Safety of an accelerated build-up phase with pollen allergoids: a retrospective study

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Features and severity of occupational asthma upon diagnosis: an Italian multicentric case review.

BACKGROUND: The severity of occupational asthma (OA) at the time of diagnosis is not known. In this study we aimed to evaluate some features of the disease at the time of diagnosis, particularly looking at severity and treatment before diagnosis. METHODS: Medical records of subjects (n = 197) who had received a diagnosis of OA in six specialized centres of Northern and Central Italy in the period 1992-97 were reviewed. The severity of the disease at the time of diagnosis was determined on the basis of symptoms, peak expiratory flow (PEF, percentage predicted), forced expiratory volume in one second (FEV1, percentage predicted), and PEF variability, following the criteria of the National Institutes of Health and World Health Organizaton (NIH/WHO) guidelines on asthma. Medications used in the month before diagnosis were recorded. RESULTS: The most common etiological agents were isocyanates (41.6%), flours (19.8%), woods (9.7%) and natural rubber latex (7.6%). The level of asthma severity (AS) was mild intermittent in 23.9% patients, mild persistent in 28.9%, moderate in 41.6%, and severe in 5.6%. Asthma severity was positively associated with current or previous smoking (P < 0.05), and was not related to atopy and current exposure. A relationship with bronchial reactivity to methacholine was shown in subjects at work. Treatment before diagnosis was consistent with the NIH/WHO guidelines in only 13.2% patients, whereas 75.6% were undertreated and 11.2% were overtreated. CONCLUSIONS: In this study we found that the majority of patients had mild asthma at the time of diagnosis and that cigarette smoking was associated with a greater severity. Moreover, the majority of patients were undertreated before etiological diagnosis.

Developmental trajectories of physical aggression from school entry to late adolescence.

The developmental perspective applied to psychopathology has led to the concept of early- and late-onset disorders. This study explores the application of the early- and late-onset concepts of antisocial behavior to physical aggression. Are there two categories of chronically physically violent adolescents: those who are physically aggressive throughout childhood and those who start being physically aggressive during adolescence? The estimation of developmental trajectories for repeated measures of two different response variables physical aggression in childhood as measured by teacher reports and physical aggression in adolescence as measured by self-reported violent delinquency is achieved with a semi-parametric, group-based method. This new method is applied to a large sample of males from Montreal who have been assessed repeatedly since kindergarten. Several salient findings emerge from the analysis. First, we find considerable change in the levels of childhood and adolescent physical aggression. Thus, there is little evidence of stability of behavior in an absolute sense. A second key finding concerns the connection of childhood aggression to adolescent aggression. Boys with higher childhood physical aggression trajectories are far more likely to transition to a higher-level adolescent aggression trajectory than boys from lower childhood physical aggression trajectories. However, for all childhood physical aggression trajectory levels the modal transition is to a relatively low-level adolescent aggression trajectory. Third, we find little evidence of "late onset" of high-level physical aggression. Specifically, the joint trajectory analysis finds no evidence of transition from a low physical aggression trajectory in childhood to a high trajectory in adolescence.

Serum eosinophil cationic protein (sECP) in subjects with a history of asthma symptoms with or without rhinitis.

BACKGROUND: Serum eosinophil cationic protein (sECP) has been proposed as a marker of disease activity in bronchial asthma. The study aimed to evaluate the role of sECP in screening asthmatics in a group of subjects with asthma and rhinitis symptoms, and the relationship between sECP and clinical and functional parameters of asthma. METHODS: A total of 185 subjects with asthma symptoms, 149 of them with rhinitis as well, underwent skin tests, spirometry, methacholine (MCH) test, blood sampling for eosinophil percentage (bEOS%) and sECP determination, and nasal secretions smear for eosinophil percentage (nEOS%) determination; PEF values, symptoms, and medication over a period of 4 weeks after sampling for sECP quantitation were recorded on a diary. RESULTS: A total of 99 (53%) subjects received a diagnosis of asthma (asthmatics), and 86 did not (nonasthmatics). In asthmatics, neither sECP nor bEOS% was significantly different from nonasthmatics. In asthmatics, sECP was higher in subjects with increased than in those with normal daily PEF variability (16.4, 6.8-24.4 vs 5.3, 3.9-8.4 microg/l; P<0.001). sECP was higher in moderate persistent asthma than in intermittent asthma (24.8, 10.6-53 vs 8.4, 5.6-14.1; P<0.05). In nonasthmatics (73 with a history of rhinitis), both sECP and bEOS% correlated with nEOS% (rho=0.35; P<0.01 and rho=0.53; P<0.001). CONCLUSIONS: In adults with asthma symptoms with or without rhinitis, sECP did not distinguish asthmatics from nonasthmatics. In asthmatics, sECP was associated with PEF variability and symptom severity. In subjects with asthma and rhinitis, as well as in subjects with only rhinitis, sECP levels are possibly influenced by nasal inflammation.

