Content validity of visual analog scales to assess symptom severity of acute angioedema attacks in adults with hereditary angioedema : an interview study

Background: Hereditary angioedema (HAE) is a rare, debilitating, potentially life-threatening condition characterized by recurrent acute attacks of edema of the skin, face/upper airway, and gastrointestinal and urogenital tracts. During a laryngeal attack, people with HAE may be at risk of suffocation, while other attacks are often associated with intense pain, disfigurement, disability, and/or vomiting. The intensity of some symptoms is known only to the person experiencing them. Thus, interview studies are needed to explore such experience and patient-reported outcome measures (PROMs) are required for systematic assessment of symptoms in the clinical setting and in clinical trials of treatments for acute HAE attacks.

Objective: The aim of this interview study was to assess the content validity and suitability of four visual analog scale (VAS) instruments for use in clinical studies. The VAS instruments were designed to assess symptoms at abdominal, oro-facial-pharyngeal-laryngeal, peripheral, and urogenital attack locations. This is the first known study to report qualitative data about the patient's experience of the rare disorder, HAE.

Methods: Semi-structured exploratory and cognitive debriefing interviews were conducted with 27 adults with a confirmed clinical/laboratory diagnosis of HAE (baseline plasma level of functional plasma protein C1 esterase inhibitor [C1INH] <50% of normal without evidence for acquired angioedema). There were 17 participants from the US and 10 from Italy, with mean age 42.5 (SD 14.5) years, range 18–72 years, mean HAE duration 21.3 (SD 14.1) years, range 1–45 years, 67% female, and 44% VAS-naïve. Experience of acute angioedema attacks was first explored, noting spontaneous mentions by participants of HAE symptomatology. Cognitive debriefing of the VAS instruments was undertaken to assess the suitability, comprehensibility, and relevance of the VAS items. Asymptomatic participants completed the VAS instruments relevant to their angioedema experience, reporting as if they were experiencing an acute angioedema attack at the time. Interviews were conducted in the clinic setting in the US and Italy over an 8-month period.

Results: Participants mentioned spontaneously almost all aspects of acute angioedema attacks covered by the four VAS instruments, thus providing strong support for inclusion of nearly all VAS items, with no important symptoms missing. Predominant symptoms found to be associated with acute angioedema attacks were edema and pain, and there was evidence of varying degrees of disruption to everyday activities supporting the inclusion of an overall severity item reflecting the disabling effects of HAE symptoms. VAS item wording was understood by participants.

Conclusion: This interview study explored and reported the patient experience of HAE attacks. It demonstrated the content validity of the four anatomical location HAE VAS instruments and their suitability for use in clinical trials of recombinant human C1INH (rhC1INH) treatment for ascertaining trial participants' assessments of the severity of acute angioedema symptoms.

Pseudomonas aeruginosa genotypes acquired by children with cystic fibrosis by age 5-years

BACKGROUND: We describe Pseudomonas aeruginosa acquisitions in children with cystic fibrosis (CF) aged ≤5-years, eradication treatment efficacy, and genotypic relationships between upper and lower airway isolates and strains from non-CF sources. METHODS: Of 168 CF children aged ≤5-years in a bronchoalveolar lavage (BAL)-directed therapy trial, 155 had detailed microbiological results. Overall, 201/271 (74%) P. aeruginosa isolates from BAL and oropharyngeal cultures were available for genotyping, including those collected before and after eradication therapy. RESULTS: Eighty-two (53%) subjects acquired P. aeruginosa, of which most were unique strains. Initial eradication success rate was 90%, but 36 (44%) reacquired P. aeruginosa, with genotypic substitutions more common in BAL (12/14) than oropharyngeal (3/11) cultures. Moreover, oropharyngeal cultures did not predict BAL genotypes reliably. CONCLUSIONS: CF children acquire environmental P. aeruginosa strains frequently. However, discordance between BAL and oropharyngeal strains raises questions over upper airway reservoirs and how to best determine eradication in non-expectorating children.

Discharge patterns of human tensor palatini motor units during sleep onset

Study Objectives: Upper airway muscles such as genioglossus (GG) and tensor palatini (TP) reduce activity at sleep onset. In GG reduced muscle activity is primarily due to inspiratory modulated motor units becoming silent, suggesting reduced respiratory pattern generator (RPG) output. However, unlike GG, TP shows minimal respiratory modulation and presumably has few inspiratory modulated motor units and minimal input from the RPG. Thus, we investigated the mechanism by which TP reduces activity at sleep onset.

Design: The activity of TP motor units were studied during relaxed wakefulness and over the transition from wakefulness to sleep.

Setting: Sleep laboratory.

