Emergency Medical Team Response during the Hokkaido Eastern Iburi Earthquake 2018: J-SPEED Data Analysis.

INTRODUCTION: In the last ten years, Japan has experienced several large-scale earthquakes with devastating social and health impacts. Earthquakes directly and indirectly cause a variety of health problems. Further investigation is required to increase preparedness and preventive efforts. In response to the Hokkaido Eastern Iburi Earthquake on September 6, 2018, 32 Emergency Medical Teams (EMTs) employed the Japanese version of Surveillance in Post-Extreme Emergencies and Disasters (J-SPEED) as a national standard daily reporting template, gathering data on the number and type of health problems treated. STUDY OBJECTIVE: The purpose of the study is to conduct a descriptive epidemiology study using the J-SPEED data to better understand the health problems during the earthquake disaster. METHODS: Reported items in J-SPEED (Ver 1.0) form were analyzed by age, gender, and time to better understand the health issues that have arisen from the earthquake. RESULTS: Most consultations (721; 97.6%) occurred between Day 1 and Day 13 of the 32-day EMT response. During the response period, disaster stress-related symptoms were the most common health event (15.2%), followed by wounds (14.5%) and skin diseases (7.0%). CONCLUSION: The most often reported health event during the response period was stress-associated illnesses related to disasters, followed by wounds and skin conditions. The health consequences of natural disasters depend on diverse local environment and population. As a result, this initial study was hard to generalize; however, it is expected that data accumulated using the J-SPEED system in the future will strengthen and extend the conclusions.

Singing Is a Risk Factor for Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Case-Control Study of Karaoke-Related Coronavirus Disease 2019 Outbreaks in 2 Cities in Hokkaido, Japan, Linked by Whole Genome Analysis.

Background: Singing in an indoor space may increase the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We conducted a case-control study of karaoke-related coronavirus disease 2019 (COVID-19) outbreaks to reveal the risk factors for SARS-CoV-2 infection among individuals who participate in karaoke. Methods: Cases were defined as people who enjoyed karaoke at a bar and who tested positive for SARS-CoV-2 by reverse-transcription polymerase chain reaction between 16 May and 3 July 2020. Controls were defined as people who enjoyed karaoke at the same bar during the same period as the cases and tested negative. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. ORs of key variables adjusted for each other were also estimated (aOR). Results: We identified 81 cases, the majority of whom were active elderly individuals (median age, 75 years). Six cases died (case fatality ratio, 7%). Among the cases, 68 (84%) were guests, 18 of whom had visited ≧2 karaoke bars. A genome analysis conducted in 30 cases showed 6 types of isolates within 4 single-nucleotide variation difference. The case-control study revealed that singing (aOR, 11.0 [95% CI, 1.2-101.0]), not wearing a mask (aOR, 3.7 [95% CI, 1.2-11.2]), and additional hour spent per visit (aOR, 1.7 [95% CI, 1.1-2.7]) were associated with COVID-19 infection. Conclusions: A karaoke-related COVID-19 outbreak that occurred in 2 different cities was confirmed by the results of genome analysis. Singing in less-ventilated, indoor and crowded environments increases the risk of acquiring SARS-CoV-2 infection. Wearing a mask and staying for only a short time can reduce the risk of infection during karaoke.

[The current situation and agendas in the prevention and control of non-communicable diseases in Vietnam].

Objectives　In Vietnam, the number of patients with non-communicable diseases (NCDs) has been increasing in recent years in association with the country's remarkable economic growth and corresponding changes in its population's lifestyle. The purposes of this research were to identify the challenges in the prevention and control of NCDs in Vietnam and to discuss countermeasures for NCDs in Vietnam and Japan.Methods　As a 2015 Regional Public Health Overall Promotion Project, an investigation team consisting of 11 public health physicians visited Hanoi, the capital of Vietnam, and its vicinities from January 11, 2016 to January 15, 2016. In Hanoi and its vicinities, we visited local healthcare institutions, such as the World Health Organization(WHO) Representative Office in Vietnam and Ministry of Health of Vietnam, and discussed the prevention and control of NCDs in Vietnam and Japan.Results　According to a survey in 2014, 73% of people of all age groups in Vietnam died from NCDs and the number of people suffering from NCDs has been sharply increasing in recent years. Major behavioral risk factors are dietary risks, tobacco smoke, alcohol use, and physical inactivity. There are four main problems with prevention and control of NCDs: 1) low awareness among the people of NCDs, 2) regional disparity of medical services, 3) shortage of healthcare staff members with professional knowledge, and 4) poor NCD surveillance.　In Vietnam, an NCD program with screening methods and medical guidelines for respective diseases was developed in 2002. However, it only covered tertiary prevention and did not fully describe the primary and secondary prevention measures. Currently, with the technical assistance of the WHO, the implementation of countermeasures emphasizing prevention and control to reduce NCD risk factors has only just begun.Conclusion　It was considered that educating each person in Vietnam on NCD prevention measures would be necessary and that a national policy, like Healthy Japan 21 of Japan, and a nationwide screening project, such as specific medical checkups, could serve as a useful reference. We found that public health activities in Japan to penetrate a region mainly involving public health nurses had played important roles for Japanese people's health. Furthermore, Japan shares with Vietnam the challenges including the shortage of human resources, and therefore, the securement of healthcare staff members who confront health challenges and the enhancement of their abilities is required.

