Context:Exposure to maternal adiposity during pregnancy is associated with higher offspring birthweight and greater adiposity through childhood and adult life. As birthweight reflects the summation ...of lean and fat mass, the extent to which fat mass at birth tracks into later life is unknown.Objective:Determine whether fat mass at birth is associated with child and adolescent adiposity.Design, Setting and Participants:UK birth cohort with markers of neonatal fat mass; cord blood leptin, adiponectin, and birthweight and adiposity outcomes at age 9 (N=2775) and 17years (N=2138).Main Outcomes:Offspring BMI, waist circumference, DXA-determined fat mass and obesity at age 9 and 17years.Results:Higher cord blood leptin was associated with higher z-scores of fat mass (difference in mean per 10pg/ml: 0.03SD,95%CI 0.00-0.06), waist circumference (0.04SD,95%CI 0.00-0.07), and BMI (0.04SD,95%CI 0.00-0.08), at age 9. However, by age 17 the adjusted results were attenuated to the null. Cord blood adiponectin was not associated with measures of adiposity at age 9. At age 17, cord blood adiponectin was positively associated with fat mass (0.02SD per 10μg/ml,95%CI 0.02-0.03) and waist circumference (0.04SD per 10μg/ml,95%CI 0.03-0.05). Birthweight was positively associated with waist circumference (0.03SD per 100g,95%CI 0.02-0.04) and BMI (0.02SD per 100g,95%CI 0.00-0.03), but not fat mass or odds of obesity. Cord blood leptin and adiponectin were not associated with obesity at either age.Conclusions:Increased cord blood leptin and adiponectin, known surrogates of fetal fat mass, were weakly associated with increased fat mass in late childhood and adolescence respectively.
Hyperbaric oxygen therapy (HBOT) has been beneficial in treating people with nocardiosis. This report describes Nocardia spp. affecting a cat, with lesions confined to the skin. To the best of the ...authors’ knowledge, this is the first report of HBOT, combined with amikacin, used to successfully treat feline cutaneous nocardiosis.
Résumé
Le traitement à l’oxygène hyperbar (HBOT) a été bénéfique pour le traitement de la nocardiose chez l’homme. Cet article décrit un chat atteint par Nocardia spp. avec des lésions cantonnées à la peau. A la connaissance des auteurs, ceci est la première description de HBOT, combinée à l’amikacine, utilisée pour traiter avec succès une nocardiose féline.
Resumen
La terapia con oxígeno hiperbárico (HBOT) ha sido beneficiosa para el tratamiento de personas con nocardiosis. Este informe describe un caso de infección cutánea con Nocardia spp. que afectaba a un gato, con lesiones limitadas a la piel. A entender de los autores, este es el primer informe de HBOT, combinado con amikacina, utilizado para tratar con éxito la nocardiosis cutánea felina.
Zusammenfassung
Die hyperbare Sauerstofftherapie (HBOT) hat sich bei der Behandlung von Menschen mit einer Nocardiose als günstig erwiesen. Dieser Fallbericht beschreibt eine Nocardia spp. Infektion bei einer Katze mit Veränderungen, die auf die Haut beschränkt waren. Nach bestem Wissen der Autoren handelt es sich hierbei um den ersten Bericht einer HBOT, die in Kombination mit Amikacin eingesetzt wurde, um eine feline kutane Nocardiose erfolgreich zu behandeln.
要約
高気圧酸素療法（HBOT）は、ノカルジア症患者の治療に有効である。本報告では、皮膚に限局した病変を有するNocardia spp.に罹患した一頭の猫について記述する。猫の筆者らの知る限り、本報告がHBOTおよびアミカシンを併用して猫の皮膚ノカルジア症の治療に成功した初めての報告である。
摘要
高压氧治疗(HBOT)对治疗诺卡菌病的病人有益。本报告描述了诺卡菌感染的猫病例，病变局限于皮肤。据作者所知，这是HBOT联合阿米卡星成功治疗猫皮肤诺卡菌病的首次报道。
Resumo
A oxigenoterapia hiperbárica (OHB) tem sido benéfica no tratamento de pessoas com nocardiose. Este relatório descreve um caso Nocardia spp. afetando um gato, com lesões limitadas à pele. De acordo com o conhecimento dos autores, este é o primeiro relato do uso de OHB, combinado com amicacina, para tratar com sucesso a nocardiose cutânea felina.
