Risk factor analysis of allergic rhinitis in 6-8 year-old children in Taipei.

The incidence of allergic rhinitis (AR) has increased rapidly in Taiwan during the past 30 years; however, potential risk factors of AR have yet to be examined. The purpose of this study is to explore the prevalence, personal and environmental risk factors of rhinitis. A cross-sectional survey was conducted in 26418 first graders (6-8 years old) in Taipei with a response rate of 94.6% (24999/26418). Modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires were completed by their parents or main caregivers. Logistic regression was used to examine possible personal and environmental (in early life and current) factors related to rhinitis. The prevalence of rhinitis in the past 12 months was 42.8% in 6-8 years old children. Multivariate logistic regression analysis for both males and females revealed that male gender, antibiotic use in first year of life, bronchiolitis before the age of two years, diagnosed asthma, and diagnosed eczema, having a cat the first year of life were associated with an increased risk of rhinitis. Having older siblings, on the other hand, may reduce the risk of rhinitis. Based on the present study, we may recommend less use of antibiotics the first year of life and not having a cat in the home in the child's first year of life as preventive measures to reduce the risk of rhinitis. From the subgroup analysis, we can take preventive measures for the different risk factors of rhinitis and the severity of rhinitis in each subgroup.

Dose-Response Relationship of Outdoor Exposure and Myopia Indicators: A Systematic Review and Meta-Analysis of Various Research Methods.

Myopia in children has dramatically increased worldwide. A systematic review and meta-analysis were conducted to evaluate the effects of outdoor light exposure on myopia. According to research data from 13 studies of 15,081 children aged 4-14 at baseline, outdoor light exposure significantly reduced myopia incidence/prevalence (odds ratio [OR] = 0.85, 95% confidence interval [CI]: 0.80-0.91, p < 0.00001; I2 = 90%), spherical equivalent refractive error (SER) by 0.15 D/year (0.09-0.27, p < 0.0001), and axial elongation by 0.08 mm/year (-0.14 to -0.02, p = 0.02). The benefits of outdoor light exposure intervention, according to pooled overall results, included decreases in three myopia indicators: 50% in myopia incidence, 32.9% in SER, and 24.9% in axial elongation for individuals in Asia. Daily outdoor light exposure of more than 120 min was the most effective intervention, and weekly intervention time exhibited a dose-response relationship with all three indicators. Subgroup comparisons revealed that interventional studies report greater benefits from outdoor light exposure compared with cohort and cross-sectional studies, and individuals with myopia in intervention studies experienced slightly greater benefits than individuals without, in terms of SER and axial elongation. Therefore, this study suggests 120 min/day of outdoor light exposure at school.

The prevalence and risk factors of atopic dermatitis in 6-8 year-old first graders in Taipei.

BACKGROUND: Despite the advance in the understanding of etiology, pathophysiology and diagnosis of atopic dermatitis (AD), its prevalence has increased annually in Taiwan. PURPOSES: The purpose of this study is to explore the prevalence, and personal and environmental risk factors of AD. METHODS: A cross-sectional survey was conducted via health centers of elementary schools in Taipei city. We used the Chinese version of ISAAC questionnaire to examine possible personal and environmental risk factors of AD. Questionnaires were completed by parents or guardians of first graders (6-8 year-old) who agreed to participate in this study. Logistic regression was conducted to examine possible personal and environmental factors related to AD (in early life and currently). RESULTS: The 12-month prevalence of AD (in the past 12 months) was 10.7% (2683/24,999) among 6- to 8-year-old first graders in Taipei. Forty-five percent of first graders with AD had their first episode of AD symptoms before the age of two. Children with asthma history were 1.65 times (95% CI: 1.51-1.79, p < 0.001) and children with rhinitis were 2.57 times (95% CI: 2.34-2.84, p < 0.001) more likely to have AD than those without the conditions. Compare to their counterarts, children who used antibiotics during their first year of life (OR = 1.37, 95% CI: 1.22-1.53, p < 0.001) and who had bronchiolitis before the age of two (OR = 1.47, 95% CI: 1.33-1.63, p < 0.001) had a higher chance to have AD during the last 12 months of the study. However, receiving breastfeeding for less than 4 months (OR = 0.75, 95% CI: 0.67-0.83, p < 0.001) and having older siblings (OR = 0.83, 95% CI: 0.76-0.92, p < 0.001) had 25% and 17% reduced risks for AD in the 12 months before this study, respectively. CONCLUSION: Our study verified personal and environmental risk factors of AD in children in Taiwan. Based on the results, we propose that avoiding bronchiolitis before the age of two, using antibiotics properly in babies, and providing diet counseling for breastfeeding mothers may be good prevention strategies of AD.