The relationship between hypertension and health-related quality of life: adjusted by chronic pain, chronic diseases, and life habits in the general middle-aged population in Japan.

OBJECTIVES: The aim of this study was to examine the relationship between hypertension and health-related quality of life (HRQoL) adjusted by chronic pain, other chronic diseases, and life habits in the general middle-aged population in Japan. METHODS: This study is a population-based cross-sectional study. In this study, 1117 participants aged 40-65 years and living in Shika Town completed a self-administered questionnaire including Short Form-36 (SF-36). The scores of SF-36 among hypertensives were compared with those of normotensives. The independent association of hypertension with each SF-36 subscale was analyzed using a multiple linear regression model adjusted by age, BMI, chronic pain, chronic diseases, sleep, exercise, and occupational status. We analyzed two groups; Group 1 which contained 846 participants completed the questionnaire without coronary heart disease and cerebral vascular disease, Group 2 which contained 686 participants without coronary heart disease, cerebral vascular disease, or diseases accompanied by chronic pain (gastroduodenal ulcer, fracture, osteoarthritis, osteoporosis, rheumatoid arthritis, and disc herniation). RESULTS: In Group 2, hypertensive women had a lower general health perception than normotensive women [unstandardized coefficients; B = -8.84, 95 % confidence interval (95 % CI) = -13.3 to -4.34, standardized coefficients; ß = -0.200, p < 0.001], whereas hypertensive men had higher social functioning than normotensive men (B = 5.66, 95 % CI = 1.30-10.0, ß = 0.149, p < 0.05) after adjusting by chronic pain and life habits. CONCLUSIONS: These results may be due to the sex difference in the light of the perception for health.

Direct and indirect suppression of interleukin-6 gene expression in murine macrophages by nuclear orphan receptor REV-ERBα.

It is now evident that many nuclear hormone receptors can modulate target gene expression. REV-ERBα, one of the nuclear hormone receptors with the capacity to alter clock function, is critically involved in lipid metabolism, adipogenesis, and the inflammatory response. Recent studies suggest that REV-ERBα plays a key role in the mediation between clockwork and inflammation. The purpose of the current study was to investigate the role of REV-ERBα in the regulation of interleukin-6 (il6) gene expression in murine macrophages. REV-ERBα agonists, or overexpression of rev-erb α in the murine macrophage cell line RAW264 cells, suppressed the induction of il6 mRNA following a lipopolysaccharide (LPS) endotoxin challenge. Also, rev-erb α overexpression decreased LPS-stimulated nuclear factor κB (NFκB) activation in RAW264 cells. We showed that REV-ERBα represses il6 expression not only indirectly through an NFκB binding motif but also directly through a REV-ERBα binding motif in the murine il6 promoter region. Furthermore, peritoneal macrophages from mice lacking rev-erb α increased il6 mRNA expression. These data suggest that REV-ERBα regulates the inflammatory response of macrophages through the suppression of il6 expression. REV-ERBα may therefore be identified as a potent anti-inflammatory receptor and be a therapeutic target receptor of inflammatory diseases.

Long-term heat exposure prevents hypoxia-induced apoptosis in mouse fibroblast cells.

