Atopic dermatitis, STAT3- and DOCK8-hyper-IgE syndromes differ in IgE-based sensitization pattern.

BACKGROUND: Increased serum IgE levels are characteristic but not specific for allergic diseases. Particularly, severe atopic dermatitis (AD) overlaps with hyper-IgE syndromes (HIES) regarding eczema, eosinophilia, and increased serum IgE levels. HIES are primary immunodeficiencies due to monogenetic defects such as in the genes DOCK8 and STAT3. As it is not known to date why allergic manifestations are not present in all HIES entities, we assessed the specificity of serum IgE of AD and HIES patients in the context of clinical and immunological findings. METHODS: Clinical data, skin prick tests, specific IgE to aero- and food allergens, and T helper (Th) subpopulations were compared in AD and molecularly defined HIES patients. RESULTS: Total serum IgE levels were similarly increased in STAT3-HIES, DOCK8-HIES, and AD patients. The ratio of aeroallergen-specific IgE to total IgE was highest in AD, whereas DOCK8-HIES patients showed the highest specific serum IgE against food allergens. Overall, clinical allergy and skin prick test results complied with the specific IgE results. Th2-cell numbers were significantly increased in DOCK8-HIES and AD patients compared to STAT3-HIES patients and controls. AD patients showed significantly higher nTreg-cell counts compared to STAT3-HIES and control individuals. High Th17-cell counts were associated with asthma. Specific IgE values, skin prick test, and T-cell subsets of STAT3-HIES patients were comparable with those of healthy individuals except decreased Th17-cell counts. CONCLUSION: Hyper-IgE syndromes and atopic dermatitis patients showed different sensitization pattern of serum IgE corresponding to the allergic disease manifestations and Th-cell subset data, suggesting a key role of DOCK8 in the development of food allergy.

Coenzyme Q10, carotenoid, tocopherol, and retinol levels in cord plasma from multiethnic subjects in Hawaii.

Coenzyme Q10 (Q10), carotenoids, tocopherols, and retinol are the major circulating lipid-phase micronutrients (LPM) known to help mitigate oxidative damage and prevent chronic diseases. However, the functions of these compounds in newborns are little understood. This is due, in part, to the paucity of studies reporting their concentrations in this population. We measured Q10, carotenoids, tocopherols, and retinol in cord plasma from 100 multiethnic subjects living in Hawaii using HPLC with diode array and electrochemical detection. Appropriate internal standards were used including, for the first time, custom designed oxidized (UN10) and reduced (UL10) Q10 analogues. These compounds reflected the oxidation of UL10 to UN10 that occurred during sample processing and analysis and thus permitted accurate adjustments of natively circulating Q10 levels. All LPM measured were much lower in cord than in peripheral plasma. Cord plasma levels of total carotenoids, tocopherols, and retinol were approximately 10-fold, 3- to 5-fold and 1.5- to 3-fold lower than those in children or women. Cord plasma levels of total Q10 (TQ10; median, 113 ng/mL) were approximately 2-fold or 7- to 9-fold lower than peripheral plasma levels of neonates or children and adults, respectively. In contrast, the UN10/TQ10 ratio was substantially higher in cord (24%) than in peripheral plasma of children (3-4%) or adults (9%). Among the 5 ethnic groups in our cohort, no differences were observed in the levels of UN10, UL10, or TQ10. However, significant differences in many of the LPM were observed between ethnicities. More research is needed to explain these phenomena.

[Halm-Zielke instrumentation as primary stable improvement of the Zielke-VDS in idiopathic scoliosis. 1 to 4 year outcome of a prospective study of 29 consecutive patients]. / Halm-Zielke-Instrumentation als primärstabile Weiterentwicklung der Zielke-VDS bei idiopathischen Skoliosen. 1- bis 4-Jahres-Ergebnisse einer prospektiven Studie bei 29 konsekutiven Patienten.

Halm-Zielke Instrumentation (HZI) was developed to eliminate the disadvantage of ventral derotation spondylodesis (VDS)-Zielke in terms of lack of primary stability and in order to simplify sagittal plane control. Within a prospective clinical trial started in 1993, we have studied whether HZI fulfills these demands. HZI is an anterior double-rod system with a two screw per vertebral body fixation. The longitudinal components consist of a threaded VDS rod and a solid rod, which are attached to a hinge-conducted lid plate. Twenty-nine consecutive patients with idiopathic scoliosis and curves ranging from 36 degrees to 92 degrees were treated with HZI. The follow-up period ranged from 1 to 4 years. Correction of the frontal plane within the instrumented levels averaged 71.6% and 70.5% postoperatively and at follow-up, respectively. Derotation averaged 53.7% and mean correction of the tilt of the lowest instrumented vertebra was 69.5% at final follow-up. Thoracolumbar kyphosis was present in eight patients and was always completely corrected from +18.8 degrees to 3.3 degrees on average. One implant-related complication involved a screw breakage 18 months postoperatively without adverse effects. There was no case of pseudoarthrosis. All patients were mobilized without any additional external immobilization in terms of a brace or cast, and were allowed to go swimming for physiotherapeutical purposes immediately after wound healing. This study proves that HZI is a primary stable implant to perform VDS. Implant-related disadvantages typical of VDS are eliminated. Thereby, the period of rehabilitation is shortened by many months due to avoidance of cast and brace treatment.