Evaluation of efficacy and safety of Lactobacillus rhamnosus in children aged 4-48 months with atopic dermatitis: An 8-week, double-blind, randomized, placebo-controlled study.

OBJECTIVE: The main objective of this study was to evaluate the efficacy and safety of Lactobacillus rhamnosus in children aged 4-48 months with atopic dermatitis. METHODS: The design of this study was a two-center, double-blind, randomized, and placebo-controlled study with two parallel groups to evaluate the efficacy and safety profile of L. rhamnosus in children aged 4-48 months with atopic dermatitis diagnosed using Hanifin and Rajka criteria and with a Scoring of Atopic Dermatitis (SCORAD) ≥ 15 at enrollment. The duration of this study was 8 weeks with a total of five visits. The enrolled patients were allocated into either a treatment group (one ComProbi capsule containing L. rhamnosus a day) or a control group (one capsule of placebo a day) at a ratio of 1:1. The primary endpoint was to compare the mean change from baseline in SCORAD after 8 weeks of treatment. The other secondary end points were to compare the following: the mean changes from baseline in SCORAD at postbaseline visits, the frequency and total amount of the use of corticosteroids during the 8-week treatment, the frequency of atopic dermatitis and the symptom-free duration, the mean changes from baseline in Infant Dermatitis Quality of Life Questionnaire at Week 4 and Week 8, and the mean changes from baseline in the Dermatitis Family Impact Questionnaire at Week 4 and Week 8. RESULTS: The mean changes in SCORAD from baseline at Week 8 was -21.69 ± 16.56 in the L. rhamnosus group and -12.35 ± 12.82 in the placebo group for the intent-to-treat population (p = 0.014). For the per-protocol population, the mean change of SCORAD from baseline was -23.20 ± 15.24 in the L. rhamnosus group and -12.35 ± 12.82 in the placebo group (p = 0.003). Significant differences were demonstrated between groups at Week 8 in intensity in the intent-to-treat population and per-protocol population. Throughout the period, the amount of topical corticosteroids used showed no difference between groups. No significant difference was noted in the overall symptom-free durations compared with the placebo group. Infant Dermatitis Quality of Life Questionnaires and Dermatitis Family Impact Questionnaires scores improved significantly at Week 4 and Week 8 but did not reach statistical significance. Adverse events were documented in 14/33 patients in the L. rhamnosus group (42.42%, 35 events) and in 15/33 placebo patients (45.45%, 37 events). CONCLUSIONS: The results of this study indicated that L. rhamnosus was effective in decreasing symptoms of atopic dermatitis after an 8-week treatment by comparing the mean change of SCORAD from baseline with a placebo (p < 0.05). The reduction in SCORAD resulted from a consistent decrease in all components of SCORAD. Patients who took L. rhamnosus for 8 weeks expressed less SCORAD in the three components: area of affected skin, intensity of atopic dermatitis, and patient symptoms, with a significant decrease in the mean change of intensity from baseline compared with placebo.

A survey of serum specific-lgE to common allergens in primary school children of Taipei City.

