Widespread expression of beta-defensin hBD-1 in human secretory glands and epithelial cells

We compared the expression of human alpha- and beta-defensins by various human tissues. mRNA for alpha-defensins HNP1-3, abundant in bone marrow, was detected in peripheral blood leukocytes, spleen and thymus by RT-PCR, which revealed alpha-defensins HD5 and HD6 only in the small intestine. In contrast, the pancreas and kidney expressed high levels of hBD-1 and lower levels of this beta-defensin were found in many organs by RT-PCR (salivary gland > trachea > prostate and placenta > thymus, testis, small intestine). hBD-1 mRNA was produced constitutively by cultured normal human epithelial cells derived from the trachea, bronchi, small airways and the mammary gland. These largely non-overlapping tissue distributions of human alpha- and beta-defensins suggest that hBD-1 may be positioned to defend epithelial cells and mucosae from infection, whereas expression of HNP1-3 in neutrophils and HD5 and HD6 in Paneth cells allows these alpha-defensins to participate in systemic and small intestinal host defenses, respectively.

Phages will out: strategies of host cell lysis

Most phages accomplish host lysis using a muralytic enzyme, or endolysin, and a holin, which permeabilizes the membrane at a programmed time and thus controls the length of the vegetative cycle. By contrast, lytic single-stranded RNA and DNA phages accomplish lysis by producing a single lysis protein without muralytic activity.

Photodynamic therapy of non-melanoma malignant tumours of the skin using topical delta-amino levulinic acid sensitization and laser irradiation

Eighty basal cell carcinomas (BCCs) in 21 patients, 10 lesions of Bowen's disease in three patients, and four lesions of cutaneous T-cell lymphoma in two patients, were treated with photodynamic laser therapy (PDT), using topical application of the haem precursor delta-amino levulinic acid (ALA). The diagnoses were confirmed histologically prior to treatment. Fifty-five of the BCCs were superficial lesions, and 25 were nodular. Of the 80 BCCs, 39 (49%) were located on the trunk, 36 (45%) on the head and neck region, four (15%) on the leg and one on the arm. The two principal locations of the 10 Bowen's disease lesions were the leg (50%) and the trunk (40%). The T-cell lymphoma lesions were located on the shoulder and on the arm. A water-in-oil based cream containing 20% ALA was applied to the lesions, with a margin of about 10-20 mm beyond the visible tumour border, 4-6 h before the laser procedure. During this period of time the highly fluorescent and photodynamically active substance protoporphyrin IX (Pp IX) is synthesized via the haem cycle. Laser-induced fluorescence (LIF) was used for real-time monitoring of the Pp IX distribution in the tumour and in the normal surrounding skin, before and after treatment in all patients. Before laser treatment the Pp IX distribution demonstrated by LIF showed a demarcation between tumour and normal skin of about 15:1 for BCC and Bowen's disease, and 5:1 for T-cell lymphomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Photodynamic therapy vs. cryosurgery of basal cell carcinomas: results of a phase III clinical trial

BACKGROUND

A previously reported randomized clinical trial showed treatment of Bowen's disease using photodynamic therapy (PDT) with topically applied delta-aminolaevulinic acid (ALA) to be at least as effective as cryosurgery and to be associated with fewer adverse effects.

OBJECTIVES

To compare ALA-PDT and cryotherapy in the treatment of histopathologically verified basal cell carcinomas (BCCs) in a non-blinded, prospective phase III clinical trial.

METHODS

One lesion from each of 88 patients was included. The BCCs were divided into superficial and nodular lesions. The follow-up period was restricted to 1 year with close follow-up for the first 3 months. Efficacy was assessed as the recurrence rate 12 months after the first treatment session, verified by histopathology. Tolerability was evaluated as the time of healing, pain and discomfort during and after the treatment, and final cosmetic outcome.

RESULTS

Histopathologically verified recurrence rates in the two groups were statistically comparable and were 25% (11 of 44) for ALA-PDT and 15% (six of 39) for cryosurgery. However, clinical recurrence rates were only 5% (two of 44) for PDT and 13% (five of 39) for cryosurgery. Additional treatments, usually one, had to be performed in 30% of the lesions in the PDT group. The healing time was considerably shorter and the cosmetic outcome significantly better with PDT. Pain and discomfort during the treatment session and in the following week were low, and were equivalent with the two treatment modalities.

