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Background: A new role of a regional core hospital for educating medical personnel through a regional therapy association has been previously reported in the COVID-19 crisis. In the present study, physical (PT), occupational (OT), and speech language hearing therapist (ST) and physiatrists, who have been providing COVID-19 rehabilitation in a regional core hospital, were instructed how to control infection via a webinar. The purpose of this report was to investigate the effects of webinars on therapists working in local facilities. Methods: The webinar was sponsored by the Wakayama Physical Therapy Association. A PT, OT, ST, and physiatrist from Wakayama Medical University Kihoku Hospital, who had been providing rehabilitation for mildly and/or moderately infected COVID-19 patients. All participants answered the 18-item online questionnaire after the webinar to assess the educational effects. Results: There were 41 participants in this region and 30 participants from 19 facilities responded the questionnaire (valid responses ratio was 73%) and 30% of the respondents had experienced COVID-19 rehabilitation. Most responders (83%) felt that difficulty level of the contents was appropriate and 80% of the respondents replied that rehabilitation was necessary for the patients. 70% of the respondents replied that got confidence after this webinar, even 7 of the 13 respondents (43%), who attended the webinar about infection control of COVID-19 for the first time, were involved. Conclusion: A webinar from therapists and physiatrists in a regional core hospital, who had experiences to provide COVID-19 rehabilitation, were satisfactory and effective for the education of regional therapists.

Umas das principais dificuldades enfrentadas por estudantes ingressantes em cursos de computação/informática é a compreensão da lógica de programação, sendo essa uma base para que o estudante avance em todas as disciplinas relacionadas a programação. Dessa forma, o objetivo deste resumo é mostrar os resultados preliminares obtidos no desenvolvimento de um chatbot para a plataforma WhatsApp com tecnologia aberta Rasa, cuja finalidade é promover um suporte e auxílio para os estudantes dos cursos de TI. Utilizou-se uma metodologia de natureza qualitativa, bibliográfica e aplicada. Os resultados parciais obtidos através do levantamento de requisitos e da prototipagem, demonstram que é plenamente possível o desenvolvimento de um chatbot educacional, trazendo assim um auxílio aos estudantes das disciplinas de TI.

[Purpose] To determine the effects of lower limb ergometer exercise on the spasticity and joint range of motion of the lower extremity and gait function in patients with cerebral palsy and spastic paralysis. [Participants and Methods] This study included 8 participants with cerebral palsy and spastic paralysis (GMFCS levels I to IV) who received care at the outpatient clinic. After a 5-min rest, the lower limb ergometer exercises were performed for 10 min. We measured the participants’ arterial blood pressure, pulse rate, passive range of knee joint extension, muscle tone using the Modified Ashworth scale (MAS) and Modified Tardieu scale (MTS), and 10-m walk test (10MWT). Measurements were collected three times (at baseline before exercise, immediately at the end of exercise, and 5 min after exercise during recovery). [Results] The 10-min lower limb ergometer exercise significantly improved the knee joint extension, MAS and MTS scores, and reduced lower extremity spasticity. Furthermore, it significantly increased the range of knee joint extension and decreased the 10MWT score. [Conclusion] The results showed that the 10-minute lower limb ergometer exercise is beneficial in reducing the spasticity of the lower limb muscles and in increasing the range of motion of knee extension in paraplegic patients with cerebral palsy, suggesting that its implementation in young children could prevent spasticity and enhance motor function.

Treatment of esophageal cancer is based on tumor-node-metastasis (TNM) classification, and surgical treatment is chosen based on the patient’s ability to tolerate surgery. Surgical endurance partly depends on activity status, with performance status (PS) generally used as an indicator. This report describes a 72-year-old man with lower esophageal cancer and an 8-year history of severe left hemiplegia. He had sequelae of cerebral infarction and a TNM classification of T3, N1, and M0, and was judged ineligible for surgery because his PS was grade three; he underwent preoperative rehabilitation with hospitalization for 3 weeks. He had been able to walk with a cane in the past, but once he was diagnosed with esophageal cancer, he began using a wheelchair and was dependent on assistance from his family in his daily life. Rehabilitation consisted of strength training, aerobic exercise, gait training, and activities of daily living (ADL) training for 5 h a day, according to the patient’s condition. After 3 weeks of rehabilitation, his ADL ability and PS improved sufficiently for surgical indication. No complications occurred postoperatively, and he was discharged when his ADL ability was higher than that before preoperative rehabilitation. This case provides valuable information for the rehabilitation of patients with inactive esophageal cancer.