Long-term continuous exposure to high ambient temperatures induces complete heat acclimation in humans and animals. However, to date, the effects of long-term exposure to heat stress on cells have not been fully evaluated. In this study, we investigated an adaptive physiological process induced in culture cells by continuous exposure to mild heat stress for 60 days. The results of this investigation provide evidence that after long-term heat acclimation in cells, (1) heat shock protein levels are increased, (2) hypoxia inducible factor-1α (HIF-1α) expression is upregulated, and (3) heat shock-induced and hypoxia-induced apoptoses are attenuated. These results suggest that the hypoxia response pathway is an intrinsic part of the heat acclimation repertoire and that the HIF-1 pathway following long-term heat acclimation induces cells with cross tolerance against hypoxia.

Theobromine, the primary methylxanthine found in Theobroma cacao, prevents malignant glioblastoma proliferation by negatively regulating phosphodiesterase-4, extracellular signal-regulated kinase, Akt/mammalian target of rapamycin kinase, and nuclear factor-kappa B.

Theobromine, a caffeine derivative, is the primary methylxanthine produced by Theobroma cacao. We previously showed that methylxanthines, including caffeine and theophylline, have antitumor and antiinflammatory effects, which are in part mediated by their inhibition of phosphodiesterase (PDE). A member of the PDE family, PDE4, is widely expressed in and promotes the growth of glioblastoma, the most common type of brain tumor. The purpose of this study was to determine whether theobromine could exert growth inhibitory effects on U87-MG, a cell line derived from human malignant glioma. We show that theobromine treatment elevates intracellular cAMP levels and increases the activity of p38 mitogen-activated protein kinase and c-Jun N-terminal kinase, whereas it attenuates p44/42 extracellular signal-regulated kinase activity and the Akt/mammalian target of rapamycin kinase and nuclear factor-kappa B signal pathways. It also inhibits cell proliferation. These results suggest that foods and beverages containing cocoa bean extracts, including theobromine, might be extremely effective in preventing human glioblastoma.

Attitudes towards cross-border reproductive care among infertile Japanese patients.

OBJECTIVES: The attitudes towards cross-border reproductive care (CBRC) held by infertile Japanese patients have not been explored. The objective of the present study was to examine interest levels, preferred destinations, motivations, and sources of information related to CBRC. Our findings provide a general outline of CBRC and the future of reproduction and assisted reproductive technology (ART) in Japan. METHODS: The study used a cross-sectional design. Data were collected from 2,007 infertile Japanese patients from 65 accredited ART clinics in Japan (response rate, 27.4 %) via anonymous questionnaires. RESULTS: Most of the infertile Japanese patients who responded denied using CBRC. However, by group, 171 (8.5 %) patients in non-donor in vitro fertilization, 150 (7.5 %) in egg donation, 145 (7.2 %) in pre-implantation genetic diagnosis, and 129 (6.4 %) in surrogacy said that, depending on the situation, they might travel abroad in the future. Older respondents were more likely to express an intention to travel overseas for egg donation in the future. The most popular destination for CBRC was the United States. Popular reasons for interest in CBRC among those considering or planning using this approach to third-party reproduction were that egg donation or surrogacy was unavailable or that obtaining ethical approval takes too long in Japan, whereas these processes are legal and affordable overseas. However, high cost was the most common reason for hesitancy regarding CBRC. Among the participants who were considering or planning to travel abroad for this purpose, TV, medical agencies, print media, and message boards on websites were popular sources of information, whereas doctors, friends, and patient self-help groups were not. CONCLUSIONS: Although CBRC among infertile Japanese patients is not at present common, the demand for and use of this approach may increase in the future in the context of the increasingly aging population. Lack of regulation and unavailability of third-party reproduction is a major cause of CBRC among Japanese patients. Health care provider faces an urgent need for giving useful information for patients regarding CBRC.

Decreased activity of daily living produced by the combination of Alzheimer's disease and lower limb fracture in elderly requiring nursing care.