Dispensing home nebulizers for acute wheezing from the hospital is cost-effective.

The objective was to investigate the use characteristics of home nebulizers and to measure the benefit gained from dispensing home nebulizers (compared with their cost) to patients from the hospital. During the study period, August 28,1996 to May 17,1997, a sample of 232 of the 291 entries from a log of home nebulizers dispensed by the hospital respiratory care department were surveyed over the telephone. Of the 232 study subjects under the age of 21, a telephone interview of a guardian or supervising adult was completed in 106 subjects (46%) a mean of 43 weeks after the home nebulizer was prescribed (47% of the cohort received their home nebulizers from the inpatient service and another 47% were discharged with home nebulizers from the emergency department (ED)). An average of 3.6 estimated additional ED visits and 5.4 office/clinic visits for each patient were prevented by the home nebulizer. The benefit (savings from reduced ED and office visits alone) to cost ratio estimates range from $855:$90 to $1710:$90 or more. The overwhelming majority of the patients felt that the home nebulizer was a good idea, it was easy to use, they had no problems with the nebulizer and they received adequate training for home nebulizer use. Home nebulizers are a cost-effective means of providing home nebulized albuterol for selected outpatients. Hospital inpatient units and EDs which have the ability to dispense a home nebulizer, have an additional therapeutic option available for selected patients who may benefit from it. Medical insurance companies should fully support (ie, pay for) home nebulizers because it is cost effective. If there is any concern about the reliability of the patient to follow-up with their primary physician, the patient's primary physician should be contacted to discuss the feasibility of discharging the patient with a home nebulizer.

[Halm-Zielke instrumentation in idiopathic scoliosis. Results in 25 consecutive patients with a minimum follow-up of 2 years]. / Halm-Zielke-Instrumentation bei idiopathischen Skoliosen. Ergebnisse bei 25 konsekutiven Patienten mit einem Mindestnachbeobachtungszeitraum von 2 Jahren.

AIM OF THE STUDY: Halm-Zielke Instrumentation (HZI) was developed to eliminate the disadvantage of VDS-Zielke in terms of lack of primary stability and in order to simplify sagittal plane control. Since 1993 we study within a prospective clinical trial, whether HZI fulfills these demands. METHODS: HZI is an anterior double-rod system with a two screw per vertebral body fixation. The longitudinal components consist of a threaded VDS-rod and a solid rod, which are attached to a hinge-conducted lid plate. 25 consecutive patients with idiopathic scoliosis and curves ranging from 36 degrees to 92 degrees were treated with HZI. The follow-up period ranges from 2 to 4 years. RESULTS: Correction of the frontal plane within the instrumented levels averaged 71.4% and 70.4% postoperatively and at follow-up, respectively. Derotation averaged 51.7% and mean correction of the tilt of the lowest instrumented vertebra was 69.5% at final follow-up. Thoracolumbar kyphosis was present in 7 patients and always completely corrected. One implant related complication, a screw breakage 12 months postoperatively without adverse effects was noted. There was no case of pseudarthrosis. All patients were mobilized without any additional external immobilization in terms of a brace or cast and were allowed to go swimming for physio-therapeutical purposes immediately after wound healing. CONCLUSION: This study proves that HZI is a primary stable implant to perform the Ventral Derotation Spondylodesis. The VDS-typical implant related disadvantages are eliminated. With this the period of rehabilitation is shortened by many months due to avoidance of cast and brace treatment.

Comparing ease of intraosseous needle placement: Jamshidi versus cook.

In a sample of 34 study subjects, Cook and Jamshidi intraosseous (IO) needles were compared for ease of insertion into turkey bones. The averaged lapsed time of insertion was significantly shorter using the Jamshidi needle (25.5 v 56.2 seconds, P < .0001). The mean difficulty of insertion score was lower using the Jamshidi needle (3.0 v 7.1 on a 10-cm visual analog scale, P < .0001). The less costly Jamshidi needle is easier to use in IO insertion in this turkey bone model.