CONCLUSIONS

In terms of efficacy, ALA-PDT is comparable with cryosurgery as a treatment modality for BCCs. Retreatments are more often required with PDT than with cryosurgery. This can easily be performed due to the shorter healing time, less scarring and better cosmetic outcome that follows ALA-PDT.

The effect of prenatal perfluorinated chemicals exposures on pediatric atopy

BACKGROUND

The role of perfluorinated compounds (PFCs) in the immune system and allergic diseases is not well-known. This study examined the effects of pre-natal exposure to PFCs on immunoglobulin E (IgE) levels and atopic dermatitis (AD).

METHODS

In Taiwan Birth Panel cohort study, newborns with cord blood and peri-natal factors (i.e. birth body weight, weeks of gestation, and type of delivery) gathered at birth were evaluated. At the age of 2 years, information on the development of AD, environmental exposures, and serum total IgE were collected. The AD and non-AD children were compared for the concentration of cord blood serum PFCs measured by Ultra-performance liquid chromatography/triple-quadrupole mass (UPLC-MS/MS). Correlations among cord blood IgE, serum total IgE at 2 years of age, and cord blood PFC levels were made.

RESULTS

Of 244 children who completed the follow-up and specimen collections, 43 (17.6%) developed AD. Concentrations of cord blood serum perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS) were median (range) 1.71 (0.75-17.40), 5.50 (0.11-48.36), 2.30 (0.38-63.87), and 0.035 (0.035-0.420)ng/mL, respectively. PFOA and PFOS levels positively correlated with cord blood IgE levels (per ln-unit: β=0.134 KU/l, p=0.047 for PFOA; β=0.161 KU/l, p=0.017 for PFOS). Analyses stratified by gender revealed that PFOA and PFOS levels positively correlated with cord blood IgE levels only in boys (per ln-unit: β=0.206 KU/l, p=0.025 for PFOA; β=0.175 KU/l, p=0.053 for PFOS). When dividing cord blood serum PFCs into quartiles in the fully adjusted models, AD had no significant association with PFOS.

CONCLUSIONS

Pre-natal PFOA and PFOS exposures positively correlated with cord blood IgE levels.

Early life phthalate exposure and atopic disorders in children: a prospective birth cohort study

The role of phthalate exposure at different stages in the immune system and atopic disorders is not well-known. This study aims to evaluate the effects of prenatal and postnatal phthalate exposures on immunoglobulin E (IgE) levels and atopic dermatitis (AD) in children by objective biomarkers. We conducted a prospective Taiwan Birth Panel cohort study with 483 mother/infant pairs. Finally, 161 urine specimens at 3rd trimester of pregnancy, 219 urine specimens from children at age 2, and 192 urine specimens at age 5 were analyzed after excluding missing data and loss to follow-up. Urine monoethyl phthalate (MEP), monobutyl phthalate (MBP), monobenzyl phthalate (MBzP), and mono-(2-ethylhexyl) phthalate (MEHP) at 3rd trimester of pregnancy and at ages 2 and 5 were measured by ultra-performance liquid chromatography coupled with tandem mass spectrometry. At ages 2 and 5, information on the development of AD and serum total IgE was collected. The association between urine phthalate metabolite levels at different stages and serum IgE and AD was evaluated by multivariate linear regression and logistic regression. Urine phthalate metabolite levels were higher at age 2 than those at pregnancy and age 5. At each period, urine MBP levels were higher than MEP, MEHP, and MBzP. MEHP levels at age 2 positively correlated with serum IgE levels (per ln-unit: β=0.191, p=0.02). Analyses stratified by gender revealed that MEHP levels positively correlated with serum IgE levels only in boys (per ln-unit: β=0.256, p=0.03). When dividing into quartiles, urine MBzP levels at age 2 had a significant association with AD. We found no statistically significant association of other phthalate metabolites with IgE and AD. Early life phthalate exposure may increase the risk of allergic sensitization and atopic disorders.

Allergens, air pollutants, and childhood allergic diseases

BACKGROUND

The synergistic effect of allergens and air pollutants on the risk of allergic diseases is unclear.

OBJECTIVE

To evaluate the joint effect of outdoor pollutants and indoor allergens on the risk of allergic diseases.

