Twenty‐six patients with stable angina pectoris, resistant to medical treatment, were randomized to either active or sham acupuncture in a single‐blind design. Sham acupuncture was defined as the insertion of needles in a point within the same spinal segments as the active acupuncture, but outside the Chinese meridian system. The effect was evaluated from anginal attack rate, nitroglycerin consumption and exercise tests. Compared to patients receiving sham acupuncture the patients receiving active acupuncture increased cardiac work capacity significantly, expressed as dPRP (difference in pressure‐rate‐product between rest and maximum exercise) and maximal PRP during exercise (p<0.001). None of the other variables showed any significant difference between the two groups. Concerning exercise tolerance the median difference was 138 Wmin (95% confidence limits ‐12.5 to 325 Wmin), concerning anginal attack rate the median difference was 29.5% (95% confidence limits 55% to ‐11%) and with regard to nitroglycerin consumption the median difference was 5% (95% confidence limits +67% to ‐44%). No significant effect of sham treatment was observed, no adverse effect was observed. We suggest that acupuncture may improve cardiac work capacity in patients with angina pectoris, refractory to medical treatment.

One hundred and twenty-three children, aged 1.5-18 months, participated in a randomized, double-blind, placebo-controlled multicentre study comparing different treatments for acute wheezing. The children were admitted to one of five participating paediatric departments. They were randomized into one of four treatment groups: (1) soluble prednisolone+placebo inhalation+terbutaline inhalation; (2) soluble placebo+budesonide inhalation+terbutaline inhalation; (3) soluble placebo+placebo inhalation+terbutaline inhalation; and (4) soluble placebo+placebo inhalation+normal saline inhalation. On admission, measurements of temperatures, respiratory rate and heart rate were made and once-a-day thereafter. Wheezing, accessory respiratory muscle use, prolonged expiration and general condition were scored on a scale ranging from 0 to 3. Significantly more treatment failures were recorded in the placebo group. Children from both steroid groups were discharged earlier than children from the terbutaline group. Compared with children from the placebo group, children from all three treatment groups had a greater improvement in symptom score, but this was significant for the budesonide group only.

We carried out a randomized, placebo-controlled, double-blinded trial to evaluate the effect on morbidity of high dose oral vitamin A, given on hospital admission to 592 children aged 1-59 months with moderate and severe pneumonia. Severely underweight children were not included, but 45% were moderately underweight. The vitamin A and placebo groups were comparable in baseline characteristics. Four patients died. Among all of the surviving children, no differences were found regarding mean time for normalization of fever, respiratory rate and time of hospitalization. Stratification for moderate malnutrition, degree of pneumonia, age and sex revealed moderately malnourished vitamin A-supplemented children to have a shorter time of hospitalization (p = 0.04), due to an effect in females aged > 12 months (p = 0.02) and females with very severe pneumonia (p = 0.048). This study indicates that, in developing countries like Vietnam, supplementation with vitamin A in children with pneumonia could shorten the recovery rate in the ones that are undernourished, especially females > 1 y old.

Age related differences in immunological reactions include variations in the in vitro functions of blood mononuclear cells (MNC). In an attempt to understand the mechanism behind these differences we examined age related differences in the phenotype profiles of MNC in parallel with the in vitro production of interleukin IL-6, tumour necrosis factor alpha (TNF alpha) and interferon gamma (IFNg) in neonates, children and adults. In cultures without added polyclonal activators IL-6 and TNF alpha levels in children were 3-6 times higher than those of umbilical cords and adults. However, using optimal in vitro stimulation (E. coli lipopolysaccharide (LPS), phytohaemmagglutinin or pokeweed mitogen (PWM)) no significant differences in the levels of these cytokines were observed. The levels of IFNg in PWM driven cultures followed a different pattern with comparable levels in children and adults, and unmeasurable levels in cord blood MNC. Flow cytometry analysis of the phenotypic distribution of MNC revealed age related differences in the expression of CD3, CD4, CD8, CD14, CD19, CD45RA, CD45R0, CD2, LFA-1, ICAM-1 and LFA-3. Correlation studies did not indicate that the observed differences in cytokine production could be ascribed to differences in the frequency of monocytes, T cells or B cells. The TNF alpha levels in suboptimally stimulated cultures correlated negatively with the expression of LFA-3 and positively with CD45RA, while IFNg correlated positively with CD2, LFA-1, CD45R0 and CD8. In conclusion, the study provides evidence of age related differences in the production of TNF alpha, IL-6 and IFNg among neonates, children and adults. These differences may to some extent be caused by differences in the expression of cell surface molecules involved in cellular interactions and signalling.