Environmental factors and eating habits have had a significant impact on the increased sensitization to allergens in children. This study investigated changes in common allergen sensitivities among children in Taipei City, Taiwan. A total of 142 primary schools in Taipei City, which included 25,094 students aged 7-8 years, were surveyed using an ISAAC questionnaire to screen for allergies. For positive responders, serum allergen-specific IgE was confirmed using the Pharmacia CAP system. A total of 1,500 students (5.98%) had confirmed sensitivities to allergens. Dust mite sensitivity among these children was nearly 90%. The prevalences of sensitivities to Dermatophagoides pteronyssinus, D. farinae and Blomia tropicalis were 90.79%, 88.24%, and 84.63%, respectively. Dog dander (29.95%) was the second most common aeroallergen to induce sensitivity. Allergies to cat dander (8.69%) and to cockroach (15.48%) had decreased dramatically compared with previous analyses. Among the food allergens studied, the most common allergens that induced sensitization were (in order of prevalence) crab, milk, egg white, and shrimp (88.08%, 22.45%, 24.23%, and 21.44%, respectively). Mold and pollen sensitization was identified in fewer than 2% of the schoolchildren. Dust mites remain the most common allergen to induce allergic sensitization among children in Taipei City, while cockroach and mold sensitivities have dramatically declined. Food allergens should also be considered as a trigger of respiratory allergy. Except for dust mites, American cockroach and crab, allergens commonly reported to induce sensitization in other Asian counties are not common in Taiwan.

Primary Epstein-Barr virus infection in 2-year-old children: report of 3 cases.

Some children less than four years old have Epstein-Barr virus (EBV)-induced infectious mononucleosis (IM). Because primary EBV infection in infants and young children is usually asymptomatic or subclinical, EBV infection diagnosis may not be easy among young children. To illustrate the clinical characteristics and diagnostic procedures for EBV infection in young children, the authors report herein three cases of primary EBV infection in two-year-old children with an evaluation of their initial clinical symptoms. The results showed that the common initial clinical manifestations are puffy eyelids and hepatosplenomegaly, and that these signs suggest a tentative diagnosis of IM. In conclusion, EBV capsid immunoglobulin (Ig)M antibodies and atypical lymphocytes are useful diagnostic measurements in very young children with symptoms suggestive of IM.

Rotavirus gastroenteritis complicated with toxic megacolon.

UNLABELLED: Rotavirus is a leading cause of gastroenteritis in young children, which may indicate hospitalization due to dehydration and electrolyte imbalance. Most cases are self-limited with good prognosis. The association between rotavirus and toxic megacolon has never been mentioned in the literature. We report a case of toxic megacolon secondary to rotavirus gastroenteritis. CONCLUSION: Toxic megacolon can occur in patients with rotavirus gastroenteritis. An abdominal radiograph should be taken for patients with rotavirus gastroenteritis who have systemic toxicity and persistent abdominal fullness.

Enhanced radiosensitivity and radiation-induced apoptosis in glioma CD133-positive cells by knockdown of SirT1 expression.

CD133-expressing glioma cells play a critical role in tumor recovery after treatment and are resistant to radiotherapy. Herein, we demonstrated that glioblastoma-derived CD133-positive cells (GBM-CD133(+)) are capable of self-renewal and express high levels of embryonic stem cell genes and SirT1 compared to GBM-CD133(-) cells. To evaluate the role of SirT1 in GBM-CD133(+), we used a lentiviral vector expressing shRNA to knock-down SirT1 expression (sh-SirT1) in GBM-CD133(+). Silencing of SirT1 significantly enhanced the sensitivity of GBM-CD133(+) to radiation and increased the level of radiation-mediated apoptosis. Importantly, knock-down of SirT1 increased the effectiveness of radiotherapy in the inhibition of tumor growth in nude mice transplanted with GBM-CD133(+). Kaplan-Meier survival analysis indicated that the mean survival rate of GBM-CD133(+) mice treated with radiotherapy was significantly improved by Sh-SirT1 as well. In sum, these results suggest that SirT1 is a potential target for increasing the sensitivity of GBM and glioblastoma-associated cancer stem cells to radiotherapy.

Montelukast as monotherapy in children with mild persistent asthma.

The cysteinyl leukotrienes cause bronchoconstriction, increased mucus production and airway inflammation, three major features of asthma. Several randomized controlled trials have shown the efficacy of leukotriene receptor antagonists for improving asthma outcomes. The drug is favored for treating childhood asthma, where poor compliance with inhalation therapy is a therapeutic challenge. To assess the effectiveness of Montelukast in asthmatic children under real-life conditions, a prospective, single-arm, multicenter, open-label observational study was performed on asthmatic children 2- to 14-years-old with a history of physician-diagnosed mild persistent asthma. Montelukast was given once daily for 12 consecutive weeks. By the end a significant improvement of the daytime asthma symptom score, nighttime asthma score, peak expiratory flow rate (PEFR) and mean score of the investigators' global evaluation was noted (p < 0.05). These results suggest that montelukast is an effective monotherapy controller in children with mild persistent asthma.

