Department of Pediatrics, Faculty of Medicine, Kyoto University, Kyoto, Japan Department of Pediatrics, Tenri Hospital, Tenri, Japan Department of Diagnostic Pathology, Faculty of Medicine, Kyoto University, Kyoto, Japan Department of Dermatology, Faculty of Medicine, Kyoto University, Kyoto, Japan Department of Life Sciences, Hokkaido Pharmaceutical University School of Pharmacy, Sapporo, Japan Department of Pediatrics, Faculty of Medicine, Tohoku University, Sendai, Japan Kazusa DNA Research Institute, Kisarazu, Japan

Background: House dust mites (HDMs) are the most common allergens in Japan. Washing futons (bedding) can reduce the levels of HDM allergens within them. Therefore, we studied the effects of futon washing on asthma control in children with HDM allergy.Methods: This was not a randomized study. Ten asthmatic children with HDM allergy were enrolled in this study, and their futons were washed with warm water and dried with hot air in March/April 2013 (active group). Nine asthmatic children with HDM allergy whose futons were not washed were also included as a control group, but 2 of these children dropped out. The amounts of Der 1 (Der p1+Der f1) in the dust collected from the subjects’ futons were measured using an enzyme-linked immunosorbent assay.Results: All 5 of the active group futons that had Der 1 levels of >100 ng/m2 in March/April 2013 exhibited lower Der 1 concentrations in July/August 2013. The controller therapies of 4 of these 5 active group children had been stepped down in July/August 2013. The Der 1 levels of 7 active group futons were lower in March/April 2014 than in March/April 2013. During the 1-year study period, the controller therapy was stepped down and unchanged in 8 and 2 of the active group children, respectively. In addition, it was stepped down, unchanged, and stepped up in 3, 1, and 3 of the control group children, respectively, and the differences between the groups were not significant (P = 0.119; 2x3 contingency table/Fisher’s exact test). However, when the daily controller therapy scores for March/April, July/August, and November/December 2013 and March/April 2014 were compared using Friedman’s test, it was found that the changes were significant in the active group (P = 0.001), but not in the control group (P = 0.996).Conclusion: Washing futons had beneficial effects on asthma patients with HDM allergy. Washing futons is burdensome, but it might aid HDM avoidance, and hence, promote asthma control.

