Prostaglandin E2 (PGE2) is produced in the lung but unlike most other lipid mediators has potentially important antiallergic effects. Whether these properties are relevant to asthma has not been established. The effect of inhaled PGE2 on allergen-induced asthma was examined in a double-blind crossover study of eight subjects with asthma. In Study 1 subjects inhaled 100 micrograms PGE2 or placebo 5 min before a normal saline challenge, and FEV1 and bronchial reactivity to methacholine was measured at intervals for 7 h. In Study 2, which had a similar design, subjects inhaled the same dose of PGE2 or placebo followed by a dose of allergen previously shown to cause a fall in FEV1 of 20% or more. On the normal saline challenge day inhaled PGE2 caused a small increase in FEV1 that lasted for around 60 min; there was no difference in the provocative dose of methacholine causing a 20% fall in FEV1 (PD20) at 4 and 7 h compared with placebo. PGE2 caused marked inhibition of the early and late response to allergen. The mean maximum fall in FEV1 0 to 2 h after allergen was 37.8 and 7.7% with placebo and PGE2 pretreatment, respectively (mean difference 30%; 95% CI 15, 45%; p < 0.005). The mean maximum fall in FEV1 from 4 to 7 h after allergen was 25.5 and 8.8% respectively (mean difference 16.7%; 95% CI 4, 29%; p< 0.02). The methacholine PD20 fell significantly after allergen with placebo but not with PGE2. The difference was 1.5 doubling doses at both 4 and 7 h (p < 0.01 and p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

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The objective of this study was to evaluate the clinical safety of intravenous gadolinium-based contrast media used in patients who underwent MRI at a single institution. Acute adverse reactions to intravenous gadolinium-based contrast media used for MRI at the Princess Margaret Hospital, Hong Kong, SAR, from January 1999 to November 2004 were recorded in an incidence log book. The medical records of patients' demographics were retrospectively reviewed and the nature, frequency and severity of the adverse reactions were investigated and documented. The incidence of acute adverse reactions to intravenous gadolinium-based contrast media was 0.48% (45 patients with 46 adverse reactions). The severity of these adverse reactions were 96% mild, 2% moderate (one patient developed shortness of breath that required oxygen supplementation and intravenous steroidal management) and 2% severe (one patient developed an anaphylactoid reaction, but successfully recovered through timely resuscitation). No patients were recorded as having contrast extravasation and none died as a result of any adverse reaction. Among the 45 patients who developed adverse reactions, three patients (6.7%) had prior adverse reactions to iodinated contrast media, three (6.7%) had prior reactions to a different gadolinium-based contrast agent, one (2%) had asthma and nine (20%) had a history of drug/food allergy. Overall, 41% of the adverse reactions were not documented in the final MRI report or the clinical medical records. Gadolinium-based contrast media are safe and well tolerated by the vast majority of patients. In our study, the adverse reaction rate (0.48%) and the incidence of severe anaphylactoid reaction (0.01%) concur with those reported in the literature. Although most of the symptoms are mild and transient, these adverse reactions must be accurately documented and managed.

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Objective-To investigate the eYcacy of an increased dose of inhaled steroid used within the context of an asthma self management plan for treating exacerbations of asthma. Design-Randomised, double blind, placebo controlled, crossover trial. Methods-Twenty eight children aged 6-14 years with asthma of mild to moderate severity were studied for six months. Eighteen pairs of exacerbations were available for analysis, during which subjects took an increased dose of inhaled steroids or continued on the same dose. Results-There was no significant diVerence between increasing inhaled steroids or placebo on morning or evening peak expiratory flow rates (PEFRs), diurnal peak flow variability, or symptom scores in the two weeks following an asthma exacerbation. DiVerence (95% confidence intervals) in baseline PEFR on days 1-3 were 3.4% (−3.5% to 10.4%) and −0.9% (−4.7% to 2.9%) for inhaled steroid and placebo, respectively. Spirometric function and the parents' opinion of the eVectiveness of asthma medications at each exacerbation were also not significantly diVerent between inhaled steroid or placebo. Conclusion-This study suggests that increasing the dose of inhaled steroids at the onset of an exacerbation of asthma is ineffective and should not be included in asthma self management plans. (Arch Dis Child 1998;79:12-17)

Both CT and MR arthrography have a very high degree of accuracy for diagnosing tears of the SLL, LTL, and TFCC with both being more accurate than conventional MR imaging.

Formin 1 confers actin nucleation by generating long stretches of actin microfilaments to support cell movement, cell shape, and intracellular protein trafficking. Formin 1 is likely involved in microtubule (MT) dynamics due to the presence of a MT binding domain near its N terminus. Here, formin 1 was shown to structurally interact with α-tubulin, the building block of MT, and also end-binding protein 1 (a MT plus [+]-end-binding protein that stabilizes MT) in the testis. Knockdown of formin 1 in Sertoli cells with an established tight junction barrier was found to induce down-regulation of detyrosinated MT (a stabilized form of MT), and disorganization of MTs, in which MTs were retracted from the cell cortical zone, mediated through a loss of MT polymerization and down-regulation of Akt1/2 signaling kinase. An efficient knockdown of formin 1 in the testis reduced the number of track-like structures conferred by MTs and F-actin considerably, causing defects in spermatid and phagosome transport across the seminiferous epithelium. In summary, formin1 maintains MT and F-actin track-like structures to support spermatid and phagosome transport across the seminiferous epithelium during spermatogenesis.

BackgroundLateral epicondylitis is one of the most common overuse injuries, and has been reported to reduce function and affect daily activities. There is no standard therapy for lateral epicondylitis. In Hong Kong, acupuncture and extracorporeal shockwave therapy (ESWT) have been popular in treating lateral epicondylitis in recent years.ObjectiveThis study is to compare the treatment effects of acupuncture and ESWT on lateral epicondylitis.MethodsIn this study, we evaluated 34 patients (34 elbows) with lateral epicondylitis. Seventeen patients were treated by 3-week ESWT, one session per week. Another 17 were treated by 3-week acupuncture therapy, two sessions per week. The outcome measures included pain score by visual analogue scale, maximum grip strength by Jamar dynamometer, and level of functional impairment by disability of arms, shoulders, and hands questionnaire. Participants were assessed at three time points: baseline; after treatment; and 2-week follow-up.ResultsThe two treatments showed no significant difference at any assessment time-point. Both treatment groups had significant improvement in pain score in longitudinal comparisons. No significant difference was found in maximum grip strength and functional impairment in either treatment group, but a trend of improvement could be observed. In addition, improvement in pain relief stopped when treatment ended for either groups.ConclusionsThe treatment effects of acupuncture and ESWT on lateral epicondylitis were similar. The pain relief persisted for at least two weeks after treatment.