Seven bypasses simulation set: description and validity assessment of novel models for microneurosurgical training.

OBJECTIVE: Microsurgical training remains indispensable to master cerebrovascular bypass procedures, but simulation models for training that accurately replicate microanastomosis in narrow, deep-operating corridors are lacking. Seven simulation bypass scenarios were developed that included head models in various surgical positions with premade approaches, simulating the restrictions of the surgical corridors and hand positions for microvascular bypass training. This study describes these models and assesses their validity. METHODS: Simulation models were created using 3D printing of the skull with a designed craniotomy. Brain and external soft tissues were cast using a silicone molding technique from the clay-sculptured prototypes. The 7 simulation scenarios included: 1) temporal craniotomy for a superficial temporal artery (STA)-middle cerebral artery (MCA) bypass using the M4 branch of the MCA; 2) pterional craniotomy and transsylvian approach for STA-M2 bypass; 3) bifrontal craniotomy and interhemispheric approach for side-to-side bypass using the A3 branches of the anterior cerebral artery; 4) far lateral craniotomy and transcerebellomedullary approach for a posterior inferior cerebellar artery (PICA)-PICA bypass or 5) PICA reanastomosis; 6) orbitozygomatic craniotomy and transsylvian-subtemporal approach for a posterior cerebral artery bypass; and 7) extended retrosigmoid craniotomy and transcerebellopontine approach for an occipital artery-anterior inferior cerebellar artery bypass. Experienced neurosurgeons evaluated each model by practicing the aforementioned bypasses on the models. Face and content validities were assessed using the bypass participant survey. RESULTS: A workflow for model production was developed, and these models were used during microsurgical courses at 2 neurosurgical institutions. Each model is accompanied by a corresponding prototypical case and surgical video, creating a simulation scenario. Seven experienced cerebrovascular neurosurgeons practiced microvascular anastomoses on each of the models and completed surveys. They reported that actual anastomosis within a specific approach was well replicated by the models, and difficulty was comparable to that for real surgery, which confirms the face validity of the models. All experts stated that practice using these models may improve bypass technique, instrument handling, and surgical technique when applied to patients, confirming the content validity of the models. CONCLUSIONS: The 7 bypasses simulation set includes novel models that effectively simulate surgical scenarios of a bypass within distinct deep anatomical corridors, as well as hand and operator positions. These models use artificial materials, are reusable, and can be implemented for personal training and during microsurgical courses.

Nutritional assessment in esophageal fast-track surgery: comparisons of 4 objective malnutrition screening tools.

BACKGROUND: This cohort study aimed to compare the performance of the 2015 diagnostic criteria for malnutrition of the European Society of Clinical Nutrition and Metabolism (ESPEN), the Nutritional Risk Screening 2002 (NRS 2002), Malnutrition Universal Screening Tool (MUST), and Short-Form of Mini-Nutritional Assessment (MNA-SF) in detecting malnutrition risk and predicting postoperative complications and the failure of early oral feeding (EOF) programs in esophageal cancer patients. METHODS: The 4 tools were used to conduct malnutrition assessments before surgery. The patients were divided into the groups of severe malnutrition and mild/moderate malnutrition and the incidences of the endpoints were observed. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were conducted. RESULTS: Two hundred and nineteen consecutive esophageal cancer patients were included in the study. The prevalence rates of severe malnutrition as determined by the ESPEN 2015 criteria, MUST, NRS 2002, and MNA-SF were 24.7%, 29.7%, 23.7%, and 16.0%, respectively. The moderate/severe malnutrition risk screened by the MUST had a high sensitivity (100.0%) with malnutrition identified by the ESPEN 2015 criteria. In total, 42 (19.2%) patients experienced major complications, and the incidence rate of EOF failure was 7.3%. The severe malnutrition identified by the ESPEN 2015 criteria, MUST, and NRS 2002 were comparable in predicting the incidence of postoperative pulmonary complications, anastomotic leakage, readmission to intensive care units (ICUs), and EOF failure, but the ESPEN 2015 criteria was better in predicting postoperative overall complications, major complications, and delayed hospital discharge. CONCLUSIONS: The ESPEN 2015 criteria specializes in identifying severe malnutrition and is better in predicting adverse surgical outcomes; however, the MUST and NRS 2002 are better superior in detecting early malnutrition and are also valuable in the perioperative management in esophageal surgery. It is recommended that the MUST be used as the malnutrition screening tool before the ESPEN 2015 criteria is applied.

