Clinical evaluation of efficacy of transcortical anesthesia for the extraction of impacted mandibular third molars: a randomized controlled trial

BACKGROUND: This study aimed to compare the pain levels during anesthesia and the efficacy of the QuickSleeper intraosseous (IO) injection system and conventional inferior alveolar nerve block (IANB) in impacted mandibular third molar surgery.METHODS: This prospective randomized clinical trial included 30 patients (16 women, 14 men) with bilateral symmetrical impacted mandibular third molars. Thirty subjects randomly received either the IO injection or conventional IANB at two successive appointments. A split-mouth design was used in which each patient underwent treatment of a tooth with one of the techniques and treatment of the homologous contralateral tooth with the other technique. The subjects received 1.8 mL of 2% articaine. Subjects' demographic data, pain levels during anesthesia induction, tooth extractions, and mouth opening on postoperative first, third, and seventh days were recorded. Pain assessment ratings were recorded using the 100-mm visual analog scale. The latency and duration of the anesthetic effect, complications, and operation duration were also analyzed in this study. The duration of anesthetic effect was considered using an electric pulp test and by probing the soft tissue with an explorer.RESULTS: Thirty patients aged between 18 and 47 years (mean age, 25 years) were included in this study. The IO injection was significantly less painful with lesser soft tissue numbness and quicker onset of anesthesia and lingual mucosa anesthesia with single needle penetration than conventional IANB. Moreover, 19 out of 30 patients (63%) preferred transcortical anesthesia. Mouth opening on postoperative first day was significantly better with intraosseous injection than with conventional IANB (P = 0.013).CONCLUSION: The IO anesthetic system is a good alternative to IANB for extraction of the third molar with less pain during anesthesia induction and sufficient depth of anesthesia for the surgical procedure.

Standardization of measurement of cervical elastography, its reproducibility, and analysis of baseline clinical factors affecting elastographic parameters

¿Cosmopolitismo o subordinación? La participación de científicos latinoamericanos en programas europeos: motivaciones y dinámicas analizadas desde el punto de vista de los líderes europeos / Cosmopolitanism or subordination? Latin American scientists' participation in European programs: motivations and dynamics analyzed from the European scientific leaders' point of view

Resumen Partiendo de un enfoque cualitativo, pretendemos dar cuenta de las motivaciones de grupos científicos y sus dinámicas de cooperación internacional. Consideramos la participación de científicos latinoamericanos en consorcios europeos y analizamos el punto de vista de los líderes europeos. Dentro de la cooperación científica "Norte-Sur", planteamos tres niveles de análisis: a nivel institucional, comprender el interés de Europa en cooperar con Latinoamérica; en relación con las estrategias cognitivas, averiguar las motivaciones de líderes europeos para enrolar latinoamericanos en sus investigaciones; a nivel de las prácticas, conocer la organización del trabajo en el interior de esos consorcios. Hacia el final, proponemos una tipología de algunas configuraciones de cooperación científica de grupos latinoamericanos.

Abstract Using a qualitative approach, we explore the motivations of scientific groups and their dynamics in international cooperation. We consider the participation of Latin American scientists in European consortia and analyze the European hosts' point of view. Within the framework of "North-South" scientific cooperation, we propose three levels of analysis: on the institutional level, understanding Europe's interest in cooperating with Latin America; in terms of cognitive strategies, tracing what motivates European group leaders to include Latin Americans in their research projects; and in terms of practices, figuring out how work within these consortia is allotted. Towards the end, we propose a typology of some of the modalities of scientific cooperation by Latin American groups.