Exercise has been reported to improve short-term outcomes for patients with LSS in terms of disability and back and leg pain. However, no studies have compared supervised exercise with unsupervised exercise or quantified physical activity using a pedometer to confirm compliance with a home exercise program.To compare the effectiveness of supervised physical therapy (PT) with unsupervised exercise for patients with lumbar spinal stenosis (LSS).A single-center, open-label, randomized controlled trial.Patients presenting with symptoms of neurogenic claudication caused by LSS, which was confirmed by magnetic resonance imaging.The primary outcome was improvement in symptom severity scores on the Zurich Claudication Questionnaire (ZCQ) at 6 weeks. Secondary outcomes included physical function on the ZCQ, self-paced walking test (SPWT) performance, pain indicated using a numerical rating scale (NRS), and the number of daily steps measured by pedometer.Patients with LSS were randomized to a PT group, who performed supervised PT twice a week for 6 weeks, or a home exercise (HE) group. PT sessions included manual therapy, individually tailored stretching and strengthening exercises, cycling, and body weight-supported treadmill walking.Forty-three patients were randomly allocated to the PT group and 43 patients to the HE group. Compared with the HE group, the PT group had greater percentage of responders achieving minimum clinically important difference in ZCQ symptom severity (difference for percentage between groups [95%confidence interval], 30.2% [9.1-48.6], p=.01), ZCQ physical function (32.6% [11.6-50.6], p.01), walking distance on the SPWT (39.5% [18.8-56.7], p.01), leg pain on the NRS (34.9% [13.9-52.7], p.01), and number of daily steps (25.6% [4.9-43.9], p=.01).Supervised PT for patients with LSS resulted in significant short-term improvements in symptom severity, physical function, walking distance, pain, and physical activity compared with unsupervised exercise.

Objective: To determine the relationship between physical findings, wheelchair sitting time, and interface pressure on ischial region in subjects with spinal cord injury (SCI). Design: Cross-sectional study. Setting: Rehabilitation center in Japan. Participants: Manual wheelchair users with chronic SCI (n = 45). Interventions: Pressure ulcers (PU) were diagnosed by inspection, palpation, and ultrasonography. Self-reports were obtained on wheelchair sitting time and pressure mapping was recorded while the subject was seated on the wheelchair. Outcome measures: Subjects were divided into those with ultrasonographically low-echoic lesions (PU-positive group, n = 11) and no such lesions (PU-negative group, n = 34). Outcome measures included wheelchair sitting time and interface pressure at bilateral ischial regions. Results: Using ultrasonography, 13 low-echoic lesions were identified in 11 subjects of the PU-positive group. The pressure duration was longer and interface pressure was significantly higher in subjects of the PU-positive group compared with those of the PU-negative group (P

Background: Wheat allergy is the third most common food allergy that develops during infancy in Japan. To identify factors associated with persistent wheat allergy, we assessed the rate of tolerance acquisition among Japanese children aged less than 6 years with an immediate-type wheat allergy using the oral food challenge (OFC) method. Methods: This retrospective cohort study included 83 children (born in 2005–2006) who had a history of immediate-type allergic reaction to wheat and were followed until 6 years of age. The subjects were divided to form “tolerant” (n = 55; tolerance acquired by 6 years of age) and “allergic” (n = 28; tolerance not acquired by 6 years of age) groups based on their OFC results. Results: The rates of tolerance acquisition to 200 g of udon noodles at 3, 5, and 6 years of age were 20.5% (17/83), 54.2% (45/83), and 66.3% (55/83), respectively. The total number of anaphylactic reactions experienced prior to 3 years of age in response to all foods (p < 0.01) and to wheat (p = 0.043) was significantly higher in the allergic than in the tolerant group. Wheat- and ω-5 gliadin-specific immunoglobulin E (IgE) levels were significantly higher in the allergic group than in the tolerant group (p < 0.01), and wheat-specific IgE levels were more likely to increase after infancy in the allergic group. Conclusions: A history of anaphylaxis to all foods including wheat and/or a high level of wheat- or ω-5 gliadin-specific IgE antibodies were identified as risk factors for persistent wheat allergy.

