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.
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 (Kd) and the number of binding sites (Bmax), 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 Kd and Bmax 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.
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