The IFMIF-DONES Project: Design Status and Main Achievements Within the EUROfusion FP8 Work Programme

International Fusion Materials Irradiation Facility-DEMO-Oriented NEutron Source (IFMIF-DONES) is a high-intensity neutron irradiation facility for qualification of fusion reactor materials, which is being designed as part of the European roadmap to fusion-generated electricity. Its main purpose is to study the behavior of materials properties under irradiation in a neutron flux able to simulate the same effects in terms of relevant nuclear responses as those expected in the first wall of the DEMO reactor which is envisaged to follow ITER. It is thus a key facility to support the design, licensing and safe operation of DEMO as well as of the fusion power plants that will be developed afterwards. The start of its construction is foreseen in the next few years. In this contribution, an overview of the IFMIF-DONES neutron source is presented together with a snapshot of the current engineering design status and of the relevant key results achieved within the EUROfusion Work Package Early Neutron Source (WPENS) as part of the 2014–2020 EURATOM Research and Training Programme, complementary to the EU Horizon 2020 Framework Programme (FP8). Moreover, some information on the future developments of the project are given.

The Fluoro-Pauson-Khand Reaction in the Synthesis of Enantioenriched Nitrogenated Bicycles Bearing a Quaternary C-F Stereogenic Center

A variety of enantioenriched fluorinated 6H-cyclopenta[c]pyridin-6-one bicycles, a scaffold present in several classes of monoterpenic alkaloids with varied biological activity, were synthesized in just five steps from simple aldehyde starting materials. The synthesis presented wide functional group tolerance and moderate to high yields and diastereoselectivities and could be carried out on a gram scale. These products were suitable for further transformations, such as hydrogenation and deprotection of the tert-butylsulfonyl protecting group.

Antivenom effect on lymphatic absorption and pharmacokinetics of coral snake venom using a large animal model

Context: Historically, administration and dosing of antivenom (AV) have been guided primarily by physician judgment because of incomplete understanding of the envenomation process. As demonstrated previously, lymphatic absorption plays a major role in the availability and pharmacokinetics (PK) of coral snake venom injected subcutaneously, which suggests that absorption from subcutaneous tissue is the limiting step for venom bioavailability, supporting the notion that the bite site is an ongoing venom depot. This feature may underlie the recurrence phenomena reported in viperid envenomation that appear to result from a mismatch between venom and AV PK. The role of lymphatic absorption in neutralization of venom by AV administered intravenously remains unclear. Methods: The effect of AV on systemic bioavailability and neutralization of Micrurus fulvius venom was assessed using a central lymph-cannulated sheep model. Venom was administered by subcutaneous injection in eight sheep, four with and four without thoracic duct cannulation and drainage. Two hours after venom injection, AV was administered intravenously. Venom and AV concentrations in serum and lymph were determined by ELISA assay from samples collected over a 6-h period and in tissues harvested post-mortem. Results: After AV injection, venom levels in serum fell immediately to undetectable with a subsequent increase in concentration attributable to non-toxic venom proteins. In lymph, AV became detectable 6 min after treatment; venom levels dropped concurrently but remained detectable 4 h later. Post-mortem samples from the venom injection site confirmed the presence of venom near the point of injection. Neither venom nor AV was detected at significant concentrations in major organs or contralateral skin. Conclusions: Intravenous AV immediately neutralizes venom in the bloodstream and can extravasate to neutralize venom absorbed by lymph but this neutralization seems to be slow and incomplete. Residual venom in the inoculation site demonstrates that this site functions as a depot where it is not neutralized by AV, which allows the venom to remain active with slow delivery to the bloodstream for ongoing systemic distribution.

Chemistry of detrifluoroacetylativelyin situgenerated fluoro-enolates

This review article provides a summary of the detrifluoroacetylativein situgeneration of fluorine-containing enolates and their related reactions.

