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Objective To explore the clinical characteristics of acute attacks of bronchial asthma （BA） in children in Kashgar region， and analyze the impact of 25-hydroxyvitamin D3 （25（OH）D3） levels on disease severity. Methods Children with acute BA attacks， aged 6-14 years， admitted to a certain thirdtier A-level Hospital of Kashgar were enrolled and divided into different groups according to disease severity （mild， moderate and severe） and 25（OH）D3 levels （normal， insufficiency and deficiency）. Clinical characteristics were compared among different groups. The correlation between 25（OH）D3 levels and disease severity was analyzed. Results A total of 112 children were enrolled， with a male-to-female ratio of 2.61∶1， with a median age of 9.0 （7.0-11.0） years old. The highest incidence was found in spring （42.9%）. The positive rate of allergens is 74.1%（83/112）， with inhaled allergens as the main type （89.1%）， and the tree combination had the highest positive rate （47.0%）.Based on disease severity， 36 cases were assigned into the mild group， 51 cases in the moderate group， and 25 cases in the severe group. As the disease severity was aggravated， the forced vital capacity （FVC）， forced expiratory volume at 1 second （FEV1）， and the ratio of FEV1 to FVC（FEV1/FVC） were gradually decreased （all P <0.001）. The eosinophil （EOS） count in the severe group was higher than that in the mild group （P < 0.05）. According to 25（OH）D3levels， 28 cases had normal 25（OH）D3 levels， 21 cases with insufficient 25（OH）D3 levels， and 35 cases with 25（OH）D3 deficiency. The FVC， FEV1， FEV1/FVC， and peak expiratory flow （PEF） in the 25（OH）D3 deficiency group were significantly lower than those in the insufficient and normal 25（OH）D3 groups （all P < 0.05）. The disease severity significantly differed among three groups （H = 9.538， P = 0.008）. Serum 25 （OH） D3 levels were negatively correlated with the severity of BA attacks （τ = -0.304， P =0.002）. Conclusions Spring is the peak season of acute attacks of BA in school-age children from Kashgar. Inhaled allergens are mainly composed of tree combination. As the severity of this condition deteriorates， lung function of the affected children are gradually declined. Serum 25 （OH） D3 levels are associated with lung function and the severity of acute attacks in children with BA.

Objective To explore the clinical characteristics of acute attacks of bronchial asthma (BA) in children in Kashgar region, and analyze the impact of 25-hydroxyvitamin D3 (25 (OH) D3) levels on disease severity. Methods Children with acute BA attacks, aged 6-14 years, admitted to a certain thirdtier A-level Hospital of Kashgar were enrolled and divided into different groups according to disease severity (mild, moderate and severe) and 25 (OH) D3 levels (normal, insufficiency and deficiency) . Clinical characteristics were compared among different groups. The correlation between 25 (OH) D3 levels and disease severity was analyzed. Results A total of 112 children were enrolled, with a male-tofemale ratio of 2.61:1, with a median age of 9.0 (7.0-11.0) years old. The highest incidence was found in spring (42.9%) . The positive rate of allergens is 74.1% (83/112), with inhaled allergens as the main type (89.1%), and the tree combination had the highest positive rate (47.0%) .Based on disease severity, 36 cases were assigned into the mild group, 51 cases in the moderate group, and 25 cases in the severe group. As the disease severity was aggravated, the forced vital capacity (FVC), forced expiratory volume at 1 second (FEV1), and the ratio of FEV1 to FVC (FEV1/FVC) were gradually decreased (all P < 0.001) . The eosinophil (EOS) count in the severe group was higher than that in the mild group (P < 0.05) . According to 25 (OH) D3 levels, 28 cases had normal 25 (OH) D3 levels, 21 cases with insufficient 25 (OH) D3 levels, and 35 cases with 25 (OH) D3 deficiency. The FVC, FEV1, FEV1/FVC, and peak expiratory flow (PEF) in the 25 (OH) D3 deficiency group were significantly lower than those in the insufficient and normal 25 (OH) D3 groups (all P < 0.05) . The disease severity significantly differed among three groups (H = 9.538, P = 0.008). Serum 25 (OH) D3 levels were negatively correlated with the severity of BA attacks (τ= -0.304, P = 0.002). Conclusions Spring is the peak season of acute attacks of BA in school-age children from Kashgar. Inhaled allergens are mainly composed of tree combination. As the severity of this condition deteriorates, lung function of the affected children are gradually declined. Serum 25 (OH) D3 levels are associated with lung function and the severity of acute attacks in children with BA. [ABSTRACT FROM AUTHOR]

Objective: Plasma exchange (PE) and immunoadsorption (IA) are recognized as effective ways to treat attacks in AQP4 antibody‐positive NMOSD, but high‐quality evidence was lacking. To evaluate the efficacy and safety of PE/IA plus intravenous methylprednisolone (IVMP) in NMOSD attacks using propensity scores to match IVMP as control. Methods: Patients were from a prospective observational cohort study. Stratification and interval propensity score matching (PSM) were used to reduce selection bias by matching baseline characteristics (gender, age, time to IVMP, EDSS at attack) between PE/IA + IVMP and IVMP group (in a ratio of 1:2). The primary endpoint of efficacy was EDSS change at 6 months. Adverse events and changes in laboratory tests were recorded. Results: Four hundred and eleven attacks of 336 patients were screened for PSM, and 90 attacks (30 PE/IA + IVMP and 60 IVMP) were included in the analysis. There were significant differences in EDSS [6.25 vs. 6.75; IQR (4.50–8.38 vs. 5.00–8.00), p = 0.671] and visual acuity [median logMAR = 0.35 vs. 1.00; IQR (0.30–0.84 vs. 0.95–1.96), p = 0.002] change between two groups at 6 months. PE/IA + IVMP treatment demonstrated predictive capacity for good recovery as indicated by an area under the curve (AUC) of 0.726. Fibrinogen reduction was found during PE/IA + IVMP treatment [n = 15 (50.00%)], but no severe adverse events led to apheresis treatment discontinuation. Discussion: After PSM analysis, IVMP+PE/IA in acute attack of NMOSD achieved better and continuous improvement in neurological function within 6 months compared with IVMP alone. PE/IA treatment showed a good safety profile. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate the intervention effect of meteorological risk forecasting service on acute onset and medical expenses of chronic obstructive pulmonary disease（COPD） patients， and to provide scientific basis for the establishment of health management model for chronic obstructive pulmonary disease（COPD） patients.MethodsStudy subjects were recruited from chronic obstructive pulmonary patients aged ≥40 in Pudong New Area. Propensity score matching method was used to determine the intervention group and the control group. The control group received regular health education and follow-up management， and the intervention group was provided with meteorological and environmental risk forecasting services through WeChat， mobile phone short message service（SMS）and telephone. Finally， a total of 2 589 subjects were included in the analysis， including 1 300 in the intervention group and 1 289 in the control group. General demographic data， past medical history and family history of COPD， COPD related knowledge and practice survey， COPD related symptom assessment， acute onset， health service utilization and medical expenses before and after intervention were collected through questionnaire survey. The differences of acute attack， health service utilization and related medical expenses between the two groups before and after intervention were compared to evaluate the intervention effect.ResultsIn terms of acute attacks， after intervention， the incidence of acute attacks in the intervention group was lower than that before intervention（χ2=52.901， P0.05）. After intervention， the difference between the control group and the intervention group with different intervention methods was statistically significant （H=11.864， P

