Objective. To establish the minimal change on a pain visual analog scale (VAS) associated with change in self-reported quality of life in pediatric rheumatology patients. Methods. Subjects were a cohort of 533 pediatric rheumatology patients in Toronto. Pain and perceived quality of life were measured at 2 consecutive visits to a clinic. Results. Among patients who rated quality of life at the second visit as "a little better" and "much better," the mean change in pain score on a 10-cm VAS was reduced by 0.82 and 1.45 cm, respectively. For those whose quality of life changed to "a little worse" and "much worse," the pain scores increased by 1.90 and 3.69 cm. Conclusion. Our results suggest that future studies of the assessment and treatment of pain in this population should aim for a minimum reduction in pain score of 0.82 cm on a 10-cm VAS to achieve clinical improvement in quality of life.
Background
Few studies have examined how developing obesity in early adulthood affects the course of asthma.
Objective
We analyzed lung function and asthma impairment and risk among non-obese children with asthma, comparing those who were obese in young adulthood to those who remained non-obese.
Methods
Post-hoc analysis of 771 subjects with mild-moderate asthma who were not obese (pediatric definition, body mass index (BMI) <95th percentile) when enrolled in the Childhood Asthma Management Program at ages 5–12 years. Subjects were then followed to age ≥ 20 years. For visits at ages ≥ 20 years, spirometry values as percent predicted and recent asthma symptom scores and prednisone exposure were compared between 579 subjects who were non-obese at all visits and 151 who obese (adult definition of BMI ≥ 30 kg/m2) on at least one visit (median number of visits when obese = 4, IQR 2–7).
Results
Compared to participants who were non-obese (BMI 23.4 ± 2.6 kg/m2), those who became obese (BMI 31.5 ± 3.8 kg/m2) had significant decreases in FEV1/FVC (p<0.0003) and FEV1 (p = 0.001), without differences in FVC (p=0.15) during visits at ages ≥ 20 years. For each unit increase of BMI, FEV1 percent predicted decreased by 0.29 (p=0.0009). The relationship between BMI and lung function was not confounded by sex or BMI at baseline. Asthma impairment (symptom scores) and risk (prednisone use) did not differ between the two groups.
Conclusion
Becoming obese in early adulthood was associated with increased airway obstruction, without impact on asthma impairment or risk.
The traditional use of core temperature to assess the thermal effects of clothing has recently been questioned. The purpose of this study was to assess the reproducibility of body temperature in five subjects (mean age, 22.6 +/- 1.5 years) wearing either athletic clothing or a chemical protective overgarment while exercising at 20 degrees C and at 40 degrees C. The exercise was preceded by a 1 h adaptation period in a controlled environmental chamber. Results indicated that mean group change in rectal temperature (delta Tr) appeared to be reproducible for both garment ensembles at 20 degrees C but not at 40 degrees C. For mean change in oesophageal temperature (delta T(oes)) at 20 degrees C, reproducibility was obtained for the overgarment but not for the athletic garment; at 40 degrees C, mean delta T(oes) appeared to be reproducible with both garments. However, when individual responses were examined, there was little reproducibility for either delta Tr or delta T(oes). In addition, these measurements failed to show differences in the types of clothing worn. It was concluded that the use of core temperature to assess heat stress imposed by wearing clothing during exercise may lead to erroneous conclusions.
Background: VB4-845 (Proxinium) is a recombinant protein engineered from the fusion of a humanized scFv specific for the epithelial cell adhesion molecule, EpCAM, to a truncated form of Pseudomonas Exotoxin A. EpCAM is highly expressed on carcinoma cells of epithelial origin, with limited normal cell expression, VB4-845 selectively targets and kills EpCAM positive tumors. A phase I dose-escalation trial was completed to determine the safety, tolerability, pharmacokinetic (PK) profile and preliminary efficacy of intratumorally injected VB4-845 in patients with advanced Squamous Cell Carcinoma of the Head & Neck (SCCHN). Conclusions: VB4-845 administered on a weekly basis for 4 weeks was safe and well tolerated. The MTD on this schedule was defined at 930 μg/day. Moreover, although this study was primarily designed to evaluate safety and tolerability, clinical observations indicate that VB4-845 demonstrated promising anti-tumor responses against EpCAMpositive SCCHN tumors in a highly treatment-refractory patient population. Further development is therefore warranted.
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