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WAO News & Notes - July 2007 七月医学杂志回顾
Volume 4, Issue 7

Medical Journal Review

七月医学杂志回顾
WAO Now: What's New in the World of WAO

今日WAOWAO领域新进展

And In Other News . . .
其他新闻


Medical Journal Reviews
医学期刊回顾

Prof. Richard F. Lockey, MD, WAO Web Editor-in-Chief, reviewed premier medical journal articles for practicing allergists. Read his top 4 picks below and for the other 10 reviews, click here.

Richard F. Lockey教授,医学博士,WAO网站主编,他为在业的变态反应科医生回顾了主要医学杂志的一些重要文章。以下是4篇主要的文章,点击这里阅读其它10篇。

1 1a. RESCUE USE OF BECLOMETHASONE (B) AND ALBUTEROL (A) IN A SINGLE INHALER FOR MILD ASTHMA
This is a 6-mo double-blind, double-dummy, randomized, parallel-group trial of 455 patients (18 to 65 yrs) with mild asthma [FEV1 of 2.96 liters (88.36% of the predicted value)]. After a 4-week run-in, patients were randomly assigned to one of four regimens: placebo (P) 2X/day plus B, 250 μg, and A, 100 μg, in a single inhaler prn; P 2X/day plus A, 100 μg, prn; B, 250 μg, 2X/day, and A, 100 μg, prn; or B, 250 μg, and A, 100 μg, in a single inhaler 2X/day plus A, 100 μg, prn. Morning PEF during the last two weeks of the 6-mo treatment was higher (P = 0.04) and the number of exacerbations during the 6-mo treatment lower (P = 0.002) in the as-needed combination therapy than in the prn A therapy group. However, the values in the prn combination therapy were not significantly different from regular B therapy or regular combination therapy. The authors conclude that the symptom driven use of prn inhaled B, 250 μg and A, 100 μg, in a single inhaler, is effective treatment and is associated with a lower 6-mo cumulation dose of inhaled corticosteroids. Papi A, et al. N Engl J Med 2007; 356: 2040.
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1a. 单次吸入倍氯米松(B)和沙丁氨醇(A)治疗轻度哮喘
这是一项为期6个月的双盲双模拟随机平行临床研究,455名轻度哮喘患者(18-65岁)入组[FEV1 2.96L (88.36%预计值)]。经过4周洗脱期后,患者随机分组到下列四组方案治疗:安慰剂(P)每日吸入两次,B倍氯米松)250ugA(沙丁氨醇)100ug必要时同时吸入一吸;安慰剂(P)每日吸入两次,加A(沙丁氨醇)100ug必要时吸入一吸; B倍氯米松)250ug 每日吸入两次和A(沙丁氨醇)100ug必要时吸入一喷;A(沙丁胺醇)和B倍氯米松)每日吸入两次加A(沙丁胺醇)必要时吸入。在六个月观察期的最后2周,按需联合疗法组清晨峰流速高于按需单用沙丁氨醇组(P = 0.04),前者症状加重次数少于后者(P = 0.002)。但按需联合疗法疗效与规律使用倍氯米松组无明显差别。作者总结:按需吸入倍氯米250ug 和沙丁氨醇100ug是一种有效的治疗,而且6个月吸入皮质激素的累积剂量较小。Papi A, et al. N Engl J Med 2007; 356: 2040.

1b. RANDOMIZED COMPARISON OF STRATEGIES FOR REDUCING TREATMENT IN MILD PERSISTENT ASTHMA
500 patients (six yrs or older) with mild asthma, well-controlled with inhaled fluticasone (F), 100 μg 2X/day, were randomly assigned to receive continued F, 100 μg 2X/day, montelukast (M), 5 or 10 mg each night, or F, 100 μg, plus salmeterol (S),50 μg, each night for 16 weeks in a DB study. Treatment failure was the primary outcome. 20% of patients assigned to receive F or F + S failed compared to 30.3% of those on M. The hazard ratio for both comparisons was 1.6 (95% CI, 1.1 to 2.6; P = 0.03). The % of asthma free days was similar across the three groups. The authors conclude that patients controlled with 2X/daily F can be switched to 1X/daily F + S without increased treatment failure. However, a switch to M results in an increased treatment failure and decreased asthma control, even though M treated patients remained free of symptoms on 78.7% of treatment days. Editor’s comment: Three physicians’ comments on various treatment options for mild, persistent asthma are included. One of the experts would use prn B and A in a combined inhaler, another, a leukotriene antagonist plus a prn rescue β-agonist, and the third, once daily inhaled corticosteroid plus a long-acting β-agonist in a single inhaler. William Osler, the Father of American Medicine, stated, “The practice of medicine is an art, based on science”. No single treatment may be absolutely correct to treat mild, persistent asthma. The American Lung Association Asthma Clinical Research Centers. N Engl J Med 2007; 356: 2027. Clinical Decisions. Kraft M: 2096. Israel E: 2097. O’Connor GT: 2098.
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1b.在轻度持续哮喘患者减量治疗的随机对照
500例氟替卡松(100ug Bid)控制良好的轻度哮喘患者被随机分组到3个治疗组之一:继续接受氟替卡松治疗;孟鲁司特 5mg10mg QN氟替卡100ug加沙美特罗50ug QN。该DB(双盲)研究为期16周。以治疗失败为研究终点。氟替卡或氟替卡松加沙美特罗组患者中20%治疗失败,孟鲁司特组患者中30.3%治疗失败。两组的危险比为1.6%,三组之间无哮喘症状日的百分比相似。作者总结:每天两次氟替卡松控制良好的患者可以改为每天一次氟替卡松加沙美特罗而不增加治疗失败率。但改为孟鲁司特治疗后,治疗失败率增加,哮喘控制率降低,尽管孟鲁司特组患者观察期内78.7%时间无症状。编辑点评:三名医生比较了轻度持续哮喘患者使用不同治疗方案的疗效。一名专家用倍氯米松和沙丁氨醇联合按需吸入治疗,另一种治疗方案是白三烯拮抗剂加β受体激动剂急救药按需治疗,第三种治疗方案为每日一次皮质激素吸入加长效β受体激动剂复合制剂。美国医学之父William Osler曾经说过:“医学实践是一门以科学为基础的艺术。”轻度持续性哮喘的治疗方案中,也许没有一项是绝对正确的。美国肺和哮喘临床研究中心。 N Engl J Med 2007; 356: 2027. Clinical Decisions. Kraft M: 2096. Israel E: 2097. O’Connor GT: 2098.
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2. REMODELING AND AIRWAY HYPERRESPONSIVENESS (AHR) BUT NOT CELLULAR INFLAMMATION PERSIST AFTER ALLERGEN CHALLENGE IN ASTHMA (A)
Fiberoptic bronchoscopy was performed at baseline, 24 hrs and seven days after allergen inhalational challenge of dual responders with mild-moderate asthma. At each time point, AHR, spirometry, and expression of tenascin (extracellular matrix protein), procollagen I, procollagen III, and heat shock protein (HSP)-47 (markers of collagen synthesis), and α-smooth muscle actin (myofibroblasts) were evaluated as markers of activation of airway remodeling. Likewise, numbers of mucosal major basic protein-positive eosinophils, CD68+ macrophages, CD3+, CD4+, CD8+ T cells, elastase-positive neutrophils, and tryptase-positive mast cells were assayed. AHR was increased from baseline at 24 hrs and seven days after allergen challenge. However, reticular basement membrane tenascin expression, elevated at 24 hrs, returned to baseline levels at seven days. Reticular basement membrane procollagen III expression was significantly elevated at seven days, and procollagen 1, HSP-47, and α-smooth muscle actin were all higher at seven days vs. 24 hrs. Eosinophil, macrophage, neutrophil, and CD3+ T cells increased at 24 hrs but returned to baseline by seven days. The authors conclude that the 24-hr increase after allergen challenge in dual responders with asthma in airway wall cellular inflammation resolves by seven days, whereas increases in AHR and markers of remodeling persist. Editor’s comment: AHR is associated with remodeling and not cellular inflammation. Kariyawasam HH, et al. Am J Respir Crit Care Med 2007; 175: 896.

