is no evidence that they are at risk if they do so.Plain Language SummaryDietary marine fatty acids (fish oil) for asthma in adults and childrenEating more fish has been recommended as one way of possibly reducing asthma. Populations (such as Eskimo communities) with diets high in fish also have low rates of asthma. As diets in other communities have become higher in saturated fats, asthma has also increased. The theory has been that an ingredient in fish oil may reduce inflammation. Inflammation causes the swelling in the airways of the lungs that leads to asthma attacks. However, this review of trials found that people with asthma changing their diets to include more fish oil did not improve their asthma.

Efficacy of Chest Physiotherapy in Pediatric Patients With Acute Asthma Exacerbations

To determine the effectiveness of chest physiotherapy (CPT) in children hospitalized with asthma exacerbations and provide evidence-based support for this therapy. Prospective-controlled randomized study of 40 hospitalized children (4–18 years) with diagnosed asthma. Patients were classified (mild or moderate/severe asthma), then randomized to the intervention (+CPT; 6 treatments [1 every 4 h for 24 h]) or control (−CPT) group. Outcome endpoints at (t = 0 h; baseline) and end (t = 24 h) of the study were improvement in airway resistance (AR) between groups, ability to be weaned from supplemental oxygen, degree of improvement in respiratory distress measured by thoraco-abdominal motion, phase angle (PA), and improvement in peak flow (PF) measurements. AR was unchanged in both groups and was within standard limits for age, height, and gender. There was no difference between treatment groups (+CPT vs. −CPT) over time. Oxygen saturations were normal as a function of group and over time. PA decreased (P < 0.005) in both groups over the same time interval, suggesting overall improvement in synchrony. An improvement (P < 0.005) in PF measurements was shown in both groups over time. All of the above findings were independent of CPT. Endpoint parameters of asthma recovery improved overall in pediatric patients hospitalized with asthma independent of CPT. These findings suggest that with standard emergency room stabilization, the expense, time, and effort involved in treating hospitalized patients with status asthmaticus by CPT may not be justifiable.

Video-Assisted Thoracoscopic Spinal Fusion Compared with Posterior Spinal Fusion with Thoracic Pedicle Screws for Thoracic Adolescent Idiopathic Scoliosis

Although the gold standard for the surgical treatment of thoracic adolescent idiopathic scoliosis has been posterior spinal fusion, video-assisted thoracoscopic surgery recently has become a viable alternative. In the treatment of structural thoracic curves, video-assisted thoracoscopic surgery has demonstrated outcomes equivalent to those of posterior spinal fusion with use of an all-hook or hybrid pedicle screw-hook construct. No study to date, however, has compared this technique with posterior spinal fusion with thoracic pedicle screws, which has become the current standard of care. A matched-pair analysis of thirty-four consecutive patients (seventeen pairs) undergoing either video-assisted thoracoscopic surgery or posterior spinal fusion with thoracic pedicle screws for the treatment of structural scoliosis was performed; the study included eight male and twenty-six female patients with an average age of 15.0 years. Pairs were matched according to curve type and magnitude, patient age, and sex. Clinical data, the results of the Scoliosis Research Society questionnaire, and radiographic data were collected preoperatively and at a minimum of two years postoperatively and were compared between the groups. Video-assisted thoracoscopic surgery was associated with significantly increased operative times (mean, 326 compared with 246 minutes; p = 0.033) and reduced blood loss (mean, 371 compared with 1018 mL; p = 0.001), but there were no differences between the groups in terms of the transfusion rate (18% compared with 29%; p = 0.69) or the length of stay. The percentage correction of the major curve was 57.3% for the video-assisted thoracoscopic surgery group and 63.8% for the posterior spinal fusion group (p = 0.08). With the numbers available, no differences were detected in terms of the cephalad thoracic curve, caudad compensatory lumbar curve, coronal balance, thoracic kyphosis, lumbar lordosis, sagittal balance, end vertebra tilt angle, or angle of trunk rotation measurements preoperatively or at the time of the latest follow-up. The average number of fused levels was 5.9 in the video-assisted thoracoscopic surgery group and 8.9 in the posterior spinal fusion group (p < 0.001). Relative to the Cobb end vertebra, the most caudad instrumented vertebra was 0.81 level more cephalad in the video-assisted thoracoscopic surgery group as compared with the posterior spinal fusion group (p = 0.004). No significant differences were detected in any of the questionnaire outcomes at any time point. Although both groups experienced similar improvement from baseline in terms of pulmonary function at two years, the posterior spinal fusion group had significantly improved peak flow measurements (p = 0.04) in comparison with the video-assisted thoracoscopic surgery group. For single thoracic curves of <70 degrees in patients with a normal or hypokyphotic thoracic spine, video-assisted thoracoscopic surgery can produce equivalent radiographic results, patient-based clinical outcomes, and complication rates in comparison with posterior spinal fusion with thoracic pedicle screws, with the exception that posterior spinal fusion with thoracic pedicle screws may result in better major curve correction. The potential advantages of video-assisted thoracoscopic surgery over posterior spinal fusion with thoracic pedicle screws include reduced blood loss, fewer total levels fused, and the preservation of nearly one caudad fusion level, whereas the disadvantages include increased operative times and slightly less improvement in pulmonary function.

Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials

Objective To assess the effects of the neuraminidase inhibitors oseltamivir and zanamivir in treatment of children with seasonal influenza and prevention of transmission to children in households.Design Systematic review and...

Efficacy and Cost Comparisons of Bronchodilatator Administration Between Metered Dose Inhalers with Disposable Spacers and Nebulizers for Acute Asthma Treatment

Despite demonstration of equivalent efficacy of beta agonist delivery using a metered dose inhaler (MDI) with spacer vs. nebulizer in asthma patients, use of a nebulizer remains standard practice. We hypothesize that beta agonist delivery with a MDI/disposable spacer combination is an effective and low-cost alternative to nebulizer delivery for acute asthma in an inner-city population. This study was a prospective, randomized, double-blinded, placebo-controlled trial with 60 acute asthma adult patients in two inner-city emergency departments. Subjects (n = 60) received albuterol with either a MDI/spacer combination or nebulizer. The spacer group (n = 29) received albuterol by MDI/spacer followed by placebo nebulization. The nebulizer group (n = 29) received placebo by MDI/spacer followed by albuterol nebulization. Peak flows, symptom scores, and need for rescue bronchodilatator were monitored. Median values were compared with the Kolmogorov-Smirnov test. Patients in the two randomized groups had similar baseline characteristics. The severity of asthma exacerbation, median peak flows, and symptom scores were not significantly different between the two groups. The median (interquartile range) improvement in peak flow was 120 (75-180) L/min vs. 120 (80-155) L/min in the spacer and nebulizer groups, respectively (p = 0.56). The median improvement in the symptom score was 7 (5-9) vs. 7 (4-9) in the spacer and nebulizer groups, respectively (p = 0.78). The median cost of treatment per patient was $10.11 ($10.03-$10.28) vs. $18.26 ($9.88-$22.45) in the spacer and nebulizer groups, respectively (p < 0.001). There is no evidence of superiority of nebulizer to MDI/spacer beta agonist delivery for emergency management of acute asthma in the inner-city adult population. MDI/spacer may be a more economical alternative to nebulizer delivery.

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Using mathematical modelling to inform on the ability of stormwater ponds to improve the water quality of urban runoff

This paper concerns the mathematical modelling of flow and solute transport through stormwater ponds. The model is based on appropriate lumped system conservation equations that are solved using standard numerical techniques. The model was used to route a first flush pollution scenario through a cylindrical pond for 16 combinations of elevation and diameter of a submerged pipe outlet, in conjunction with a high level weir. Higher pipe elevations and smaller pipe diameters created larger pond volumes and hence led to greater dilution of the pollutant. In contrast, lower pipe elevations created larger storage volumes, leading to better flow attenuation. Interestingly, larger pipe diameters improved peak flow attenuation, even though the storage used decreased.

Regular vs Ad-lib Albuterol for Patients Hospitalized With Acute Asthma

Inhaled, short-acting beta-agonists and systemic corticosteroids form the mainstay of therapy in acute asthma exacerbation. Asthma, however, is an inflammatory disease of the airways, and its underlying pathology is not impacted by short-acting beta-agonists. While the efficacy of ad-lib beta-agonist administration in outpatient management of asthma symptoms is well established, little data exist to support this strategy in patients with acute, severe asthma. We postulate that as long as patients hospitalized with severe asthma exacerbation receive systemic corticosteroids, regular, scheduled administration of short-acting beta-agonists is unnecessary. Similar therapeutic outcomes can be achieved with the ad-lib administration of the short-acting beta-agonists. Prospective, randomized, double-blind, placebo-controlled trial. Pulmonary floor of a 600-bed municipal hospital. Sixty-two patients hospitalized for acute asthma. Patients were randomized to receive either albuterol nebulizations (regular albuterol group) or saline solution nebulizations (ad-lib group) every 4 h with management of breakthrough symptoms with albuterol metered-dose inhaler or nebulizations for both groups. All patients received systemic corticosteroids. Peak expiratory flows, asthma symptoms, and need for rescue bronchodilator were followed up on each patient until discharge. There was no significant difference in the length of hospitalization (median length, 48 h for ad-lib group vs 57.5 h for regular albuterol group, p = 0.82), rate of improvement in peak flow, or symptoms between the two groups. Ad-lib beta-agonist use compared to regular albuterol scheduled use resulted in a significant reduction in the total number of albuterol treatments administered (median, 7 treatments vs 19 treatments, p = 0.001) during hospitalization. In the management of asthma exacerbation, ad-lib administration of albuterol is therapeutically as effective as regular, scheduled administration. This method of drug administration also reduces the total dose of beta-agonists received by the hospitalized patient.