A Data Augmentation-Based Evaluation System for Regional Direct Economic Losses of Storm Surge Disasters.

The accurate prediction of storm surge disasters' direct economic losses plays a positive role in providing critical support for disaster prevention decision-making and management. Previous researches on storm surge disaster loss assessment did not pay much attention to the overfitting phenomenon caused by the data scarcity and the excessive model complexity. To solve these problems, this paper puts forward a new evaluation system for forecasting the regional direct economic loss of storm surge disasters, consisting of three parts. First of all, a comprehensive assessment index system was established by considering the storm surge disasters' formation mechanism and the corresponding risk management theory. Secondly, a novel data augmentation technique, k-nearest neighbor-Gaussian noise (KNN-GN), was presented to overcome data scarcity. Thirdly, an ensemble learning algorithm XGBoost as a regression model was utilized to optimize the results and produce the final forecasting results. To verify the best-combined model, KNN-GN-based XGBoost, we conducted cross-contrast experiments with several data augmentation techniques and some widely-used ensemble learning models. Meanwhile, the traditional prediction models are used as baselines to the optimized forecasting system. The experimental results show that the KNN-GN-based XGBoost model provides more precise predictions than the traditional models, with a 64.1% average improvement in the mean absolute percentage error (MAPE) measurement. It could be noted that the proposed evaluation system can be extended and applied to the geography-related field as well.

Resistance risk assessment for Fusarium graminearum to pydiflumetofen, a new succinate dehydrogenase inhibitor.

BACKGROUND: Pydiflumetofen is a new generation succinate dehydrogenase inhibitor currently undergoing the process of registration in China for the control of Fusarium head blight in wheat. A resistance risk assessment of Fusarium graminearum to pydiflumetofen was undertaken in this study. RESULTS: A total of 75 pydiflumetofen-resistant mutants were generated through spontaneous selection and displayed high resistance with an average resistance factor (RF) value of 78. Four mutants were generated through UV mutagenesis and displayed very high resistance with an RF value >1000. The sequence analysis results for Sdh genes and fitness studies revealed the existence of four types of mutations. In particular, 32 spontaneous selection mutants (SP mutants) had an arginine (R) to histidine (H) transition at position 86 in FGSdhC, resulting in seriously reduced fitness. Seven SP mutants had an R to cysteine (C) transition at position 86 in FGSdhC, resulting in reduced fitness. Thirty-six SP mutants had an alanine (A) to valine (V) transition at position 83 in FGSdhC and had no fitness penalties. The efficacy of pydiflumetofen towards a mutant carrying A83V in FGSdhC in vivo was significantly decreased at 42.7%. Four UV mutants had no mutations on all Sdh genes and no fitness penalties. Cross-resistance among boscalid, fluopyram and pydiflumetofen was observed. CONCLUSION: Sdhc mutations were found and other target site resistance may be present in laboratory PR mutants of F. graminearum. An overall moderate risk of resistance development in F. graminearum was recommended for pydiflumetofen. © 2019 Society of Chemical Industry.

Proposing a validated clinical app predicting hospitalization cost for extracranial-intracranial bypass surgery.

OBJECT: United States healthcare reforms are focused on curtailing rising expenditures. In neurosurgical domain, limited or no data exists identifying potential modifiable targets associated with high-hospitalization cost for cerebrovascular procedures such as extracranial-intracranial (ECIC) bypass. Our study objective was to develop a predictive model of initial cost for patients undergoing bypass surgery. METHODS: In an observational cohort study, we analyzed patients registered in the Nationwide Inpatient Sample (2002-2011) that underwent ECIC bypass. Split-sample 1:1 randomization of the study cohort was performed. Hospital cost data was modelled using ordinary least square to identity potential drivers impacting initial hospitalization cost. Subsequently, a validated clinical app for estimated hospitalization cost is proposed (https://www.neurosurgerycost.com/calc/ec-ic-by-pass). RESULTS: Overall, 1533 patients [mean age: 45.18 ± 19.51 years; 58% female] underwent ECIC bypass for moyamoya disease [45.1%], cerebro-occlusive disease (COD) [23% without infarction; 12% with infarction], unruptured [12%] and ruptured [4%] aneurysms. Median hospitalization cost was $37,525 (IQR: $16,225-$58,825). Common drivers impacting cost include Asian race, private payer, elective admission, hyponatremia, neurological and respiratory complications, acute renal failure, bypass for moyamoya disease, COD without infarction, medium and high volume centers, hospitals located in Midwest, Northeast, and West region, total number of diagnosis and procedures, days to bypass and post-procedural LOS. Our model was validated in an independent cohort and using 1000-bootstrapped replacement samples. CONCLUSIONS: Identified drivers of hospital cost after ECIC bypass could potentially be used as an adjunct for creation of data driven policies, impact reimbursement criteria, aid in-hospital auditing, and in the cost containment debate.