2.哮喘病人在过敏原激发后气道重建和气道高反应性持续进行而非细胞炎症
轻症哮喘患者进行可诱发双相反应的过敏原吸入激发试验,激发试验前(基线)和24小时后以及7天后进行纤维支气管镜检查。评价各时间点的气道高反应、肺功能和粘胶丝(细胞外间质蛋白)、前胶原蛋白I、前胶原蛋白III和热休克蛋白HSP-47(胶原合成的标记)以及α-平滑肌肌动蛋白(肌纤维母细胞)作为气道重建的标志物。同时分析粘膜中主要碱性蛋白阳性的嗜酸粒细胞的数量,CD68+ 巨噬细胞, CD3+, CD4+, CD8+ T 细胞, 弹性蛋白酶阳性的中性粒细胞和类胰蛋白酶阳性的肥大细胞。过敏原激发试验后气道反应性24小时和7天后均升高。网状基底膜粘胶丝表达激发试验24小时后升高,但7天后恢复到基线水平。网状基底膜前胶原蛋白I表达激发试验7天后显著升高,前胶原蛋白IIIHSP-47以及α-平滑肌肌动蛋白7天时比24小时高。嗜酸粒细胞、巨噬细胞、中性粒细胞和CD3+T细胞激发试验后24小时升高,但7天后回到基线水平。作者总结:激发试验24小时后的哮喘双向反应中气道壁细胞炎症在7天后消退,但气道高反应性和气道重建标志物在7天后仍持续存在。编辑点评:气道高反应性与气道重建相关,而细胞炎症与气道重建不相关。 Kariyawasam HH, et al. Am J Respir Crit Care Med 2007; 175: 896.

3. A COMPREHENSIVE ANALYSIS OF ADVERSE OBSTETRIC AND PEDIATRIC COMPLICATIONS IN WOMEN WITH ASTHMA (A)
Outcomes for 37,585 pregnancies of women with A were compared to 243,434 without A. Risks of stillbirth and therapeutic abortion were similar; however, the risk of miscarriage was slightly higher (OR 1.10; 95% CI, 1.06 – 1.13). Risk of placental abruption, placental insufficiency, placenta previa, preeclampsia, hypertension, gestational diabetes, thyroid disorders in pregnancy, and assisted delivery were similar with the exception of increases in antepartum (OR, 1.20; 95% CI, 1.08-1.34) or postpartum (OR, 1.38; 95% CI, 1.21-1.57) hemorrhage, anemia (OR, 1.06; 95% CI, 1.01-1.12), depression (OR, 1.52; 95% CI, 1.36-1.69), and C-section (OR, 1.11; 95% CI, 1.07-1.16). Editor’s comment: Asthma is not a major risk factor in pregnancy. Tata LJ, et al. Am J Respir Crit Care Med 2007; 175: 991.
3.
哮喘妇女的产科和儿科不良并发症综合分析
37,585名哮喘妊娠的妇女和243,434 名非哮喘妊娠妇女进行预后比较。死胎和治疗性流产两组相似,但哮喘组流产率稍高(似然比OR 1.10; 95% CI 1.06 – 1.13)。胎盘早剥、胎盘剥离不全、前置胎盘、先兆子痫、高血压、妊娠糖尿病、妊娠甲状腺疾病和辅助分娩措施在两组是相似的,但产前出血(OR, 1.20; 95% CI, 1.08-1.34)和产后出血(OR, 1.38; 95% CI, 1.21-1.57),贫血(OR, 1.06; 95% CI, 1.01-1.12),抑郁(OR, 1.52; 95% CI, 1.36-1.69),和剖腹产比率(OR, 1.11; 95% CI, 1.07-1.16)哮喘组稍高。编辑点评:哮喘不是妊娠的主要危险因素。 Tata LJ, et al. Am J Respir Crit Care Med 2007; 175: 991

4. HERPESVIRUS LATENCY CONFERS SYMBIOTIC PROTECTION FROM BACTERIAL INFECTION

Reviewed by Gary Hellermann, PhD
Can herpesvirus infection be good for you? In this intriguing report, mice were infected with gamma herpesvirus (GHV) and the infection allowed to proceed to latency after which the animals were challenged with the intracellular pathogen, Listeria monocytogenes (L.m.). Mice without latent GHV suffered much greater susceptibility to L.m. infection than those previously infected with GHV. The mechanism for this enhanced antibacterial response may lie with subclinical reactivation of the virus producing sufficient viral antigen to maintain a prolonged increase in interferon gamma production. Editor’s comment: While this unusual type of latency-induced cross protection has not yet been shown in humans, this report demonstrates once again that in studying the immune system the rules are always subject to change. Barton ES, et al. Nature 2007; 447:326.