1. Concentration of hepatitis Be antigen in the various HBV carrier states: Kiyohiko Kurai, et al. (1st Dept Intern Med, Fac Med, Univ of Tokyo) 2. HBV related markers in hemodialysis unit --HBel, e2 AgAb systems-: Atsushi Kanno (3rd Dept Intern Med, Tohoku Univ Sch Med) 3. Studies of the pathogenesis and prognosis in HBs antigen carrier--Clinical course of anti-HBe positive patients: Toshihiko Iigima, Yasumitsu Imai, Hiroshi Ueyama, Ryuichi Sakita, Seiichi Kobayashi, Izumi Yoshino and Masaji Nambu (Dept Gastroenterol, Centr HospJNR) 4. Changes of HBeAg/Ab system and development of chronic hepatitis: Mikio Matsuo, Kenji Kato, Yukihiko Tameda and Yoshitane Kosaka (lst Dept Intern Med, Mie Univ) 5. Antibody to polymerized human serum albumin receptor of HBsAg, in HBsAb positive serum: Fumitake Ohryohji, Kazuo Ohkochi* and Shunichi Koga* (Iizuka Hosp, *Kyushu Univ) 6. Clinical study of albumin receptor and HBsAg-IgM complex on chronic hepatitis B infection: H. Seto (lst Dept Intern Med, Hiroshima Univ Sch Med) 7. An immunoelectronmicroscopical study of the ~ antigen: Yoshimi Ito (lst Dept Med, Chiba Univ Sch Med) 8. Diagnosis of fulminant hepatitis type B by measurement of anti-HBc IgM: Naoto Maruyama (2nd Dept Intern Med, Kurume Univ Sch Med) 9. The clinical significance of IgM-anti HBc for hepatitis: H. Furui, S. Nakano, K. Sugiyama, H. Watahiki, I. Takeda, H. Kozawa, Y. Kurita and Y, Watanabe (Dept Gastroenterol, Ogaki Munic Hosp, Ogaki) 10. Clinical significance of anti-HBc IgM in HBsAg positive hepatic disease: Shuichi Amaki (3rd Dept Intern Med, Nihon Univ Sch Med) 11. Significance of IgM anti HBc --Comparison between IgM anti HBc RIA kit and RzYME-M--: K. Morioka, H. Honjo, M. Unoura, N. Tanaka, Y. Kato, K. Kobayashi and N. Hattori (lst Dept Intern Med, Kanazawa Univ) 12. Clinical study of anti-HBc (IgM): M. Kikkawa (lst Dept Intern Med, Hiroshima Univ Sch Med) !3. The significance of IgM antibodies to hepatitis B core antigen in hepatitis B-associated liver diseases: J. Toyota, K. Yanagida, Y. Okuuchi, T. Matsushima, T. Sugawara and T. Miyazaki (3rd Dept Intern Med, Hokkaido Univ Sch Med) IgM-anti HBc in the sera of patients with clinical symptoms of acute hepatitis: Nobuyuki Adachi, et al. (Gifu Pref Gifu Hosp) Clinical evaluation of chronic hepatitis B with transient appearance of IgM type anti-HBc: K. Manabe, G. Yamada, I. Hyodo, T. Nishihara, H. Okushin, S. Kinoyama, M. Mizuno, Y. Sakamoto and H. Nagashima (lst Dept Intern Med, Okayama Univ Med Sch) Detection of HBV-DNA in the serum by spot hybridization test: Yasuhisa Matsuyama, et al. (lst Dept Med, Chiba Univ Sch Med) Analysis of hepatitis B virus DNA in the serum of chronic HBV carriers: Keiji Mitamura (Inst Clin Med, Univ of Tsukuba) Studies on methods for determination of serum HB-virus DNA: Terukatsu Arima, Hajime Hada, Shigeru Morichika and Hideo Nagashima (lst Dept Intern Med, Okayama Univ Med Sch) Analysis of replicative forms of hepatic HBV-DNA in relation to IFN-yA treatment of HBeAg positive chronic hepatitis: Osamu Yokosuka (lst Dept Med, Chiba Univ Sch Med) Swift increase in alcohol metabolism (SIAM) and its heredity: Takehiko Yuki, Ronald G. Thurman*, 14.

Four cases revealed high retention of ICG test and normal retention of BSP test were reported. The results of liver function test of these cases showed within normal limit except ICG retention. ICG disappearance rate ranged from 0.017 to 0.025, whereas BSP disappearance rate ranged from 0.069 to 0.126. The transfer rate of ICG from plasma to liver markedly decreased by two compartmental analysis of the decay curve and slightly reduced transfer rate of BSP from plasma to liver was also observed. The step on both ICG and BSP disappearance curve was observed during 20 to 25 minutes after the injection in all cases and in repeated observations. The step formation is one of the characteristic changes in these cases. The ICG binding capacity of serum protein decreased in the first peak and increased in the third peak eluted by gel filtration of Sephadex G-200. Light microscopic findings of the liver showed normal histology. The electronmicroscopic findings showed the increase of lipofuscin-like lysosome, modification and paracrystalline like array of mitochondria and increase of reticulum fiber in Disse's space. Father of a case showed ICG retention without BSP retention. From these results it is suggested that these cases are a new type of dye excretory disorder of liver with heredity or constitution.