Abstract Background Hereditary angioedema (HAE), which is caused by C1-inhibitor (C1-INH) deficiency or dysfunction, is a rare and potentially life-threatening disease. In patients with HAE, excess production of bradykinin causes acute unpredictable recurrent attacks of angioedema in localized regions, including the larynx and intestines. Given the fact that HAE is an autosomal dominant disease, C1-INH produced in patients with HAE is 50% of that produced in healthy individuals. However, most patients with HAE present plasma C1-INH function of

Objective To explore the risk factors of acute gout flares. Methods A total of 4 649 patients with gout were divided into the observation group (302 cases, acute stage of gout) and control group (4 347 cases, chronic stage of gout) according to whether they were in the acute stage of gout. Univariate analysis and multivariate Logistic regression analysis were used to explore the correlation factors and risk factors of acute gout flares. Results Significant differences were found in the serum γ -glutamyltransferase (GGT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IDBIL), blood glucose (GLU), triglyceride (TG), blood urea nitrogen (BUN), creatinine (CREA), uric acid (UA), glomerular filtration rate (eGFR) and combined tophi between these two groups (all P<0. 05) . Multivariate analysis showed that high GGT, AST, GLU, TG, BUN, CREA, and combined tophi were independent risk factors for acute gout attack (all P<0. 05) . Conclusion GGT, AST, GLU, TG, BUN, CREA and combined tophi are risk factors for acute gout flares. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to explore the clinical characteristics of perioperative acute gout attacks in patients with varying uric acid levels undergoing orthopedic surgery, identify the risk factors for gout recurrence within the first postoperative year, and provide a disease prevention and diagnostic reference. Methods This hospital-based retrospective study was conducted between January 2018 and December 2020. According to the blood uric acid levels at admission, the patients were grouped into either the normal uric acid level group or the hyperuricemia group. Patient comorbidities, serum uric acid levels, inflammatory indicators, follow-up recurrence rates, and other indicators were compared. Result The uric acid decline ratio and the inflammatory indexes (white blood cell count and C-reactive protein level) at the time of the attack were significantly higher in the normal uric acid level group than in the hyperuricemia group (P

Background: Hereditary angioedema (HAE), which is caused by C1-inhibitor (C1-INH) deficiency or dysfunction, is a rare and potentially life-threatening disease. In patients with HAE, excess production of bradykinin causes acute unpredictable recurrent attacks of angioedema in localized regions, including the larynx and intestines. Given the fact that HAE is an autosomal dominant disease, C1-INH produced in patients with HAE is 50% of that produced in healthy individuals. However, most patients with HAE present plasma C1-INH function of < 25% owing to the chronic consumption of C1-INH by kallikrein–kinin, contact, complement, coagulation, and fibrinolysis cascades. Recently, several therapeutic options have been developed for acute attacks and prophylaxis in the treatment of HAE; however, currently, there is no curative therapy for HAE. Case presentation: Here we report the case of a 48-year-old male patient who presented with a long-standing history of HAE and underwent bone marrow transplantation (BMT) for acute myeloid leukemia (AML) at the age of 39 years and has been in complete remission of AML and HAE thereafter. Notably, after BMT, his C1-INH function gradually increased as follows: < 25%, 29%, 37%, and 45.6%. Since his 20 s, he intermittently presented with an acute attack of HAE once every 3 months from the initial attack. Further, after undergoing BMT, the number of acute attacks decreased to twice within 4 years until the age of 45 years, and subsequently, the patient has been free of acute attacks. C1-INH is mainly synthesized by hepatocytes, but it is known to be partially produced and secreted from peripheral blood monocytes, macrophages, endothelial cells, and fibroblasts. We speculate that the C1-INH function may be increased by extrahepatic production of C1-INH, possibly synthesized by differentiated cells derived from hematopoietic and mesenchymal stem cells after BMT. Conclusions: This case report supports efforts to focus on extrahepatic production of C1-INH in the next strategy of new treatment development for HAE. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the clinical characteristics of perioperative acute gout attacks in patients with varying uric acid levels undergoing orthopedic surgery, identify the risk factors for gout recurrence within the first postoperative year, and provide a disease prevention and diagnostic reference. Methods: This hospital-based retrospective study was conducted between January 2018 and December 2020. According to the blood uric acid levels at admission, the patients were grouped into either the normal uric acid level group or the hyperuricemia group. Patient comorbidities, serum uric acid levels, inflammatory indicators, follow-up recurrence rates, and other indicators were compared. Result: The uric acid decline ratio and the inflammatory indexes (white blood cell count and C-reactive protein level) at the time of the attack were significantly higher in the normal uric acid level group than in the hyperuricemia group (P < 0.05). Patients in the hyperuricemia group with diabetes and tophi and those administered diuretics were more prone to acute gout attacks than those in the normal uric acid level group (P < 0.05). In the normal uric acid level group, 22 patients (84.6%) exhibited single joint involvement, whereas only 18 patients (47.4%) in the hyperuricemia group demonstrated single joint involvement (P < 0.05). After 1 year of follow-up, the gout recurrence rate in the hyperuricemia group was 44.7%, which was significantly higher that the recurrence rate in the normoglycemic group (11.5%; P < 0.05). Presenting tophi in perioperative orthopedic surgery patients was found to be an independent risk factor for gout recurrence within 1 year (RR = 4.80; P = 0.029). Conclusion: The recurrence rate of gout in patients with hyperuricemia during perioperative period increased 1 year after operation. Therefore, it is crucial to monitor the uric acid level to prevent acute gout attacks during the perioperative period and recurrence during the 1-year follow-up period. Moreover, the risk of an acute gout recurrence 1 year after operation increased in patients who presented tophi; therefore, it is necessary to maintain appropriate blood uric acid level during perioperative period among patients undergoing orthopedic surgery. [ABSTRACT FROM AUTHOR]