4.
疱疹病毒潜伏期具有象征性保护细菌感染的能力
Gary Hellermann, PhD复习该文
疱疹病毒感染是否有利于你?在这一有趣的报道中,小鼠被γ单纯疱疹病毒(GHV)感染,感染潜伏后以细胞内病原体单核细胞增多性李司特(L.m.)进行攻击。与预先感染疱疹病毒的小鼠相比,未感染组L.m.明显更易感。这一抗细菌感染反应产生的机制可能是亚临床病毒感染可导致产生足够的病毒抗体,从而导致较长时间内产生了更多IFN-γ。编辑点评:尽管这种病毒导致的保护性效应尚未在人体得到证实,但这一报道再一次表明:在研究免疫系统时,规律总是在变化中。Barton ES, et al. Nature 2007; 447:326.

5. SMOKING AFFECTS RESPONSE TO INHALED CORTICOSTEROIDS OR LEUKOTRIENE RECEPTOR ANTAGONISTS IN ASTHMA (A)

44 nonsmokers and 39 light smokers with mild A were randomly assigned to treatment with inhaled beclomethasone (B) or once daily oral montelukast (M) in a multicenter, placebo-controlled, double-blind, double-dummy, crossover trial The primary outcome was change in prebronchodilator FEV 1 in smokers versus nonsmokers. Secondary outcomes include PF, PC20 methacholine, symptoms, QOL, and markers of airway inflammation. Subjects with A who smoked, had significantly more symptoms, worse QOL, and lower daily PF than nonsmokers. B significantly reduced sputum eosinophils and ECP in both smokers and nonsmokers but increased FEV1 (170 ml, P = 0.0003) only in nonsmokers. M significantly increased A.M. PF in smokers ( 12.6 L/min, P = 0.002) but not in nonsmokers The authors conclude that in subjects with mild A who smoke, the response to B is attenuated and that M may be appropriate to treat smokers with A. They call for larger studies to confirm these data. Editor’s comment: Perhaps leukotrienne antagonists and not B will be more helpful for smokers than nonsmokers with A Lazarus SC, et al. Am J Respir Crit Care Med 2007; 175:783.
5.
吸烟可影响吸入皮质激素或白三烯受体拮抗剂治疗哮喘的效果
在这一多中心-安慰剂对照-双盲-双模拟-交叉的临床研究中,44例非吸烟和39例轻度吸烟的轻度哮喘患者被随机分组到吸入倍氯米松组或口服孟鲁司特组。主要观察指标是吸烟患者vs非吸烟患者吸入支气管扩张剂前的FEV1。次要观察指标包括峰流速、PC20乙酰甲胆碱、症状、生活质量和气道炎症标志物。与非吸烟者相比,吸烟者症状更多,生活质量较差,每日峰流速较低。倍氯米松在吸烟者和非吸烟者均可降低嗜酸粒细胞和ECP含量,但只有非吸烟者才有FEV1改善。孟鲁司特在吸烟者显著改善造成峰流速,而非吸烟者则无明显改善.作者总结:轻度哮喘的吸烟患者对吸入皮质激素倍氯米松的效果减弱,而孟鲁司特更适合治疗吸烟的哮喘患者。作者希望更大量样本的研究以进一步证实这一结论。编辑点评:相对不吸烟的哮喘患者而言,也许白三烯受体拮抗剂而不是倍氯米松更适合吸烟的哮喘患者。 Lazarus SC, et al. Am J Respir Crit Care Med 2007; 175:783

6. OSTEOPONTIN HAS A CRUCIAL ROLE IN ALLERGIC AIRWAY DISEASE THROUGH REGULATION OF DENDRITIC CELL SUBSETS

Reviewed by Gary Hellermann, PhD
Osteopontin (Opn), also known as early T lymphocyte activation-1 (Eta-1) factor, is a cytokine that wears many hats. Bone researchers found that it assists osteoclasts in localizing to bone matrix while cancer researchers reported Opn is involved in tumor suppression. Opn-1 is produced in abundance by activated T lymphocytes and binds to the cell adhesion receptor, CD44, affecting homing and attachment of lymphocytes and other immune system cells. New research now implicates the secreted form of the cytokine, Opn-s, in differential regulation of the allergic immune response through actions on dendritic cells. In this report on a mouse model, Opn-s proved to be pro-inflammatory during allergen sensitization, but anti-inflammatory during challenge. Editor’s comment: The demonstration of both pro- and anti-inflammatory activities in the same molecule emphasizes the need for great care in the design and evaluation of clinical trials of cytokines such as Opn. Xanthou G, et al. Nature Medicine 2007, 13:570.