Hyperbaric oxygen therapy (HBOT) has been beneficial in treating people with nocardiosis. This report describes Nocardia spp. affecting a cat, with lesions confined to the skin. To the best of the authors’ knowledge, this is the first report of HBOT, combined with amikacin, used to successfully treat feline cutaneous nocardiosis.
Background
Preterm birth and subsequent neonatal ventilatory treatment disrupts development of the hypoxic ventilatory response (HVR). An attenuated HVR has been identified in preterm neonates, ...however it is unknown whether the attenuation persists into the second year of life. We investigated the HVR at 12–15 months corrected postnatal age and assessed predictors of a blunted HVR in those born very preterm (<32 weeks gestation).
Methods
HVR was measured in infants born very preterm. Hypoxia was induced with a three-step reduction in their fraction of inspired oxygen (F
I
O
2
) from 0.21 to 0.14. Respiratory frequency (
f
), tidal volume (
V
T
), minute ventilation (
V
E
), inspiratory time (
t
I
), expiratory time (
t
E
),
V
T
/
t
I
, t
I
/
t
TOT
,
V
T
/
t
TOT
, area under the low-volume loop and peak tidal expiratory flow (PTEF) were measured at the first and third minute of each F
I
O
2
. The change in respiratory variables over time was assessed using a repeated measures ANOVA with Greenhouse-Geisser correction. A blunted HVR was defined as a <10% rise in
V
E
, from normoxia. The relationship between neonatal factors and the magnitude of HVR was assessed using Spearman correlation.
Results
Thirty nine infants born very preterm demonstrated a mean (SD) HVR of 11.4 (10.1)% (increase in
V
E
) in response to decreasing F
I
O
2
from 0.21 to 0.14. However, 17 infants (44%) failed to increase
V
E
by ≥10% (range −14% to 9%) and were considered to have a blunted response to hypoxia. Males had a smaller HVR than females Δ
V
E
(−9.1%; −15.4, −2.8;
p
= 0.007).
Conclusion
Infants surviving very preterm birth have an attenuated ventilatory response to hypoxia that persists into the second year of life, especially in males.
The objective of these studies was to assess the efficacy and safety of pregabalin in the treatment of human immunodeficiency virus (HIV)-associated neuropathic pain. Patients with HIV-associated ...distal sensory polyneuropathy (DSP) were randomized to treatment with flexible-dose pregabalin (150-600 mg/day) or placebo for 17 weeks in a single-blind, placebo lead-in, randomized, double-blind, parallel-group, placebo-controlled multinational trial. The primary efficacy outcome was the change in mean pain score on an 11-point numeric rating scale (NRS) from baseline to study endpoint. Participants who completed this trial were invited to participate in a 6-month open-label extension study with pregabalin. Of the 377 patients enrolled in the randomized controlled trial (pregabalin, n=183; placebo, n=194), 68.4% completed treatment. In the open-label extension, 217 patients were treated and 59.4% completed treatment. Both studies were terminated by the sponsor after a preplanned interim analysis indicated trial futility. At endpoint, the change from baseline in least-squares mean NRS pain scores in the intent-to-treat population was -2.04 for pregabalin versus -2.11 for placebo (P=.709). There were no significant differences between the pregabalin and placebo groups in the secondary efficacy measures. Incidence of adverse events was lower than seen in previous pregabalin studies. Overall, this trial did not show pregabalin to be more efficacious than placebo in treating HIV-associated DSP. Studies such as these, which fail to support their primary hypotheses, may be important in informing the methodology of future trials, especially when novel approaches to limit variability in the control group are included. ClinicalTrials.gov identifiers: NCT01049217 and NCT01145417.
Introduction
The European Respiratory Society Oscillometry Taskforce identified that clinical correlates of bronchodilator responses are needed to advance oscillometry in clinical practice. The ...understanding of bronchodilator‐induced oscillometry changes in preterm lung disease is poor. Here we describe a comparison of bronchodilator assessments performed using oscillometry and spirometry in a population born very preterm and explore the relationship between bronchodilator‐induced changes in respiratory function and clinical outcomes.