METHODS

We enrolled 2661 kindergarten children from the CEAS cohort. Data on allergic diseases and environmental exposure were collected. Skin prick tests were performed. Individual exposure to air pollution was estimated using a geographic information system with the mean concentration of air pollutants. Multiple logistic regression analysis was performed to estimate the association between air pollutants, allergen exposure and the risk of allergic diseases with adjustments for potential confounders.

RESULTS

Overall, 12.6% of the children had asthma, 30.0% had allergic rhinitis (AR), and 14.4% had atopic dermatitis (AD). Mite sensitization significantly increased the risk of AD, AR, and asthma (OR (95%CI) 2.15 (1.53-3.03), 1.94 (1.46-2.58), and 2.31 (1.63-3.29), respectively). Exposure to PM10, PM(2.5), CO, and O(3) was associated with asthma (OR (95% CI) 1.39 (1.03-1.87), 1.45 (1.07-1.97), 1.36 (1.01-1.83), and 0.68 (0.51-0.92), respectively). PM(2.5) may have increased the risk of AR (OR (95% CI) 1.54 (1.03-2.32). Mite sensitization showed a synergistic effect with PM(2.5) on the development of asthma (p < 0.001). Moreover, mite allergens may modify the effect of air pollutants on allergic diseases.

CONCLUSION

Dust mites and PM(2.5) play an important role on the risk of asthma and AR. Exposure to PM(2.5) and mite allergens had a synergistic effect on the development of asthma. Avoiding co-exposure to allergens and air pollutants is important.

Preliminary evaluation of two fluorescence imaging methods for the detection and the delineation of basal cell carcinomas of the skin

BACKGROUND AND OBJECTIVE

Fluorescence techniques can provide powerful noninvasive means for medical diagnosis, based on the detection of either endogenous or exogenous fluorophores. The fluorescence of delta-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) has already shown promise for the diagnosis of tumors. The aim of the study was to investigate the localization of skin tumors after the topical application of ALA, by detecting the PpIX fluorescence either in the spectral or in the time domain. STUDY DESIGN/MATERIALS N AND METHODS: Two fluorescence imaging systems were used to identify basal cell carcinomas of the skin in humans, after topical application of 20% ALA ointment. Both systems rely on the comparison between the exogenous and the endogenous fluorescence, performed either in the spectral domain or in the time domain. The first system works by using three images acquired through different spectral filters, whereas the second one measures the spatial map of the average fluorescence lifetime of the sample.

RESULTS

A clear demarcation of skin malignancies was successfully performed in vivo noninvasively with both fluorescence imaging systems.

CONCLUSION

The two complementary approaches considered in the present study show promise for skin tumor detection and delineation based on specific fluorescence features.

Kinetic fluorescence studies of 5-aminolaevulinic acid-induced protoporphyrin IX accumulation in basal cell carcinomas

Laser-induced fluorescence (LIF) investigations have been performed in connection with photodynamic therapy (PDT) of basal cell carcinomas and adjacent normal skin following topical application of 5-aminolaevulinic acid (ALA) in order to study the kinetics of the protoporphyrin IX (PpIX) build-up. Five superficial and 10 nodular lesions in 15 patients are included in the study. Fluorescence measurements are performed prior to the application of ALA, 2, 4 and 6 h post ALA application, immediately post PDT (60 J cm-2 at 635 nm), and 2 h after the treatment. Hence, the build-up, photobleaching and re-accumulation of PpIX can be followed. Superficial lesions show a maximum PpIX fluorescence 6 h post ALA application, whereas the intensity is already the highest 2-4 h after the application in nodular lesions. Immediately post PDT, the fluorescence contribution at 670 nm from the photoproducts is about 2% of the pre-PDT PpIX fluorescence at 635 nm. Two hours after the treatment, a uniform distribution of PpIX is found in the lesion and surrounding normal tissue. During the whole procedure, the autofluorescence of the lesions and the normal skin does not vary significantly from the values recorded before the application of ALA.

Changing indications for penetrating keratoplasty in Taiwan from 1987 to 1999

PURPOSE

To determine the leading indications for penetrating keratoplasty and to identify changing trends in these indications during the past 12 years.