Pharmacological Dissection of Intrinsic Optical Signal Reveals a Functional Coupling between Synaptic Activity and Astrocytic Volume Transient

The neuronal activity-dependent change in the manner in which light is absorbed or scattered in brain tissue is called the intrinsic optical signal (IOS), and provides label-free, minimally invasive, and high spatial (~100 µm) resolution imaging for visualizing neuronal activity patterns. IOS imaging in isolated brain slices measured at an infrared wavelength (>700 nm) has recently been attributed to the changes in light scattering and transmittance due to aquaporin-4 (AQP4)-dependent astrocytic swelling. The complexity of functional interactions between neurons and astrocytes, however, has prevented the elucidation of the series of molecular mechanisms leading to the generation of IOS. Here, we pharmacologically dissected the IOS in the acutely prepared brain slices of the stratum radiatum of the hippocampus, induced by 1 s/20 Hz electrical stimulation of Schaffer-collateral pathway with simultaneous measurement of the activity of the neuronal population by field potential recordings. We found that 55% of IOSs peak upon stimulation and originate from postsynaptic AMPA and NMDA receptors. The remaining originated from presynaptic action potentials and vesicle fusion. Mechanistically, the elevated extracellular glutamate and K⁺ during synaptic transmission were taken up by astrocytes via a glutamate transporter and quinine-sensitive K2P channel, followed by an influx of water via AQP-4. We also found that the decay of IOS is mediated by the DCPIB- and NPPB-sensitive anion channels in astrocytes. Altogether, our results demonstrate that the functional coupling between synaptic activity and astrocytic transient volume change during excitatory synaptic transmission is the major source of IOS.

A new method to measure the accuracy of intraoral scanners along the complete dental arch: A pilot study

PURPOSE: The purpose of this study is to assess the accuracy of three intraoral scanners along the complete dental arch and evaluate the feasibility of the assessment methodology for further in vivo analysis.MATERIALS AND METHODS: A specific measurement pattern was fabricated and measured using a coordinate measuring machine for the assessment of control distances and angles. Afterwards, the pattern was placed and fixed in replica of an upper jaw for their subsequent scans (10 times) using 3 intraoral scanners, namely iTero Element1, Trios 3, and True Definition. 4 reference distances and 5 angles were measured and compared with the controls. Trueness and precision were assessed for each IOS: trueness, as the deviation of the measures from the control ones, while precision, as the dispersion of measurements in each reference parameter. These measurements were carried out using software for analyzing 3-dimensional data. Data analysis software was used for statistical and measurements analysis (α=.05).RESULTS: Significant differences (P<.05) were found depending on the intraoral scanner used. Best trueness values were achieved with iTero Element1 (mean from 10 ± 7 µm to 91 ± 63 µm) while the worst values were obtained with Trios3 (mean from 42 ± 23 µm to 174 ± 77 µm). Trueness analysis in angle measurements, as well as precision analysis, did not show conclusive results.CONCLUSION: iTero Element1 was more accurate than the current versions of Trios3 and True Definition. Importantly, the proposed methodology is considered reliable for analyzing accuracy in any dental arch length and valid for assessing both trueness and precision in an in vivo study.

Pattern of Extraocular Muscle Involvements in Miller Fisher Syndrome

BACKGROUND AND PURPOSE: The most-common initial manifestation of Miller Fisher syndrome (MFS) is diplopia due to acute ophthalmoplegia. However, few studies have focused on ocular motility findings in MFS. This study aimed to determine the pattern of extraocular muscle (EOM) paresis in MFS patients. METHODS: We consecutively recruited MFS patients who presented with ophthalmoplegia between 2010 and 2015. The involved EOMs and the strabismus pattern in the primary position were analyzed. Antecedent infections, other involved cranial nerves, and laboratory findings were also reviewed. We compared the characteristics of the patients according to the severity of ophthalmoplegia between complete ophthalmoplegia (CO) and incomplete ophthalmoplegia (IO). RESULTS: Twenty-five patients (15 males and 10 females) with bilateral ophthalmoplegia were included in the study. The most-involved and last-to-recover EOM was the lateral rectus muscle. CO and IO were observed in 11 and 14 patients, respectively. The patients were aged 59.0±18.4 years (mean±SD) in the CO group and 24.9±7.4 years in the IO group (p<0.01), and comprised 63.6% and 21.4% females, respectively (p=0.049). Elevated cerebrospinal fluid protein was identified in 60.0% of patients with CO and 7.7% of patients with IO (p=0.019) for a mean follow-up time from the initial symptom onset of 3.7 days. CONCLUSIONS: The lateral rectus muscle is the most-involved and last-to-recover EOM in ophthalmoplegia. The CO patients were much older and were more likely to be female and have an elevation of cerebrospinal fluid protein than the IO patients.