Impact of Hospital Caseload and Elective Admission on Outcomes After Extracranial-Intracranial Bypass Surgery.

BACKGROUND: Limited information exists evaluating the impact of hospital caseload and elective admission on outcomes after patients have undergone extracranial-intracranial (ECIC) bypass surgery. Using the Nationwide Inpatient Sample (NIS) for 2001-2014, we evaluated the impact of hospital caseload and elective admission on outcomes after bypass. METHODS: In an observational cohort study, weighted estimates were used to investigate the association of hospital caseload and elective admission on short-term outcomes after bypass surgery using multivariable regression techniques. RESULTS: Overall, 10,679 patients (mean age, 43.39 ± 19.63 years; 59% female) underwent bypass across 495 nonfederal U.S. hospitals. In multivariable models, patients undergoing bypass at high-volume centers were associated with decreased probability of mortality (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.22-0.70; P < 0.001), length of stay (OR, 0.86; 95% CI, 0.82-0.90; P < 0.001), postbypass neurologic complications (OR, 0.66; 95% CI, 0.49-0.89; P = 0.007), venous thromboembolism (OR, 0.69; 95% CI, 0.49-0.97; P = 0.033), and acute renal failure (OR, 0.45; 95% CI, 0.26-0.80; P = 0.007), and higher hospitalization cost (26.3% higher) compared with low-volume centers. Likewise, patients undergoing elective bypass were associated with decreased likelihood of mortality (OR, 0.38; 95% CI, 0.25-0.59; P < 0.001), unfavorable discharge (OR, 0.57; 95% CI, 0.43-0.76; P < 0.001), length of stay (OR, 0.62; 95% CI, 0.59-0.64; P < 0.001), venous thromboembolism (OR, 0.61; 95% CI, 0.49-0.77; P < 0.001), acute renal failure (OR, 0.64; 95% CI, 0.43-0.94; P = 0.022), wound complications (OR, 0.71; 95% CI, 0.53-0.96; P = 0.028), and lower hospitalization cost (34.5% lower) compared with nonelective admissions. CONCLUSIONS: Our findings serve as a framework for strengthening referral networks for complex cases to centers performing high volumes of cerebral bypass. Also, our study supports improved outcomes in select patients undergoing elective bypass procedures.

Revisiting racial disparities in access to surgical management of drug-resistant temporal lobe epilepsy post implementation of Affordable Care Act.

OBJECTIVES: Prior to enactment of the Affordable Care Act(ACA), several reports demonstrated remarkable racial disparities in access to surgical care for epileptic patients. Implementation of ACA provided healthcare access to 7-16 million uninsured Americans. The current study investigates racial disparity post ACA era in (1) access to surgical management of drug-resistant temporal lobe epilepsy (DRTLE); (2) short-term outcomes in the surgical cohort. PATIENT AND METHODS: Adult patients with DRTLE registered in the National Inpatient Sample (2012-2013) were identified. Association of race (African Americans and other minorities with respect to Caucasians) with access to surgical management of TLE, and short-term outcomes [discharge disposition, length of stay (LOS) and hospital charges] in the surgical cohort were investigated using multivariable regression techniques. RESULTS: Of the 4062 patients with DRTLE, 3.6%(n=148) underwent lobectomy. Overall, the mean age of the cohort was 42.35±16.33years, and 54% were female. Regression models adjusted for patient demographics, clinical and hospital characteristics demonstrated no racial disparities in access to surgical care for DRTLE. Likewise, no racial disparity was noted in outcomes in the surgical cohort. CONCLUSION: Our study reflects no racial disparity in access to surgical care in patients with DRTLE post 2010 amendment of the ACA. The seismic changes to the US healthcare system may plausibly have accounted for addressing the gap in racial disparity for epilepsy surgery.