Methods
Participants aged 6–23 born ≤32 (N = 288; 132 with bronchopulmonary dysplasia) and ≥37 weeks' gestation (N = 76, term‐born controls) performed spirometry and oscillometry. A significant bronchodilator response (BDR) to 400 μg salbutamol was classified according to published criteria.
Results
A BDR was identified in 30.9% (n = 85) of preterm‐born individuals via spirometry and/or oscillometry, with poor agreement between spirometry and oscillometry definitions (k = 0.26; 95% confidence interval CI 0.18–0.40, p < .001). Those born preterm with a BDR by oscillometry but not spirometry had increased wheeze (33% vs. 11%, p = .010) and baseline resistance (Rrs5 z‐score mean difference (MD) = 0.86, 95% CI 0.07–1.65, p = .025), but similar baseline spirometry to the group without a BDR (forced expiratory volume in 1 s FEV1 z‐score MD = −0.01, 95% CI −0.66 to 0.68, p > .999). Oscillometry was more feasible than spirometry (95% success rate vs. 85% (FEV1), 69% (forced vital capacity) success rate, p < .001), however being born preterm did not affect test feasibility.
Conclusion
In the preterm population, oscillometry is a feasible and clinically useful supportive test to assess the airway response to inhaled salbutamol. Changes measured by oscillometry reflect related but distinct physiological changes to those measured by spirometry, and thus these tests should not be used interchangeably.
Take home message
In the assessment of the airway response to salbutamol, oscillometry reflects related but distinct physiological changes to spirometry in preterm populations. Whilst oscillometry is a feasible and clinically useful supportive test, it should not be used interchangeably with spirometry.
One of the most significant complications of preterm birth is bronchopulmonary dysplasia (BPD). The pathophysiology of BPD has changed in recent years as advances in neonatal care have led to ...increased survival of smaller, more preterm, infants who display alterations to alveolar and pulmonary microvascular development. It is becoming clear that infants with ‘new’ BPD experience lung disease that persists into later childhood, however, the oldest of these children are just now entering young adulthood and therefore the longer term pulmonary implications remain unknown. The role of lung function testing in the identification and subsequent management of patients with lung disease resulting from a neonatal classification of BPD is reviewed based on the underlying pathophysiology of the disease.
Watch the Video introducing the Review Series on lung function testing
Objectives
The long-term cardiopulmonary outcomes following preterm birth during the surfactant era remain unclear. Respiratory symptoms, particularly exertional symptoms, are common in preterm ...children. Therefore, cardiopulmonary exercise testing may provide insights into the pathophysiology driving exertional respiratory symptoms in those born preterm. This review aims to outline the current knowledge of cardiopulmonary exercise testing in the assessment of children born preterm in the surfactant era.
Design
This study is a narrative literature review.
Methods
Published manuscripts concerning the assessment of pulmonary outcomes using cardiopulmonary exercise testing in preterm children (aged <18 years) were reviewed. Search terms related to preterm birth, bronchopulmonary dysplasia, and exercise were entered into electronic databases, including Medline, PubMed, and Google Scholar. Reference lists from included studies were scanned for additional manuscripts.
Results
Preterm children have disrupted lung development with significant structural and functional lung disease and increased respiratory symptoms. The association between these (resting) assessments of respiratory health and exercise capacity is unclear; however, expiratory flow limitation and an altered ventilatory response (rapid, shallow breathing) are seen during exercise. Due to the heterogeneity of participants, treatments, and exercise protocols, the effect of the aforementioned limitations on exercise capacity in children born preterm is conflicting and poorly understood.
Conclusion
Risk factors for reduced exercise capacity in those born preterm remain poorly understood; however, utilizing cardiopulmonary exercise testing to its full potential, the pathophysiology of exercise limitation in survivors of preterm birth will enhance our understanding of the role exercise may play. The role of exercise interventions in mitigating the risk of chronic disease and premature death following preterm birth has yet to be fully realized and should be a focus of future robust randomized controlled trials.