The present study was designed to clarify the roles of N-type and P/Q-type calcium channels in the increased sympathetic activity of spontaneously hypertensive rats (SHR/Izm). We also tested in SHR/Izm the contribution to increased vascular tone of α1A adrenoceptor-linked L-type calcium channels and α1B receptor-mediated calcium mobilization from the sarcoplasmic reticulum. Methods: Six-week-old SHR/Izm and Wistar-Kyoto rats (WKY/Izm) were used. A superior mesenteric arterial preparation was electrically stimulated before and after treatment with ω-conotoxin GVIa (N-type calcium channel blocker [CgTX]) and ω-agatoxinIVa (P/Q-type calcium channel blocker [AgaTX]). Pressor response to norepinephrine was measured before and after treatment with the α1A blocker WB-4101 and the α1B blocker chloroethyl clonidine (CEC). To determine the intracellular calcium store size, the effects of ryanodine on pressor response and caffeine-induced vascular contraction were also tested. Results: Norepinephrine overflow evoked by electrical stimulation was increased in SHR/Izm. CgTX but not AgaTX suppressed the increased NE overflow in SHR/Izm. WB-4101 suppressed the pressor response to norepinephrine in SHR/Izm but not WKY/Izm rats. CEC had no effects on pressor response to norepinephrine in both types of rats. Caffeine-induced contraction to a high potassium-induced maximal contraction ratio was reduced in SHR/Izm. The effect of ryanodine on pressor response was reduced in SHR/Izm. Conclusion: N-type calcium channels but not P/Q-type calcium channels play an important role in the increased sympathetic tone in SHR/ Izm. Although α1A adrenoceptor-linked L-type calcium channels contribute to the increased vascular tone, the intracellular calcium store size was reduced in SHR/Izm.

Background Development of neurological complications of varicella zoster virus reactivation is relatively uncommon, particularly in an immunocompetent child. Case presentation An 11-year-old Asian girl presented with headache and skin rash on her left chest. She was diagnosed with meningitis, and herpes zoster was confirmed by polymerase chain reaction using cerebrospinal fluid. Acyclovir was administered intravenously. Given the favorable evolution of the clinical course, she was discharged from the hospital on day 8 of her illness. She had no apparent sequelae or comorbidities at the time of the 6-week follow-up. Conclusions Neurological complications such as meningitis due to varicella zoster virus reactivation are uncommon, especially in an immunocompetent child; no specific immune deficiency was identified in our patient. We conclude that, although rare, varicella zoster virus should be recognized as a potential cause of viral meningitis in immunocompetent children.

The pupil is a suitable end organ for studying autonomic function because both sympathetic and parasympathetic nerve activity can be evaluated independently using a light stimulus. Sympathetic response elicited by physical stress is augmented in hypertensive patients compared with normotensive subjects, which increases the risk of cardiovascular events. We used pupillometry to evaluate the effects of the calcium channel blockers azelnidipine (AZ) and amlodipine (AM) on changes in autonomic nervous activity induced by isometric exercise in patients with hypertension. Twenty patients with essential hypertension who were administered AM and 21 who were administered AZ underwent a pupillary function test and blood pressure (BP) and pulse rate (PR) measurements before and after isometric handgrip exercise (IHG). Maximal velocities of pupil constriction (VC) and re-dilation (VD) obtained with light stimulation for 1 s were used as indices of parasympathetic and sympathetic nerve activity, respectively. Increases in systolic BP and PR elicited by IHG were significantly smaller in the AZ group than in the AM group. After IHG, both VC and VD significantly increased in the AM group but not in the AZ group. The low-to-high frequency ratio obtained from analysis of PR variability, another measure of sympathetic activity, also increased in only the AM group. Thus AZ inhibited autonomic activation and suppressed cardiovascular responses to IHG more effectively than AM. The sympathoinhibitory effect of AZ may therefore be beneficial for patients with essential hypertension. In addition, pupillometry was shown to be a useful tool for assessing autonomic function in hypertensive patients.