6.骨桥蛋白通过调节树突状细胞对过敏性呼吸道疾病有重要作用
Gary Hellermann, PhD复习该文
骨桥蛋白Opn)是一种早期T淋巴细胞活化因子(Eta-a),这种细胞因子有多种作用(被冠以很多帽子)。骨科研究者发现骨桥蛋白可帮助成骨细胞定位于骨基质,而肿瘤研究者发现这种细胞因子参与了肿瘤抑制。Opn-1由活化的T淋巴细胞大量产生,与细胞粘附受体CD44结合,影响淋巴细胞和其他免疫系统细胞的归巢和粘附。新的研究提示,这种细胞因子的分泌形式Opn-s,通过影响树突状细胞来影响过敏免疫反应的分化调节。在这一鼠模型为研究对象的研究中,Opn-s被证明是过敏原致敏过程中是前炎症物质,但在过敏原激发中有抗炎作用。编辑点评:在进行类似Opn这样的细胞因子的临床试验的设计和评价时,应注意同一细胞因子的前炎症和抗炎双重作用。Xanthou G, et al. Nature Medicine 2007, 13:570

7. A WEB-BASED, TAILORED ASTHMA (A) MANAGEMENT PROGRAM FOR URBAN AFRICAN-AMERICAN HIGH SCHOOL STUDENTS

This study was developed and evaluated as a multimedia, web-based A management program which specifically targeted urban high school students in an attempt to alter their behavior as it related to A outcome. High school students were randomized to receive the treatment website vs a sham website on school computers. At 12 mo, treatment students reported fewer symptom-days, symptom-nights, school days missed, restricted activity days, and hospitalizations for asthma when compared to controls (RR and 95% CIs all significant). Editor’s comment: Education, which leads to compliance, is a key to improved asthma outcomes in all populations. Joseph CLM, et al. Am J Respir Crit Care Med 2007; 175: 888.

7.
针对城市中非洲裔美国人中学生定制的基于网络的哮喘控制计划
本研究是一项专为城市中学生定制并评价的基于网络的多媒体哮喘管理计划,以改变患者影响哮喘预后的生活方式。高中生被随机分组到接受学校计算机网络治疗vs虚拟网络治疗。12个月后,与对照组相比,治疗组有症状天数更少,夜间症状更少,因病缺课较少,活动受限天数较少,因哮喘住院更少。编辑点评:在所有人群中,哮喘教育会增加治疗顺应性,对改善哮喘治疗效果都非常关键。Joseph CLM, et al. Am J Respir Crit Care Med 2007; 175: 888.

8. ADENOTONSILLECTOMY (AT) IMPROVES SLEEP, BREATHING, AND QUALITY OF LIFE (QOL) BUT NOT BEHAVIOR

This retrospective cohort study was designed to obtain parental perspectives on changes in sleep, breathing, QOL, and neurobehavioral outcomes after AT was performed for obstructive sleep apnea syndrome (OSAS) from 1993 to 2001. Children who underwent AT were compared to children who did not. 138 of the 166 questionnaires returned (35%) from parents of 473 children were complete. Compared to controls, parents of children who had AT reported improvements in sleep, breathing and QOL but not in concentration, school performance, and intellectual or developmental progress. Both short and long term, there were no significant effects of AT on any of the Conners’ Parent Rating Scale-Revised behavior subscales. The authors conclude that AT improves sleep, breathing, and QOL but not neurobehavioral outcomes. Editor’s Comment: Neurobehavioral outcomes did not improve in this study following AT for sleep apnea in children. More data are necessary. Constantin E, et al. J Peds 2007; 150: 540.

8.
腺样体切除(AT)改善睡眠、呼吸和生活质量但不能改善行为
这一回顾性队列研究目的是研究19932001年阻塞性睡眠呼吸暂停综合征(OSAS)患者腺样体切除后,父母对患儿睡眠、呼吸、生活质量和神经行为的评价。手术腺样体切除术治疗组儿童和未手术组比较。向473名患儿家长发放调查问卷,返回166份(35%),其中138为完整问卷。与对照组相比,腺样体切除组患儿家长报道患儿在睡眠、呼吸和生活质量方面得到改善,但在注意力集中、学校表现和学习成绩和身体发育无明显改善。根据Conners 父母评价分系统改进的行为亚评分系统,无论是进行短期还是长期评价,两组间在任何指标均无显著性差异。作者总结认为腺样体切除术可改善睡眠、呼吸和生活质量,但不改善神经行为结果。编辑点评:本研究中,睡眠呼吸暂停的儿童腺样体切除术后,精神行为结果并未改善。尚需更多的临床资料。 Constantin E, et al. J Peds 2007; 150: 540.

9. BASAL SERUM TRYPTASE (T) LEVEL CORRELATES WITH SEVERITY OF HYMENOPTERA STING AND AGE
109 patients, 63 wasp venom and 46 honey bee venom-allergic, had basal serum T levels measured. T levels were elevated in 12 (11%) and increased from a mean of 5.14 to 6.98 μg/L for patients with sting reactions from grades I through IV, (Mueller classification). Serum T levels correlated significantly with the sting reaction severity (r = 0.2752; P = .004) and with age (r = 0.2906; P = .002). Sting reaction severity also correlated with age (r = 0.3654; P = .001). The authors conclude that serum T levels correlate with both sting severity and age. Editor’s comment: This is another paper which indicates that basal levels of serum T probably influence outcomes of sting induced anaphylaxis. Kucharewicz I, et al. J Investig Allergol Clin Immunol 2007; 17: 65.

9.
基础血清类胰蛋白酶水平(T)与膜翅目昆虫叮蜇和年龄的关系
109例患者(63例黄蜂蜂毒过敏,46例蜜蜂蜂毒过敏)进行了基础类胰蛋白酶水平检测。患者的叮蜇反应I-IV级(Mueller分级法)12例(11%)的血清类胰蛋白酶水平从 5.14 高到 6.98 μg/L叮蜇严重程度和血清类胰蛋白酶水平显著相关,(r = 0.2752; P = .004)也与年龄相关 (r = 0.2906; P = .002)。作者总结:血清类胰蛋白酶水平与年龄和叮蜇严重程度均相关。编辑点评:这是关于基础类胰蛋白酶水平可能影响叮蜇导致的过敏性休克预后的另一篇文章。Kucharewicz I, et al. J Investig Allergol Clin Immunol 2007; 17: 65

10. THE VARIABILITY OF REGIONAL AIRFLOW OBSTRUCTION WITHIN THE LUNGS OF PATIENTS WITH ASTHMA: ASSESSMENT WITH HYPERPOLARIZED HELIUM-3 MAGNETIC RESONANCE (H3HeMR) IMAGING

Using hyperpolarized helium-3 magnetic resonance (H3HeMR) imaging, airspaces are depicted and focal areas of airflow obstruction are shown as “ventilation defects”. The authors investigate the regional changes in airflow obstruction with time and repeated bronchoconstriction. H3HeMR and spirometry were performed before and immediately after methacholine challenge in 10 patients (18-35 yrs) with asthma on two days that were 7-476 days (mean, 185.3 ± 37.2 days) apart. Pair-wise image comparisons demonstrate that 41% ± 10% and 69% ± 5% (P = .017) of defects , respectively, were in the same location, and of those, 69% ± 12% and 43% ± 5% (P = .022), respectively, did not change size. Comparing premethacholine vs. postmethacholine images, of defects were in the same location on day one and 73% ± 7% (P = .088) on day two. The authors conclude that ventilation defects persist or recur in the same locations in asthmatics and suggest that regional changes of the airflow obstruction are relatively fixed. Editor’s comment: There is tremendous variability in asthma, even in different areas of the lung of the same subject. deLange EE, et al. JACI 2007; 119:1072.