Background and purpose: Neuromyelitis optica spectrum disorder (NMOSD) is a severe neurological inflammatory disease mainly caused by pathogenic aquaporin‐4 antibodies (AQP4‐IgG). The safety and efficacy of the neonatal Fc receptor antagonist batoclimab addition to conventional intravenous methylprednisolone pulse (IVMP) therapy in patients with NMOSD acute attacks was assessed. Methods: In an open‐label, dose‐escalation phase 1b study, NMOSD patients with acute myelitis and/or optic neuritis received four doses of weekly subcutaneous injections of either 340 mg or 680 mg batoclimab with concurrent IVMP and were followed up for 27 weeks. The primary end‐points were safety and tolerability. Secondary end‐points included pharmacodynamics and efficacy, with key efficacy assessment at week 4. Results: In total nine NMOSD patients were enrolled, including two and seven in the 340 and 680 mg groups. Five patients had acute myelitis, while the remaining four had unilateral optic neuritis. Batoclimab add‐on therapy had an overall good safety profile without serious adverse events. In the 680 mg group, mean immunoglobulin G (IgG) reached its maximum reduction at the last dose (day 22). In the meantime, AQP4‐IgG was undetectable in six of seven subjects whose baseline AQP4‐IgG titers ranged from 1:32 to 1:320. Expanded Disability Status Scale score was reduced by 1.3 ± 0.4 at week 4 (2.7 ± 1.3) compared with baseline (4.0 ± 1.0). Conclusions: Batoclimab add‐on therapy to IVMP is safe and tolerated in patients with NMOSD. Preliminary evidence suggests a beneficial neurological effect. A randomized controlled trial would be needed to prove the efficacy. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Health Sciences / Sağlık Bilimleri Dergisi is the property of Erciyes Universitesi Saglik Bilimleri Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study investigated the effect of influenza vaccination on prevention of acute attacks in elderly patients with chronic airway disease and provides evidence for the prevention and control strategy of chronic airway disease in the elderly population. A total of 348 elderly patients in Linquan County, Anhui Province, China, who were also in stationary phases of chronic airway disease and were vaccinated with either the tetravalent or trivalent influenza vaccine were selected. The number of patients with acute attacks, the number of outpatients with acute attacks, the number of outpatients, the number of inpatients, the total cost of patients, the cost of outpatients, the cost of hospitalization, and the length of hospitalization were collected before vaccination and after a one-year follow-up. There was no significant difference in age and sex ratio among the two vaccination groups. The ratios of acute attacks, outpatient visits, and hospitalizations and number of outpatient visits, number of hospitalizations, total medical expenses, outpatient expenses, and hospitalization expenses were significantly higher before vaccination than those after vaccination in both the trivalent-vaccination group and tetravalent-vaccination group. Additionally, there was no significant difference in the length of stay between before and after vaccination in either the trivalent-vaccination group or tetravalent-vaccination group. The protection effect between the trivalent-vaccination group and tetravalent-vaccination group was not significant. Influenza vaccination can effectively prevent the acute attack of chronic airway disease and delay the progress of chronic airway disease. [ABSTRACT FROM AUTHOR]

Background: Acute hepatic porphyria includes four inherited disorders caused by partial deficiencies of enzymes related to the heme biosynthesis. Clinical manifestations include acute attacks, occurring mainly among female patients. This study describes the diversity of acute symptoms, changes in triggering factors and life expectancy among female patients during the past five decades. Methods: 107 Finnish female patients were enrolled into a retrospective, longitudinal study during 2015. Clinical, biochemical and genetic data was obtained from the medical reports, registry data and a questionnaire designed for the study. Causes of death were studied in additional 32 female patients. Results: Of the 43 patients with hospitalization, 33% had non-complicated, 35% prolonged and 28% severe attacks with no correlation with the disease-causing mutation. Of the deceased patients, 31% died of an acute attack during 1957–1979. Thereafter the incidence and severity of acute attacks have decreased substantially. 55% of the subjects reported acute symptoms (dysautonomia and mental symptoms) without hospitalization, 29% had porphyria symptoms >10 times, and 23% within the last year. Despite 22% of the female patients had died of primary liver cancer, the life expectancy increased more than 10 years during the follow-up, and did not differ from the normal population at present. Conclusions: The incidence of acute attacks requiring hospitalization has decreased, but more than half of the female patients reported acute symptoms affecting their well-being. Symptoms are currently triggered by hormonal changes and weight loss emphasizing the importance of early recognition and active management to avoid disease exacerbation. Death due to primary liver cancer is common and should be screened regularly.

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

AIM: To investigate the effect of combined application of fluorouracil and adjustable suture in trabeculectomy for acute attack of primary angle-closure glaucoma in middle-aged patients. METHODS: This was a prospective study. 60 patients(60 eyes)with primary angle-closure glaucoma in middle-aged patients were selected in our hospital from October 2016 to March 2019. Patients were randomly divided into suture group, 5-FU group and combined group, with 20 cases(20 eyes)in each group. Followed up for 6mo postoperatively, the patient's vision, visual field, intraocular pressure, adjuvant therapy and quality of life were observed.RESULTS:The best corrected visual acuity among the three groups in the first week after operation was higher than that before surgery(P PPPP>0.05). The CLVQOL scores of the combined group(110.60±2.44)was higher than that of the suture group(101.50±2.61)and the FU group(98.55±2.50)at 6mo after operation(PPCONCLUSION: Combined use of 5-FU and adjustable suture in trabeculectomy for the treatment of acute attack of middle-aged primary acute angle-closure glaucoma patients is safe and effective, which can improve the quality of life.