METHODS

We retrospectively performed a chart review of the hospital records of all patients undergoing penetrating keratoplasty at the National Taiwan University Hospital during a 12-year period (1987-1999). When possible, the clinical indication was corroborated by the pathologic report.

RESULTS

A total of 770 corneal transplants were performed. The leading indications for penetrating keratoplasty. in order of decreasing frequency, were corneal scars (27.9%), regraft (21.0%), acute necrotizing and ulcerative keratitis (17.9%), pseudophakic or aphakic bullous keratopathy (17.6%), Fuchs' dystrophy (4.5%), and keratoconus (2.5%). A trend of increasing frequency of regraft and acute necrotizing and ulcerative keratitis, a decreasing frequency of corneal scar, and an initially decreasing then increasing frequency of pseudophakic and aphakic bullous keratopathy were found during the 12-year study period. Acute necrotizing and ulcerative keratitis was found to be the most frequent indication for regraft.

CONCLUSION

In this series, corneal scars, regraft, and acute necrotizing and ulcerative keratitis were the leading indications for penetrating keratoplasty. A changing incidence of pseudophakic and aphakic bullous keratopathy noted during the study period was related to the type of intraocular lens implanted and the method of cataract surgery performed. This study found a comparatively high frequency of acute necrotizing and ulcerative keratitis and an extremely low frequency of keratoconus compared with previous reports.

Effects of phthalate exposure on asthma may be mediated through alterations in DNA methylation

Background

Phthalates may increase the asthma risk in children. Mechanisms underlying this association remain to be addressed. This study assesses the effect of phthalate exposures on epigenetic changes and the role of epigenetic changes for asthma. In the first step, urine and blood samples from 256 children of the Childhood Environment and Allergic diseases Study (CEAS) were analyzed. Urine 5OH-MEHP levels were quantified as an indicator of exposure, and asthma information was collected. DNA methylation (DNA-M) was measured by quantitative PCR. In the screening part of step 1, DNA-M of 21 potential human candidate genes suggested by a toxicogenomic data were investigated in 22 blood samples. Then, in the testing part of step 1, positively screened genes were tested in a larger sample of 256 children and then validated by protein measurements. In step 2, we replicated the association between phthalate exposure and gene-specific DNA-M in 54 children in the phthalate contaminated food event. In step 3, the risk of DNA-M for asthma was tested in 256 children from CEAS and corroborated in 270 children from the Isle of Wight (IOW) birth cohort.

Results

Differential methylation in three genes (AR, TNFα, and IL-4) was identified through screening. Testing in 256 children showed that methylation of the TNFα gene promoter was lower when children had higher urine 5OH-MEHP values (β = −0.138, P = 0.040). Functional validation revealed that TNFα methylation was inversely correlated with TNFα protein levels (β = −0.18, P = 0.041). In an additional sample of 54 children, we corroborated that methylation of the TNFα gene promoter was lower when urine 5OH-MEHP concentrations were higher. Finally, we found that a lower methylation of 5′CGI region of TNFα was associated with asthma in 256 CEAS children (OR = 2.15, 95% CI = 1.01 to 4.62). We replicated this in 270 children from the IOW birth cohort study. Methylation of the CpG site cg10717214 was negatively associated with asthma, when children had ‘AA’ or ‘AG’ genotype of the TNFα single nucleotide rs1800610.

Conclusions

Effects of phthalate exposure on asthma may be mediated through alterations in DNA methylation.

Electronic supplementary material

The online version of this article (doi:10.1186/s13148-015-0060-x) contains supplementary material, which is available to authorized users.

Photodynamic therapy utilising topical delta-aminolevulinic acid in non-melanoma skin malignancies of the eyelid and the periocular skin

PURPOSE

Photodynamic therapy utilising delta-aminolevulinic acid-induced protoporphyrin IX photosensitisation, was evaluated as a treatment modality for nonmelanoma skin malignancies of the eyelids and the periocular skin.

METHODS

Photodynamic therapy with laser light at 635 nm was performed in 13 patients with 19 basal cell carcinomas and one patient with 3 cutaneous T-cell lymphoma lesions. A topical application regimen was used and in median 3 treatment sessions were given to each lesion.