Metal-Free and User-Friendly Regioselective Hydroxyfluorination of Olefins

A simple, user-friendly, metal-free protocol for the regioselective anti-Markovnikov hydrofluorination of olefins using readily available and inexpensive reagents has been developed. This new approach displays a broader scope than previously reported methodologies and has been applied to the late-stage fluorination of a complex molecule, giving rise to a fluorosteroid derivative. The stereochemistry of the process has also been studied in some detail.

Recent advances in the synthesis of functionalised monofluorinated compounds

Over the past few years, we have tackled the synthesis of interesting monofluorinated organic molecules, such as: dihydronaphthalene derivatives, β-fluoro sulfones and related carbonyl compounds, fluorohydrins and allylic alcohols.

Comparison of total water vapor column from GOME-2 on MetOp-A against ground-based GPS measurements at the Iberian Peninsula

Water vapor column (WVC) obtained by GOME-2 instrument (GDP-4.6 version) onboard MetOp-A satellite platform is compared against reference WVC values derived from GPS (Global Positioning System) instruments from 2007 to 2012 at 21 places located at Iberian Peninsula. The accuracy and precision of GOME-2 to estimate the WVC is studied for different Iberian Peninsula zones using the mean (MBE) and the standard deviation (SD) of the GOME-2 and GPS differences. A direct comparison of all available data shows an overestimation of GOME-2 compared to GPS with a MBE of 0.7 mm (10%) and a precision quantified by a SD equals to 4.4mm (31%). South-Western zone presents the highest overestimation with a MBE of 1.9 mm (17%), while Continental zone shows the lowest SD absolute value (3.3mm) due mainly to the low WVC values reached at this zone. The influence of solar zenith angle (SZA), cloud fraction (CF), and the type of surface and its albedo on the differences between GOME-2 and GPS is analyzed in detail. MBE and SD increase when SZA increases, but MBE decreases (taking negative values) when CF increases and SD shows no significant dependence on CF. Under cloud-free conditions, the differences between WVC from GOME-2 and GPS are within the WVC error given by GOME-2. The changes of MBE and SD on Surface Albedo are not so evident, but MBE slightly decreases when the Surface Albedo increases. WVC from GOME-2 is, in general, more precise for land than for sea pixels.

UV and global irradiance measurements and analysis during the Marsaxlokk (Malta) campaign

Abstract. A solar radiation measurement campaign was performed in the south-eastern village of Marsaxlokk (35°50' N; 14°33' E; 10 m a.s.l), Malta, between 15 May and 15 October 2012. Erythemal solar radiation data (from a UVB-1 pyranometer), and total horizontal solar radiation (global and diffuse components) from two CM21 pyranometer were recorded. A comparison of atmospheric compounds from ground measurements and satellites shows that TOC (total ozone column) data from the Ozone Monitoring Instrument OMI, TOMS and DOAS algorithms correlate well with ground-based recorded data. The water vapour column and the aerosol optical depth at 550 nm show a significant correlation at the confidence level of 99 %. Parametric models for evaluating the solar UV erythemal (UVER), global (G) and diffuse (D) horizontal irradiances are calibrated, from which aerosol effects on solar irradiance are evaluated using the Aerosol Modification Factor (AMF). The AMFUVER values are lower than AMFG, indicating a greater aerosol effect on UVER than on global solar irradiance. In this campaign, several dust event trajectories are identified by means of the HYbrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) model and by synoptic conditions for characterizing desert dust events. Hence, changes in the UV index due to atmospheric aerosols are described.

Diagnostic and predictive value of urine PCA3 gene expression for the clinical management of patients with altered prostatic specific antigen

OBJECTIVE

Analyze the impact of the introduction of the study of PCA3 gene in post-prostatic massage urine in the clinical management of patients with PSA altered, evaluating its diagnostic ability and predictive value of tumor aggressiveness.