Occupational asthma: a longitudinal study on the clinical and socioeconomic outcome after diagnosis.

AIM: To evaluate the clinical outcome and socioeconomic consequences of occupational asthma (OA). SUBJECTS AND METHODS: Twenty-five patients with OA both to high- and low-molecular-weight agents (3 and 22, respectively) confirmed by specific inhalation challenge were followed up for 12 months after the diagnosis. Upon diagnosis, each patient received a diary on which to report peak expiratory flow rate (PEFR), symptoms, drug consumption, expenses directly or indirectly related to the disease, as well as information regarding personal socioeconomic status. At each follow-up visit (1, 3, 6, and 12 months), the patients underwent clinical examination, spirometry, methacholine (Mch) challenge, and assessment of diary-derived parameters and socioeconomic status. Asthma severity (AS) was classified into four levels, based on symptoms, drug consumption, and PEFR variability. RESULTS: At 12 months, 13 patients (group A) had ceased exposure; the remaining 12 patients (group B) continued to be exposed. At diagnosis, FEV1 percent and provocative dose causing a 20% fall in FEV1 (PD20) of Mch were lower in group A than in group B; patients of group A were also characterized by significantly higher basal AS levels. At 12 months, no significant variation in FEV1 percent or PD20 was found for either group, while AS levels improved in both groups, the change being more marked for group A than group B. Pharmaceutical expense at 12 months significantly (p < 0.05) decreased, as compared with the first month, in group A, whereas it tended to increase in group B. In group A, 9 of 13 subjects had reported a deterioration of their socioeconomic status as compared with 2 of 12 in group B (p < 0.01). A significant loss of income was registered in patients of group A (median 21.45, 25th to 75th percentiles 16.9 to 25.8 Italian liras x 10(6) on the year preceding diagnosis and 15.498, 10.65 to 21.087 Italian liras x 10(6) on the year after diagnosis; p < 0.01), whereas no significant change was seen for patients in group B. CONCLUSIONS: In OA, cessation of exposure to the offending agent results in a decrease in asthma severity and in pharmaceutical expenses, but it is associated with a deterioration of the individual's socioeconomic status (professional downgrading and loss of work-derived income). There appears to be a great need for legislation that facilitates the relocation of these patients.

Dynamic changes in gonadotropin releasing hormone receptor mRNA content in the mediobasal hypothalamus during the rat estrous cycle.

The purpose of the present study was to determine if GnRH receptor mRNA levels in the rat brain undergo changes during the estrous cycle. We focused on the arcuate and ventromedial nuclei of the hypothalamus and on the hippocampus which are sites in the rat central nervous system that have been shown to contain measurable amounts of GnRH receptor mRNA. Groups of regularly cycling female rats were decapitated at 08.00 and 17.00 h of each day of the estrous cycle, trunk blood was collected for radioimmunoassay analysis of circulating LH levels, and the brains were processed for 'in situ' hybridization. A cDNA probe encoding the rat pituitary GnRH receptor was transcribed 'in vitro' in the presence of (33)P-alpha UTP and used under saturating conditions to label GnRH receptor mRNA. The results show that in the arcuate and ventromedial nuclei GnRH receptor mRNA levels are relatively high during diestrus 1, they decline slightly during diestrus 2 before they rise to the highest levels at 08.00 h of proestrus. By 17.00 h of proestrus, GnRH receptor mRNA levels had declined to the lowest levels of the estrous cycle where they remain through the morning of estrus. The GnRH receptor mRNA levels rise again sharply during the afternoon of estrus. The changes in the hippocampus follow a similar pattern in that a decline in GnRH receptor mRNA levels to its lowest levels occurs between 08.00 and 17.00 h of proestrus. However, the changes in the hippocampus did not reach statistical significance. It is concluded that GnRH receptor mRNA levels in the arcuate and ventromedial nuclei are upregulated in the morning of proestrus, probably by rising estradiol levels, in preparation for the GnRH-LH preovulatory surge while this effect of estradiol is not apparent in the hippocampus.

