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One important goal of asthma treatment is to reduce exacerbations. The current authors investigated if the use of sputum cell counts to guide treatment would achieve this goal.A total of 117 adults with asthma were entered into a multicentre, randomised, parallel groupeffectiveness study for two treatment strategies over a 2-yr period. In one strategy (the clinical strategy: CS) treatment was based on symptoms and spirometry. In the other (the sputum strategy: SS) sputum cell counts were used to guide corticosteroid therapy to keep eosinophils f2%; symptoms and spirometry were used to identify clinical control, exacerbations and other treatments. Patients were blind to sputum cell counts in both strategies and physicians were blind in the CS, thus removing bias. First, the minimum treatment to maintain control was identified in 107 patients (Phase 1) and then this treatment was continued (Phase 2) for the remaining of the 2 yrs. The primary outcomes were the relative risk reduction for the occurrence of the first exacerbation in Phase 2 and the length of time without exacerbation. The current authors also examined the type and severity of exacerbations and the cumulative dose of inhaled steroid needed.The duration and number of exacerbations in Phase 1 were similar in both groups. In Phase 2 there were a 126 exacerbations of which 79 occurred in the CS (62.7%) and 47 (37.3%) in the SS groups. The majority of the 126 exacerbations (101; 80.1%) were mild. The majority of the 102 exacerbations, where sputum examination was performed before any treatment (n570), were noneosinophilic. In the SS patients, the time to the first exacerbation was longer (by 213 days) especially in those considered to need treatment with a long acting b 2 -agonist (by 490 days), the relative risk ratio was lower (by 49%), and the number of exacerbations needing prednisone was reduced (5 versus 15). This benefit was seen mainly in patients needing treatment with inhaled steroid in a daily dose equivalent to fluticasone .250 mg, and was due to fewer eosinophilic exacerbations. The cumulative dose of corticosteroid during the trial was similar in both groups.Monitoring sputum cell counts was found to benefit patients with moderate-to-severe asthma by reducing the number of eosinophilic exacerbations and by reducing the severity of both eosinophilic and noneosinophilic exacerbations without increasing the total corticosteroid dose. It had no influence on the frequency of noneosinophilic exacerbations, which were the most common exacerbations.

Rituximab resulted in an overall platelet count response in 62.5% of adults with ITP. However, this finding derives from uncontrolled studies that also reported significant toxicities, including death in 2.9% of cases. These data suggest that providers should avoid indiscriminate use of rituximab and that randomized, controlled trials of rituximab for ITP are urgently needed.

The bone resorption marker Ntx provides valuable prognostic information in patients with bone metastases receiving bisphosphonates.

Baseline and recent bone marker levels were predictive of negative clinical outcomes in patients with bone metastases secondary to prostate cancer and to NSCLC and other solid tumors. N-telopeptide levels were more consistent prognostic indicators than bone-specific alkaline phosphatase for all tumor types, reflecting the key role of osteolysis in the development of skeletal complications.

Preparation and characterization of blends and copolymers of a fluorinated polyimide with network constituents is reported. 4,4′‐Hexafluoroisopropylidene diphthalic anhydride and 4,4′‐diaminodiphenyl ether (6FDA–DDE) polyimide were used as the linear hosts and mellitic acid hexamethyl ester ‐ 4,4′‐diaminodiphenyl ether (MAHE–DDE) was employed as the network constituent for the blend and copolymer. Cast films of the polyimides were characterized by FTIR, XPS, DMA, and TGA. The multifunctional nature of MAHE facilitated crosslinking among the constituents. Both blends and copolymers showed significant improvement in the storage modulus and glass transition temperature relative to that observed for the 6FDA homopolymer. The occurrence of a single glass transition temperature for the blends suggests that they were at least partially miscible. Presence of low molecular weight species in the copolyimides, combined with steric hindrance to crosslinking, may have resulted in the existence of an optimum in the amount of the network components for improving the mechanical properties. Inclusion of network components is presented as a facile method for improving the desirable properties of polyimide. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 100: 3000–3008, 2006

Men with nonmetastatic prostate cancer and rising PSA despite androgen deprivation therapy have a relatively indolent natural history. Baseline PSA and PSA velocity independently predict time to first bone metastasis and survival.