METHODS

Observational, prospective, multicenter study of patients with suspected prostate cancer (PC) candidates for biopsy. We present a series of 670 consecutive samples of urine collected post-prostatic massage for three years in which we determined the "PCA3 score" (s-PCA3). Biopsy was only indicated in cases with s-positive PCA3.

RESULTS

The s-PCA3 was positive in 43.7% of samples. In the 124 biopsies performed, the incidence of PC or atypical small acinar proliferation was 54%, reaching 68,6% in s-PCA3≥100. Statistically significant relationship between the s-PCA3 and tumor grade was demonstrated. In cases with s-PCA3 between 35 and 50 only 23% of PC were high grade (Gleason≥7), compared to 76.7% in cases with s-PCA3 over 50. There was a statistically significant correlation between s-PCA3 and cylinders affected. Both relationships were confirmed by applying a log-linear model.

CONCLUSIONS

The incorporation of PCA3 can avoid the need for biopsies in 54% of patients. s-PCA3 positivity increases the likelihood of a positive biopsy, especially in higher s-PCA3 100 (68.6%). s-PCA3 is also an indicator of tumor aggressiveness and provides essential information in making treatment decisions.

Fluorescent in situ hybridization as a predictor of relapse in urothelial carcinoma

OBJECTIVE

To assess the value of the study of chromosomal alterations by fluorescent in situ hybridization in a series of patients diagnosed of urothelial carcinoma and a minimum follow up of twenty four months, as well as evaluate its putative predictive potential.

MATERIAL AND METHODS

The overall series includes 338 samples from 98 patients with 84 episodes of urothelial carcinoma. A subgroup of 24 patients who had at least one recurrence during the follow up was used to evaluate the predictive potential of the test. Three categories were considered (positive coherent episode, negative coherent episode, and incoherent episode) depending on the relationship between the fluorescent in situ hybridization result in the concomitant study of the new episode and those of the preceding samples.

RESULTS

Fluorescent in situ hybridization showed higher sensitivity regardless of grade, negative predictive value and accuracy, while specificity and positive predictive value were superior with conventional cytology. In the recurrence, series 19/29 episodes were coherent, 11/19 were positive coherent with urothelial carcinoma all high grade and 8/19 negative coherent, most low grade.

CONCLUSIONS

Fluorescent in situ hybridization test shows good sensitivity during a follow up of twenty four months and is able to predict recurrence, especially in cases of high grade. Our data demonstrate the existence of urothelial carcinomas without detectable chromosomal abnormalities by currently available methodology. The results support a multidisciplinary follow up combining fluorescent in situ hybridization, cytology and cystoscopy.

Distribution of CYP2D6 and CYP2C19 polymorphisms associated with poor metabolizer phenotype in five Amerindian groups and western Mestizos from Mexico

BACKGROUND

The distribution of polymorphisms in the CYP2D6 and CYP2C19 genes allows inferring the potential risk for specific adverse drug reactions and lack of therapeutic effects in humans. This variability shows differences among human populations. The aim of this study was to analyze single-nucleotide polymorphisms related to a poor metabolizer (PM) phenotype in nonpreviously studied Amerindian groups and Mestizos (general admixed population) from Mexico.

METHODS

We detected by SNaPshot(®) different polymorphisms located in CYP2D6 (*3, *4, *6, *7, and *8) and CYP2C19 (*2, *3, *4 and *5) in western Mestizos (n=145) and five Amerindian groups from Mexico: Tarahumaras from the North (n=88); Purépechas from the Center (n=101); and Tojolabales (n=68), Tzotziles (n=88), and Tzeltales (n=20) from the Southeast. Genotypes were observed by capillary electrophoresis. The genetic relationships among these populations were estimated based on these genes.