RATIONALE: Asthmatic children sometimes receive inhalation therapy with nebulizer while sleeping, but we have reported that inhalation efficiency was poorer during sleep than in awake. The aim of this study was to evaluate the usefulness of physiatric manipulations for inhalation during sleep. METHODS: Urinary excretion of disodium cromoglycate (DSCG) following DSCG inhalation has been reported as a useful indicator of inhalation efficiency. Urinary DSCG concentration was measured using HPLC. External chest compression is a technique to assist expiration. One operator placed its hands on the lateral or anterior chest wall of asthmatic children, gently squeezing their chest wall during expiration, and another sprayed DSCG (20mg) with a nebulizer near their nostrils during sleep. Post-lift is a technique to assist inspiration. One operator placed a towel under the waist of children, pulling up both ends of the towel during inspiration. RESULTS: Urinary excretion (microgram) of DSCG with and without external chest compression was 367 and 320 in patient 1; 217 and 203 in patient 2; 432 and 415 in patient 3; 160 and 288 in patient 4. Urinary excretion with and without post-lift was 489 and 371 in patient 5; 331 and 1056 in patient 6; 899 and 384 in patient 3; 777 and 663 in patient 4. Patient 6 waked up many times while lifted up. CONCLUSIONS: For inhalation therapy during sleep, post-lift was effective in some patients, but external chest compression was not effective.

RATIONALE: Since the optimal method of inhalation is not established, we compared the inhalation efficiencies following some inhalation conditions. METHODS: In inhalation therapy with a nebulizer, some asthmatic children inhale aerosol through nose, and some do through mouth. Some inhale it with effort ventilation, and some do with resting ventilation. Urinary excretion of disodium cromoglycate (DSCG) has been reported as a useful indicator of inhalation efficiency. Therefore, three healthy volunteers inhaled 20mg of DSCG (1)through nose with effort ventilation, (2)through nose with resting ventilation, (3)through mouth with effort ventilation, or (4)through mouth with resting ventilation, via a nebulizer with a face mask. Urine samples from them were collected more than 4 hours after inhalation administration. Urinary concentrations of DSCG were measured by high-performance liquid chromatography. RESULTS: Each amount (microgram) of urinary excretion of DSCG in subject A was 851,381,850,and 428 in order of (1)-(4)(shown above); in subject B was 959,447,348 and 259; in subject C was 447,769,1540,and 1015. CONCLUSIONS: "Which is more effective, inhaling aerosol through nose or through mouth" depends on individuals. In most cases in this study, inhalation efficiency is higher when aerosol was inhaled with effort ventilation than with resting ventilation.

Background IL-18 has been shown to exert anti-allergic or allergy-promoting activities, but the existence of genetic polymorphisms in the coding regions of IL-18 gene has not been demonstrated.Objective The aim of this study was to investigate whether polymorphism is present in the coding regions of the IL-18 gene and, if so, to further analyse the association between polymorphism and asthma in a case-control study.Methods We screened the coding regions of the IL-18 gene for polymorphisms by using PCRsingle-stranded conformation polymorphism and direct sequencing of PCR products, followed by analysis of the association between polymorphism and asthma.Results We identified one polymorphism (105A/C) in the coding regions. The frequency of the 105A allele was significantly higher in asthmatic patients than in controls (P < 0.01; odds ratio (OR) = 1.83 (1.37-2.26)). Significant linkage disequilibrium was observed between the 105A/C and -137G/C polymorphisms in the 5' flanking region of the IL-18 gene (D = 0.58, P < 0.0001). However, in asthmatic patients the 105A allele was not associated with either total serum IgE or IL-18 levels.Conclusion The 105A/C polymorphism of the IL-18 gene may be associated with the pathogenesis of asthma.

We report of an infant with neonatal glycogen storage disease type IV (GSD IV) who was examined for severe hypotonia and cardiomyopathy. On the muscle biopsy there were many fibers with diastase-resistant polyglucosan bodies. Glycogen branching enzyme (GBE1) activity in the muscle was markedly reduced. The infant had a homozygous single nucleotide deletion in the open reading frame of GBE1 gene.