Association of Sensitization to Different Aeroallergens With Airway Function and Nasal Patency in Urban Children

PURPOSE: Children with sensitization to aeroallergens have decreased lung function and nasal patency. Our purpose was to determine the association of sensitization to different aeroallergens with airway function and nasal patency. METHODS: Four hundred and eighty-six randomly selected 11 year-old children who lived in Seongnam City were examined. Serum specific immunoglobulin E (IgE) levels against 6 common allergens (Dermatophagoidesfarinae, birch, cat, dog, Japanese hop and Alternaria), impulse oscillometry (IOS) results for the evaluation of airway dysfunction, and acoustic rhinometry for the determination of nasal airway patency were obtained. RESULTS: IOS indicated that children sensitized to Alternaria (n = 38, 7.8%) and dog dander (n = 69, 14.2%) had decreased lung function, based on resistance at 10 Hz (Rrs10; aβ = 0.0072; 95% CI, 0.017, 0.127; P = 0.010) and 1 Hz (Rrs1; aβ = 0.038; 95% CI, 0.001, 0.074; P = 0.042). Children sensitized to D. farinae (n = 281, 57.8%) had decreased post-decongestant nasal volume at 0 to 5 cm (aβ = −0.605; 95% CI, −1.005, −0.205; P = 0.003), but normal IOS results at all measured frequencies (P > 0.05). Increased serum eosinophil level was associated with Rrs1 (P = 0.007) and Rrs2 (P = 0.018) and post-decongestant nasal volume at 0 to 5 cm (aβ = −0.885; 95% CI, −1.331, −0.439; P < 0.001). CONCLUSIONS: Sensitivity to specific aeroallergens, serum eosinophil count and total IgE level had different associations with upper and lower airway dysfunction in urban children.

Accuracy of casts produced from conventional and digital workflows: A qualitative and quantitative analyses

PURPOSE: Comparing the accuracy of casts produced from digital workflow to that of casts produced from conventional techniques. MATERIALS AND METHODS: Whole arch alginate (ALG) and polyvinyl siloxane (PVS) impressions were taken with stock trays and custom trays, respectively. The ALG impressions were poured with type III dental stone, while the PVS impressions were poured with type IV dental stone. For the digital workflow, IOS impressions were taken and physical casts were produced by 3D printing. In addition, 3D printed casts were produced from images obtained from a laboratory scanner (LS). For each technique, a total of 10 casts were produced. The accuracies of the whole arch and separated teeth were virtually quantified. RESULTS: Whole arch cast accuracy was more superior for PVS followed by LS, ALG, and IOS. The PVS and ALG groups were inferior in the areas more susceptible to impression material distortion, such as fossae and undercut regions. The LS casts appeared to have generalized errors of minor magnitude influencing primarily the posterior teeth. The IOS casts were considerably more affected at the posterior region. On the contrary, the IOS and LS casts were more superior for single tooth accuracy followed by PVS and ALG. CONCLUSION: For whole arch accuracy, casts produced from IOS were inferior to those produced from PVS and ALG. The inferior outcome of IOS appears to be related to the span of scanning. For single tooth accuracy, IOS showed superior accuracy compared to conventional impressions.