Background Hen's egg (HE) allergy develops during infancy. We investigated tolerance acquisition in Japanese children allergic to HE aging Methods In this retrospective study, 226 children born in 2005 with a history of immediate-type HE allergy underwent an oral food challenge (OFC). Tolerance was defined as no reaction to an OFC with half of whole heated HE or accidental HE consumption at home. Participants were divided into three groups based on age at tolerance acquisition: group I ( n = 66), group II (3–6 years) ( n = 98), and group III (prolonged allergic groups) ( n = 62). Results Tolerance acquisition occurred in 30% (66/226) by 3 years of age, 59% (133/226) by 5 years of age, and 73% (164/226) at 6 years of age. At 3 years, incidences of allergy-related complications (bronchial asthma, p = 0.02; atopic dermatitis, p = 0.04) were higher in the group III than in the group I. Anaphylaxis to any food occurred more frequently in the group III than in the group I ( p = 0.03); anaphylaxis to HE was more common in the group III ( p = 0.04). Egg white (EW)- and ovomucoid (OM)-specific immunoglobulin E (IgE) levels were higher in the group III than in the group I ( p Conclusions The group III experienced HE-related anaphylaxis and complications more frequently and exhibited sustained, high EW- and OM-specific IgE levels.

In the spring of 2015, we experienced a cluster of 4 sporadic cases of yersiniosis in children in Nagano prefecture, a rural area of Japan. Two patients developed appendicitis-like episodes; one had acute gastroenteritis, and the other had bacteremia associated with liver abscess. The causative agent of these infections was Yersinia enterocolitica serogroup O:8. None of the patients had an underlying illness, and all have recovered completely. The patients were neither socially nor geographically related to each other. These 4 consecutive cases suggest that Y. enterocolitica O:8 has spread substantially in the middle part of Japan, and that this virulent strain might be more common than previously reported in our country.

Background: Children who avoid cow’s milk (CM) because of food allergy may show disturbed growth. Calcium insufficiency, in particular, was reported among those who completely avoided dairy products. We retrospectively examined whether oral immunotherapy (OIT) affected the stature of patients who had completely avoided CM owing to their severe CM allergy. Methods: The CM-OIT group included subjects who had completely avoided milk their entire lives and were administered OIT between 2009 and 2013. The complete milk avoidance (CM-Avoid) group included subjects who were diagnosed with a CM allergy using oral food challenges between 2013 and 2014 who subsequently avoided CM completely. By examining clinical records and questionnaires, we investigated patient height changes over time. We calculated age- and sex-stratified height standard deviation scores (HtSDS) and analyzed changes in HtSDS retrospectively. The observation period was 1–2 years. To exclude pubertal growth spurts, we set the age criteria as less than 11 years in boys and less than 9 years in girls. Results: We recruited 29 patients (19 boys) for the CM-OIT group and 20 (9 boys) for the CM-Avoid group. The patients’ median ages at the start of the observation period were 7.5 years (6.1–9.6) for boys and 6.8 years (5.8–7.8) for girls in the CM-OIT group, and 5.4 years (5.0–7.5) for boys and 5.7 years (5.0–7.1) for girls in the CM-Avoid group. The initial HtSDS in the CM-OIT group was −0.31 (median) and increased to −0.22 (median) after OIT (p = 0.016). In contrast, there was no significant change in HtSDS for the CM-Avoid group. Conclusions: Physical growth of pediatric patients with severe CM allergies, who have avoided CM completely, could be improved by OIT for CM allergy. Keywords: Diet, Immunotherapy, Milk allergy, Pediatrics, Cow’s milk

Background: Cow’s milk (CM) allergy is the second most common food allergy developed during infancy in Japan. To identify predictors of persistent CM allergy, we investigated the tolerance acquisition rate based on an oral food challenge in children under 6 years of age, diagnosed with immediate-type CM allergy. Methods: This retrospective cohort study included 131 children born in 2005 with a history of immediate allergic reaction to CM, of whom 39 were excluded because of ongoing oral immunotherapy (n = 18) or a lack of follow-up data (n = 21). The 92 remaining participants were followed for 6 years. Tolerance was defined as no adverse reaction to 200 mL of CM and regular intake of milk at home. Subjects were divided into 3 groups based on age at tolerance acquisition: group I (n = 31), group II (3–6 years; n = 42), and group III (persistent allergic group; n = 19). Results: Tolerance acquisition rates by 3, 5, and 6 years of age were 32.6% (30/92), 64.1% (59/92), and 84.8% (70/92), respectively. Age at first hospital visit was significantly higher in groups II and III than in group I (p < 0.001). The incidence of anaphylaxis to other foods was also higher in group III than in group I (p = 0.04), as was CM-induced anaphylaxis (p = 0.03). Furthermore, milk and casein-specific immunoglobulin E (IgE) levels were significantly higher in group III than in group II after birth and remained high thereafter (p < 0.05). Conclusions: The history of anaphylaxis and high milk-specific IgE levels were associated with persistent CM allergy.