Participants: Nine young (21.4 ± 3.4 years) males were studied on a total of 11 nights.

Intervention: Sleep onset.

Measurements and Results: Two TP EMGs (thin, hooked wire electrodes), and sleep and respiratory measures were recorded. One hundred twenty-one sleep onsets were identified (13.4 ± 7.2/subject), resulting in 128 motor units (14.3 ± 13.0/subject); 29% of units were tonic, 43% inspiratory modulated (inspiratory phasic 18%, inspiratory tonic 25%), and 28% expiratory modulated (expiratory phasic 21%, expiratory tonic 7%). There was a reduction in both expiratory and inspiratory modulated units, but not tonic units, at sleep onset. Reduced TP activity was almost entirely due to de-recruitment.

Conclusions: TP showed a similar distribution of motor units as other airway muscles. However, a greater proportion of expiratory modulated motor units were active in TP and these expiratory units, along with inspiratory units, tended to become silent over sleep onset. The data suggest that both expiratory and inspiratory drive components from the RPG are reduced at sleep onset in TP.

Water-binding capacity and viscosity of Australian sweet lupin kernel fibre under in vitro conditions simulating the human upper gastrointestinal tract

There is currently little understanding of the physicochemical properties in the human gastrointestinal tract of Australian sweet lupin (Lupinus angustifolius) kernel fibre (LKF), a novel food ingredient with potential for the fibre enrichment of foods such as baked goods. Since physicochemical properties of dietary fibres have been related to beneficial physiological effects in vitro, this study compared water-binding capacity and viscosity of LKF with that of other fibres currently used for fibre-enrichment of baked goods, under in vitro conditions simulating the human upper gastrointestinal tract. At between 8.47 and 11.07g water/g dry solids, LKF exhibited water-binding capacities that were significantly higher (P<0.05) than soy fibre, pea hull fibre, cellulose and wheat fibre at all of the simulated gastrointestinal stages examined. Similarly, viscosity of LKF was significantly higher (P<0.05) than that of the other fibres at all simulated gastrointestinal stages. The relatively high water-binding capacity and viscosity of LKF identified in this study suggests that this novel fibre ingredient may elicit different and possibly more beneficial physiological effects in the upper human gastrointestinal tract than the conventional fibre ingredients currently used in fibre-enriched baked goods manufacture. We are now performing human studies to investigate the effect of LKF in the diet on health-related gastrointestinal events.

Shortest equals fastest : upper primary children`s pre-conceptions of speed

An understanding of speed as distance travelled per unit time is fundamental to the development of the more complex conception of acceleration. This paper examines the opportunities provided for upper primary children to reveal and modify their pre-conceptions of speed through a walking activity developed as part of the Practical Mechanics in Primary Mathematics project.

Diesel exhaust particulate matter induces multinucleate cells and zinc transporter-dependent apoptosis in human airway cells

The cellular effects of biodiesel emissions particulate matter (BDEP) and petroleum diesel emissions particulate matter (PDEP) were compared using a human airway cell line, A549. At concentrations of 25 µg/ml, diesel particulate matter induced the formation of multinucleate cells. In cells treated with a mixture of 80% PDEP:20% BDEP, 52% of cells were multinucleate cells compared with only 16% of cells treated with 20% PDEP:80% BDEP with a background multinucleate rate of 7%. These results demonstrate a causal relation between the formation of multinucleate cells and exposure to exhaust particulate matter, in particular diesel exhaust. Exposure of A549 cells to PDEP induced apoptosis, seen by active caspase-3 expression and the presence of cleaved pancytokeratin. PDEP exhaust was a much stronger inducer of cellular death through apoptosis than BDEP. There was an eightfold increase in the expression of SLC30A3 (zinc transporter-3 or ZnT3) in cells exposed to 80% PDEP:20% BDEP compared to untreated cells. The increase in ZnT3 expression seen in apoptotic cells following PDEP suggests a role for this zinc transporter in the apoptotic pathway, possibly through controlling zinc fluxes. As exposure to diesel exhaust particles is associated with asthma and apoptosis in airway cells, diesel exhaust particles may directly contribute to asthma by inducing epithelial cell death through apoptotic pathway.