RESULTS AND DISCUSSION

The wild-type allele (*1) of both genes was predominant in the Mexican populations studied. The most widely observed alleles were CYP2C19*2 (range, 0%-31%) and CYP2D6*4 (range, 1.2%-7.3%), whereas CYP2D6*3 was exclusively detected in Mestizos. Conversely, CYP2C19*4 and *5, as well as CYP2D6*3, *6, *7, and *8, were not observed in the majority of the Mexican populations. The Tarahumaras presented a high frequency of the allele CYP2C19*2 (31%) and of homozygotes *2/*2 (10.7%), which represent a high frequency of potentially PM phenotypes in this Amerindian group. The genetic distances showed high differentiation of Tarahumaras (principally for CYP2C19 gene). In general, a relative proximity was observed between most of the Amerindian, Mexican-Mestizo, and Latin-American populations.

CONCLUSION

In general, the wild-type allele (*1) predominates in Mexican populations, outlining a relatively homogeneous distribution for CYP2C19 and CYP2D6. The exception is the Tarahumara group that displays a potentially increased risk for adverse reactions to CYP2C19-metabolized drugs.

Effect of protocol-related variables and women's characteristics on the cumulative false-positive risk in breast cancer screening

BACKGROUND

Reducing the false-positive risk in breast cancer screening is important. We examined how the screening-protocol and women's characteristics affect the cumulative false-positive risk.

METHODS

This is a retrospective cohort study of 1,565,364 women aged 45-69 years who underwent 4,739,498 screening mammograms from 1990 to 2006. Multilevel discrete hazard models were used to estimate the cumulative false-positive risk over 10 sequential mammograms under different risk scenarios.

RESULTS

The factors affecting the false-positive risk for any procedure and for invasive procedures were double mammogram reading [odds ratio (OR)=2.06 and 4.44, respectively], two mammographic views (OR=0.77 and 1.56, respectively), digital mammography (OR=0.83 for invasive procedures), premenopausal status (OR=1.31 and 1.22, respectively), use of hormone replacement therapy (OR=1.03 and 0.84, respectively), previous invasive procedures (OR=1.52 and 2.00, respectively), and a familial history of breast cancer (OR=1.18 and 1.21, respectively). The cumulative false-positive risk for women who started screening at age 50-51 was 20.39% [95% confidence interval (CI) 20.02-20.76], ranging from 51.43% to 7.47% in the highest and lowest risk profiles, respectively. The cumulative risk for invasive procedures was 1.76% (95% CI 1.66-1.87), ranging from 12.02% to 1.58%.

CONCLUSIONS

The cumulative false-positive risk varied widely depending on the factors studied. These findings are relevant to provide women with accurate information and to improve the effectiveness of screening programs.

[Ciprofloxacin vs cefazolin in the prevention of infection in cirrhotic patients with gastrointestinal bleeding]

AIM

To determine if prophylaxis with cefazolin produces a significant reduction in infections in cirrhotic patients with gastrointestinal bleeding when compared with ciprofloxacin.

METHODS

Randomized clinical trial. Patients 18 years or older with diagnosis of cirrhosis, gastrointestinal bleeding and no clinical or laboratory evidence of infection who were admitted to the gastrointestinal bleeding unit of HNERM between July 2008 and July 2010 were included. Patients were allocated to receive either i.v. ciprofloxacin 200 mg bid or i.v. cefazolin 1 gm tid for 7 days.

RESULTS

98 patients were included, 53 in the cefazolin group and 45 in the ciprofloxacin one. Age average was 66 +/- 10 years, 61% were male, 59,2% had ascites. Overall rate of infections was 14,3% (14/98). Rebleeding rate was 8,1% and mortality 4,1%. There were no differences in age, sex, Child Pugh score, ascites, hepatic encephalopathy nor in billirubin, albumin, PT and creatinine levels between the study groups. Infection rate in the cefazolin groups was 11,3% while in the ciprofloxacin one 17,8% (p=0,398).When Child-Pugh A and patients without ascites were excluded of the analysis, the cefalozin group had 22,2% of infections and 26,9% in the ciprofloxacin one (p=0,757).