Background: Interleukin-6 receptor blockade is effective in reducing the risk of relapses in neuromyelitis optica spectrum disorder (NMOSD). However, its efficacy during acute attacks of NMOSD remains elusive. Objective: We investigated the effects of tocilizumab on disability during acute attacks, as well as its maintenance, in patients with moderate-to-severe myelitis. Methods: Nineteen patients with NMOSD received tocilizumab treatment as add-on to high-dose methylprednisolone (HDMP) in acute myelitis and twenty-two patients who only received HDMP were compared. Disease disability was assessed using a multi-level scaling system that included the expanded disability status scale (EDSS), Hauser ambulation index (HAI), modified Rankin scale (mRS), pain numerical rating scale (NRS), functional assessment of chronic illness therapy-fatigue scale (FACIT-F), activity of daily living (ADL), EuroQol five-dimensions-three-level questionnaire (EQ-5D-3L), and sensory function score and bowel and bladder function score in Kurtzke functional systems scores (FSS). Results: Improved EDSS, HAI, and mRS, as well as increased ADL and EQ-5D-3L were significant in patients on tocilizumab compared with those on steroids as monotherapy at 3 months (p < 0.05). Both groups of patients showed improved pain, fatigue, sensory function, and autonomic function at follow-ups, compared with baseline respectively. The changes in NRS, FACIT-F, and sensory and autonomic FSS showed no significant differences between the two groups. Tocilizumab significantly lowered the risk of relapses (HR = 0.21, 95% CI 0.06–0.76, p = 0.017) and reduced the annualized relapse rate compared with those by steroids (0.1 ± 0.2 vs 0.5 ± 0.6, p = 0.013). Conclusion: Early initiation of tocilizumab provided a safe and effective add-on alternative during attacks, and its maintenance contributed to a significant reduction of relapse rate in NMOSD. [ABSTRACT FROM AUTHOR]

BackgroundInterleukin-6 receptor blockade is effective in reducing the risk of relapses in neuromyelitis optica spectrum disorder (NMOSD). However, its efficacy during acute attacks of NMOSD remains elusive.ObjectiveWe investigated the effects of tocilizumab on disability during acute attacks, as well as its maintenance, in patients with moderate-to-severe myelitis.MethodsNineteen patients with NMOSD received tocilizumab treatment as add-on to high-dose methylprednisolone (HDMP) in acute myelitis and twenty-two patients who only received HDMP were compared. Disease disability was assessed using a multi-level scaling system that included the expanded disability status scale (EDSS), Hauser ambulation index (HAI), modified Rankin scale (mRS), pain numerical rating scale (NRS), functional assessment of chronic illness therapy-fatigue scale (FACIT-F), activity of daily living (ADL), EuroQol five-dimensions-three-level questionnaire (EQ-5D-3L), and sensory function score and bowel and bladder function score in Kurtzke functional systems scores (FSS).ResultsImproved EDSS, HAI, and mRS, as well as increased ADL and EQ-5D-3L were significant in patients on tocilizumab compared with those on steroids as monotherapy at 3 months (p < 0.05). Both groups of patients showed improved pain, fatigue, sensory function, and autonomic function at follow-ups, compared with baseline respectively. The changes in NRS, FACIT-F, and sensory and autonomic FSS showed no significant differences between the two groups. Tocilizumab significantly lowered the risk of relapses (HR = 0.21, 95% CI 0.06–0.76, p = 0.017) and reduced the annualized relapse rate compared with those by steroids (0.1 ± 0.2 vs 0.5 ± 0.6, p = 0.013).ConclusionEarly initiation of tocilizumab provided a safe and effective add-on alternative during attacks, and its maintenance contributed to a significant reduction of relapse rate in NMOSD.

This study investigated the effect of influenza vaccination on prevention of acute attacks in elderly patients with chronic airway disease and provides evidence for the prevention and control strategy of chronic airway disease in the elderly population. A total of 348 elderly patients in Linquan County, Anhui Province, China, who were also in stationary phases of chronic airway disease and were vaccinated with either the tetravalent or trivalent influenza vaccine were selected. The number of patients with acute attacks, the number of outpatients with acute attacks, the number of outpatients, the number of inpatients, the total cost of patients, the cost of outpatients, the cost of hospitalization, and the length of hospitalization were collected before vaccination and after a one-year follow-up. There was no significant difference in age and sex ratio among the two vaccination groups. The ratios of acute attacks, outpatient visits, and hospitalizations and number of outpatient visits, number of hospitalizations, total medical expenses, outpatient expenses, and hospitalization expenses were significantly higher before vaccination than those after vaccination in both the trivalent-vaccination group and tetravalent-vaccination group. Additionally, there was no significant difference in the length of stay between before and after vaccination in either the trivalent-vaccination group or tetravalent-vaccination group. The protection effect between the trivalent-vaccination group and tetravalent-vaccination group was not significant. Influenza vaccination can effectively prevent the acute attack of chronic airway disease and delay the progress of chronic airway disease.

ObjectiveTo explore the outcomes of NMOSD attacks and investigate serum biomarkers for prognosis and severity.MethodPatients with NMOSD attacks were prospectively and observationally enrolled from January 2019 to December 2020 at four hospitals in Guangzhou, southern China. Data were collected at attack, discharge and 1/3/6 months after acute treatment. Serum cytokine/chemokine and neurofilament light chain (NfL) levels were examined at the onset stage.ResultsOne hundred patients with NMOSD attacks were included. The treatment comprised intravenous methylprednisolone pulse therapy alone (IVMP, 71%), IVMP combined with apheresis (8%), IVMP combined with intravenous immunoglobulin (18%) and other therapies (3%). EDSS scores decreased significantly from a medium of 4 (interquartile range 3.0–5.5) at attack to 3.5 (3.0–4.5) at discharge, 3.5 (2.0–4.0) at the 1-month visit and 3.0 (2.0–4.0) at the 3-month visit (p