RESULTS

A visually judged complete response was achieved in 42% (8/19) of the basal cell carcinomas and in 100% of the T-cell lymphoma lesions (3/3). Partial tumour response was seen in 42% (8/19) and no response in 16% (3/19) of the basal cell carcinomas. The median follow-up time was 12 months. No, or very little scarring and loss of cilia were induced by the treatment.

CONCLUSION

Photodynamic therapy with delta-aminolevulinic acid can eradicate eye-close non-melanoma skin malignancies without compromising the function of the eyelids. Further development of the method is needed to reach the same cure rates as those of the conventional treatment modalities.

Polycyclic aromatic hydrocarbons exposure, oxidative stress, and asthma in children

PURPOSE

Polycyclic aromatic hydrocarbons (PAHs) are known for their carcinogenic and teratogenic properties. However, little is known about the effect of PAH on our immune and respiratory systems. Hence, we investigated associations (1) between PAH exposure and IgE levels and asthma in children and (2) between PAH exposure and the oxidative stress marker 8OHdG potentially involved in disease pathogenesis stratifying by (3) sex-based differences.

METHODS

A total of 453 kindergarten children were recruited and provided samples. Urine biomarker of PAH exposure (1-OHP levels) was measured by UPLC-MS/MS and a marker of oxidative stress (8OHdG) was measured by ELISA. Serum IgE were assessed and information on asthma was collected. Associations between 1-OHP levels, 8OHdG, IgE and asthma were analyzed by multivariate linear and logistic regression. A mediation analysis was conducted to evaluate whether the risk of increased IgE and asthma related to PAH exposure is explained by 8OHdG changes.

RESULTS

Urine 1-OHP levels were positively related to 8OHdG levels (per ln-unit: β = 0.30kU/l, p = 0.002). Similar results were also found for 1-OHP levels with IgE levels (per ln-unit: β = 0.27 kU/l, p = 0.027). 1-OHP levels (per ln-unit) were significantly associated with asthma, with an OR (95% CI) of 1.42 (1.18-1.70). In addition, 1-OHP levels were associated with asthma. It is estimated that 35% of the effect of PAH exposure on asthma is mediated by 8OHdG levels.

CONCLUSION

Exposure to PAH may enhance oxidative stress and may induce asthma. The effect of PAH exposure on asthma may be mediated by oxidative stress.

Pharmacokinetic studies on 5-aminolevulinic acid-induced protoporphyrin IX accumulation in tumours and normal tissues

Laser-induced fluorescence (LIF) for in vivo point monitoring and fluorescence microscopy incorporating a CCD camera were used to study the fluorescence distribution of 5-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) in tumours. Fluorescence in a chemically-induced adenocarcinoma in the liver of rats and in an aggressive basal cell carcinoma in a patient were studied after intravenous injection of ALA at a dose of 30 mg/kg body weight. The LIF technique demonstrated slightly more ALA-induced PpIX fluorescence in the tumour than in the surrounding normal liver and abdominal muscle of rats. The visible parts of the human basal cell carcinoma exhibited strong ALA-induced fluorescence, while this fluorescence was much weaker in the necrotic areas of the tumour and in the surrounding normal skin.

Lead exposure, IgE, and the risk of asthma in children

Lead (Pb) has adverse effects on our nervous system and renal systems. Young children are more vulnerable to Pb exposure. However, the role of low-level Pb exposure in the immune system and allergic diseases in children is not well established. The aims of this study are to investigate the associations between Pb exposure and allergic diseases; between Pb and immunoglobulin E (IgE) as an intervening variable; and gender-based differences. We used multistage stratified random sampling to recruit kindergarten children nationwide in Taiwan. Information about allergic diseases and environmental exposures was collected by questionnaire. We compared children with and without allergic diseases for blood Pb levels measured by inductively coupled plasma mass spectrometry. The association between blood Pb and allergic diseases was assessed by logistic regression and those between Pb and IgE by generalized linear models. We also conducted mediation analysis to evaluate how much risk of allergic diseases related to Pb exposure is explained by IgE. A total of 930 children completed specimen collections. There was a positive association between Pb and asthma. Blood Pb were also positively linked with serum IgE (β=0.26 kU/l per ln-unit increase Pb concentration; 95% CI 0.009-0.50 kU/l), after adjusting for potential confounders. Analyses stratified by gender revealed that blood Pb correlated with IgE only in boys (β=0.40 kU/l; 95% CI 0.03-0.76 kU/l). We estimated that 38% of the total effect of Pb exposure on asthma is mediated by IgE levels. In conclusion, Pb exposure is associated with both blood IgE and asthma in boys. Moreover, the effect of Pb exposure on asthma may be mediated by IgE levels.