CONCLUSION

there were no differences in infection rates between patients with prophylaxis with cefazolin and ciprofloxacin after an episode of gastrointestinal bleeding.

Unmet needs for cataract surgery in Spain according to indication criteria. Evaluation through a simulation model

AIMS

Despite the increase in cataract surgery rates, the volume of unmet needs for this type of surgery in the population is substantial due to ageing and widening of the indication criteria. Our objective was to assess future trends in needs for cataract surgery according to different scenarios of indication criteria.

METHODS

A discrete-event simulation model was built for the population aged 50 years or older in five regions of Spain (45.7% of the population). Different scenarios of worse eye visual acuity thresholds for indication criteria were compared. Data from the North London Eye Study were used to project the baseline needs for surgery onto the study population. The surgery rate of each region was calculated using the Minimum Data Set. The model used data for the year 2003 and the simulation horizon was 5 years.

RESULTS

The volume of need predicted for the year 2008 when scenarios of 0.5 (20/40) and 0.4 (20/50) visual acuity thresholds were used was 69,214 and 51,315 surgeries needed per million inhabitants, respectively. However, unmet needs decreased when a 0.3 (20/70) threshold was used. The increment in the cataract surgery rate needed to prevent the cataract backlog from increasing was 60% for a 0.5 threshold and 50% for a 0.4 threshold.

CONCLUSION

Application of indication criteria following current guidelines would substantially increase unmet needs for surgery in the next 5 years.

[Clinical and epidemiological profile of cirrhosis in the liver unit at Edgardo Rebagliati Martins National Hospital]

BACKGROUND

Liver cirrhosis is an important cause of morbidity and mortality all around the world. In Peru it is the 5th cause of general mortality and the 2nd one between all those related to gastrointestinal and hepatobiliary diseases. At HNERM it is the principal etiology between all the cases that need hospitalization in gastroenterology. It is clear that we need to know all the clinical and epidemiologic characteristics to propose national actions to try to control and prevent this disease.

MATERIAL AND METHODS

The present is a descriptive, transversal and observational study to clarify the clinical and epidemiological profile of patients with cirrhosis hospitalized in the Liver unit at the Edgardo Rebagliati Martins National Hospital between january 2001 and june 2004.

RESULTS

475 patients were included, 45.1% were female, medium age was 63.4 years (r =26-93). The most frequent causes of cirrhosis were alcoholism (28%), chronic hepatitis B (15.2%), and chronic hepatitis C (11.8%). According to Child-Pugh score 42.3% was in stage B, and 42.5% en C. The main cause for hospitalization was upper gastrointestinal bleeding related to portal hypertension, followed by ascitis and encephalopathy. The principal infections were urinary, pulmonar and spontaneous bacterial peritonitis. Hepatocellullar carcinoma was found in 7.9% of the cases.

CONCLUSIONS

Liver cirrhosis affects principally males. The principal causes are alcoholism and chronic viral hepatitis. The principal cause of hospitalization is upper gastrointestinal bleeding. Most of the patients have an advanced disease at the moment of diagnosis. Principal infections are urinary, Pneumonia and SBP.

[Systematic review of population-based studies of the prevalence of cataracts]

OBJECTIVE

The prevalence of cataracts has increased due to the progressive ageing of the population and the fact that cataracts affect a wide and increasing proportion of the population. The goal of the present study was to describe the prevalence of cataracts through a systematic and exhaustive review of population-based studies.

METHODS

A systematic review of population-based studies of the prevalence and incidence of cataracts was performed. Inclusion criteria were: a healthy non- institutionalised population, older than 40 years of age, of white race, with a sample size of greater than 1,000 and published between 1980 and 2002.