OBJECTIVES: Alzheimer's disease (AD) impairs cognitive functions, subsequently decreasing activity of daily living (ADL), and is frequently accompanied by lower limb fracture including hip fracture in the elderly. However, there have been few studies on what kinds of physical functions are affected or what degrees of dysfunction are produced by this combination. This study aims to clarify the relationship between decreased ADL and the combination of AD and lower limb fracture. METHODS: We examined present illness and ADL in 4340 elderly aged 82.8 ± 9.36 years [average ± standard deviation (SD)] requiring nursing care and compared ADL between elderly with and without AD or lower limb fracture treated with surgery or conservatively using analysis of covariance (ANCOVA), with age and sex as covariants. RESULTS: We recognized that activities of cognitive function (p < 0.001), eating (dysphagia) (p < 0.001), eating (feeding) (p < 0.001), and toilet use (p < 0.001) in the elderly with AD were significantly lower than in those without the disease, even after adjusting for sex and age. Activities of bed mobility (p < 0.05), transfer and locomotion (p < 0.001), and bathing (p < 0.05) in the elderly with a fracture treated with surgery were significantly lower, which differed from the results of AD. Significant interactions of AD and fracture treated with surgery on the ADL scores for bed mobility (p < 0.001), dysphagia (p < 0.01), feeding (p < 0.001), and toilet use (p < 0.05) show that the combination had a much more profound influence on the ADL scores than AD or fracture alone. We obtained almost the same results for fractures treated conservatively as for fractures treated with surgery. CONCLUSIONS: These results demonstrated that the combined effects of AD and lower limb fracture were significantly greater than expected additive effects of AD and fracture, suggesting that the combination of AD and lower limb fracture has synergistic effects on almost all types of ADL except cognitive functions.

Targeted activation of PKA and Epac promotes glioblastoma regression in vitro.

Ras-p44/42 mitogen-activated protein kinase (MAPK) and Akt signaling are the key pathways involved in the promotion of glioblastoma formation. Notably, phosphodiesterase 4 (PDE4) is widely expressed in brain tumors and promotes their growth. PDE4 inhibitors have been reported to suppress glioblastoma growth in vitro and in vivo. The mechanisms underlying these actions, however, have yet to be elucidated. The aim of this study was to investigate whether intracellular cyclic adenosine monophosphate (cAMP) was able to suppress the Ras-p44/42 MAPK signaling pathway via protein kinase A (PKA) and exchange protein directly activated by cAMP (Epac) in U87MG human malignant glioma cells. Forskolin, an activator of adenylate cyclase, inhibited cell growth and the phosphorylation of p44/42 MAPK in U87MG cells, whereas the non-hydrolyzable cAMP analog 8-bromoadenosine 3',5'-cAMP (8-Br-cAMP) considerably suppressed cell growth and phosphorylation of p44/42 MAPK. The inhibitory effects of forskolin were partially prevented by the PKA inhibitor H89. The Epac-selective agonist 8-(4-chlorophenylthio)-2'-O-methyladenosine cAMP (8-CPT-cAMP) inhibited phosphorylation of p44/42 MAPK. These findings suggest that PKA and Epac are involved in the effect of intracellular cAMP on the Ras-p44/42 MAPK signaling pathway.

Fatal and non-fatal cases of lime sulfide exposure and pathogenetic mechanisms underlying pancreatic injury: Case reports with an animal experiment.

Lime sulfide poisoning by the oral route is rarely encountered in the practice of forensic science, whereas hydrogen sulfide poisoning is seen frequently. We report here two cases of fatal lime sulfide poisoning with several related cases and in addition induced histological damage with acute inflammation in animal models under at similar concentrations. We also evaluated sulfide and thiosulfate concentrations and speculated as to the cause of pancreatic damage in these cases.

Cellular heat acclimation regulates cell growth, cell morphology, mitogen-activated protein kinase activation, and expression of aquaporins in mouse fibroblast cells.

The heat shock response has been extensively studied by a number of investigators to understand the molecular mechanism underlying the cellular response to severe heat stress (higher than 42°C). But, body or tissue temperature increases by only a few degrees Celsius during physiological events. Therefore, the physiological cellular response to mild heat stress rather than severe heat stress is likely to be more important. Repeated exposure to hyperthermia for consecutive 5 days induces heat acclimation which is an adaptive physiological process in humans and animals. However, thus far, the effect of continuous exposure to heat stress on cells has not been fully evaluated. In this study, we investigated an adaptive physiological process that is induced in culture cells by continuous exposure to mild heat stress for 5 days. Exposure to heat activated p38-mitogen-activated protein kinase; inhibited cell growth without apoptosis; and increased the levels of HSPs and HSF-1 in mouse fibroblast cells. Interestingly, exposure to heat regulated the expression of aquaporins and induced morphological change. In a physiological sense, these results suggested that continuous exposure to mild heat stress for 5 days, in which heat acclimation is attained in humans and animals, might induce molecular adaptation to heat in cells.

