Ciclesonide is an onsite-activated inhaled corticosteroid (ICS) for the treatment of asthma. This study compared the efficacy, safety and effect on quality of life (QOL) of ciclesonide 160 microg (ex-actuator; nominal dose 200 microg) vs. budesonide 400 microg (nominal dose) in children with asthma. Six hundred and twenty-one children (aged 6-11 yr) with asthma were randomized to receive ciclesonide 160 microg (ex-actuator) once daily (via hydrofluoroalkane metered-dose inhaler and AeroChamber Plus spacer) or budesonide 400 microg once daily (via Turbohaler) both given in the evening for 12 wk. The primary efficacy end-point was change in forced expiratory volume in 1 s (FEV1). Additional measurements included change in daily peak expiratory flow (PEF), change in asthma symptom score sum, change in use of rescue medication, paediatric and caregiver asthma QOL questionnaire [PAQLQ(S) and PACQLQ, respectively] scores, change in body height assessed by stadiometry, change in 24-h urinary cortisol adjusted for creatinine and adverse events. Both ciclesonide and budesonide increased FEV1, morning PEF and PAQLQ(S) and PACQLQ scores, and improved asthma symptom score sums and the need for rescue medication after 12 wk vs. baseline. The non-inferiority of ciclesonide vs. budesonide was demonstrated for the change in FEV1 (95% confidence interval: -75, 10 ml, p = 0.0009, one-sided non-inferiority, per-protocol). In addition, ciclesonide and budesonide showed similar efficacy in improving asthma symptoms, morning PEF, use of rescue medication and QOL. Ciclesonide was superior to budesonide with regard to increases in body height (p = 0.003, two-sided). The effect on the hypothalamic-pituitary-adrenal axis was significantly different in favor of ciclesonide treatment (p < 0.001, one-sided). Both ciclesonide and budesonide were well tolerated. Ciclesonide 160 microg once daily and budesonide 400 microg once daily were effective in children with asthma. In addition, in children treated with ciclesonide there was significantly less reduction in body height and suppression of 24-h urinary cortisol excretion compared with children treated with budesonide after 12 wk.

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One of the rarest lesions is in-stent restenosis chronic total occlusion (CTO). Limited data suggest that the treatment success rate is dependent on the possibility to cross into the lumen of an occluded stent, and the decision about what technique to use varies by operator preference. The knuckle technique is used to create a deliberate dissection plane in various CTO techniques. A guide wire is pushed until a complex loop is formed and advanced through the lesion. In this report we present a case where a knuckle wire guided by intravascular ultrasound control is used to penetrate the distal cap in an in-stent restenosis CTO lesion.

Coronary artery spasm is sometimes an unrecognized cause of myocardial ischemia. Myocardial ischemia is not always a product of fixed stenosis; it can also be induced by dynamic, transient stenosis. The angiogram represents the current state of vasculature at the time of examination and absence of stenosis does not mean disease absence. We present a case of right coronary artery spasm that caused non-ST elevation myocardial infarction and arrhythmias and was induced again in the cath lab due to vasovagal reaction.

Background: Previous studies on adult asthmatics have shown that the disease is associated with alterations in glucocorticoid receptor (GR) function. Objectives: The aim of the present study was to examine GR functional properties in adolescent asthma of different severity. Therefore, we determined GR hormone binding parameters, e.g. the equilibrium dissociation constant (K_d) and the number of binding sites (B_max), as well as the level of receptor expression in mononuclear cells isolated from the peripheral blood of patients with mild/moderate persistent asthma. Methods: The GR hormone binding activity was assessed by whole-cell binding assay, while receptor expression was evaluated by quantitative Western blotting. Results: In peripheral blood mononuclear cells (PBMCs) of patients suffering from moderate asthma, the GR displayed higher K_d and B_max values (78.0 ± 19.5 nM and 11,715 ± 1,952 sites/cell, respectively; n = 17) in comparison to healthy subjects (23.8 ± 7.7 nM and 6,124 ± 1,369 sites/cell; n = 12) and mild asthmatics (22.4 ± 8.0 nM and 4,840 ± 776 sites/cell; n = 11). However, the GR protein level in PBMCs was found to be similar in the three study groups. Conclusion: The results provide data on GR expression and its functional status in inflammatory cells of pediatric asthmatic patients. In moderate asthma, functional characteristics of GR are altered, though the significance of these findings remains to be clarified.

The aim of the present study was to examine whether changes in the antioxidant status and expression of major intracellular stress proteins are associated with pathophysiology of childhood asthma and severity of the disease. The activities of copper/zinc (CuZn) and manganese (Mn) superoxide dismutase (SOD) and catalase (CAT) in peripheral blood mononuclear cells (PBMCs) of 28 stable pediatric patients (11 mild persistent and 17 moderate persistent asthmatics) and 12 healthy children were assessed by native gel assays. The levels of two heat shock proteins (HSPs), Hsp70 and Hsp90, were examined by quantitative Western blot analysis. Moderate asthmatics, in comparison to healthy children, displayed higher activity of CuZnSOD, while differences of MnSOD and CAT activity between the groups of patients were not found. The levels of Hsp90 and the inducible isoform of Hsp70 were increased in moderate asthmatics as compared to mild asthmatics and healthy children. The results demonstrate an imbalance in cellular antioxidant and stress response systems that may contribute to pathogenesis of childhood asthma, but are not necessarily related to severity of the disease

IntroductionPsychological characteristics of patients, depression, stress and anxiety are recognized as important confounding risk factors for ischemic heart disease. However, the impact of psychological characteristics on coronary ischemia and vice versa remain poorly understood.AimTo demonstrate the interplay of psychological characteristics, depression, stress and anxiety with coronary ischemia estimated with fractional flow reserve (FFR).Material and methodsFrom 2014 to 2016, 147 patients who were planned for FFR measurement were included in this study. Psychological characteristics of patients were evaluated using the Depression, Anxiety and Stress Scale 21 items (DASS 21) self-report questionnaire.ResultsComparing the FFR ischemic vs. FFR non-ischemic groups, a significant difference was observed regarding results achieved for the depression, anxiety and stress scales. Multivariate logistic regression analysis was used to model the correlation between FFR and the DAS scale. It was clear, when controlling for previous myocardial infarction, that FFR was significant in all analyses. However, when the Canadian Cardiovascular Society grading of angina pectoris (CCS) class was entered in the model, FFR was not a significant predictor of anxiety, but was significant in other analysis.ConclusionsHigher degrees of the psychological characteristics depression, stress and anxiety were observed in the group of patients with coronary ischemia, corresponding to lower fractional flow values.

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