Accuracy of digital and conventional dental implant impressions for fixed partial dentures: A comparative clinical study

PURPOSE: The newest technologies for digital implant impression (DII) taking are developing rapidly and showing acceptable clinical results. However, scientific literature is lacking data from clinical studies about the accuracy of DII. The aim of this study was to compare digital and conventional dental implant impressions (CII) in a clinical environment. MATERIALS AND METHODS: Twenty-four fixed zirconia restorations supported by 2 implants were fabricated using conventional open-tray impression technique with splinted transfers (CII group) and scan with Trios 3 IOS (3Shape) (DII group). After multiple verification procedures, master models were scanned using laboratory scanner D800 (3Shape). 3D models from conventional and digital workflow were imported to reverse engineering software and superimposed with high resolution 3D CAD models of scan bodies. Distance between center points, angulation, rotation, vertical shift, and surface mismatch of the scan bodies were measured and compared between conventional and digital impressions. RESULTS: Statistically significant differences were found for: a) inter-implant distance, b) rotation, c) vertical shift, and d) surface mismatch differences, comparing DII and CII groups for mesial and dist al implant scan bodies (P≤.05). CONCLUSION: Recorded linear differences between digital and conventional impressions were of limited clinical significance with two implant-supported restorations.

Horizontal Effects of 10-mm Inferior Oblique Recession versus 14-mm Inferior Oblique Recession

PURPOSE: The aim of this study was to investigate the quantitative effect of inferior oblique (IO) 10- and 14-mm recession on postoperative horizontal deviation. METHODS: Patients (22 men and 18 women) who underwent IO recession were divided into two groups for comparison studies: group 1 (10-mm IO recession, 15 patients) and group 2 (14-mm IO recession, 25 patients). Preoperative and postoperative horizontal deviations were measured, and the resulting horizontal deviations from the 10- and 14-mm IO recession surgeries were compared. The effects of superior oblique underaction, IO overaction, and combined exodeviation on postoperative horizontal deviation were analyzed. RESULTS: Although group 1 did not show a significant horizontal deviation change after surgery (1.9 ± 4.5 prism diopters [PD], p = 0.452), group 2 had a meaningful horizontal change after 14-mm recession (2.2 ± 3.8 PD, p = 0.022). Both groups showed a significant esodrift in horizontal deviation (group 1, p = 0.017; group 2, p = 0.030) in patients with exodeviation over 8 PD. The mean change in horizontal deviation was 6.0 ± 5.4 PD for group 1 and 9.0 ± 5.0 PD for group 2. Although the amount of superior oblique underaction did not affect the extent of change in horizontal deviation, patients with severe IO overaction showed a significant change in horizontal deviation after 14-mm IO recession. CONCLUSIONS: Fourteen-millimeter IO recession could make a statistically significant change in horizontal deviation after surgery. In addition, esodrift should be considered after IO recession in patients with a preoperative exodeviation greater than 8 PD or severe IO overaction.

Effects of Sling and Resistance Rotation Exercises on Pelvic Rotation and Pain in Patients with Chronic Low Back Pain

PURPOSE: This study compared the different sling and resistance exercises on pelvic rotation during active straight leg raises (ASLR) and on pain in patients with chronic low back pain (CLBP). METHODS: Twenty subjects were divided randomly into a sling group (SG) and a resistance exercise group (REG). Internal oblique (IO), external oblique (EO), rectus abdominis (RA), and rectus femoris (RF) muscle activity; pelvic rotation angle during ASLR; and visual analogue scale, pressure pain threshold were measured. Sling and resistance exercises were then performed for 30 minutes and the measurements taken again. RESULTS: Both groups showed significantly lower RF muscle activity and significantly higher EO and IO muscle activity (p < 0.05). The RA muscle activity decreased significantly in the SG, but increased significantly in the REG (p < 0.05). The pelvic rotation angle was significantly lower in the SG (p < 0.05). The pain press threshold increased significantly in both groups (p < 0.05). The visual analogue scale decreased significantly in the SG (p < 0.05). CONCLUSION: Both exercises appear to be beneficial for modifying the muscle activity and pain control in the intervention of CLBP. On the other hand, the sling was more effective in increasing the pressure threshold than resistance exercise, and the pelvic rotation angle was reduced. Therefore, both exercises can help patients with CLBP change their muscle activity and control pain. CLBP patients should use a sling for short periods of time to learn to reduce the pain and control pelvic rotation.