10.
哮喘患者的肺局部气流阻塞局部变异度:用高极化氦-3磁共振进行的评估
用高极化氦-3磁共振成像(H3HeMR)进行气流受限患者的评价时,气流阻塞病灶处显示为空间缺损,被称为“通气缺损”。作者观察了气流阻塞的随着时间和反复支气管痉挛的局部改变。2天内,对10例哮喘患者(18-35 )进行了乙酰甲胆碱激发试验,试验前后分别进行肺功能试验和H3HeMR7-476 days (平均185.3 ± 37.2 )。对缺损图像进行了配对对比研究,结果显示缺损的41% ± 10% 69% ± 5% (P = .017) 分布于同一部位,而且这一缺损的大小没有改变[69% ± 12% 43% ± 5% (P = .022)] 乙酰甲胆碱激发试验前后缺损对比,激发试验后第一天58% ± 9%缺损位于同一位置,第二天73% ± 7% (P = .088)缺损位于同一位置。作者总结认为:通气缺损持续或反复发生在同一部位,提示气流受限的局部改变是相对固定的。编辑点评:哮喘的变异是很大的,即使是在同一患者肺部的不同部位也是如此。deLange EE, et al. JACI 2007; 119:1072.

11. STRUCTURAL INSIGHT INTO PRE-B CELL RECEPTOR FUNCTION
Reviewed by Gary Hellermann, PhD
B cells, like T lymphocytes, undergo constant scrutiny by regulatory cells to ensure that self-tolerance is maintained. One checkpoint is at the stage where the pre-B cell receptor contains an intermediate known as the surrogate light chain (SLC). Only those B cells in which the SLC can pair with the newly expressed heavy chain are allowed to go on to clonal expansion. In this report, the human pre-B cell receptor was crystallized and the structure of the SLC examined. Editor’s comment: Structural analysis at the submolecular level reveals significant new information about the interaction of the SLC with the heavy chain and suggests how this binding affects the yea or nay decision on B cell survival Bankovich, AJ et al. Science 2007; 316:291.

11.
洞悉前B细胞受体结构
该文献由Gary Hellermann, PhD复习
B
细胞,和T细胞一样,在调节细胞持续考察下确保获得自我耐受。一个检查点是前B细胞受体包含一个过渡产物――被称为代理轻链(SLC)的时期。只有那些SLC和新表达的重链可以配对的B细胞可以获得克隆增殖。在这一报道中,把人类前B细胞受体进行了结晶,并研究了SLC的结构。编辑点评:亚细胞水平的结构研究提示关于SLC和重链之间互相影响的新信息,这一结合对B细胞生存的影响。Bankovich, AJ et al. Science 2007; 316:291

12. ONCE-YEARLY ZOLEDRONIC ACID (ZA) FOR TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS (O)
This is a 3-year DBPC trial of 3889 patients (mean age, 73 yrs) randomly assigned to receive a single 15-minute infusion of ZA, 5 mg, or 3876 placebo (P) at baseline, 12 mo, and 24 mo. They were followed until 36 mo. Primary end points were new vertebral fracture (in patients not taking concomitant osteoporosis medications) and hip fracture (all patients). Secondary end points included bone mineral density (BMD), bone turnover markers, and safety outcomes. Treatment with ZA reduced the risk of vertebral fracture by 70% compared to P (3.3% in ZA vs 10.9% in P, relative risk, 0.30; 95% CI, 0.24 to 0.38) and reduced the risk of hip fracture by 41% (1.4% in ZA vs 2.5% in P; hazard ratio, 0.59; 95% CI, 0.42 to 0.83). Non-vertebral fractures, clinical fractures, and clinical vertebral fractures were reduced by 25%, 33%, and 77%, respectively (P<0.001 for all comparisons). ZA was associated with improvement in BMD and bone metabolism markers. Atrial fibrillation occurred more frequently in the ZA group (50 vs 20 patients, P<0.001), without serious consequences. Once a year infusion of ZA significantly reduces the risk of vertebral, hip, and other fractures. Editor’s comment: Once a year treatment for osteoporosis is on its way. Black DM, et al. N Engl J Med 2007; 356: 1809. Editorial, Compston J: 1878.

12.
每年一次酸注射治疗绝经后骨质疏松
这是一个为期三年的双盲安慰剂对照的临床观察,3889名患者入组(平均年龄73岁)后随机分组到接受单次酸治疗(5mg 静脉注射/15分钟内)和安慰剂(P),观察基线期、12个月,24个月。随访持续到治疗后36个月。主要研究终点是脊椎骨折(在没有进行骨质疏松治疗的患者)和骨盆骨折(所有患者)。次要研究终点包括骨密度、骨骼代谢周转标记和安全结果。与安慰剂组比较,酸治疗组降低脊椎骨折率70%( 膦酸组3.3% vs 安慰剂组10.9%, 相对危险度RR 0.3095% CI0.24 to 0.38),降低骨盆骨折率降低41%(膦酸组1.4%vs安慰剂组2.5%;危害比0.59; 95%CI 0.42 to 0.83)膦酸组的非脊椎骨折、临床骨折和临床脊椎骨折分别降低了25%33%77% (P<0.001)酸与骨密度的改善和骨代谢标记物相关。治疗组房颤的发生率增加(膦酸组50 vs安慰剂组 20, P<0.001),均未造成严重后果。每年一次酸注射治疗显著降低了脊椎骨盆和其他部位的骨折。编辑点评:骨质疏松每年一次疗法正在发展中。N Engl J Med 2007; 356: 1809. Editorial, Compston J: 1878.

