Monitoring the hospital management of acute asthma: the Italian Pediatric Network experience.

BACKGROUND: The Study Group on Accreditation and Quality Improvement of the Italian Society of Pediatrics has developed an observational study about the hospital management of pediatric patients affected by severe asthma, in order to evaluate how the Guidelines for severe asthma in childhood are applied in the daily practice. METHODS: This study included patients between 2 and 17 years, hospitalized or under short intensive observation for acute asthma. The data collection was carried out through the compilation of on-line forms. The statistical technique used was the Chi Square test. RESULTS: 409 forms were filled in by 32 Italian Centers. 17% of the patients showed severe asthma, 59% moderate and 24% mild. On arrival at the Emergency Room the oximetry was measured in 95% of the patients, the respiratory rate in 64% while the heart rate in 88% of them. 48% of the children were exposed to chest X-ray. More than half of the children received oxygen therapy, 98.5% received short-acting beta-2 agonists and systemic steroid therapy was given to 82% of children, mainly orally. At discharge only half of the children were provided with written instructions for the management of any subsequent asthmatic episode. The analysis of the collected data highlights that not all the children had their oxygen saturation measured, although this parameter is one of the main indicators of disease severity, as well as the respiratory rate, which was detected in a minimal percentage of cases. The frequency of chest X-ray was extremely high, even though it does not have any indication in the majority of asthma cases. The evaluation of the therapeutic treatment denotes an adequate use of the oxygen therapy according to the oximetry values found on arrival, but an abuse of steroid therapy. Critical issues emerge at discharge: children are not always educated about the home management of the disease and the self-evaluation of the illness seriousness. CONCLUSION: The pediatric network has become an excellent system of monitoring of the clinical management of asthmatic children, highlighting strengths and weaknesses on which to focus actions of improvement.

Differential ovotoxicity of 4-vinylcyclohexene and its analog, 4-phenylcyclohexene.

Vinylcyclohexene (VCH) is an industrial byproduct that is known to cause the destruction of ovarian follicles in mice. Its analog, 4-phenylcyclohexene (4PC), is a volatile product from latex-backed carpeting. These studies were undertaken to assess the structure-activity relationships of these compounds and the potential for 4PC to cause ovotoxicity. Female B6C3F1 mice were dosed with VCH (6 mmol/kg/day, ip) or 4PC (3 or 6 mmol/kg/day, ip) daily for 30 days. Treatment with VCH caused dramatic reductions in small and growing follicles as compared to those of vehicle controls. No treatment-related ovarian lesions were associated with 4PC administration. Plasma FSH concentrations were unaltered by treatment with either compound. These results indicate that in mice, the substitution of the phenyl for the vinyl group in the 4 position eliminates the ovotoxicity caused by this class of compounds. Presumably, the ability of the vinyl group to form an epoxide (or dihydrodiol) and/or its smaller size accounts for this difference in ovarian toxicity.

[Transient hyperphosphatasemia in childhood. 4 new cases and review of the literature]. / Iperfosfatasemia transitoria dell'infanzia. Quattro nuovi casi e revisione della letteratura.

Transient hyperphosphatasemia of infancy is a biochemical syndrome characterized by a striking, transient increase in serum alkaline phosphatase in children without any evidence of bone or liver disease and of a familial occurrence. The abnormal isoenzyme pattern frequently observed in this syndrome may represent an excessively sialylated form of the liver isoenzyme, not normally removed from circulation. Here are described four new cases of this syndrome, followed biochemically and clinically until normalization of the serum abnormalities; a review of literature is also presented.

Rat erythrocyte NADH-cytochrome b5 reductase. Quantitation and comparison between the membrane-bound and soluble forms using an antibody against the rat liver enzyme.

The subcellular distribution of rat erythrocyte NADH-cytochrome b5 reductase was determined by radioimmunoassay, using a rabbit antibody against the cathepsin D cleaved water-soluble fragment of rat liver microsomal reductase (I-reductase), which is known to be immunologically similar to the red cell enzyme. Erythrocytes contained approximately 30 ng of reductase/mg of protein, of which 90% were recovered in the hemolysate supernatant and 2.3% in the ghost fraction. After concentration by precipitation with 70% saturated (NH4)2SO4, the NADH-cytochrome c reductase activity of the soluble enzyme could be assayed in the presence of cytochrome b5, and was found to be inhibited by anti 1-reductase antibodies. The sodium dodecyl sulfate-polyacrylamide gel electrophoretic mobilities of erythrocyte membrane-associated and soluble reductase of the liver microsomal enzyme and its cathepsin D cleaved hydrophilic fragment (I-reductase) were examined in crude fractions by blotting followed by specific and highly sensitive immunostaining. The intact microsomal enzyme and the two erythrocyte reductases all had similar mobilities and migrated behind 1-reductase. However, the ghost-associated reductase, which was not attributable to contaminating leukocyte or reticulocyte membranes, was distinguishable from the soluble form by two criteria: (i) a lower dependence on exogenous cytochrome b5 in the NADH-cytochrome c reductase assay; and (ii) a larger apparent Mr upon gel filtration in the presence of Triton X-100, presumably because of detergent binding. Considering these results, possible biogenetic relations between membrane-bound and soluble erythrocyte reductase are discussed.