Rates of preterm birth (<37 weeks of gestation) are increasing worldwide. Improved perinatal care has markedly increased survival of very (<32 weeks gestation) and extremely (<28 weeks gestation) ...preterm infants, however, long term respiratory sequalae are common among survivors. Importantly, individual's lung function trajectories are determined early in life and tend to track over the life course. Preterm infants are impacted by antenatal, postnatal and early life perturbations to normal lung growth and development, potentially resulting in significant shifts from the “normal” lung function trajectory. This review summarizes what is currently known about the long-term lung function trajectories in survivors of preterm birth. Further, this review highlights how antenatal, perinatal and early life factors are likely to contribute to individual lung health trajectories across the life course.
Background
Cannabidiol (CBD) in hemp oil has become a widely used product in veterinary medicine. To date, there have been no reports of cutaneous adverse events associated with CBD‐containing oil in ...the veterinary literature.
Clinical summary
A 4‐year‐old castrated male Labrador retriever presented with pad sloughing and rapidly progressive cutaneous and mucosal ulceration within five days of administering an oral CBD oil product. Histopathological findings in combination with cutaneous signs were consistent with Stevens–Johnson syndrome. All lesions completely resolved after discontinuation of the hemp oil in addition to a 12 day course of cephalexin and prednisone. Given the lack of alternative causes including other medications, an adverse drug event was deemed probable according to the Naranjo algorithm.
Conclusions and clinical importance
To the best of the authors’ knowledge, this is the first report of suspected cutaneous adverse drug reaction to a CBD‐containing hemp oil product.
RésuméContexteLe cannabidiol (CBD) dans l’huile de chanvre est un produit largement utilisé en médecine vétérinaire. A ce jour, aucun effet indésirable cutané n’a été décrit en association avec l’huile contenant du CBD dans la littérature vétérinaire.Résumé cliniqueUn Labrador retriever mâle castré de 4 ans, présenté pour décollement des coussinets et ulcération progressive rapide de la peau et des muqueuses après cinq jours d’administration d’un produit oral contenant du CBD. Les données histopathologiques associées aux signes cliniques étaient compatibles avec un syndrome de Stevens‐Johnson. Toutes les lésions se sont totalement résolues avec l’arrêt de l’administration de l’huile de chanvre et de 12 jours de céphalexine et prednisone. Compte tenu de l’absence d’autres causes comme d’autres médicaments, la réaction médicamenteuse était fortement probable selon l’algorithme de Naranjo.Conclusions et importance cliniqueA la connaissance des auteurs, ceci est la première description d’une réaction cutanée médicamenteuse liée à de l’huile de chanvre contenant du CBD.
ResumenIntroducciónel cannabidiol (CBD) en el aceite de cáñamo se ha convertido en un producto ampliamente utilizado en pacientes veterinarios. Hasta la fecha, no ha habido informes de efectos adversos cutáneos asociados con el aceite que contiene CBD en la literatura veterinaria.Resumen clínicoun perro labrador macho castrado de 4 años presentó desprendimiento de la almohadilla y ulceración cutánea y de mucosas rápidamente progresiva a los cinco días posteriores a la administración de un producto de aceite de CBD oral. Los hallazgos histopatológicos en combinación con signos cutáneos fueron indicativos de un síndrome de Stevens‐Johnson. Todas las lesiones se resolvieron por completo después de la interrupción de la administración de aceite de cáñamo, además de un curso de 12 días de cefalexina y prednisona. Dada la falta de causas alternativas que incluyen otros medicamentos, el efecto adverso del fármaco se consideró probable según el algoritmo de Naranjo.Conclusiones e importancia clínicaa entender de los autores, este es el primer informe de sospecha de reacción cutánea adversa a un producto de aceite de cáñamo que contiene CBD.