13. EXERCISE-INDUCED BRONCHOSPASM (EIB): DIAGNOSIS AND TREATMENT

This CME article is an excellent review of the subject of EIB asthma (A). EIB is usually suspected from the clinical history; a methacholine, exercise, or eucapnic voluntary hyperventilation challenge can be helpful in its diagnosis. First-line pharmacologic treatment is a short-acting β-agonist. However, regularly used inhaled corticosteroids, leukotriene inhibitors, long-acting β-agonists and mast cell stabilizers are all effective treatments. Editor’s comment: EIB often goes unrecognized, untreated, and interferes with exercise. Bruns AS and Parsons JP. JCOM 2007; 14: 211.

13.
运动诱发哮喘的诊断和治疗
这篇继续教育文章是关于运动诱发哮喘的非常好的综述。从临床病史可拟诊运动诱发哮喘,乙酰甲胆碱、运动或eucapnic voluntary 高通气 激发试验可能对诊断有帮助。一线治疗是短效β受体激动剂。然而规律使用皮质激素吸入治疗、白三烯受体拮抗剂、长效β受体激动剂和和肥大细胞稳定剂都是有效的治疗。编辑点评:运动诱发哮喘不易辨别,治疗率低,会阻碍患者运动。JCOM 2007; 14: 211.

To read the additional reviews, click here.
要阅读其它文献,请点击这里



WAO Now: What's New in the World of WAO
                 
今日WAOWAO领域新进展

bangkok logoWorld Allergy Congress (WAC) 2007 – Bangkok, Thailand
Immunotherapy and Food Allergy Symposiums

Immunotherapy and Food Allergy are two major concerns for the practicing Allergist. To address these important topics in depth, World Allergy Congress in Bangkokwill start, 2 December 2007, with a full day symposium on Immunotherapy, co-sponsored by ALK, Dynavax (in partnership with UCB Pharma), Greer and Stallergens and the final day, 6 December 2007, will be a full day symposium on Food Allergy co-sponsored by Dey LP and Heinz. Our faculty will comprise world experts on each topic, bringing exciting updates on latest developments and debating new therapies. To see the programs for the symposia click here (Immunotherapy) or here (Food Allergy).

世界变态反应会议2007-曼谷,泰国
免疫治疗和食物过敏专题讨论会
免疫治疗和食物过敏是变态反应医生关注的两个主要问题。为更深入阐述这两个重要议题,孟买世界变态反应会议将在 2007122全天召开免疫治疗的专题讨论会,由ALK, Dynavax (in partnership with UCB Pharma), Greer and Stallergens 共同赞助。而会议的最后一天, 126将会举行全天食物过敏研讨会,由Dey LP Heinz共同赞助。我们的讲者每一议题的包括世界级的专家,他们将带来令人振奋的最新动态,并讨论新的治疗。要看专题研讨会请点击这里(免疫治疗)和这里(食物过敏)。

WAO – Nycomed International Fellows for 2007-2008

WAO, in partnership with Nycomed, is sponsoring 9 international fellows in order to identify and support up-coming key opinion leaders in asthma and/ or allergic rhinitis.  WAO is delighted to announce the nine winners of the WAO-Nycomed International Short-Term Fellowship for 2007-2008. Each fellowship includes a 2-week stay at a research host center, as well as inclusion in the World Allergy Congress (WAC) in Bangkok, Thailand where fellows will have a chance to present posters on their research project at the Fellowship Luncheon.  Please join us in congratulating:

WAO――Nycomed国际fellows2007-2008
WAONycomed合作资助9名国际成员,以确定和支持这些成员主持的哮喘和过敏性鼻炎重要课题。WAO非常高兴地宣布2007-2008年度9WAO-Nycomed 国际短期会员资格名单。每一名获奖者将获得一项为期两周的客座研究中心的研究,同时还获得一个曼谷会议中以展板形式展示自己研究课题的机会。让我们共同祝贺:

Zuzana Rennerová, Slovakia
Damian Tworek, Poland
Mirjana Turkalj, Croatia
Corina Ureche, Romania
Mariana Malucelli, Brazil
Anne Ellis, Canada
Katja Adamic, Slovenia
Paraskevi Xepapadaki, Greece
Thaneshvari Moodley, South Africa

New Educational Postings on the WAO Website

WAO Conversations
We have the pleasure of announcing a new interview with the President of WAO, Michael Kaliner, MD. Please take a moment to listen to Dr. Kaliner share his extensive knowledge in the 2007 Annual WAO Update.

Ask the Expert – Exclusive Benefit to WAO Members
Ask the Expert is a new online tool available exclusively to WAO Members. Directed by Professors Cassim Motala and Ruby Pawankar, this online service provides the opportunity to pose educational, scientific and medical questions about allergy, asthma, and clinical immunology to one of the many WAO volunteer experts located throughout the world. We invite all WAO Members to become a part of this online service. To Ask the Expert, click here.

WAO网站新教育posting
对话WAO
我们非常高兴地宣布WAO主席Michael Kaliner, MD接受了一次采访。请Dr. Kaliner发布的2007年年会最新动态。
向专家提问――WAO成员的特殊权益
向专家提问是一个新的在线工具,只针对WAO会员。在Cassim Motala Ruby Pawankar教授指导下,这一在线服务提供了你向世界各地变态反应专家提问,获得关于变态反应、哮喘和临床免疫的教育、科学和医学问题解答的机会。我们邀请所有的WAO会员参与进来,成为这一在线服务的一部分。向专家提问,请点击这里

New Interactive Case Review
Take a moment to test your knowledge with the new Interactive Case Review based on a Clinical Case Report – Acute Parotitis by Dr. Andrew Bagg.
Interactive Case Reviews give you the chance to test your knowledge and make a diagnosis on an unusual case history. The case study is pictorially presented, along with questions and possible diagnoses. Once you select your diagnosis, you immediately learn whether or not your diagnosis corresponds to that of the experts who posted the case, and are able to read the rationale for the diagnosis and suggested treatment provided by the expert.