RESULTS

Ten studies met the inclusion criteria (3 European, 5 from the United States and 2 from Australia), and were performed between 1984 and 2001. The cataract prevalence, according to lens opacity criteria, ranged between 15% and 19%. When the cataract was defined as a lens opacity combined with a decreased visual acuity, the prevalence ranged from 15% to 30%. The overall prevalence increased with age, reaching 40% and more than 60% in populations older than 70 and 75 years respectively. The prevalence among women was higher than that among men, with a more marked increase being evident at older ages than for men.

CONCLUSIONS

There were variations among the criteria used to measure the prevalence of cataract, which made it difficult to compare all the studies. Overall the prevalence was higher in the older population, especially among women. The increasing prevalence associated with age predicts an increasing burden of cataract to health services, this being particularly related to the ageing of the population.

[Clinical and molecular study of Chilean patients with McCune-Albright syndrome]

BACKGROUND

McCune-Albright Syndrome (MAS) is characterized by precocious puberty, "cafe au lait" skin lesions and polyostotic fibrous dysplasia. It is caused by 4 post-zygotic mutations of G alpha s protein with a mosaic distribution.

AIM

To describe the clinical presentation and to investigate the presence of the Arg by his substitution (R201H) in 14 girls with MAS.

PATIENTS AND METHODS

We performed a clinical analysis of the patients and specific allele PCR in DNA obtained from leukocytes.

RESULTS

Twelve of 14 patients presented with precocious puberty, one with cyclical vaginal bleeding and one with pathological bone fractures. Eight girls had polyostotic fibrous dysplasia, one had hyperthyroidism, four had pathological fractures, ten had ovarian cysts, six had breast hyperpigmentation and ten had "cafe au lait" skin lesions. We detected the R2O1H mutation in 10 of 14 patients. We found no difference in the severity of symptoms or in the age of presentation between the patients with and without the mutation.

CONCLUSIONS

The R201H mutation can be detected in white blood cells, in approximately 70% of cases. Patients exhibit wide clinical variability with the same molecular defect. This suggests that tissues have different proportions of mutant cells.

[Importance of 5569G/A polymorphism in intron 4 of HFE gene in the diagnosis of hereditary hemochromatosis]

BACKGROUND

The presence of the 5569A polymorphism may lead to misdiagnosis of patients susceptible of hereditary hemochromatosis (HH). For that reason, samples containing the Cys282Tyr mutation were revised and the frequency of this polymorphism in our environment was assessed.

PATIENTS AND METHOD

Twenty samples were retested and 56 controls were included. The study was performed by PCR-RFLP.

RESULTS

The diagnosis was confirmed in 8 cases susceptible of error. However, an amplification deficiency of normal alleles was detected in 2 heterozygous (17%). The allelic frequency of the 5569A polymorphism in the control population was 14.3%.

CONCLUSIONS

Although misdiagnosis was not committed, we recommend changing to any primer that does not include the 5569G/A polymorphism in the study of HH.

Localization of an exonic splicing enhancer responsible for mammalian natural trans-splicing

Carnitine octanoyltransferase (COT) produces three different transcripts in rat through cis- and trans-splicing reactions, which may lead to the synthesis of two proteins. Generation of the three COT transcripts in rat does not depend on sex, development, fat feeding, the inclusion of the peroxisome proliferator diethylhexyl phthalate in the diet or hyperinsulinemia. In addition, trans-splicing was not detected in COT of other mammals, such as human, pig, cow and mouse, or in Cos7 cells from monkey. Rat COT exon 2 contains two purine-rich sequences. Mutation of the rat COT exon 2 upstream box does not affect the trans-splicing in vitro between two truncated constructs containing exon 2 and its adjacent intron boundaries. In contrast, mutation of the downstream box from the rat sequence (GAAGAAG) to a random sequence or the sequence observed in the other mammals (AAAAAAA) decreased trans-splicing in vitro. In contrast, mutation of the AAAAAAA box of human COT exon 2 to GAAGAAG increases trans-splicing. Heterologous reactions between COT exon 2 from rat and human do not produce trans-splicing. HeLa cells transfected with minigenes of rat COT sequences produced cis- and trans-spliced bands. Mutation of the GAAGAAG box to AAAAAAA abolished trans-splicing and decreased cis-splicing in vivo. We conclude that GAAGAAG is an exonic splicing enhancer that could induce natural trans-splicing in rat COT.