Clinical multi-colour fluorescence imaging of malignant tumours--initial experience

PURPOSE

The detection of malignant tumours relies on a variety of diagnostic procedures including X-ray images and, for hollow organs, endoscopy. The purpose of this study was to present a new technique for non-invasive tumour detection based on tissue fluorescence imaging.

MATERIAL AND METHODS

A clinically adapted multi-colour fluorescence system was employed in the real-time imaging of malignant tumours of the skin, breast, head and neck region, and urinary bladder. Tumour detection was based on the contrast displayed in fluorescence between normal and malignant tissue, related to the selective uptake of tumour-marking agents, such as haematoporphyrin derivative (HPD) and delta-amino levulinic acid (ALA), and natural chromophore differences between various tissues. In order to demarcate basal cell carcinomas of the skin, ALA was applied topically 4-6 h before the fluorescence investigation. For urinary bladder tumour visualisation (transitional cell carcinoma of different stages including carcinoma in situ), ALA was instilled into the bladder 1-2 h prior to the study. Malignant and premalignant lesions in the head and neck region were imaged after i.v. injection of HPD (Photofrin). Finally, the extent of in situ and invasive carcinomas of the breast was investigated in surgically excised specimens from patients that received a low-dose injection of HPD 24 h prior to the study. The tumour imaging system was coupled to an endoscope. Fluorescence light emission from the tissue surface was induced with 100-ns-long optical pulses at 390 nm, generated from a frequency-doubled alexandrite laser. With the use of special image-splitting optics, the tumour fluorescence, intensified in a micro-channel plate, was imaged in 3 selected wavelength bands. These 3 images were processed together to form a new optimised-contrast image of the tumour. This image, updated at a rate of about 3 frames/s, was mixed with a normal colour video image of the tissue.

RESULTS

A clear demarcation from normal surrounding tissue was found during in vivo measurements of superficial bladder carcinoma, basal cell carcinoma of the skin, and leukoplakia with dysplasia of the lip, and in in vitro investigations of resected breast cancer.

CONCLUSIONS

The initial clinical experience of using multi-colour fluorescence imaging has shown that the technique has the potential to reveal malignant tumour tissue, including non-invasive early carcinoma and also precancerous tissue. Further investigations are needed to fully develop the method.

The correlation between neurological evaluations and neurological outcome in acute encephalitis: a hospital-based study

Acute encephalitis is a common CNS infectious disease in children. However, there are limited studies concerning about the correlation between the clinical evaluations and neurological outcome. To investigate the value of neurological evaluations, and the correlation between these evaluations and neurological outcomes of acute encephalitis, in the present study we retrospectively evaluated the neurological outcome of 0- to 16-year-old children with encephalitis or meningoencephalitis between 1999 and 2000. Of 101 children enrolled, 4 died and 25 had other neurological sequelae, including epilepsy, headache, developmental delay, and emotional or behavioral changes during the 5 years of follow-up. The causative organisms in patients with neurological sequelae were herpes virus (HSV) 2/2 (100%), influenza 2/3 (67%), mycoplasma 5/12 (42%), and enterovirus 71 2/7 (29%). The important predictors for adverse outcomes were focal neurological signs, multiple seizures or status epilepticus on admission, leukopenia, focal slow waves or continuous generalized delta waves in electroencephalography (EEG), and focal cortical parenchymal hyperintensity in the magnetic resonance imaging (MRI) (p<0.05). Patients with initial presentations of focal neurological signs, papilledema, myoclonic jerks, and status epilepticus tended to have higher incidence of abnormal findings in brain MRI, although not achieving statistic significances. In addition, children with focal spikes or continuous generalized delta waves in EEG also had higher incidence of MRI abnormalities. We conclude that brain MRI studies may be indicated in patients with focal neurological signs, intractable seizure, and focal spikes, focal delta waves, or continuous generalized delta waves in EEG. For those with MRI examinations, focal cortical hyperintensity suggests poorer neurological outcomes.