Objective: To explore the outcomes of NMOSD attacks and investigate serum biomarkers for prognosis and severity. Method: Patients with NMOSD attacks were prospectively and observationally enrolled from January 2019 to December 2020 at four hospitals in Guangzhou, southern China. Data were collected at attack, discharge and 1/3/6 months after acute treatment. Serum cytokine/chemokine and neurofilament light chain (NfL) levels were examined at the onset stage. Results: One hundred patients with NMOSD attacks were included. The treatment comprised intravenous methylprednisolone pulse therapy alone (IVMP, 71%), IVMP combined with apheresis (8%), IVMP combined with intravenous immunoglobulin (18%) and other therapies (3%). EDSS scores decreased significantly from a medium of 4 (interquartile range 3.0–5.5) at attack to 3.5 (3.0–4.5) at discharge, 3.5 (2.0–4.0) at the 1-month visit and 3.0 (2.0–4.0) at the 3-month visit (p<0.01 in all comparisons). The remission rate was 38.0% at discharge and 63.3% at the 1-month visit. Notably, relapse occurred in 12.2% of 74 patients by the 6-month follow-up. Higher levels of T helper cell 2 (Th2)-related cytokines, including interleukin (IL)-4, IL-10, IL-13, and IL-1 receptor antagonist, predicted remission at the 1-month visit (OR=9.33, p=0.04). Serum NfL levels correlated positively with onset EDSS scores in acute-phase NMOSD (p<0.001, R2 = 0.487). Conclusions: Outcomes of NMOSD attacks were generally moderate. A high level of serum Th2-related cytokines predicted remission at the 1-month visit, and serum NfL may serve as a biomarker of disease severity at attack. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT04101058 , identifier NCT04101058. [ABSTRACT FROM AUTHOR]

AIM: To explore the effect of persistent high intraocular pressure(IOP)on cataract surgery in eyes with acute primary angle-closure glaucoma(PACG)and its correlative factor, and to discuss the choice of treatment for persistent high IOP.METHODS: Totally 284 cases(293 eyes)were diagnosed as acute PACG and underwent cataract surgery. According to preoperative IOP, these patients were divided into three groups: Group 1(188 eyes), Group 2(61 eyes)and Group 3(44 eyes). Group 1 was defined that preoperative IOP can be controlled within the normal range under systemic and local drug. Group 2 was defined that preoperative IOP higher than 40 mmHg after drug therapy, which can be controlled after an anterior chamber puncture treatment. Group 3 was defined that preoperative IOP higher than 40 mmHg after multiple anterior chamber puncture. Group 1 underwent cataract extraction and intraocular lens(IOL)implantation. Group 2 and Group 3 underwent cataract extraction and IOL implantation with goniosynechiolysis. The preoperative and postoperative visual acuity, IOP, anterior chamber depth(ACD)and subfoveal choroidal thickness were obtained, and gonioscopic measurement of chamber angle was recorded. Preoperative and postoperative measurements were compared using non-parametric tests.RESULTS: After surgical treatment, the rate of postoperative one-week IOP control rate was respectively: Group 1(100%), Group 2(95%), Group 3(82%)(the rate of Group 2 is higher than Group 3, χ2=4.795, PCONCLUSION: Acute PACG eyes with persistent high preoperative IOP had good effects after cataract surgery, but demonstrated wider goniosynechia range and higher risk of hyphema compared to eyes with normal preoperative IOP.

Gadolinium (Gd)-contrast MRI for reliable detection of blood–brain barrier (BBB) breakdown is widely used in neuromyelitis optica spectrum disorder (NMOSD) attack. Nonetheless, little is known about the predictive role of gadolinium-enhancing lesion in prognosis of NMOSD attack. The aim of this work is to investigate the predictive value of persistently Gd-enhanced lesions to medium-term outcome after attack. Data for this analysis came from an ongoing prospective cohort study (CLUE). NMOSD patients with acute attack were enrolled from January 2019 to March 2020. All patients underwent Gd-contrast MRI at baseline and 1 month, and disability was assessed by Expanded Disability Status Scale (EDSS). Primary outcome was EDSS improvement from baseline to month 6. Multiple logistic regression identified predictors for poor recovery of NMOSD attack. Forty-one participants were analyzed, of which 21 patients had persistently Gd-enhancing lesions. Patients in no enhancement (NE) group showed a significant shift in 6-month EDSS distributions compared with those in persistent enhancement (PE) group (p = 0.005). Poor recovery rate of the PE group was higher than that of the NE group at 6 months (p = 0.033). In patients with aquaporin-4-positive, first-attack, transverse myelitis or in a high-dose steroid treatment subgroup, the improvement of EDSS scores in the PE group was still less compared with that in the NE group (p < 0.05). The presence of persistently Gd-enhancing lesion appears to be associated with poor recovery after attack (OR = 5.473, p = 0.014). Our study found that persistently gadolinium-enhancing lesion is a poor prognosis predictor after NMOSD attack. Trial registration ID: NCT04106830 [ABSTRACT FROM AUTHOR]

The article describe the pathophysiology, clinical presentation and management of an acute attack of porphyria, including the appropriate use of haemarginate (HA). It discuss the perioperative considerations for managing patients with latent or active porphyria presenting for elective and emergency surgery.

To investigate the correlation between the expression level of exhaled nitric oxide (Fe NO) and lung function in children with acute bronchial asthma. 69 children with moderate to severe bronchial asthma who were admitted to our hospital from March 2016 to March 2019 were selected as the observation group. 58 children with moderate bronchial asthma and 11 patients with severe bronchial asthma during acute attack. In addition, 69 normal healthy children who were admitted to our hospital during the same period were selected as the control group. The expressions of Fe NO, forced vital capacity (FVC), maximum expiratory flow rate as a percentage of predicted value (PEF%), forced expiratory volume in the first second as a percentage of predicted value (FEV1%) in children with moderate and severe bronchial asthma in the acute observation group were compared with healthy children in the control group. The correlation between Fe NO expression level and lung function in the observation group was analyzed. The expression level of Fe NO in the observation group was higher than that in the control group, and the expression level of Fe NO in the severe group was higher than that in the moderate group. The difference was statistically significant (P<0.05). The PEF%, FEV1%, and FVC levels in the observation group were higher than those in the control group, and the PEF%, FEV1%, and FVC levels in the severe group were higher than those in the moderate group (P<0.05). The expression of Fe NO in the observation group was negatively correlated with FVC, PEF% and FEV1%(r=-0.503, -0.551, -0.532, P<0.05). The expression of Fe NO in children with moderate to severe bronchial asthma is negatively correlated with lung function. The degree of inflammation can be judged indirectly by monitoring the level of Fe NO. [ABSTRACT FROM AUTHOR]