Effects of Flexible Pole Training Combined with Lumbar Stabilization on Trunk Muscles Activation in Healthy Adults

OBJECTIVE: This study aimed to determine the efficacy of flexible pole training combined with lumbar stabilization in improving trunk muscle activities and to investigate the difference according to posture in young adults. METHODS: Twenty-five participants were enrolled in this study. The subjects were randomly allocated into either the flexible pole group or the rigid pole group. Participants performed lumbar stabilization exercises on quadruped and curl-up, with the flexible pole or rigid pole. Electromyography was used to assess the percent maximal voluntary isometric contracion (%MVIC) of the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and erector spine (ES) muscles. All participants completed one 30-minute session per day, 3 days per week, for 6 weeks. The evaluation was performed before and 6 weeks after the training, and follow-up. The data were analyzed using independent t-test and two-way repeated measure analysis of variance to determine the statistical significance. RESULTS: The flexible pole in curl-up showed significant differences in EO and IO muscle activities compared with the rigid pole. The flexible pole in quadruped showed significant differences in IO and ES muscle activities compared with the rigid pole. The RA, EO, IO, and ES muscle activities of both groups were significantly higher after 6 weeks training. CONCLUSION: The flexible pole in curl-up and quadruped showed an improvement in trunk muscle activation. The flexible pole combined with lumbar stabilization will be useful as an exercise tool to improve activity of trunk muscles.

Scleral Buckling under a Slit-lamp Illumination System with a Contact Wide-angle Viewing Lens Compared with an Indirect Ophthalmoscope

PURPOSE: To investigate the outcomes of scleral buckling surgery performed under a slit-lamp illumination system (Visulux) with a contact wide-angle viewing lens (Mini Quad) in patients with rhegmatogenous retinal detachment (RRD) and to compare these outcomes with those of surgery performed under an indirect ophthalmoscope. METHODS: By retrospective review of electronic medical records, patients with RRD who had undergone scleral buckling surgery were identified. Scleral buckling surgeries were performed with two illumination instruments, a slit-lamp (SL group) and an indirect ophthalmoscope (IO group). Subretinal fluid drainage, cryopexy, and intravitreal gas injection were performed optionally. At 6 months after surgery, anatomical and functional outcomes were evaluated and compared between the two groups. Operation time was also compared between the two groups. RESULTS: Of the 45 total patients (45 eyes), 28 were included in the SL group, and 17 were included in the IO group. In the SL and IO groups, the primary anatomical success rate was 89.3% and 88.2%, respectively (p = 0.92). The logarithm of the minimal angle of resolution change, which reflects improvement in best-corrected visual acuity after surgery, was −0.19 ± 0.38 in the SL group and −0.21 ± 0.63 in the IO group; this difference was not statistically significant (p = 0.91). The mean operation time was significantly shorter in the SL group (78.9 ± 11.8 minutes) than in the IO group (100.0 ± 13.9 minutes, p < 0.001), especially for patients who underwent additional procedures such as subretinal fluid drainage and cryopexy (81.4 ± 12.9 and 103.5 ± 12.3 minutes, respectively, p < 0.001). CONCLUSIONS: Scleral buckling surgery performed under a slit-lamp illumination system yielded a similar anatomical success rate and similar functional improvement in RRD compared with surgery performed under an indirect ophthalmoscope. The slit-lamp system could save time, especially in bullous RRD, which requires additional subretinal fluid drainage.