Comparison of the heart rate variability parameters obtained from the electrocardiogram and the blood pressure wave

Four temporal and four spectral parameters of heart rate variability were compared after they were computed with two different time series generation methods: the RR intervals and the numerical values of heart rate provided by the Finapres. Recordings were obtained from 10 healthy subjects throughout five experimental conditions: supine, standing, controlled breathing, exercise and recovery. The mean and the RMS value of successive differences showed significant differences between the two methods. The spectral parameters were statistically different only during standing and exercise. The larger high frequency component and the lower HF/LF ratio by the Finapres method, observed during exercise, can be explained by the higher breathing influence on the peak-to-peak pressure intervals, in relation to RR intervals. Therefore, the high frequency component within mechanic intervals could possibly reflect the non-neural respiratory influence. In conclusion, values of heart rate provided by the Finapres are not completely interchangeable with those obtained from the ECG during the studied conditions.

[Serum lipid levels in children and teenagers from Concepción, Chile]

BACKGROUND

There is a relationship between serum lipid levels in children with those of adults. Preventive measures to reduce serum lipid levels should start in childhood.

AIM

To study serum lipid levels in a representative sample of children and teenagers from Concepción, Chile.

SUBJECTS AND METHODS

Serum total, HDL cholesterol and triglycerides were measured in 1,286 males and 816 females from 5 to 18 years old in the city of Concepción.

RESULTS

Mean total cholesterol levels were 159 +/- 30 and 162 +/- 31 mg/dl in males and females respectively. The figures for HDL cholesterol were 46 +/- 11 and 47 +/- 11 mg/dl, for LDL cholesterol were 94 +/- 27 and 96 +/- 29 mg/dl and for triglycerides were 80 +/- 35 and 87 +/- 38 mg/dl. Nine percent of males and 12% of females had a total cholesterol over 200 mg/dl. Likewise 10% of males and 11% of females had a LDL cholesterol over 130 mg/dl.

CONCLUSIONS

These numbers will help to plan and perform interventions in children, in order to prevent cardiovascular diseases.

A comparison of albuterol solution nebulized versus albuterol powder given by breath activated metered dose inhaler

The goal of the present study was to compare the efficacy of nebulized vs powdered albuterol in patients with exacerbated bronchial asthma who required hospitalization. From January to May 1990 known asthmatics admitted with acute exacerbation were included by established criteria. Two groups were randomized. Group I for Albuterol powder 200 micrograms inhaled q 4 hours. Group II with Albuterol nebulized solution 2.5 mg inhaled q 4 hrs. Force Vital Capacity and Force Expiratory Volume in one second were measured with a pressure differential transducer upon admission, 30 minutes and 24-hours following therapies. Absolute FEV1 improvement was calculated. Statistical analysis was performed using student's T-Test and Fisher's exact Test with significance established at p > 0.01%. Fifteen patients enrolled in both groups, two patients of group I were excluded from the statistic analysis due to refusal to continue with the therapy. Both groups were comparable with respect to sex, asthma exacerbations/year, smoking history and hospital length of stay. FVC and FEV1 were comparable also. In contrast, there were significant difference when the absolute improvement were compared. The mean +/- SE for FEV1 absolute improvement at the first 30 min was 0.42 +/- 0.08 lts for the Group I versus 0.65 +/- 0.6 lts in the Group II. In the next 24 hours, Group I was 0.16 +/- 0.2 lts versus 0.30 +/- 0.7 lts in Group II (p > .01). We conclude that although the dose equivalence of both delivery systems have not been established in our study, the nebulized solution was more effective during the first 24 hours of hospitalization than the dry powder.