The relationship between social capital and self-rated health in a Japanese population: a multilevel analysis.

OBJECTIVE: The aim of this study was to use a multilevel analysis to examine whether cognitive and structural dimensions of regional social capital were associated with individual health outcomes after adjusting for compositional factors. METHODS: Data from the Japanese General Social Surveys project, a nationwide study with a two-stage stratified random sampling method conducted in 2000, 2001, 2002, 2005, and 2006, were aggregated and used for the multilevel analysis (n = 11,702). We examined whether both cognitive and structural aspects of social capital (social trust, neighborhood safety, and social participation) were associated with the self-rated health (SRH) of residents from 118 regions after adjustment for compositional factors. RESULTS: Social trust and existing neighborhood safety were negatively associated with poor SRH, whereas the effect of social participation was not significant. Social trust was still negatively associated with poor SRH after adjusting for individual demographic factors and socioeconomic status (p = 0.001). In contrast, neighborhood safety and social participation did not reach significance after adjusting for compositional factors. CONCLUSION: Based on the results of this study, social trust was associated with health outcomes. Further study is needed to clarify the path linking regional trust in others to individual health outcomes in the Japanese population.

The differences in the involvements of loci of promoter region and Ile50Val in interleukin-4 receptor α chain gene between atopic dermatitis and Japanese cedar pollinosis.

BACKGROUND: Atopic dermatitis (AD) and Japanese cedar pollinosis (JCP) are common chronically allergic diseases associated with the activation of T-helper 2 cells. Recent studies have shown that polymorphisms in the genes for IL-4 receptor α chain (IL4RA) may contribute to susceptibility of AD and JCP, although the differences in the involvements of loci of IL4RA gene between AD and JCP are unclear. In this study, we investigated the role of polymorphisms in IL-4RA gene in conferring susceptibility to the development of AD and/or JCP using a family analysis and an association analysis in a Japanese population. METHODS: Five polymorphisms in the IL-4RA gene, C-3223T, T-1914C, T-890C, Ile50Val and Glu375Ala, have been genotyped using PCR-based methods in 75 trios families, including 15 AD families, 30 JCP families, and 30 families with combination of AD and JCP in the family analysis. Forty-five AD, 60 JCP and 125 control children constituted the association study. RESULTS: The transmission disequilibrium test showed that the allele of Ile50 was significantly transmitted to children with JCP alone (p < 0.05). Haplotype analysis showed that the -3223T/Ile50 haplotype was preferentially transmitted to both AD (p < 0.01) and JCP children (p < 0.01), while that the C-3223/Ile50 haplotype was preferentially transmitted to only JCP children (p < 0.01). The association study showed that -3223T and haplotype of -3223T/Ile50 were associated with AD children, but not with JCP. Ile50 was associated with both AD and JCP. CONCLUSIONS: Our data suggest that -3223T and the -3223T/Ile50 haplotype were risk factors for AD. Ile50 allele seems to be involved in both JCP and AD. Interactions of the IL-4RA loci may play a role both conferring susceptibility and modulating severity of AD.

Activation of tumor suppressor protein PTEN and induction of apoptosis are involved in cAMP-mediated inhibition of cell number in B92 glial cells.

During brain development, cAMP induces morphological changes and inhibits growth effects in several cell types. However, the molecular mechanisms underlying the growth inhibition remain unknown. Tumor suppressor protein phosphatase and tensin homolog deleted on chromosome 10 (PTEN) is a lipid phosphatase that inhibits the phosphoinositide 3-kinase (PI3K) pathway. The phosphorylation of Akt, which is one of the key molecules downstream of PI3K, inhibits apoptosis. In this study, we investigated the role of PTEN in cAMP-mediated growth inhibition. B92 rat glial cells were treated with 2 different cAMP stimulatory agents, a phosphodiesterase (PDE) inhibitor and a ß-adrenoceptor agonist. Both cAMP stimulatory agents induced marked morphological changes in the cells, decreased cell number, decreased Akt phosphorylation, activated PTEN, cleaved caspase-3, and induced the condensation and fragmentation of nuclei. These results indicate that the cAMP stimulatory agents induced apoptosis. Protein phosphatase inhibitor prevented cAMP-induced dephosphorylation of PTEN and Akt. In addition, cAMP analogs and Epac-selective agonists affected PTEN and Akt activities. These results suggested that cAMP-induced apoptosis may be mediated by PTEN activation and Akt inhibition through protein phosphatase in B92 cells. Our results provide new insight into the role of PTEN in cAMP-induced apoptosis in glial cells.