In vitro Dosimetric Study of Biliary Stent Loaded with Radioactive 125I Seeds.

BACKGROUND: A novel radioactive 125I seed-loaded biliary stent has been used for patients with malignant biliary obstruction. However, the dosimetric characteristics of the stents remain unclear. Therefore, we aimed to describe the dosimetry of the stents of different lengths - with different number as well as activities of 125I seeds. METHODS: The radiation dosimetry of three representative radioactive stent models was evaluated using a treatment planning system (TPS), thermoluminescent dosimeter (TLD) measurements, and Monte Carlo (MC) simulations. In the process of TPS calculation and TLD measurement, two different water-equivalent phantoms were designed to obtain cumulative radial dose distribution. Calibration procedures using TLD in the designed phantom were also conducted. MC simulations were performed using the Monte Carlo N-Particle eXtended version 2.5 general purpose code to calculate the radioactive stent's three-dimensional dose rate distribution in liquid water. Analysis of covariance was used to examine the factors influencing radial dose distribution of the radioactive stent. RESULTS: The maximum reduction in cumulative radial dose was 26% when the seed activity changed from 0.5 mCi to 0.4 mCi for the same length of radioactive stents. The TLD's dose response in the range of 0-10 mGy irradiation by 137Cs γ-ray was linear: y = 182225x - 6651.9 (R2=0.99152; y is the irradiation dose in mGy, x is the TLDs' reading in nC). When TLDs were irradiated by different energy radiation sources to a dose of 1 mGy, reading of TLDs was different. Doses at a distance of 0.1 cm from the three stents' surface simulated by MC were 79, 93, and 97 Gy. CONCLUSIONS: TPS calculation, TLD measurement, and MC simulation were performed and were found to be in good agreement. Although the whole experiment was conducted in water-equivalent phantom, data in our evaluation may provide a theoretical basis for dosimetry for the clinical application.

The Influence of Surface Modification on the Photoluminescence of CdTe Quantum Dots: Realization of Bio-Imaging via Cost-Effective Polymer.

To impart biocompatibility, stability, and specificity to quantum dots (QDs)-and to reduce their toxicity-it is essential to carry out surface modification. However, most surface-modification processes are costly, complicated, and time-consuming. In addition, the modified QDs often have a large size, which leads to easy aggregation in biological environments, making it difficult to excrete them from in vivo systems. To solve these problems, three kinds of conventional polymers, namely, polyvinyl alcohol (PVA, neutral), sodium polystyrene sulfonate (PSS, negative charged), and poly(diallyl dimethyl ammonium chloride) (PDDA, positive charged) were selected to modify the surface of QDs at low cost via a simple process in which the size of the QDs was kept small after modification. The effect of polymer modification on the photoluminescence (PL) properties of the QDs was systematically investigated. High quantum yields (QYs) of 65 % were reached, which is important for the realization of bio-imaging. Then, the cytotoxicity of CdTe QD-polymer composites was systematically investigated via MTT assay using the Cal27 and HeLa cell lines, especially for high concentrations of QD-polymer composites in vitro. The experimental results showed that the cytotoxicity decreased in the order CdTe-PDDA>CdTe>CdTe-PSS>CdTe-PVA, indicating that PSS and PVA can reduce the toxicity of the QDs. An obvious cytotoxicity of CdTe-PVA and CdTe-PSS was present until 120 h for the Cal27 cell line and until 168 h for the HeLa cell line. At last, the Cal27 cell line was selected to realize bio-imaging using CdTe-PSS and CdTe-PVA composites with different emission colors under one excitation wavelength.

Risk assessment of deep-vein thrombosis after acute stroke: a prospective study using clinical factors.