Systemic lupus erythematosus associated with extreme hypertriglyceridemia.

Only a few cases of hypertriglyceridemia in patients with systemic lupus erythematosus (SLE) have been reported. We report a case of a 13-year-old girl suffering from SLE associated with severe hypertriglyceridemia. The persistent hypertriglyceridemia was extremely well tolerated. As a result of steroid treatment, serum triglycerides fell dramatically from a high of 5601 mg/dL to 75 mg/dL despite the patient switching to a free diet. We considered the presence of an autoantibody to lipoprotein lipase and commenced immunosuppression. The role of steroids in completely correcting deficient lipoprotein lipase activity is discussed.

Caffeic acid phenethyl ester preferentially enhanced radiosensitizing and increased oxidative stress in medulloblastoma cell line.

OBJECTIVES: Caffeic acid phenethyl ester (CAPE), an active component of propolis, was recently reported to have radiosensitizing effects on medulloblastoma (MB) cells. However, the mechanisms of radiosensitivity involved in medulloblastoma cells are still unclear. The specific aim of this study was to investigate the role of CAPE-induced oxidative stress to influence of radiosensitivity and anti-proliferative effects in medulloblastoma cells. MATERIALS AND METHODS: Medulloblastoma (Daoy) cells were treated with CAPE in different concentrations and assessed for cell viability. The following were also evaluated: migratory ability, reduced glutathione (GSH) level, reactive oxygen species (ROS) level, nuclear factor-kappaB (NF-kappaB) activity, and apoptosis in CAPE alone, radiation alone, or radiation combined with CAPE in Daoy cells. RESULTS: The results indicated that CAPE inhibited the growth of Daoy cells. CAPE treatment in Daoy cells could effectively decrease glutathione reductase and significantly increase glutathione peroxidase. Radiation-activated NF-kappaB was reversed by CAPE pretreatment. Finally, the result of terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay showed that CAPE treatment can enhance radiation-induced apoptosis in Daoy cells. CONCLUSIONS: Our study demonstrated the anti-proliferative and radiosensitizing effects of CAPE on MB cells, which may be achievable through depleting GSH, increased ROS activity, and inhibiting NF-kappaB activity.

Eicosanoids in asthma.

Eicosanoids belong to a diverse family of bioactive fatty acids that play important roles in regulating airway inflammation and reactivity. They are the key mediators of the pathobiology of asthma. Among the eicosanoids, lipoxins (LXs) were the first agents to be identified and recognized as potential anti-inflammatory endogenous lipid mediators. Lipoxins are biosynthesized in vivo at inflammation sites. They result mainly from the interaction between 5 and 15-lipoxygenases (LOs), which are distinct from leukotrienes (LTs) and prostaglandins (PGs) in structure and function. Leukotrienes are potent proinflammatory mediators and directly and indirectly stimulate fibroblast chemotaxis, proliferation, and collagen synthesis. Prostaglandins have both bronchoconstrictive and bronchoprotective effects and the bronchoconstriction mediated by PGD2 and PGF2alpha is only occurred in asthmatic patients but not in healthy subjects. Lipoxins counter-regulate the proinflammatory actions of LTs and activate resolution of the inflammatory response. At least two classes of receptors, CysLT1 receptors and Asprin-triggered lipoxin A4 (ALX) receptors, can interact with lipoxin A4 (LXA4) and LXA4 analogs to mediate their biologic actions. Allergen challenge initiates airway biosynthesis of LXA4 and increases expression of its receptor. In addition, LXA4 affects the release of interleukin-8 by blood mononuclear cells, and ALX affects calcium influx into epithelial cells. Therefore, the pivotal role of LXs is mediating airway homeostasis, and LXs may be part of a novel, multipronged approach for treating human asthma.