C-reactive protein is associated with cigarette smoking-induced hyperfiltration and proteinuria in an apparently healthy population.

Although cigarette smoking is known to be an important risk factor for renal disease, the mechanism by which smoking induces progressive renal disease in a healthy population has not been established. We hypothesized that oxidative stress (measured as 8-iso-prostaglandin F(2α), 8-iso-PGF2a), inflammation (highly sensitive C-reactive protein (CRP), hs-CRP) and nitric oxide may be associated with an alteration in the estimated glomerular filtration rate (eGFR) and proteinuria in otherwise healthy smokers. A total of 649 eligible subjects were classified according to their smoking status. Plasma NOx was measured using ozone-based chemiluminescence, urinary 8-iso-PGF2a was measured using enzyme immunoassay and serum hs-CRP was measured using a latex aggregation nephelometry method. The levels of 8-iso-PGF2a and hs-CRP increased in current smokers (P=0.001 and P=0.029, respectively), although there was not an increase in the NOx level. The prevalence of a high eGFR increased in light smokers (odds ratio (OR) 1.15 (95% confidence interval (CI), 0.61-2.17)) and heavy smokers (OR 2.33 (95% CI, 1.06-5.10)) when compared with non- and past smokers (P for trend=0.024). The multivariable-adjusted mean values of the eGFR in current smokers, reported from the lowest to the highest quintiles of hs-CRP levels, were 82.1, 85.1, 86.4 and 88.5 ml per min per 1.73 m² (P for trend=0.027). The mean values of proteinuria were 28.6, 34.6, 37.2 and 39.5 mg g⁻¹ creatinine (P for trend=0.003). The correlation coefficient between hs-CRP and eGFR was increased significantly (P=0.03) across non- (r=0.03), past (r=-0.17), light (r=0.13) and heavy smokers (r=0.31). In conclusion, cigarette smoking is a risk factor for renal function alteration in healthy smokers and is characterized by a high eGFR and a high urinary protein associated with an increase in the hs-CRP. This finding suggests that hs-CRP may help mediate the alteration of renal function in smokers.

Association between the incidence of premature rupture of membranes in pregnant women and seismic intensity of the Noto Peninsula earthquake.

OBJECTIVES: The Noto Peninsula earthquake struck the coast of the Noto Peninsula, Japan on March 25, 2007, resulting in the death of one woman and injury to 356 people. A total of 684 houses were totally destroyed by this earthquake, and more than 2,500 people were forced to live at shelters. In this study, we have evaluated the association between the incidence of peripartum abnormalities and seismic intensity of the Noto Peninsula earthquake. METHODS: Demographic data, births, seismic intensity of the earthquake and the incidence of peripartum abnormalities between June 25, 2007 and January 31, 2008 were surveyed. The dataset included 126 pregnant women who lived in the disaster area. The seismic intensity of the earthquake was expressed on the scale (0-7, with 7 being the strongest measure) used by the Japan Meteorological Agency. The subjects of the analysis included 19.7% of the pregnant women affected by the disaster. RESULTS: Of the pregnant women included in this study, 7.9% had a premature rupture of membranes (PROM), with the percentage being significantly higher in the group that experienced a seismic intensity of 6 than in that experienced a seismic intensity of 5. CONCLUSIONS: Our epidemiologic study shows that the PROM among our study cohort was associated with seismic intensity, suggesting that the physical outcome was due to aftershocks of the earthquake at a seismic intensity ≥6. This outcome may result from the psychological stress caused by the earthquakes.

[Environmental factors in allergic diseases].

The prevalence of allergic diseases such as asthma and pollinosis is steadily increasing and seems to be associated with modern lifestyle. Therefore, it has been hypothesized that high living standards and hygienic conditions reduce exposure to microbial components, and lead to an imbalance in the immune system, especially in the Thl and Th2 system, which increases the risk for the development of allergic diseases. However, recent accumulated epidemiological evidences have demonstrated that air pollutants including diesel exhaust particulate (DEP) and NO2 are responsible for the increased prevalence of allergies. The effects of environmental chemicals have also been supported by the in vivo and in vitro studies. It is important to prevent allergy development in our life as early as possible (e.g., since our infancy).