Search

For decades, precoated heat- and solvent-set tissues have been the preferred method for mending certain types of library and archival materials due to their translucency and ability to be used with...

This contribution presents results from the ongoing technical study of a rare fifteenth-century Armenian illuminated manuscript in the collection of the Library of Congress. Characterization of the manuscript components has been undertaken to create a preservation plan for the manuscript. Analytical results from the miniature of Mark allow identification of some unusual pigments, including tin white; these are discussed in the context of Armenian manuscript illumination, indigenous craft technologies and Near Eastern artistic traditions.

Objective To determine whether an antistatic valved holding chamber/mask improves lung bioavailability of hydrofluoroalkane (HFA) fluticasone in young children. Study design Twelve patients, age 1 to 6 years, with well-controlled asthma were treated with an HFA fluticasone metered-dose inhaler (Flovent HFA) twice daily (440 μg/day). The drug was delivered by tidal breathing through conventional (AeroChamber Plus) and antistatic (AeroChamber MAX) valved holding chambers (VHCs) with masks in a randomized, crossover manner, each for 3 to 7 days. When adherence was 100% at home, blood was collected for measurement of steady-state fluticasone plasma concentration (FPC) 1 hour after the last dose was administered in the clinic. FPC indicates systemic exposure directly and airway delivery indirectly. It was measured by liquid chromatography-mass spectrometry. Data were analyzed by regression analysis. Results The mean ± SD FPC was 107 ± 30 pg/mL after conventional VHC and 186 ± 134 pg/mL after the antistatic VHC (P = .03). In 5 patients (40%), the antistatic VHC increased FPC by ≥ 100%, to potentially excessive levels in 4 of them; it had little effect in 7 patients. Conclusions HFA fluticasone was delivered to the airways by both devices even though the patients could not inhale deeply and breath hold. The antistatic VHC variably increased lung bioavailability. To reduce systemic exposure, the dose should be weaned to the minimum required to maintain asthma control.

Background Omalizumab, an anti-IgE monoclonal antibody, is administered by injection once or twice monthly in offices and clinics. It offers a potential alternative intervention for patients with allergic asthma that is not well controlled because of recalcitrant poor adherence to inhaled corticosteroid therapy. Objective To assess the effect of omalizumab therapy by measuring airway responsiveness to adenosine, a marker of allergic airway inflammation, and resource use. Methods Patients (N = 17) aged 6 to 26 years (mean age, 16.4 years) with poorly controlled persistent allergic asthma, less than 50% adherence to inhaled corticosteroid therapy, a forced expiratory volume in 1 second (FEV 1 ) of 60% predicted or higher, and adenosine provocation concentration that caused a decrease in FEV 1 of 20% (PC 20 ) of 60 mg/mL or less were randomized to receive 4 months of omalizumab or placebo in a double-blind, crossover trial with a 3- to 4-month washout between treatments. Patients were instructed to continue taking inhaled corticosteroids throughout the study. The PC 20 was measured before and after each period. Results Fifteen patients completed the study. The mean baseline PC 20 was 14.1 mg/mL (95% CI, 10.8–18.4 mg/mL). The fold change PC 20 was 0.9 (95% CI, 0.5–1.7) during placebo and 3.1 (95% CI, 1.6–6.2) during omalizumab treatment; the estimated ratio was 3.4 (95% CI, 1.2–9.3; P = .02). Six patients required one or more short courses of oral corticosteroids for asthma exacerbations during placebo, but none required this intervention during omalizumab. During the study, the median prescription refills for inhaled corticosteroids was 0.15 (95% CI, 0.00–0.33) canisters per month. Conclusion Omalizumab therapy is an alternative for patients with more severe poorly controlled asthma in whom adherence does not improve with conventional interventions. Trial Registration clinicaltrials.gov Identifier: NCT00133042.

We performed this study to evaluate how age and device affect the systemic exposure of inhaled fluticasone propionate (FP) in children. The findings indicate an anti-static valved holding chamber significantly increases systemic exposure of FP.