AIMS: Deep-vein thrombosis (DVT) represents a serious complication in acute stroke patients with pulmonary embolus (PE) as a potential outcome. Prediction of DVT may help with formulating a proper prevention strategy. To assess of the risk of deep venous thrombosis (DVT) in acute stroke patients, we developed and validated a clinical score in a cohort study. METHODS: Incidence of Deep Venous Thrombosis after Acute Stroke in China (INVENT-China) is a multicenter prospective cohort study. The potential predictive variables for DVT at baseline were collected, and the presence of DVT was evaluated using ultrasonography on the 14 ± 3 days. Data were randomly assigned to either a training data set or a test data set. Multivariate logistic regression analysis was used to develop risk scores to predict DVT in the training data set and the area under the receiver operating characteristic curve to validate the score in the test data set. RESULTS: From 2006-2007, 862 hospital-based acute stroke patients were enrolled in China. The overall incidence of DVT after acute stroke within two weeks was 12.4% (95%CI 10.3-14.7%). A seven-point score derived in the training data set (age [≥65 years = 1], sex [female gender = 1]), obesity [BMI ≥ 25 kg/m(2) = 1], active cancer [yes = 2], stroke subtype [cerebral hemorraghe = 1], muscle weakness [≥2 on Lower limb NIHSS score = 1] was highly predictive of 14-day risk of DVT(c statistic = 0.70, 95% CI, 0.64-0.76, P < 0.001), in the overall study population(c statistic = 0.65, 95% CI 0.59-0.70, P < 0.001). CONCLUSIONS: This clinical score may help identify acute stroke patients with high risk of DVT. In addition, it also serves as a platform to develop further models of DVT prediction in stroke patients based on clinical factors.

Preliminary report on admission profiles for children under 5 years old in Taiwan: disparities between 2000 and 2009.

BACKGROUND/PURPOSE: Data on hospital admissions for children under 5 years old, concerning the admission rate, leading diagnoses, categories of disease, average hospitalization days, costs and between-year differences are scarce. Our study aims to investigate such admission profiles. METHODS: Five percent of admission data for children under 5 years old in 2000 and 2009 was collected from the National Health Insurance Research Database in Taiwan. We calculated the admission rate in regards to total admission, the patients' gender, the ten leading diagnoses, the ten most systemic common categories of disease, and the average hospitalization days and costs. The differences of the rates between 2000 and 2009 were evaluated by incidence rate ratios (IRR). RESULTS: The admission rate per thousand children (population) was higher in 2009 (172.9) than 2000 (153.1). The ten most common systemic categories of disease were similar in both years. Furthermore, it was observed that the hospitalization days decreased by 3.7% in 2009, while medical expenditures increased by 10.9%. CONCLUSIONS: Efforts should be made to decrease the admission rate and hospitalization days in Taiwan to the levels of well-developed countries. Our data may serve as baseline data for future evaluations of child morbidity.

Coexistence of allergic diseases: patterns and frequencies.

The atopic march hypothesis suggests that allergy diseases often progress from atopic dermatitis to allergic asthma, and allergic rhinitis. How often can the classic progression of allergic diseases be observed in the pediatric patient population? This study aimed to observe the pattern of allergic diseases progression, onset age, disease intervals, and frequency of the allergic march. Data from the National Health Insurance Research Database in the period 1996-2008 were used to obtain a cohort of children with allergic disease. Physician's diagnosis was used to confirm the allergic disease based on the international disease coding. The age of disease onset was compared. There were 10,729 children aged <5 years enrolled from the 200,000 individuals randomly sampled in 2000. Of these, 5866 (54.7%) had been diagnosed with at least one allergic disease. The rate of only one of three diseases diagnosed was 29.8% (3195 patients), whereas 18.8% had two allergic diseases and 6.1% had all three allergic diseases. Only 4.2% of cases matched the allergic march. Patients with more than one disease had earlier onset age than those who had only one disease (4.17 versus 2.79 and 2.32 years old; p < 0.05). The allergic march accounts for only 4.2% in this study. A patient with only one allergic disease after the age of 4.17 years will not have another allergic disease until the age of 12 years. However, a patient with an allergic disease before 2.79 years old will probably have another allergic disease in 1.96-2.5 years.

Health care utilization and costs of adult asthma in Taiwan.

The burden of asthma is sufficient to warrant its recognition as a high-priority disorder in governmental health strategies in many countries. However, the components of the total health care costs for patients with asthma have not been well studied, and an overall understanding of health care utilization patterns in this population is lacking in Taiwan. We evaluated 95,110 patients aged 18-55 years who were enrolled in the National Health Insurance Research Database from January 1 to December 31, 2002. Health care utilization and costs, including those related to office, outpatient hospital, emergency department, and inpatient hospital visits were compared between patients with and patients without asthma. In 2002, the period prevalence of treated asthma was 1.8%. Patients with asthma used substantially more services than did those without asthma in all categories. The mean costs of hospitalizations for patients with asthma were 2.7-fold higher than those of patients without asthma. Asthma care represented 26% of all health-care services that patients with asthma received, while the remaining 74% were for nonasthma care. Almost one-half of all asthma-related costs were attributable to hospitalizations. These findings may serve as baseline data for future evaluations of changes in health care utilization and expenditures among asthmatic patients.