ZusammenfassungHintergrundCannabiol (CBD) in Hanföl ist bei veterinärmedizinischen Patienten ein weitverbreitet eingesetztes Produkt geworden. Bis zum heutigen Tag gibt es in der Veterinärliteratur keine Berichte über kutane Nebenwirkungen im Zusammenhang mit CBD‐enthaltenden Tropfen.Klinische ZusammenfassungEin 4 Jahre alter kastrierter Labrador Retrieverrüde wurde mit sich ablösenden Zehenballen und einer rasch fortschreitenden kutanen und mukokutanen Ulzeration, welche innerhalb von fünf Tagen nach Verabreichung eines CBD Ölprodukts per os begann, vorgestellt. Histopathologische Befunde in Kombination mit kutanen Zeichen stimmten mit dem Stevens‐Johnson Syndrom überein. Alle Veränderungen heilten nach Absetzen des Hanföls und einer 12 tägigen Verabreichung von Cephalexin und Prednisolon völlig ab. Da es kaum andere Gründe, auch keine andere Medikation gab, wurde eine Nebenwirkungsreaktion dem Naranjo Algorithmus folgend für wahrscheinlich gehalten.Schlussfolgerungen und klinische BedeutungNach bestem Wissen der Autoren handelt es sich hierbei um den ersten Bericht einer vermeintlichen kutanen Nebenwirkungsreaktion auf ein CBD‐hältiges Hanfölprodukt.
要約背景麻油に含まれるカンナビジオール（CBD）は、獣医療患者に広く使用される製品になった。今日まで、獣医学文献にはCBD含有油に関連する皮膚有害事象の報告はない。臨床要約4歳、去勢雄のラブラドール・レトリバーは、経口CBDオイル製品を投与してから5日以内に、パッドの脱落、皮膚および粘膜の潰瘍が急速に進行した。皮膚兆候と組み合わせた組織病理学的所見は、スティーブンス・ジョンソン症候群と一致していた。セファレキシンおよびプレドニゾンの12日間コースに加え、麻油の中止後にすべての病変が完全に解消した。他の薬物療法を含む代替の原因がないため、Naranjoアルゴリズムによると、薬物有害事象は可能性が高いと見なされた。結論と臨床的重要性著者の知る限り、これはCBD含有麻油製品に対する皮膚の副作用の疑いの最初の報告である。
摘要背景大麻油中的大麻二酚(CBD)已成为兽医病例中被广泛使用的产品。迄今为止，在兽医文献中尚未报告CBD油可引起皮肤不良反应。临床总结一只4岁去势雄性拉布拉多犬在口服CBD油产品后，5天内出现爪垫脱落和快速发展的皮肤和粘膜溃疡。组织病理学结果结合皮肤体征符合斯蒂文森强森综合征。除12天疗程的头孢氨苄和泼尼松外，停用大麻油后，所有病变均完全消退。由于缺乏其他原因（包括其他药物），根据纳兰霍算法，认为很可能是药物不良反应。结论和临床重要性据作者所知，这是首次报告怀疑含CBD大麻油产品导致皮肤药物不良反应。
ResumoContextoO canabidiol (CBD) em óleo de cânhamo tornou‐se um produto amplamente utilizado em pacientes veterinários. Até o momento, não há relatos de eventos adversos cutâneos associados ao óleo contendo CBD na literatura veterinária.Resumo clínicoUm cão Labrador macho castrado de 4 anos de idade apresentou descamação e ulceração cutânea e mucosa rapidamente progressiva dentro de cinco dias após a administração de um produto à base de óleo de CBD por via oral. Os achados histopatológicos em combinação com os sinais cutâneos foram consistentes com a síndrome de Stevens‐Johnson. Todas as lesões foram completamente resolvidas após a descontinuação do óleo de cânhamo, além de um curso de 12 dias de cefalexina e prednisona. Dada a falta de causas alternativas, incluindo outros medicamentos, o evento adverso ao medicamento foi considerado provável, de acordo com o algoritmo de Naranjo.Conclusões e importância clínicaSegundo o conhecimento dos autores, este é o primeiro relato de suspeita de reação adversa cutânea a medicamentos causada por um produto à base de óleo de cânhamo contendo CBD.
Background – Cannabidiol (CBD) in hemp oil has become a widely used product in veterinary medicine. To date, there have been no reports of cutaneous adverse events associated with CBD‐containing oil in the veterinary literature. Conclusions and clinical importance – To the best of the authors’ knowledge, this is the first report of suspected cutaneous adverse drug reaction to a CBD‐containing hemp oil product.
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