BackgroundAsthma is a serious global health problem. However, few studies have investigated the relationship between cold spells and pediatric outpatient visits for asthma.ObjectiveTo examine the association between cold spells and pediatric outpatient visits for asthma in Shanghai, China.MethodsWe collected daily data on pediatric outpatient visits for asthma, mean temperature, relative humidity, and ozone from Shanghai between 1 January 2007 and 31 December 2009. We defined cold spells as four or more consecutive days with temperature below the 5th percentile of temperature during 2007–2009. We used a Poisson regression model to examine the impact of temperature on pediatric outpatient visits for asthma in cold seasons during 2007 and 2009. We examined the effect of cold spells on asthma compared with non-cold spell days.ResultsThere was a significant relationship between cold temperatures and pediatric outpatient visits for asthma. The cold effects on children's asthma were observed at different lags. The lower the temperatures, the higher the risk for asthma attacks among children.ConclusionCold temperatures, particularly cold spells, significantly increase the risk of pediatric outpatient visits for asthma. The findings suggest that asthma children need to be better protected from cold effects in winter.

for post-operative HDRB (Figure 1. If the final pathological report confirmed the "suitable" status for APBI, planification CT-scan was performed to deliver a 16 Gy single fraction. Clinical target volume dose constraints (CTV Z clips + 15 mm) were V100 3 95%, V150<33%, V200<12%, DNR<0.35. Organ at risk (skin, chest wall) were outlined with calculation of D0.1, D1 and D2cc and V25, V50 and V75%. Dosevolume adaptation was manually achieved by graphical optimization. Surveillance was performed at 1, 3 and 6 months after HDRB for acute toxicity analysis (CTCv4.0), quality of life (QLQ-C30V3; QLQ-BR23) and cosmetic outcome (patient and doctor point of view, photos reviewed by 2 independent radiation oncologists). Geriatric assessment was performed by the geriatric oncology team (MMSE, MNA, GDS, ADL, and IADL). Results: Median age was 77 years [69 e 89], median BMI was 26 [18 e 37] (Cup 3 C Z 54%). Median time interval between lumpectomy and HDRB was 7 days [6 e 12]. Median CTV was 46 cc [27-93] (median catheter number Z 12 [7-15], median plan number Z 2 [2 e 3]. Median V100, V150, and V200 were 97% [89-100], 33% [27-43], and 12% [9-16] respectively. Median DNR was 0.35 [0.27 e 0.43]. Median V25, V50 and V75% of the skin and the chest wall were 42, 6, 0 cc and 46, 12, 2 cc respectively. Acute toxicity was observed in 17 pts (65%) who presented 39 toxicities (G1: 31 pts (80%) mainly breast fibrosis; G2: 6 pts (15%) hematoma, pain, skin reaction; G3: 2 pts (5%) hematoma and infection. All patients who experienced acute toxicity fully recovered 6 months after HDRB. Cosmetic evaluation at 6 months was excellent/good in 90% for the patients and 99% for the doctors. Results of quality of life, independent photo review, and geriatric assessment will be presented during the ASTRO meeting. Conclusion: A single dose (HDRB) of 16 Gy delivered post-operatively for APBI suitable elderly patients appear feasible and reproducible. Acute toxicity is acceptable as well as early cosmetic outcome. Longer follow-up and larger patient cohort will be necessary to confirm those preliminary results.

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