Regulation of hippocampal gonadotropin releasing hormone (GnRH) receptor mRNA and GnRH-stimulated inositol phosphate production by gonadal steroid hormones.

The purpose of the present study was to determine if gonadal steroids can alter the amounts of GnRH receptor mRNA in the pyramidal and granule neurons of the hippocampus of female and male rats and if GnRH causes a change in the production of inositol phosphates in hippocampal slices in vitro. The results show that in the ovariectomized rat the amount of GnRH receptor mRNA is increased to 137% in area CA1 and to 147% in area CA3 and in the dentate gyrus when compared to the ovariectomized, estradiol-progesterone treated animal. Similarly, in the orchidectomized male rat the amount of GnRH receptor mRNA is increased to 155% in area CA1, to 146% in area CA3 and to 145% in the dentate gyrus when compared to the intact male rat. There was no significant difference in the relative amounts of GnRH receptor mRNA when gonadectomized male and female rats were compared. Addition of GnRH (100 pM-1 microM) to hippocampal slices in vitro caused a dose-dependent increase in the production of [3H]inositol phosphate which was abolished by co-administration of a GnRH antagonist. The increase in inositol phosphate production was significantly higher at low doses of GnRH (100 pM-1 nM) in estradiol-progesterone treated female and in intact male rats when compared to gonadectomized rats. The results suggest that the amount of GnRH receptor mRNA in the hippocampus is at least in part regulated by gonadal steroids and that the steroid hormones can sensitize the GnRH target neurons to respond more robustly to a GnRH stimulus.

A comprehensive study of physical parameters, biomechanical properties, and statistical correlations of iliac crest bone wedges used in spinal fusion surgery. I. Physical parameters and their correlations.

Iliac crest bone wedges are commonly used in spinal fusion procedures and must be capable of withstanding considerable mechanical stress during the healing process. The variability of "quality" of bone materials used in the production of bone wedges suggests that some bone materials may not be suitable for use in vertebral fusion procedures and some quantifiable means of predicting the suitability of bone wedges would be desirable. A total of 250 iliac crest wedges were used in this study. Physical parameters of iliac crest wedges, such as total cross-sectional area, cancellous cross-sectional area, cortical cross-sectional area, percentage of cortical cross-sectional area, "width," and apparent density were determined. The statistical correlations among physical parameters were investigated. These correlations revealed that the relative percentage of cortical and cancellous bone remained fairly constant at 41% and 59%, respectively, regardless of total cross-sectional area of a wedge, that apparent density did not appreciably change with donor age, and that ash (inorganic) and organic content (weight) correlated well with the apparent density.

A comprehensive study of physical parameters, biomechanical properties, and statistical correlations of iliac crest bone wedges used in spinal fusion surgery. II. Mechanical properties and correlation with physical parameters.

Iliac crest wedges have been the most frequently used bone graft in spinal fusion procedures since the 1970s. Physical parameters and correlations among physical parameters of allogeneic iliac crest wedges have been described in part I of this series. This article discusses the mechanical properties, as well as their correlations with physical parameters, of iliac crest wedges. A total of 250 frozen-thawed, freeze-dried, and rehydrated iliac crest wedges were used in this study. The axial load-bearing capacities for wedges in the three subgroups showed no statistically significant differences, however, rehydrated wedges appeared to have the greatest load bearing capacity and compressive strength. In addition, rehydrated wedges were more deformable than either the frozen-thawed or freeze-dried wedges. Based on biomechanical properties, it is suggested that rehydrated (1 hour in vacuo), or frozen-thawed iliac crest wedge should be used in spinal fusion procedures, and the direct clinical application of nonrehydrated freeze-dried wedges should be avoided.