新的互动病例讨论
请花点时间测试新的互动病例讨论,该临床病例讨论由Dr. Andrew Bagg提供----急性腮腺炎。
互动病例讨论提供了一个测试医学知识机会,根据罕见临床病史作出诊断。该病例讨论提供图片和可能的诊断,你选择一个诊断后,立刻就能知道你的诊断是否和病例提供者提供的诊断一致,而且可以知道专家提供的诊断依据和治疗建议。

wafWAF Materials Available
"Immune Tolerance”
WAF presenter materials from the recent XXVI Congress of the EAACI are now available for download on the WAF web page.

WAF 资料获取
“免疫耐受”
WAF
提供最近的XXVI EAACI会议提供的资料,可以在WAF web page点击下载。

World Allergy Forum is supported through an unrestricted educational grant from
世界变态反应组织论坛由诺华教育基金提供不限题材的赞助

Call for Applications

Long-Term Research Fellowship
The World Allergy Organization (WAO) offers one Long-Term Research Fellowship, to commence in 2008. The Fellowship will support a junior allergist following an approved research program at a WAO proposed host center for up to two years. WAO will contribute a monthly stipend of $1,700 US and once-yearly travel expenses between the home country and the host center.

Priority will be given to junior clinicians within five years of award of the most recent professional degree, who are specializing in allergy and who are affiliated with an academic department or clinical institute. Applicants must be active members of a WAO member society.

The Long-Term Fellowship will be applied to a project which meets one of the WAO Research Priorities:

  • Genetic factors involved in the development of allergic disease and response to treatment
  • Allergen characterization and standardization
  • Clinical and basic studies in allergy and asthma

Application forms including a list of host centers may be downloaded here

Applications must be received by WAO Secretariat no later than 30 September 2007

召集申请
长期研究奖学金
2008
年起,世界变态反应组织(WAO)提供一个长期的研究奖学金,该奖学金将支持一位年轻的变态反应医生在WAO指定的客座研究中心进行为期两年的科研研究。WAO将提供$1700/月费用和每年一次探亲旅行资助。这一机会就优先给予年轻的变态反应专业的医生(距获得最高学术学位五年以内),在学术和临床研究学院工作,申请者必须是WAO成员学会的成员。长期研究基金就有限授予具备下列条件之一者:

n         在变态反应疾病发生和治疗的基因研究者

n         过敏原研究和标准化研究者

n         从事变态反应和哮喘临床和基础研究者

客座研究中心名单和申请表格下载请点击此处

Upcoming Allergy Meetings

gloriaUS GLORIA Placement
Alabama Society of Allergy, Asthma and Immunology

August 10-12, 2007
Destin, Florida
US GLORIA Faculty:
Bob Lanier
Presentations:
Module 5: Treatment of Severe Asthma
Module 10: Chronic Rhinosinusitis and Nasal Polyposis
即将到来的变态反应会议
美国 GLORIA介绍
阿拉巴马变态反应,哮喘和免疫学会
2007810-12
Destin Florida
美国GLORIA 教授:
Bob Lanier
讲座内容:
模块5 严重哮喘的治疗
模块10慢性鼻窦炎和鼻息肉

GLORIA is supported through unrestricted educational grants from:

alcon

dey

schering-plough


Sign up for Online Journal Subscription -

WAO and Hogrefe & Huber Publishers are offering a limited number of free online subscriptions to Allergy & Clinical Immunology International - Journal of the World Allergy Organization for members in developing countries. If you are interested in receiving a complimentary, online subscription, please send an e-mail to info@worldallergy.org, noting "Free Journal Subscription" in the subject line, with the following details:

First name
Last (Family) name
Postal address
City, State/Province and postal code
Country
E-mail address
Name of Member Society

申请订阅网上杂志
WAO
Hogrefe & Huber 出版社为发展中国家提供名额有限的免费网上杂志《国际变态反应和临床免疫杂志世界变态反应组织杂志》。如果你有兴趣接受免费网上杂志,请发电子邮件到info@worldallergy.org,在邮件主题一栏注明“免费杂志订阅”,并提供下列信息。
姓:
名:
通讯地址:城市,州/省,邮政编码
国家电子邮箱:
所属的WAO成员学会:


And In Other News

Allergy Book Reviews

Handbook of Atopic Eczema: 2nd edition.
Editors: J Ring, B Przybilla, T Ruzicka
ISBN: 978-3-540-23133-2

List price: $169.00 USD
Available from: Springer-Verlag

Reviewer:
Dr Janet Rimmer, MBBS, MD (UNSW), FRACP
St. Vincent Clinic
Darlinghurst, NSW, Australia

Description:
The first edition of this book was printed 15 years ago and this 2nd edition has been extensively revised with the addition of new topics. As atopic eczema affects up to 25% of the population in many countries it is appropriate to have an up to date, in depth textbook on this topic. The title is somewhat misleading in that it provides a very comprehensive review of the topic rather than acting as a “handbook”.

Purpose:
The purpose of the book is to provide an in depth approach to atopic eczema.
Both the usual aspects of atopic eczema are covered as well as some very interesting sections such as ‘Complications and diseases associated with atopic eczema’ as well as ‘diseases rarely associated with eczema’; there is a comprehensive coverage of different therapy approaches eg. music therapy, eczema schools and alternative therapies.

Audience:
This textbook is targeted primarily to clinicians who have a special interest in this condition, i.e., dermatologist and allergists. While there is a paediatric chapter in the clinical aspect section, this is not repeated in the management section which is an omission as it is an important disease in childhood and there are always specific treatment considerations for this age group.

Features:
The format is divided into 3 sections: clinical aspects, pathophysiology and management. There is a synopsis at the end of each section. There are 107 contributors most of whom are based in Europe, with only 3 contributors from the USA. The book is 613 pages and there are 66 chapters divided evenly between the 3 sections. Each chapter is divided into sections, which allows for clear organization of the material, there are reasonable numbers of illustrations and copious references.