Aims: Bathing in deep, Japanese-style bathtubs is associated with high rates of sudden death in the elderly in Japan. The predominant causes of death in such cases are cardiovascular events and drowning. Blood pressure changes induced by water pressure and high temperature during bathing may be an important cause of these accidents. Therefore, we investigated the changes in blood pressure, heart rate, and oxygen saturation (SpO2) before and after bathing in elderly Japanese individuals. Methods: Forty-eight elderly (average age, 86.4 ± 7.5 years) persons were enrolled in this study. Results: Changes in systolic blood pressure after bathing correlated negatively with baseline blood pressure before bathing, and participants with baseline systolic blood pressures of

In the spring of 2015, we experienced a cluster of 4 sporadic cases of yersiniosis in children in Nagano prefecture, a rural area of Japan. Two patients developed appendicitis-like episodes; one had acute gastroenteritis, and the other had bacteremia associated with liver abscess. The causative agent of these infections was Yersinia enterocolitica serogroup O:8. None of the patients had an underlying illness, and all have recovered completely. The patients were neither socially nor geographically related to each other. These 4 consecutive cases suggest that Y. enterocolitica O:8 has spread substantially in the middle part of Japan, and that this virulent strain might be more common than previously reported in our country.

Background/objectives Developmental changes of structures in neonatal and infant skin have not been well characterized. The purpose of this study was to clarify changes in skin structures during neonatal and infant growth in vivo. Methods Fifteen healthy, full-term neonates (seven girls, eight boys) were studied. The measurements were performed 4 to 7 days (neonate) and 1, 3, and 6 months after birth on the buttock, upper thigh, and ventral forearm skin using a confocal laser scanning microscope. Developmental changes in dermoepidermal junction structures, stratum corneum thickness, epidermal thickness, and microvascular development were investigated. Results A significant decrease in stratum corneum thickness was observed over the 3 months after birth. Dermal papillae were not observed in neonatal skin but were observed gradually over the next 3 months. Epidermal thickness, determined from the skin surface to the bottom of the epidermal layer, increased significantly from 4 to 7 days to 1 month of age, indicating the formation of dermal papillae and rete ridges. Complicated microvascular structures were observed in neonatal skin but disappeared gradually and were observed only at the dermal papillae at 3 months of age. Conclusions Our results reveal that infant skin is in a developmental stage structurally up to 3 months of age, paralleling skin functional and developmental maturation.

We report two cases of lupus miliaris disseminatus faciei (LMDF) in which oral tranilast was effective. In case 1, the patient was a 33-year-old woman who had developed pale red papules on her face, especially around her eyes and lower jaw, approximately 7 months previously. Examination of a skin biopsy specimen revealed epithelioid cell granulomas accompanied by caseous necrosis, and a diagnosis of LMDF was made. The patient was treated successively with azithromycin, roxithromycin and minocycline hydrochloride, but there was no improvement. When we tried oral tranilast therapy, flattening of the papules was observed 2 weeks after the start of treatment, and by 1 month the papules had almost disappeared. In case 2, the patient was a 39-year-old man who had broken out in erythematous papules on both upper and lower eyelids, with some accompanied by scaling, 2 years before the initial examination. Pathological specimen revealed epithelioid cell granulomas accompanied by caseous necrosis, and a diagnosis of LMDF was made. There was no improvement when treated orally with minocycline hydrochloride or doxycycline hydrochloride, and treatment was switched to oral tranilast therapy. After 1 month of treatment, the papules had almost disappeared. We concluded that oral tranilast therapy should be tried as a treatment for intractable LMDF.