Prevalence and severity of symptoms of asthma, rhinitis, and eczema in 13- to 14-year-old children in Taipei, Taiwan.

BACKGROUND: The prevalence of asthma and allergic diseases in children has increased worldwide. OBJECTIVE: To perform the phase 3 survey of the International Study of Asthma and Allergies in Children (ISAAC) to report the time trend of the prevalence and severity of asthma and allergic diseases in children in Taipei. METHODS: Two junior high schools in each of the 12 school districts in Taipei were randomly chosen to enter the study. All students aged 13 to 14 years in the chosen schools were invited to participate in written and video questionnaires in Chinese (identical to those of the ISAAC phase 1 survey). The study was performed between December 1, 2001, and January 31, 2002. All data analysis followed the protocol of the ISAAC and then was submitted to the ISAAC International Data Center. RESULTS: Of 6653 eligible children from 23 high schools (1 school refused participation), 6381 (95.9%) participated. The prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in the past 12 months in 13- to 14-year-old children increased by 37%, 51%, and 193%, respectively, on written questionnaires during a 7-year period. The severity of asthma symptoms, including more than 4 wheezing attacks in the past 12 months, wheezing that disturbs sleep more than once per week, and wheezing that limited speech in the past 12 months, did not show any significant changes on written questionnaires during the 7 years. CONCLUSION: The increasing prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in 13- to 14-year-old children in Taipei in a 7-year period is a significant burden on public health systems in Taiwan.

Efficacy of nebulized budesonide in hospitalized infants and children younger than 24 months with bronchiolitis.

To evaluate the effect of nebulized budesonide on acute, young, wheezing patients, a total of 73 patients, aged below 24 months, who were hospitalized due to bronchiolitis were randomly enrolled into this study according to age. They were divided into four groups and treated with four kinds of nebulized solutions. Group I consisted of 18 patients under 12 months old who were treated with budesonide (1 mg/2 ml) diluted with 2 ml isotonic sodium chloride. Group II consisted of 18 patients under 12 months old who were treated with 4 ml isotonic sodium chloride. Group III included 16 patients between 12 and 24 months old who were treated with terbutaline (5 mg/2 ml) diluted with 2 ml isotonic sodium chloride. Group IV included 21 patients between 12 and 24 months old who were treated with budesonide (1 mg/2 ml) and terbutaline (5 mg/2 ml). Clinical data on respiratory rate, wheezing score, cyanosis score and accessory respiratory muscle utilization score were recorded in all patients before and after treatment throughout the entire hospitalization. The results of this study showed no benefits from nebulized budesonide in infants with bronchiolitis either younger than 12 months old or between 12 and 24 months of age. The duration of admission also showed no significant differences among the groups.

The function profile of compressed-air and ultrasonic nebulizers.

In order to study the detailed function of two kinds of nebulizers commonly used in clinical asthma treatment, compressed-air and ultrasonic, this study was conducted. At the beginning, various flow rates were adjusted, paired with different volumes of solutions in the container. The changes of temperature, pH, and osmolality during the course of nebulization were examined. Normal saline, terbutaline, and fenoterol solutions were used as the nebulized solutions. The study was performed in an environment in ambient temperature around 20 degrees C and relative humidity around 70%. The results showed a minimal 6 L/min flow rate was required to nebulize the solution when using the compressed-air nebulizer. The dead volume was about 0.8 ml for compressed-air and 8.5 ml for the ultrasonic nebulizer. When using the compressed-air nebulizer, the temperature, both in the solution and at the mouthpiece site, dropped gradually. On the contrary, the temperatures at both sites increased a little bit when using the ultrasonic nebulizer. The pH values of pure terbutaline and fenoterol nebulized solutions were acidic (3.58 and 3.00 respectively). The osmolality of terbutaline and fenoterol nebulized solutions were isotonic. The osmolality increased gradually during the course of nebulization, to a greater extent in the compressed-air nebulizer. In conclusion, both types of nebulizers have their special features. The ultrasonic nebulizer displays less extent in change of temperature and osmolality during nebulization and is expected to be a better device in treating asthmatic patients in terms of lesser effect on cooling and changing the osmolality of airway mucosa.