Asia Pacific Association of Allergy Asthma and Clinical Immunology White Paper 2020 on climate change, air pollution, and biodiversity in Asia-Pacific and impact on allergic diseases

Air pollution, climate change, and reduced biodiversity are major threats to human health with detrimental effects on a variety of chronic noncommunicable diseases in particular respiratory and cardiovascular diseases. The extent of air pollution both outdoor and indoor air pollution and climate change including global warming is increasing-to alarming proportions particularly in the developing world especially rapidly industrializing countries worldwide. In recent years, Asia has experienced rapid economic growth and a deteriorating environment and increase in allergic diseases to epidemic proportions. Air pollutant levels in many Asian countries especially in China and India are substantially higher than are those in developed countries. Moreover, industrial, traffic-related, and household biomass combustion, indoor pollutants from chemicals and tobacco are major sources of air pollutants, with increasing burden on respiratory allergies. Here we highlight the major components of outdoor and indoor air pollutants and their impacts on respiratory allergies associated with asthma and allergic rhinitis in the Asia-Pacific region. With Asia-Pacific comprising more than half of the world's population there is an urgent need to increase public awareness, highlight targets for interventions, public advocacy and a call to action to policy makers to implement policy changes towards reducing air pollution with interventions at a population-based level.

1. Epidemiological studies show that indoor and outdoor pollutions affect respiratory health, including an increased prevalence of asthma and allergic diseases. Global warming will increase the effects of outdoor air pollution on health.

2. The Asia-Pacific is the most populated region in the world, with a huge burden of both outdoor and indoor pollutants, including PM_2.5, PM₁₀, SPM, CO, O₃, NO₂, SO₂, NO and household pollutants including biomass and tobacco.

3. The risk factors for the epidemic rise of allergic diseases in the Asia-Pacific are due to the increasing urbanization, environmental factors of air pollution and climate changes in recent decades than in the other parts of the world.

4. In light of the different environmental exposures in different countries of the Asia-Pacific region, strategies to combat allergic disease in this region should be focused on active government policies to fight air pollution based on the local conditions.

5. Substantial efforts need to be implemented with a concerted strategy at legislative, administrative, and community levels to improve air quality.

6. Abatement of the main risk factors for respiratory diseases, in particular, environmental tobacco smoke, indoor biomass fuels, and outdoor air pollution, as well as better control of asthma and rhinitis will achieve huge health benefits.

Bisphenol A exposure may increase the risk of development of atopic disorders in children

BACKGROUND

Little is known about the effect of Bisphenol A (BPA) on atopic disorders.

OBJECTIVE

To investigated the associations (i) between postnatal BPA exposure and allergic diseases in children; (ii) between BPA and IgE levels for the possible disease pathogenesis; and (iii) gender-based differences.

METHODS

A total of 453 children from Childhood Environment and Allergic Diseases Study cohort with urine and blood samples were recruited in Taiwan. Urinary BPA glucoronide (BPAG) levels were measured by UPLC-MS/MS at ages 3 and 6 years. The associations between BPAG levels at different ages and IgE levels and the development of allergic diseases were evaluated by multivariate linear regression and logistic regression. A mediation analysis was also conducted to evaluate how much risk of allergic diseases in relation to BPA exposure is explained by IgE changes.

RESULTS

The BPAG levels at age 3 were positively associated with IgE levels at age 3 (β=64.85kU/l per ln-unit increase BPAG level; 95% CI, 14.59-115.11kU/l). Stratified by gender, BPAG levels at age 3 were positively associated with IgE levels at age 3, particularly in girls (β=139.23kU/l; 95% CI, 57.38-221.09kU/l). Similar results were also found at age 6. Urinary BPAG levels at age 3 were significantly associated with asthma at ages 3 and 6, with OR (95%CI) of 1.29(1.08-1.55) and 1.27(1.04-1.55). We estimated that 70% of the total effect of BPA exposure on asthma is mediated by IgE levels.

CONCLUSIONS

BPA exposures were associated with IgE levels and may increase the risk of development of allergic diseases in children particularly in girls.