Stereopsis before and after Inferior Oblique Weakening Surgery

PURPOSE: To analyze stereopsis change before and after inferior oblique weakening surgery. METHODS: We retrospectively reviewed the medical records of 31 patients who had undergone inferior oblique weakening surgery. The factors analyzed included sex, age at surgery, preoperative and postoperative visual acuity (VA), time from first detection to surgery, degree of inferior oblique overaction (IOOA), primary/secondary IOOA, exotropia/hypertropia, bilaterality, and type of surgery. RESULTS: Eighteen patients with a mean age 7.3 ± 3.1 years exhibited stereopsis of 60 arc seconds or better before surgery and 17 had stereopsis better than 60 arc seconds after surgery. Postoperatively, stereopsis improved in 13 patients and deteriorated in 9. Better preoperative VA and the absence of superior oblique underaction were associated with better preoperative stereopsis. Better preoperative VA, postoperative VA, and the presence of head tilt were associated with better postoperative stereopsis. Unilateral inferior oblique weakening surgery and accompanying hypertropia were associated with improved stereopsis, while the absence of hypertropia was associated with deteriorated stereopsis. CONCLUSIONS: In this retrospective study, 58.1% of patients tended to have bifoveal fixation. When a vertical deviation is present in the primary position due to unilateral IOOA, IO weakening surgery can be expected to improve binocular function.

Transient Inferior Oblique Muscle Palsy Following Transconjunctival Lower Lid Blepharoplasty / 고신대학교의과대학학술지

Although the inferior oblique (IO) muscle is positioned considerably deep in the orbit, transconjunctival lower lid blepharoplasty may affect it and transient or permanent IO muscle palsy might result. Therefore diplopia should be explained before cosmetic blepharoplasty performed with transconjunctival approach.

Regulação, eficiência e acesso à saúde e a medicamentos: margens de comercialização em países europeus

Este estudo económico sobre regulação, eficiência e acesso à saúde e a medicamentos pretende realizar uma revisão dos modelos de margens dos grossistas e das farmácias (comunitárias) com a dispensa de medicamentos e descrever as metodologias de cálculo das margens de comercialização para alguns países europeus, construindo uma análise de benchmarking da regulamentação existente. Foi realizada extensa pesquisa bibliográfica e revisão de literatura ao longo do projeto, e a análise detalhada incidiu sobre os seguintes países: Portugal, Alemanha, Bélgica, Eslováquia, Eslovénia, Espanha, França, Grécia, Itália e Suíça. Existe uma multiplicidade de metodologias de cálculo, sendo que a maioria dos países aplica margens máximas regulamentadas apenas para medicamentos comparticipados. A literatura existente sugere que os incentivos às farmácias são cruciais para a promoção da dispensa de genéricos, por meio de atribuição de uma remuneração mais elevada para esses medicamentos, que compense a perda de margem. O papel da dispensa tradicional está a ser substituído pela valorização e o reconhecimento do papel clínico do farmacêutico, devendo ser recompensado por modelos de remuneração de fee-for-performance (pagamento por desempenho) conforme descrito na literatura.

The Effects of Pilates Mat Exercise on Trunk Muscle Thickness and Balance

PURPOSE: The aim of this study was to identify the effects of Pilates mat exercise may improve trunk muscle thickness and balance in healthy adults. METHODS: Eighteen healthy adults participated in this study. They were randomly assigned to one of two groups: Pilates mat exercise group (n=9) and the control group (n=9). Subjects in Pilates mat exercise group performed the exercises three days per week for 6 weeks, which consisted of warm up, main workout, and cool down. Trunk muscle thickness of the rectus abdominis (RA), internal oblique (IO), external oblique (EO), transverse abdominis (TrA), multifidus (MF), and erector spine (ES) were measured using an ultrasonography. Balance ability was evaluated using Romberg test and limits of stability (LOS). Measurements were performed before training, 3 weeks after training, and 6 weeks after training. RESULTS: There was a significant difference of RA, EO, IO, MF, and ES according to the main effect of time (p<0.05). There was a significant difference of EO, MF, ES, Romberg, and LOS according to interaction effect between the time and group (p<0.05). There was a significant difference only for LOS according to the main effect of the group (p<0.05). CONCLUSION: Pilates mat exercise did increase trunk muscle thickness and balance. However, the effect with respect to trunk thickness was limited. Pilates mat exercise appears to be more effective in improving muscles related to trunk extension and balance.