Background: Topiramate is a drug commonly used by physicians. However, it has various systemic and ocular adverse effects. Bilateral angle closure crisis is a potentially blinding adverse reaction that is seldom reported in non-ophthalmic journals. Objective: This article aims to report a case series of topiramate-induced angle closure crisis in the eyes. Methods and material: Most patients presented to us with blurred vision and high intra-ocular pressure within days of starting topiramate tablet for headache. However, the attack resolved in those who presented early with prompt treatment, which included stopping topiramate. Conclusions: Physicians prescribing topiramate must be well aware of this potentially blinding adverse effect. Educating the patient about this possible side effect is important. Timely referral and treatment can prevent blindness in these individuals. [ABSTRACT FROM AUTHOR]

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Objective To investigate the changes and clinical significance of serum matrix metalloproteinase 9 (MMP9), monocyte chemoattractant protein-I (MCP-1) and transforming growth factor-β1 (TGF-β1) levels in children with acute asthma attack. Methods Sixty cases of children with acute asthma attack (attack group, including 20 mild cases, 18 moderate cases, and 22 severe cases), 73 cases of children with asthma in remission (remission group), and 40 cases of healthy children receiving health examination (control group) were selected. Fasting elbow venous blood was collected in the morning on the inclusion day, and serum MMP-9, MCP-1 and TGF-β1 were detected by double-antibody sandwich ELISA. The serum levels of MMP-9, MCP-1 and TGF-β1 in the three groups were compared, and the relationships between the serum levels of MMP-9, MCP-1 and TGF-β1 and the severity of the disease in children with acute asthma were analyzed. The predictive value of serum MMP-9, MCP-1, TGF-β1 for acute asthma attack was assessed by using the receiver operating characteristic (ROC) curve. Results The serum levels of MM P-9, MCP-1, and TGF-β1 in the attack group were higher than those in the remission group and the control group, and the serum levels of MM P-9, MCP-1 and TGF-β1 in the remission group were higher than those in the control group (all P < 0. 05). The serum levels of MMP-9, MCP-1 and TGF-β1 in children with acute attack of mild, moderate and severe asthma increased gradually (all P < 0. 05). The serum levels of MMP-9, MCP-1 and TGF-β1 were pos山vely correlated with the severity of acute asthma attack (rs = 0. 701, 0. 546, 0. 612, respectively, all P < 0. 05). ROC curve analysis showed that the area under the curve (AUC) of serum MMP-9, MCP-1 and TGF-β1 in predicting acute asthma attack was 0. 884, 0. 858 and 0. 809, respectively, and the optimal cut-off values were 142. 64 ng/L, 42. 21 µg/L and 47. 74 ng/L, respectively. The sensitivities of MMP-9, MCP-1 and TGF-β1 in predicting acute asthma attack were 90%, 88% and 83%, respectively, and specificities were 92%, 91 % and 84%, respectively. The AUC of serum TGF-β1， MMP-9 and MCP-1 combined in predicting the acute asthma attack was 0. 931, with the sensitivity of 93% and specificity of 82%. Conclusion The serum levels of MMP-9, MCP-1, and TGF－队 in children with acute asthma attack increse significantly, and the changes are related to the severity of the disease; the serum levels of MMP-9, MCP-1 and TGF-β1 can be used as important biochemical indexes to predict the acute asthma attack [ABSTRACT FROM AUTHOR]

Penetrance, predictive value and female patients' perspectives on genetic testing were evaluated among Finnish patients with acute porphyria. We conducted a retrospective study to evaluate prognosis among at-risk female family members depending on the primary method of diagnosis. The penetrance was calculated among 23 genetically heterogeneous families selected from the Finnish porphyria registry (n = 515, AIP 333; VP 182). We included kindreds with ≥9 patients in a family (range 9–23 patients, total 216 AIP; 129 VP). In 2015, the registry included 164 living female subjects between 14 and 85 years of age. A questionnaire was sent to 143 women, of whom 107 (75%, AIP 67; VP 40) replied. Female at-risk relatives (AIP 54; VP 30) were divided into two groups based on the primary method of diagnosis: mutation analysis (Group A, n = 40) or biochemical analysis (Group B, n = 44). Mean penetrance for all acute symptoms was 35% among AIP and 40% among VP families. In both study groups, the penetrance was higher among female (AIP 50%; VP 44%) than male patients (AIP 17%; VP 33%). Penetrance for hospitalized attacks was 30% among AIP families (range 10–80%, for women 41%) and 25% in VP (range 0–50%, for women 27%) demonstrating wide variations among families even with the similar genotype. Acute porphyria was diagnosed at the median age of 26 years (range 0–76 years) among female patients, commonly after the onset of acute symptoms. Diagnostic delay was an average of 7.4 years (range 1–30 years). Acute symptoms occurred at the median age of 24 years (range 10–57 years) and the first hospitalization at the median age of 26.5 years (range 15–57 years). At the onset of symptoms, 38% of the women were ≤ 20 years of age. According to the life table analysis, acute attacks occurred mainly during the following five years after the diagnosis and the attack risk diminished after 35 years of age. The annual risk for hospitalization due to an acute attack during fertile years was lower in Group A than Group B (0.002 vs. 0.010, p =.018), but the risk of all subsequent acute symptoms did not diminish (Group A 0.017 vs. Group B 0.019, p =.640). The cumulative risk of acute symptoms among asymptomatic patients at the time of diagnosis was 26.7% for Group A and 58.3% for Group B. The cumulative risk of the first subsequent attack requiring hospitalization after the diagnosis among all at-risk relatives was similarly less frequent in Group A than in Group B (OR 0.180; 95% CI 0.041–0.789, p =.041). If attacks were followed among symptomatic patients only, attack-free years were more frequent in Group A than in Group B. Patients preferred genetic screening before puberty to minimize the risk of acute symptoms and genetic discrimination was rare. 44% of the patients reported social, psychological or physical impairment due to acute hepatic porphyria, emphasizing the importance of supporting patients' emotional and resilience capacity. Among female at-risk relatives the annual risk for hospitalization due to an acute attack is <1% and for acute symptoms <2% during the fertile years. Genetic testing of relatives diminishes the risk of acute attacks. Diagnosis before symptom onset is key for subjects to remain asymptomatic during follow-up, and genetic screening should be done earlier than currently. [ABSTRACT FROM AUTHOR]