Shiba S, Okawa H, Uenishi H, Koike Y, Yamauchi K, Asayama K, Nakamura T, Tajima F. Longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury. Objective To investigate the longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury (SCI). Design Longitudinal study (20-y follow-up). Setting Laboratory setting. Participants Persons with SCI (N=7). Interventions Not applicable. Main Outcome Measures Maximum oxygen consumption Vo 2 max) measured in 1986–1988 and in 2006. Results Subjects with SCI maintained stable Vo 2 max in 2006. Six of the 7 continued various wheelchair sports activities, while 1 person quit sports activities 1 year after the baseline study. The latter person showed reduced Vo 2 max by 53%, while 2 persons who continued strenuous wheelchair sports activities showed increased Vo 2 max by 43% and 45% after 20 years. Conclusion The results indicated that physical capacity reflected the level of sports activity in subjects with SCI who maintained sports activities.

はじめに：胸部食道癌患者を対象に術前心肺機能強化トレーニングを行うことによりVO2maxを増加させることが可能かどうか，またトレーニング施行により術前の患者自身の精神的状態にどのように影響するかをprospectiveに検討した．対象と方法：対象は当院第2外科に入院した基準を満たす根治食道癌切除術予定の患者23例．心肺機能強化トレーニングは従来の呼吸理学療法と全身調整運動に加え，予備心拍数（heart rate reserved；以下，HRR）法を用い50～70％HRR強度の目標心拍数で自転車エルゴメーターを用いて行った．術前トレーニングによるVO2maxの変化は呼気ガス分析を実施した．また，呼吸器機能，下肢筋力の変化およびSTAI質問表による不安尺度の変化についても検討した．結果：トレーニング開始時と比較し，術直前においてVO2maxと右膝伸展筋力が有意に増加していた（p＜0.05）．一方，状態不安について23例中15例（65.2％）で低下を認めた．さらに，術後の離床経過はトレーニング導入前のControlと比較し明らかに早まっていた．結語：胸部食道癌患者において術前心肺機能強化トレーニングの導入は，VO2maxを高めることに加え下肢筋力増強と呼吸機能維持につながり，離床を早め術後合併症予防に寄与し，さらにトレーニング実施により術前の不安軽減につながる可能性が示唆された．

Pupillometry was used to evaluate the effects of the calcium channel blockers cilnidipine (CL) and amlodipine (AM) on changes in autonomic nervous activity induced by isometric exercise in patients with hypertension. After handgrip exercise, the velocity of miosis increased in both the CL and AM groups. However, the velocity of mydriasis increased in only the AM group. Velocity slopes of miosis and mydriasis were smaller in the CL group than in the AM group. The low-to-high frequency ratio obtained from pulse wave analysis increased in only the AM group. Sympathetic activation elicited by isometric exercise was suppressed more effectively by CL than by AM.

We encountered a pediatric case of bacteremia and possible cholecystitis due to Moraxella osloensis that was treated successfully. We confirmed the diagnosis with the presence of a high serum titer of the antibody to the organism. Furthermore, 16S rRNA sequencing was performed to identify the bacteria.

Oral immunotherapy (OIT) is a significant focus of treatment of food allergy. OIT appears to be effective in inducing desensitization, however, patients receiving OIT frequently developmild/moderate symptoms during the therapy. It has not been clearly established whether the clinical tolerance induced by OIT resembles natural tolerance. According to our data, the efficacy of OIT is different among food antigens, and it is comparatively difficult to achieve the clinical tolerance in milk OIT. Moreover, the definitive evidence of efficacy and safety with long-term therapy is limited. Further studies need to be offered to patients in clinical practice. Recently, novel treatments for food allergy, sublingual and epicutaneous immunotherapy, and combination treatment with an anti-IgE monoclonal antibody (omalizumab), have been examined in some studies. OIT combined with omalizumab increased the threshold doses of food without adverse reactions and may be of benefit in food allergy treatment. More studies are needed to demonstrate long-term safety and treatment benefits in a larger patient cohort.