The relationship between the cord blood level of IgE specific for Dermatophagoides pteronyssinus (Dp-IgE) and the development of allergic disorders in infants was investigated. None of the 10 infants who had no family history of allergic disorders and a cord blood Dp-IgE level of <0.07 IU/ml developed atopic dermatitis by 10 months of age. Among the infants whose mothers had atopy, those with a cord blood Dp-IgE level of > or =0.07 IU/ml showed a higher prevalence of allergic disorders at 3 years of age than those with a cord blood Dp-IgE level of <0.07 IU/ml. These observations suggest that the cord blood Dp-IgE level may be related to allergic manifestations in infancy.

Atopic dermatitis (AD) is a chronic inflammatory skin disease of unknown etiology. To examine the involvement of impaired homeostasis of oxygen/nitrogen radicals in childhood AD, we compared the levels of urinary 8-hydroxy-2'-deoxyguanosine (marker of oxidative stress), nitrite/nitrate (marker of nitric oxide synthesis) and selenium (marker of selenium store) in 27 children with AD to those of 25 healthy control children. Urinary 8-hydroxy-2'-deoxyguanosine was significantly higher and nitrite/nitrate levels were significantly lower in patients with AD than in the control. Urinary selenium levels were similar in both groups. Our findings suggest that impaired homeostasis of oxygen/nitrogen radicals and increased oxidative stress are involved in the pathophysiology of childhood AD, and indicate that suppression of oxidative stress might be a potentially useful strategy for the treatment of AD.

A 13-years-old girl was admitted to our hospital with high levels of serum IgM, thrombocytopenia and splenomegaly. Not only IgG but also IgM were found on the surface of platelets by flow-cytometry. Direct Coombs' test was positive, and IgG was also found on the surface of red blood cells. After splenectomy, platelet count was increased and serum IgM was decreased. The biopsy of salivary glands showed infiltration of lymphocytes around the ducts, and Shirmer test revealed slightly decreased secretion of tears, suggesting subclinical Sjögren syndrome.

We present a case of juvenile myelomonocytic leukemia (JMML) with ocular infiltration. A 1-month-old boy presented with myeloid precursors in peripheral blood and a white blood cell count >10 x 10(9)/l. His peripheral blood monocyte count was >1 x 10(9)/l, bone marrow blasts were <20%, and no Ph chromosome was identified. The boy also presented with hepatosplenomegaly, pallor, fever, and skin rash. We diagnosed this case as JMML, although hemoglobin F was within the normal range and no spontaneous colony growth was observed from peripheral blood mononuclear cells. Neither Epstein-Barr(EB) virus nor cytomegalovirus was detected by PCR in bone marrow aspirate or peripheral blood. The patient had several lesions into which JMML cells might have infiltrated, including skin, liver, spleen, oral cavity, right lung, sigmoid colon, and both eyes. To our knowledge, this is the first reported case of JMML with ocular involvement. Since infiltration of JMML cells into both eyes causes blindness, further consideration of the timing of bone marrow transplantation (BMT) in JMML is necessary.

A mitochondrial A 3243 G mutation in the tRNA(Leu(UUR)) gene was first described as a common cause of MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like syndrome). This same mutation is also the cause of a totally different disorder, a subtype of diabetes mellitus which is inherited maternally and often associated with sensorineural hearing loss. In this paper, we report on a Japanese boy with A 3243 G who developed a previously undescribed combination of symptoms, nephropathy and growth hormone deficiency. The patient first presented with short stature and moderate mental retardation. Growth hormone (GH) provocation tests showed deficient growth hormone secretion. During the course of follow up, he presented with progressive nephropathy followed by the development of diabetes mellitus. The results of laboratory tests and renal biopsy were against incidental association of known types of nephropathy. On PCR-RFLP analysis, the percentage of mutated mtDNA was higher in the renal biopsy specimen than 12 peripheral blood leucocytes. Our case suggests that mitochondrial diseases should be taken into account when there is nephropathy of unknown cause. In addition, the presence of growth hormone deficiency may account for part of the mechanism leading to short stature commonly seen in these patients.