Resolution of an acute attack is usually the prime objective in routine clinical management of gout. Crystal identification in synovial fluid by polarised light microscopy is considered the diagnostic gold standard. Imaging procedures such as high-resolution ultrasonography are also useful. Non-steroidal anti-inflammatory drugs, steroids and colchicine (not approved in Switzerland, available from pharmacies) are used to treat an acute gout attack. Just as important as the diagnosis and treatment of an acute attack is the long-term management of hyperuricaemia in order to prevent further gout attacks as well as possible renal, cardiac or metabolic complications. Therefore, patients with a confirmed diagnosis of gout should, apart from non-pharmacologic interventions, receive hypouricaemic therapy with a target uric acid level of <360 µmol/l (<6 mg/dl). Drugs of first choice are xanthine oxidase inhibitors. Achievement of the therapeutic objective should be periodically reviewed, adjusting therapy as necessary. [ABSTRACT FROM AUTHOR]

Hepatolithiasis is characterized by the presence of stones within the intrahepatic bile ducts proximal to the right and left hepatic ducts. It is universally recognized that the occurrence of hepatolithiasis is closely related to cholangitis, cholestasis, abnormal bile metabolism, anatomical abnormality of bile ducts, malnutrition and low socio-economic status. Surgery is the primary treatment method for hepatolithiasis in clinic, but some patients may still suffer from recurrence or complications after surgery. Traditional Chinese medicine (TCM) has its own unique advantages in preventing and treating recurrence of calculi. This article mainly explored the key points of common syndromes,TCM nursing methods and health guidance of acute attack of hepatolithiasis in order to further develop the advantages of TCM, improve its efficacy and standardized its nursing behavior. [ABSTRACT FROM AUTHOR]

Background Plasma exchange (PLEX) is routinely performed in neuromyelitis optica spectrum disorders (NMOSD) patients with an acute attack who do not respond to corticosteroids treatment. Objective To compare treatment outcomes in NMOSD patients with an acute attack between the two groups. Methods We retrospectively studied 67 attacks from 52 NMOSD patients. Outcome measurements using Expanded Disability Status Scale (EDSS), modified Rankin Scale (mRS) were compared. Results There were 23 IVMP responders, 16 IVMP non-responders refusing PLEX, 12 IVMP non-responders/PLEX responders, and 16 IVMP/PLEX non-responders. The IVMP-responders showed faster improvement since the time of discharge but seemed to have less treatment benefit over time. However, IVMP non-responders/PLEX responders showed continuous and maximum improvement at 6 months (ΔEDSS from nadir: 1 for IVMP-responders vs 0.5 for IVMP non-responders without PLEX vs 2.75 IVMP non-responders/PLEX-responders vs 0.5 IVMP/PLEX non-responders; p = 0.49) and had comparable outcomes to the IVMP-responders (nadir EDSS 8.0 to 5.25 [ΔEDSS = 2.75] vs nadir EDSS 6.5 to 5.0; [ΔEDSS = 1.5], respectively). Conclusion Add - on PLEX treatment in NMOSD patients with an acute attack should be considered in those not responding to IVMP alone. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of Traditional Chinese Medicine (TCM) nursing interventions on the acute attack of chronic asthmatic bronchitis. Methods Totally 160 patients with acute attacks of chronic asthmatic bronchitis were assigned to the control group and the study group, with 80 cases in each group. All patients received routine care during treatment, and those in the study were given TCM nursing interventions. The integral score of TCM symptoms and overall response rate of interventions were compared between two groups. Results Patients in the study group achieved better integral scores of TCM symptoms including asthma, expectoration and shortness of breath compared with those in the control group (P <0. 05). The overall response rate was 90.00% (72/80) in the study group and 81. 25% (65/80)in the control group, with a significant difference (P <0.05). Conclusion The TCM nursing interventions are effective to improve clinical symptoms of acute attack of chronic asthmatic bronchitis. [ABSTRACT FROM AUTHOR]

The Japanese Guideline for the Diagnosis and Treatment of Allergic Diseases 2010 (JAGL 2010) describes childhood asthma based on the Japanese Pediatric Guideline for the Treatment and Management of Asthma 2008 (JPGL 2008) published by the Japanese Society of Pediatric Allergy and Clinical Immunology. JAGL 2010 provides information on diagnosis by age groups from infancy to puberty, treatment for acute exacerbations, long-term management by medication, daily life guidance, and patient education to allow physicians, not specialized in childhood asthma, to refer to this guideline for routine medical treatment. JAGL differs from the Global Initiative for Asthma Guideline (GINA) in that the former emphasizes long-term management of childhood asthma based on asthma severity and early diagnosis and intervention at

Copyright of Nursing of Integrated Traditional Chinese & Western Medicine is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Fatigue is characterized by weariness unrelated to exertion levels. It has been reported in chronic neurological diseases such as multiple sclerosis, Parkinson disease and stroke. Patients with benign paroxysmal positional vertigo (BPPV) often complain about fatigue during a vertigo attack. No attention has been paid to this symptom in the literature so far. We were interested to evaluate the frequency and factors influencing fatigue in BPPV. Patients treated for idiopathic BPPV during the years 2011-2012 were prospectively evaluated for the presence of fatigue. During the first visit, patients were asked to complete two questionnaires based on their experience during the last week: the Fatigue severity scale and the Hospital anxiety and depression scale. Patients' demographic data and BPPV characteristics were registered. Among 172 patients treated for BPPV, 40 (23.2 %) reported fatigue. The mean fatigue score was 4.73 ± 1.98 indicating moderate fatigue. No correlation was found between fatigue and anxiety or fatigue and depression. Fatigue scores were inversely related to age ( r = −0.36, p = 0.020) and were not dependent on the type of BPPV, its recurrence, background diseases, gender, duration of vertigo or the presence of autonomic symptoms. Moderate fatigue is quite common during an attack of BPPV. It seems to be a genuine symptom of the entity that might worsen patients' distress. For severe or persistent fatigue treatment with fatigue relieving drugs such as amantadine, methylphenidate or modafinil could be tried in the future. [ABSTRACT FROM AUTHOR]