Allergen avoidance is the standard treatment for managing food allergies. Complete avoidance is difficult, and accidental exposure often occurs. Immunotherapy is a significant focus for treating food allergies, and oral immunotherapy (OIT) appears to be particularly effective in inducing desensitization. The majority of patients who receive OIT show increased threshold doses of their food allergen. The efficacy of OIT is different among food antigen, and milk OIT is relatively difficult to achieve tolerance. OIT may induce mild to moderate symptoms during the therapy, widespread acceptance of OIT for long-term therapy is unclear. Recently, novel immunotherapies for food allergies, such as sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT) and using an anti-IgE monoclonal antibody (omalizumab), have been assessed. In addition, a combination of OIT with omalizumab, which was found to increase the threshold doses of the offending foods without producing adverse reactions, may be effective and useful in the treatment of food allergies. These treatments have been used only in research settings; further studies in large numbers of patients are needed to demonstrate their long-term safety and benefits in clinical practice.

In the treatment of Kawasaki disease, resistance to high-dose immunoglobulin intravenous (IGIV) can occur. The neutrophil morphology analyses in 17 patients revealed that transient pseudo-Pelger-Huët anomaly was more frequently detected in the IGIV-resistant group. This finding may aid the prediction of IGIV resistance.

We report two cases of lupus miliaris disseminatus faciei (LMDF) in which oral tranilast was effective. In case 1, the patient was a 33-year-old woman who had developed pale red papules on her face, especially around her eyes and lower jaw, approximately 7 months previously. Examination of a skin biopsy specimen revealed epithelioid cell granulomas accompanied by caseous necrosis, and a diagnosis of LMDF was made. The patient was treated successively with azithromycin, roxithromycin and minocycline hydrochloride, but there was no improvement. When we tried oral tranilast therapy, flattening of the papules was observed 2 weeks after the start of treatment, and by 1 month the papules had almost disappeared. In case 2, the patient was a 39-year-old man who had broken out in erythematous papules on both upper and lower eyelids, with some accompanied by scaling, 2 years before the initial examination. Pathological specimen revealed epithelioid cell granulomas accompanied by caseous necrosis, and a diagnosis of LMDF was made. There was no improvement when treated orally with minocycline hydrochloride or doxycycline hydrochloride, and treatment was switched to oral tranilast therapy. After 1 month of treatment, the papules had almost disappeared. We concluded that oral tranilast therapy should be tried as a treatment for intractable LMDF.

Isometric muscle contraction (static exercise) induces circulatory response. Static exercise in individuals with thoracic spinal cord injury (TSCI) induces cardiovascular response and blood redistribution to the non-exercising muscles. The aim of our study was to determine the circulatory response during arm static exercise in individuals with TSCI and able-bodied (AB) controls. Mean blood pressure (MBP), heart rate (HR), cardiac output (CO), leg skin blood flow (SBF), and leg muscle blood flow (MBF) were recorded noninvasively, total peripheral resistance (TPR) was estimated by dividing MBP by CO, and hormonal changes were measured before, during and after static 35% maximal voluntary contraction (MVC) of the arm flexor muscles in seven male individuals with TSCI (T7–T11) and seven age-comparable AB control (32.2 ± 7.6 and 31.0 ± 4.7 years, respectively). The 35% MVC was similar in TSCI and AB individuals (107.3 ± 28.2 and 101.0 ± 22.5 N, respectively). HR, CO, MBP, TPR, SBF and MBF increased in both groups during arm static exercise. Plasma epinephrine concentration increased during arm static exercise in AB controls only (P < 0.05). Circulation to leg muscles was similar in TSCI and AB individuals and the lack of sympathetic vasoconstriction in the paralyzed leg area did not alter the cardiovascular responses during 35% MVC of arm static exercise. We conclude that sympathetic vasoconstriction in the resting leg area did not contribute to the pressor reflex during 35% MVC of arm static exercise.

Methods 4574 patients (average age 4.0 ± 2.6 years old, male-female ratio 1.89), who had received open-OFC to heated-egg or cow’s milk or wheat from 2005 to 2012, were enrolled to this study. Patients were divided into following 3 categories according to symptoms induced by OFC (primary diagnosis of FA). The “positive” group was patients who showed objective symptoms and “negative” group was patients who had not any symptoms. The third group was defined as “uncertain” who only showed subjective or weak objective symptoms such as slight erythema, mild abdominal pain or isolated cough. Patients with “negative” and “uncertain” group were asked to ingest causative foods or those products at home to confirm whether to induce any symptoms by the intake or not. In several weeks after OFC, we made the final diagnosis based on the information obtained from patients (final diagnosis of FA).