Assessment of small-dose fentanyl and sufentanil blunting the cardiovascular responses to laryngoscopy and intubation in children.

BACKGROUND: The authors found no study assessing the efficacy of small-dose narcotics on the cardiovascular response from intubation in children, so they observed the effects of fentanyl 2 microg x kg(-1) and sufentanil 0.2 microg x kg(-1) on the cardiovascular changes during laryngoscopy and intubation in children. METHODS: Ninety-three children aged 3-9 years were randomized to one of three groups to receive the following treatments in a double-blind manner: normal saline (group C), fentanyl 2 microg x kg(-1) (group F) and sufentanil 0.2 microg x kg(-1) (group S) 2 min before induction. Noninvasive blood pressure (BP) and heart rate (HR) were recorded before anesthesia induction (baseline value), immediately before intubation (postinduction values), at intubation and 5 min after intubation at 1-min interval. RESULTS: Tracheal intubation caused significant increases in BP and HR in the three groups compared with baseline values. BP and HR at intubation and after intubation and their maximum values during observation were significantly lower in groups F and S than in group C (P < 0.05). The mean percent increases of systolic blood pressure (SBP) and HR at intubation were significantly lower in group S, 7% and 10%, than in group F, 17% and 25% (P < 0.05). The increases in SBP and HR of more than 30% of baseline values during the observation period were significantly higher in group F, 27% and 43%, than in group S, 0% and 3% (P < 0.05). CONCLUSIONS: When used as part of anesthesia induction with propofol in children, sufentanil 0.2 microg x kg(-1) 2 min before induction is more effective in attenuating the cardiovascular intubation response than fentanyl 2 microg x kg(-1).

Health-care utilization and costs in Taiwanese pediatric patients with asthma.

BACKGROUND: In many countries, the burden of asthma is sufficient to warrant recognition as a high-priority disorder in governmental health strategies. However, the components of the total health-care costs for pediatric patients with asthma have not been well studied, and an overall understanding of health-care utilization patterns in this population is lacking in Taiwan. METHODS: A total of 33 461 patients aged 3-17 years who were enrolled in the National Health Insurance Research database from 1 January to 31 December 2002 were evaluated. Health-care utilization and costs, including those related to office, outpatient hospital, emergency department, and inpatient hospital visits were compared between pediatric patients with and without asthma. RESULTS: In 2002, the period prevalence of treated asthma was 6.0%. Pediatric patients with asthma used substantially more services than did those without asthma in all categories. Hospital outpatient visits and overall health-care expenditure for patients with asthma were 2.2-fold higher than those of patients without asthma. Asthma care represented 20% of all health-care services that patients with asthma received, while the remaining 80% were for non-asthma care. Almost three-fourths of all asthma-related costs were attributable to office and hospital outpatient visits; one-fourth was attributable to urgent care and hospitalizations. CONCLUSIONS: These findings may serve as baseline data for future evaluation of changes in health-care utilization and expenditure among pediatric patients with asthma.

Prescribing patterns of anti-asthma drugs in pediatric patients.

Guidelines from the Global Initiative for Asthma (GINA) mention several medications for the treatment of asthma. These medications include oral and inhaled beta-2 agonists, oral and inhaled corticosteroids, xanthines, leukotriene receptor antagonists, and their combinations. In addition to asthma, these drugs are commonly prescribed to treat other respiratory diseases, such as acute bronchitis, chronic cough, lower respiratory infection, or even bronchopneumonia. We analyzed differences in prescribing patterns between pediatric patients with and those without asthma, as coded in the claim records from the National Health Insurance Research Database. Oral beta-2 agonists were the most frequently monotherapy in both groups of patients (52.6-77.6% vs 62.8-84. 8%). Oral beta-2 agonists combined with xanthines or oral corticosteroids combined with an oral beta-2 agonist were the most frequent combination therapies in both groups. Inhaled corticosteroids were used in 3.1-11.0% of patients with asthma; the rate varied by patient age. In conclusion, prescribing patterns were similar in pediatric patients with and those without asthma.