Lead poisoning in rural Scotland

Nine people from four families living in rural parts of Scotland have been found to suffer from clinical or biochemical effects of lead poisoning. Five had symptoms and four had unequivocal evidence of excessive lead exposure. The source of lead has been traced to the domestic water supply which in all cases was grossly contaminated with lead acquired from lead plumbing systems, including lead storage tanks. Clinical improvement followed the replacement of lead piping in two families studied. Lead poisoning is a possible cause of chronic ill health in areas of plumbosolvent water.

Environmental risk factors for early infantile atopic dermatitis

Previous studies of predictors of atopic dermatitis (AD) in Asia have had limited sample size and small numbers of variables focused primarily on family history or dietary exposures. The purpose of this study was to evaluate the influence of various environmental risk factors for early infantile AD. We used multistage, stratified systematic sampling to recruit 2048 mother-child pairs from the Taiwan national birth registration in 2003. Information on environmental risk factors for infant AD gathered by questionnaire were available from 1760 infants at 6 months of age. Multiple logistic regression was used to estimate adjusted odds ratios (aORs) and their 95% confidence intervals (CIs) for risk factors for AD after adjusting for potential confounders. AD was noted in 118 of 1760 (6.7%) of the infants. After adjusting for maternal age and education, family history of atopy, infant gender, and gestational age, fungi on walls of the house [aOR 2.14 (95% CI 1.41-3.22)] and frequent use of microwave oven at home [aOR 1.71 (95% CI 1.13-2.58)] increased the risk of early infantile AD. This study suggests that environmental factors do play a role in early infantile AD. Fungi, a kind of aeroallergen, are especially important in humid climate as in Taiwan and their impacts might be felt at the early infant stage. The hazards of microwave use should be paid more attention.

How does HIV cause AIDS? The homing theory

The mechanism by which HIV causes depletion of CD4+ T cells in infected individuals remains unknown. Numerous theories have been proposed, but none can fully explain all of the events observed to occur in patients. Recent studies have shown that HIV binding to resting CD4+ T cells upregulates L-selectin, causing the cells to home from the blood into lymph nodes at an enhanced rate. It is possible that the disappearance of CD4+ T cells in the blood is actually the result of them leaving the blood, which can help explain the loss of CD4+ T cells in the blood occurring at a much faster rate than in lymphoid tissues. Furthermore, secondary signals through homing receptors received during the homing process induce many of these cells into apoptosis. These cells die in the lymph nodes without producing HIV particles, which can explain the 'bystander effect' observed in the lymph nodes of HIV infected individuals. If this scenario occurs in HIV+ patients, it might explain many of the clinical observations.

Association between allergic diseases, allergic sensitization and attention-deficit/hyperactivity disorder in children: A large-scale, population-based study

BACKGROUND

Increasing prevalence of allergic diseases has been matched by parallel trends in attention-deficit/hyperactivity disorder (ADHD). However, previous studies concerning the association between ADHD and allergic diseases have been inconsistent. Moreover, it is not clear whether this association is modified by allergic sensitization status. Therefore, we evaluated the association between allergic diseases, allergic sensitization, and ADHD in children.

METHODS

We conducted a large-scale cross-sectional, population-based survey to investigate the relationship between allergic diseases, allergic sensitization, and ADHD. Children aged between 3 and 6 years were selected from kindergartens, and received skin prick tests (SPTs) for mite, cockroach, dog, milk, egg, and crab allergens. Information about allergic diseases, environmental exposures, and physician-diagnosed ADHD were collected. Multiple logistic regressions were performed to estimate the association between allergic diseases and ADHD, with adjustments made for potential confounders.

RESULT

A total of 2772 children were found to be eligible for analysis; of these 411 (14.8%) had atopic dermatitis (AD), 954 (34.4%) had allergic rhinitis (AR), 451 (16.3%) had asthma, and 28 (1.01%) had ADHD. Children who had AD and asthma with allergic sensitization were found to be at increased risk for ADHD, with adjusted ORs (95% CI) of 4.50 (1.28-15.86) and 3.65 (1.07-12.49). Children who had AR, allergic conjunctivitis, or food allergies were also related to ADHD, though failed to reach statistical significance.

CONCLUSION

Our results suggest that AD and asthma with allergic sensitization are associated with ADHD in children. As allergic sensitization is an increased factor of developing allergic diseases, early control of environmental and allergens exposure could help to modify the burden of ADHD.