Isogramma Meek and Worthen, 1870 (Dictyonellida, Brachiopoda) from the upper Palaeozoic of East Asia: implications for biogeography and evolutionary trends

Isogramma manchoukuoensis from the Upper Carboniferous of northeast China is redefined based on re-examination of the type specimens. Isogramma specimens from the Middle Permian of northeastern Japan are reassigned to I. aff. paotechowensis. A new family, Schizopleuroniidae, is proposed to include Schizopleuronia, but excludes Megapleuronia, which belongs to the Megapleuroniidae Liao, 1983. The family Isogrammidae is considered to be a transitional group in the eichwaldid-isogrammid-schizopleuronid evolutionary lineage within the Dictyonellida. A review of the global distribution of Isogramma species reveals that the genus has a total of 56 species ranging from the Mississippian (Early Carboniferous) to the Lopingian (Late Permian). Isogramma diversified rapidly after its origination in the middle Viséan and its species diversity remained high throughout the Mississippian. The genus possibly suffered a severe mid-Carboniferous boundary mass extinction, with no Early Carboniferous species surviving this event. Bashkirian Isogramma species show low diversity, followed by a global recovery in the Moscovian. During the latest Carboniferous Isogramma became highly diversified again. At the Carboniferous–Permian (C/P) transition Isogramma underwent another dramatic diversity drop, followed by several stepwise declines in diversity during the Early–Middle Permian. The Wuchiapingian I. sinosa is the last Isogramma species.

Ukraine was the possible centre of origin for Isogramma. From Ukraine Isogramma spread over the Moscow Basin of Russia, Central Europe (Germany, Austria), South Europe (Spain) and West Europe (England, Ireland and Scotland), and migrated to the North American midcontinent and South China during the late Viséan (Early Carboniferous). In Europe, Isogramma migrated to Spain and eastern Europe (Serbia) in the Moscovian, from there it then dispersed into Central Asia (Uzbekistan and Kazakhstan) in the Kasimovian-Gzhelian. In the Palaeo-Tethys Isogramma migrated from South China to northeast and northwest China in the Moscovian, spread over the North China Block during the C/P transition, moved to Russian Siberia, Japan and the Qiangtang terrane of the Palaeo-Tethys during the Early–Late Permian. In North America Isogramma spread over the midcontinent during the Late Carboniferous and Early–Middle Permian and migrated to South America (Bolivia) in latest Carboniferous. Biogeographically, Isogramma was confined principally to the palaeo-tropical and warm to temperate zones throughout the Late Palaeozoic, with the possible exception of the Artinskian, as a questionable species of the genus also occurs in the Transbaikal region of southeast Russia.

Effect of heavy dynamic resistive exercise on acute upper-body power

There is limited research to support the notion that heavy resistive exercise immediately before a power movement may acutely enhance performance. Upper-body acute power enhancement during a stretch-shorten cycle (SSC) movement has not been previously investigated. The aim of this project was to determine whether a set of 5 repetitions of 5 repetition maximum (RM) bench press preceding explosive pushups would significantly influence indicators of power: impulse and maximum rate of force development. Subjects randomly performed either explosive push-ups only over a force platform or a set of 5RM bench press before the explosive push-ups. There were no significant differences for any of the force platform data when the explosive push-ups were preceded by a set of 5RM bench press. It appears that heavy dynamic resistive upper-body exercise on its own before an upper-body power activity is inadequate in augmenting short-term power.

Bovine milk fat enriched in conjugated linoleic and vaccenic acids attenuates allergic airway disease in mice

Background: It has been argued that a reduction in the Western diet of anti-inflammatory unsaturated lipids, such as n-3 polyunsaturated fatty acids, has contributed to the increase in the frequency and severity of allergic diseases.

Objective: We investigated whether feeding milk fat enriched in conjugated linoleic acid and vaccenic acids (VAs) ('enriched' milk fat), produced by supplementing the diet of pasture-fed cows with fish and sunflower oil, will prevent development of allergic airway responses.

Methods: C57BL/6 mice were fed a control diet containing soybean oil and diets supplemented with milk lipids. They were sensitized by intraperitoneal injection of ovalbumin (OVA) on days 14 and 28, and challenged intranasally with OVA on day 42. Bronchoalveolar lavage fluid, lung tissues and serum samples were collected 6 days after the intranasal challenge.

Results: Feeding of enriched milk fat led to marked suppression of airway inflammation as evidenced by reductions in eosinophilia and lymphocytosis in the airways, compared with feeding of normal milk fat and control diet. Enriched milk fat significantly reduced circulating allergen-specific IgE and IgG1 levels, together with reductions in bronchoalveolar lavage fluid of IL-5 and CCL11. Treatment significantly inhibited changes in the airway including airway epithelial cell hypertrophy, goblet cell metaplasia and mucus hypersecretion. The two major components of enriched milk fat, cis-9, trans-11 conjugated linoleic acid and VA, inhibited airway inflammation when fed together to mice, whereas alone they were not effective.

Conclusion: Milk fat enriched in conjugated linoleic and VAs suppresses inflammation and changes to the airways in an animal model of allergic airway disease.