BACKGROUND: The effect of increased oxidative stress on the development of chronic obstructive pulmonary disease (COPD) is well known. One of the antioxidative systems against oxidative stress in human body is paraoxonase (PON) enzyme that protects low density lipoproteins (LDL) against oxidation. This study aimed to explore the polymorphisms on PON1, Q192R, L55M genes of patients with COPD. METHODS: DNAs extraction was obtained from blood samples of 50 patients diagnosed with COPD and 50 patients as a control group who were presented to emergency clinic. Genotypes were obtained with polymerase chain reaction (PCR) and AIw I and Hsp92II restriction enzymes were used for Q192R and L55M polymorphisms, respectively. Analysis of data was done with the Chi-square test and Fisher's exact test. RESULTS: A statistically significant difference in Q192R polymorphism was found between the COPD patients and the control group (P=0.05). There was no statistically signifi cant difference in L55M polymorphisms between the patient and control groups (P>0.05). Q192R polymorphism was signifi cantly correlated with the PON1 gene and cigarette smoking; however other risk factors did not show any significant correlation with this polymorphism. Though L55M polymorphism was signifi cantly correlated with family history and tuberculosis, there was no signifi cant correlation with other risk factors. CONCLUSION: We believe that more studies are needed to study the correlation of L55M polymorphism with other factors. [ABSTRACT FROM AUTHOR]

Objectives To investigate features of urate deposition in gout and the association between these features and attacks of gouty arthritis using dual-energy computed tomography ( CT). Methods Dual-energy CT scans of both feet were performed in 80 consecutive patients with gout and 22 with asymptomatic hyperuricemia. Results Overall, 333 areas of urate deposition were found in patients with gout. The most commonly affected sites were the first metatarsophalangeal joint ( MPJ; 57/333), the distal area of the first toe (59/333) and the calcaneal bone (61/333). For episodes of the first MPJ arthritis, urate deposits in the flexor pollicis longus muscle tendon ( P = 0.02), as well as solitary and punctate depositions ( P = 0.03 and 0.01, respectively) were positively related to the acute attacks. For episodes of arthritis around the ankle, deposits in the area, including the talus and inferior tibia, were associated with attacks of arthritis at the ankle ( P = 0.02); additionally, deposits in the flexor tendon adjacent to the inferior tibia ( P < 0.01) and a punctiform conformation were significantly associated with attacks of arthritis ( P = 0.02). Logistic regression analysis showed that deposits around the first MPJ ( OR = 3.38, 95% CI: 1.32, 8.17) or around the talus and inferior tibia ( OR = 2.83, 95% CI: 1.11, 7.15) would increase the risk of an attack of arthritis. Conclusions Dual-energy CT imaging can be used to detect and analyze the features of urate deposition in patients with gout. Specific features of the deposits appeared to be associated with acute attacks of gouty arthritis. [ABSTRACT FROM AUTHOR]

Objectives: To assess the lung functions during an acute attack and the quality of life amongst asthmatic patients. Design: A cross sectional descriptive study was conducted to assess the lung functions during an acute attack and the quality of life amongst asthmatic patients in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). A total of 95 respondents with acute asthmatic patients who attended to yellow zone of Accident and Emergency (A&E) Unit in UKMMC were recruited. Materials and Methods: The 32 items of Asthma Quality of Life Questionnaire (AQLQ) was used to measure quality of life. Lung function assessment was measured using pulse oximetry and peak flow meter before and after administration of nebulizer Results: The findings showed that asthmatic respondents possessed moderate level of quality of life with total score of (3.79 ± 0.99). There were significant differences between the reading of pulse oximetry and peak flow meter before and after administration of nebulizer with (Z = 7.878, p = 0.000) and (Z = 8.394. p = 0.000). There was also significant difference between quality of life with income (p = 0.01 ). However, there was weak negative correlation between quality of life and patients' age (r = -0.033) and no significant association (p = 0.750). There was no significant difference between the frequency of hospitalization in a year and quality of life (Z = - 0.949, p = 0.343). Conclusions: Asthmatic patients reported better lung function after administration of nebulizer and possessed moderate level of quality of life whilst seeking treatment. The emphasis on health education would further enhance the improvement of quality of life amongst asthmatic patients. [ABSTRACT FROM AUTHOR]

The Japanese Guideline for the Diagnosis and Treatment of Allergic Diseases 2010 (JAGL 2010) describes childhood asthma based on the Japanese Pediatric Guideline for the Treatment and Management of Asthma 2008 (JPGL 2008) published by the Japanese Society of Pediatric Allergy and Clinical Immunology. JAGL 2010 provides information on diagnosis by age groups from infancy to puberty, treatment for acute exacerbations, long-term management by medication, daily life guidance, and patient education to allow physicians, not specialized in childhood asthma, to refer to this guideline for routine medical treatment. JAGL differs from the Global Initiative for Asthma Guideline (GINA) in that the former emphasizes long-term management of childhood asthma based on asthma severity and early diagnosis and intervention at <2 years and 2-5 years of age. However, a management method, including step-up or step-down of long-term management agents based on the status of asthma symptoms, is easy to understand and thus JAGL is suitable for routine medical treatment. JAGL also introduced treatment and management using a control test for children, recommending treatment and management aimed at complete control through avoiding exacerbation factors and appropriate use of antiinflammatory agents. [ABSTRACT FROM AUTHOR]

To investigate the effect on the functioning of the vestibular system of a rupture of Reissner's membrane, artificial endolymph was injected in scala media of ten guinea pigs and vestibular evoked potentials (VsEPs), evoked by vertical acceleration pulses, were measured. Directly after injection of a sufficient volume to cause rupture, all ears showed a complete disappearance of VsEP, followed by partial recovery. To investigate the effect of perilymphatic potassium concentration on the vestibular sensory and neural structures, different concentrations of KCl were injected directly into the vestibule. The KCl injections resulted in a dose-dependent decrease of VsEP, followed by a dose-dependent slow recovery. This animal model clearly shows a disturbing effect of a higher than normal K concentration in perilymph on the vestibular and neural structures in the inner ear. Potassium intoxication is the most probable explanation for the observed effects. It is one of the explanations for Menière attacks. [ABSTRACT FROM AUTHOR]