Sonographic Measurements of the Lateral Abdominal Wall Thickness and Asymmetry in Fencing Players / 대한스포츠의학회지

The purpose of this study is to compare the side-to-side thickness and asymmetry in the lateral abdominal (LAM) wall muscle group between fencing players and matched controls. Twenty fencing players (10 males and 10 females) and 20 matched controls participated in this study. The resting thicknesses of the transversus abdominis (TrA), internal oblique (IO), and external oblique (EO) of the LAM on both sides of the abdominal wall were measured in each group using 7.5 MHz linear array ultrasonography. Statistical analysis showed that the asymmetry of the fencers was 15% TrA, 13% IO, and 15% EO, whereas the control group showed 5% TrA, 5% IO, and 6% EO. The LAM was more asymmetric in the fencers than in the controls (p0.05). The thickness of the TrA, IO, and EO of the side-to-side LAM wall was more asymmetric in the fencers than in the controls. This suggests that clinicians may find benefits in providing scientific baseline data on muscle asymmetry when treating and managing fencing athletes.

Mapping of courses on vector biology and vector-borne diseases systems: time for a worldwide effort

Major emergency efforts are being mounted for each vector-borne disease epidemiological crisis anew, while knowledge about the biology of arthropods vectors is dwindling slowly but continuously, as is the number of field entomologists. The discrepancy between the rates of production of knowledge and its use and need for solving crises is widening, in particular due to the highly differing time spans of the two concurrent processes. A worldwide web based search using multiple key words and search engines of onsite and online courses in English, Spanish, Portuguese, French, Italian and German concerned with the biology of vectors identified over 140 courses. They are geographically and thematically scattered, the vast majority of them are on-site, with very few courses using the latest massive open online course (MOOC) powerfulness. Over two third of them is given in English and Western Africa is particularity poorly represented. The taxonomic groups covered are highly unbalanced towards mosquitoes. A worldwide unique portal to guide students of all grades and levels of expertise, in particular those in remote locations, is badly needed. This is the objective a new activity supported by the Special Programme for Research and Training in Tropical Diseases (TDR).

Does the different amount of short-acting bronchodilator drugs have different effects on small airway response in bronchodilator test?

PURPOSE: It is recommended to use 200 (2 puffs) or 400 (4 puffs) µg of salbutamol in the bronchodilator response (BDR) test. We aimed to compare the difference between these 2 doses with regard to small airway dysfunction. METHODS: One hundred sixteen subjects who visited the hospital for diagnosis or follow-up of asthma were consecutively enrolled between June 1 and November 31, 2013. The subjects were randomly assigned to the BDR test at the 2 doses (200 or 400 µg of salbutamol), with physicians blinded to the group each subject was assigned to and undertook the BDR test using the spirometry and impulse oscillometry system (IOS). RESULTS: A total of 116 subjects participated in this study; the mean age was 7.8±3.6 years. The number of participants who were assigned to 2 and 4 puffs groups was 59 and 57, respectively. The mean age was older in the 4 puffs group than in the 2 puffs group (P=0.008). There were no significant difference in spirometric and oscillometric parameters between the 2 and 4 puffs groups. However, in subgroup analysis of asthmatic patients on maintenance therapy (n=21), there was a significant difference in relative changes in Rrs5 between the 2 and 4 puffs groups (16.4%±9.6% vs. 28.7%±8.8%, P=0.035). The forced expiratory volume of 1 second showed a significant correlation with resistance in the 2 puffs group and with reactance in the 4 puffs group. CONCLUSION: There was a significant relationship between the amounts of bronchodilators administered and the small airway dysfunction in children with asthma on maintenance therapy. Further research is warranted to delineate changes in spirometric and IOS measures in accordance with the different amounts of bronchodilators administered.