Assessment:
This book provides a comprehensive review of a common disease. It brings together many aspects of this disease into one compact source. It is highly recommended for any clinician who has an interest in or treats this condition.
其他新闻
变态反应书籍复习
特应性皮炎手册:第二版
编者: J Ring, B Przybilla, T Ruzicka
ISBN: 978-3-540-23133-2
标价:$169.00 USD
可在线购买: Springer-Verlag

复习者:
Dr Janet Rimmer, MBBS, MD (UNSW), FRACP
St. Vincent Clinic
Darlinghurst, NSW, Australia

本书特点:
本书第一版出版于15年前。第二版中编者进行了大规模的修改,增加了很多新题目。由于特应性皮炎在很多国家发病率高达25%,因此有必要进行相关知识的更新。书的题目有些容易让人产生误解,因为该书不仅是一本简单的“手册”,而是对这一题目的一个相当深入的回顾。

目的:
本书的目的是提供对特应性皮炎的深入理解。该书不仅涵盖了特应性皮炎的常见问题,也包括一些非常有意思的题目例如“与特应性皮炎相关的并发症”和“与特应性皮炎很少相关的疾病”,同时也涵盖了一些不同的治疗方法,例如:音乐治疗、湿疹学校和替代治疗。

读者群:
这本书主要面向对这一问题感兴趣的临床医生,例如变态反应医生和皮肤科医生。本书临床表现部分有儿科一章,因为特应性皮炎是儿科重要的疾病,对于这一年龄群的患者总是有一些特殊治疗方法。在特应性皮炎的治疗一章中并不重复这些内容。

结构:
本书分为三部分:临床表现、病理生理和治疗。在每一章的末尾均附有大纲。共有107名编者,大部分来自欧洲,只有3名来自美国。本书共613页,66章,临床表现、病理生理和治疗三部分各22章。每章都分为几个部分,文章内容组织结构清晰,图表数量合理、参考文献丰富。

评价:
本书提供了特应性皮炎这一常见疾病的综合复习。把这一疾病不同方面的特点进行了归纳和总结,强烈推荐对治疗这一疾病感兴趣的临床医生阅读。

Current Problems in Dermatology, Vol. 33: Biofunctional Textiles and the Skin
Series Editor: G. Burg
Volume Editors: U.-C. Hipler, P. Elsner
ISBN:3-8055-8121-1
ISBN-13:978-3-8055-8121-9

List Price: $180.00 USD
Available From: Karger Publishers

Reviewer
James Young Joon Choi, MBBS FRACP
Allergist and Clinical Immunologist
Westmead Hospital Dermatology Registrar

Description:
Biofunctional textiles are a new and exciting scientific field established to create fabrics which have the potential to treat or prevent diseases. Much of this update focuses on the area of antimicrobial silver textiles – the biological properties of silver, the new methods of incorporating it into resilient seaweed based fibers, and its anticipated uses in the medical field – from preventing nosocomial infections to treating atopic dermatitis.

Purpose:
This book effectively combines and presents the current state of knowledge on silver antimicrobial fabrics from the perspectives of three disciplines – the microbiologist, the textile engineer, and the dermatologist.

Audience:
Researchers and clinicians interested in infection control, atopic dermatitis, chronic wounds and burns will find this book a very useful introduction and summary of what is currently possible in antimicrobial textiles.

Features:
Each chapter begins with a succinct abstract. Although most figures are in black and white, they are of high quality. Charts and tables are well designed and clearly presented. All chapters conclude with a list of references. The index is detailed and useful. Overall, I felt that although the book could be read from front to cover, each chapter was in its own right self contained and could be read alone or out of order.

Assessment:
This book is an exciting introduction into the rapidly evolving science of antimicrobial textiles. It is a very useful and up-to-date synopsis for any practitioner dealing with atopic dermatitis, and emphasizes what can be possible when there is collaboration between a medical discipline (Clinic for Dermatology and Dermatological Allergology at the Clinic of the Friedrich Schiller University at Jena) and a non-medical industry (the German Textile Research Centre North-West, Krefeld).

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现代皮肤问题 Vol. 33: 生物功能纺织物和皮肤
编者: Series Editor: G. Burg
Volume Editors: U.-C. Hipler, P. Elsner
ISBN:3-8055-8121-1
ISBN-13:978-3-8055-8121-9
价格:$180.00 USD
在线购买: Karger Publishers

复习者:
James Young Joon Choi, MBBS FRACP
Allergist and Clinical Immunologist
Westmead Hospital Dermatology Registrar

本书特点:
研究具有生物功能的纺织物是一个新的令人激动的领域,这种织物可以预防和治疗疾病。目前的主要课题是利用银的防微生物这一生物特性制成的银织物、新的纺织方法使之形成具有弹性的纤维及其在医学领域的预防性应用――在治疗特应性皮炎防止医院感染。

目的:
本书的从微生物学家、纤维工程学家和皮肤科医生不同的视角,有效地总结了目前银抗菌纤维的现状和相关知识。

读者群:
对感染控制、特应性皮炎慢性伤口和烧伤处理感兴趣的科研人员和临床医生来说,关于抗微生物纺织物的这本读物可能是非常有用的。

结构:
每章都有一个简介的内容摘要。尽管大部分的图片是黑白的,但图片的质量非常高。图和表格设计合理,一目了然。各章都附有参考文献,检索非常详细而且有用。总的来说,我感到这本书尽管可以从头到尾地阅读,每一章都相对独立,可以单独阅读或不按章节顺序阅读。

评价:
这本书介绍了抗菌纺织物这一令人兴奋的新科技产品。对于治疗特应性皮炎的医生而言,这本书是非常有用的最新概念,并且强调了在临床医生(Clinic for Dermatology and Dermatological Allergology at the Clinic of the Friedrich Schiller University at Jena)和非临床医生(the German Textile Research Centre North-West, Krefeld)之间进行合作的可能性。

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译者:北京协和医院 文利平   
Translated by
 Wen Liping MD  PUMCH Dep. of ALLERGY