A Randomized, Double-Blind, Placebo-Controlled Trial Assessing the Oral Administration of a Heat-Treated Lactobacillus paracasei  Supplement in Infants with Atopic Dermatitis Receiving Topical Corticosteroid Therapy.

BACKGROUND/AIMS: Atopic dermatitis (AD) is a common disease in infancy, for which topical steroids are the first-line therapy but have side effects. Innovative approaches are needed to reduce the burden of AD and corticosteroid usage in infants. METHODS: The once-daily consumption of heat-treated probiotic Lactobacillus paracasei GM-080 or placebo for 16 weeks as supplementary approach to topical treatment with fluticasone propionate cream was compared in AD infants aged 4-30 months. Outcomes were SCORAD and its subscores, TEWL, Infants' Dermatitis Quality of Life Index (IDQOL), corticoid "sparing effect," CCL17/TARC, and IgE status. RESULTS: SCORAD, objective SCORAD, itching, and IDQOL decreased significantly (p < 0.001) over the treatment period in both treatment groups. Slight decreases (ns) were noted in TEWL in lesional and unaffected skin and CCL17 levels. There were no differences between the treatment groups. Total IgE increased over the treatment period in both groups, with significantly higher increase in the heat-treated probiotic group (p = 0.038). There was no evidence of a corticoid "sparing effect" by the probiotic. CONCLUSIONS: In this design, the probiotic L. paracasei was not beneficial as a complementary approach to topical corticosteroids in infants with AD. However, slight beneficial effects may have been masked by the moderate potency corticoid.

Poria cocos Modulates Th1/Th2 Response and Attenuates Airway Inflammation in an Ovalbumin-Sensitized Mouse Allergic Asthma Model.

Poria cocos, called fuling, is a famous tonic in traditional Chinese medicine that reportedly possesses various pharmacological properties, including anti-inflammation and immunomodulation. However, few studies have investigated the effects of P. cocos on allergic diseases, such as allergic asthma. Allergic asthma is caused primarily by Th2 immune response and characterized by airway inflammation. This study first demonstrated the anti-allergic and anti-asthmatic effects of P. cocos extract (Lipucan®). P. cocos extract distinctly exhibited reduced inflammatory cell infiltration in the peribronchial and peribronchiolar regions compared to the asthma group in the histological analysis of pulmonary tissue sections. Prolonged P. cocos extract administration significantly reduced eosinophil infiltration, PGE2 levels, total IgE, and OVA-specific IgE. Moreover, P. cocos extract markedly suppressed Th2 cytokines, IL-4, IL-5, and IL-10. On the other hand, P. cocos extract significantly elevated IL-2 secretion by Th1 immune response. In addition, P. cocos extract elevated the IFN-γ level at a lower dose. We also observed that P. cocos extract increased the activity of NK cells. Our results suggest that P. cocos extract remodels the intrinsic Th1/Th2 response to prevent or alleviate allergy-induced asthma or symptoms.

Risk factors for infective endocarditis in children with congenital heart diseases - A nationwide population-based case control study.

BACKGROUND: Infective endocarditis (IE) is uncommon in childhood. Its associated epidemiological characteristics in patients with congenital heart disease (CHD) remain unclear. METHODS: The study population included children born in Taiwan during the years 1997 to 2005 who were diagnosed as having CHD before 3years of age. All children were followed up until the end year of 2010, the diagnosis of infective endocarditis, or death. The demographic characteristics of patients with and without IE, the invasive procedures performed during 6months before the index date, the prophylactic antibiotics related to dental procedures, and in-hospital mortality were collected. RESULTS: Information of 24,729 children with CHD were retrieved for our analysis and 237 patients with newly diagnosed IE were identified. The incidence rate of IE in all CHD lesions was 11.13 per 10,000person-years. Taking ASD for reference, the following CHD lesions were at risk for IE: cyanotic CHD (adjusted OR, 9.58; 95% confidence interval, 5.38-17.05), endocardial cushion defect (ECD) (8.01; 2.73-23.50), Left-sided lesions (4.36; 1.90-10.01) and VSD (2.93; 1.64-5.23). Patients who underwent procedures have a higher risk of acquiring IE which include central venous catheter (CVC) insertion (3.17; 2.36-4.27), cardiac catheterization (3.74; 2.67-5.22), open-heart surgery (2.47; 1.61-3.77), valve surgery (3.20; 1.70-6.02), and shunt surgery (7.43; 2.36-23.41). However, dental procedures did not increase the risk of IE, irrespective of antibiotic usage. CONCLUSIONS: The risk of IE varies markedly among CHD lesions in our study. Invasive heart procedures but not dental procedures, are more significantly associated with IE among children with CHD.

Propolis extracts exhibit an immunoregulatory activity in an OVA-sensitized airway inflammatory animal model.

Propolis, which has been used widely in folk medicine, has been shown to exhibit various biological activities but its immunoregulatory and anti-inflammatory activities in intact animals have not been well studied. We investigated these activities of propolis using an ovalbumin-induced asthma animal model. Mice were immunized and sensitized by exposure to ovalbumin (OVA) antigen and administered with low- (65 mg/kg body weight) and high-dose (325 mg/kg body weight) propolis water extracts by tube feeding. The serum OVA-specific IgE titer and cytokine profiles in cultured splenocytes and bronchoalveolar lavage fluids (BALF) were analyzed. The number of eosinophils in BALF was counted. Here we demonstrate that propolis extracts can suppress the serum levels of OVA-specific IgE and IgG(1), and airway hyperresponsiveness (AHR) in OVA-sensitized mice. There are no significant differences in the concentration of eotaxin or the number of eosinophils in BALF among the four groups. However, the higher dose of propolis extracts decreases the level of IL-5 in BALF. The splenocytes from mice administered with propolis extracts (low- and high-dose groups) exhibit a strong inhibition of IL-10 secretion and up-regulation of IFN-gamma secretion in splenocytes stimulated with concanavalin A (ConA). In addition, cytokine (IFN-gamma, IL-6, and IL-10) secretion in OVA-stimulated splenocytes from the propolis groups was significantly lower than that in the control group. These results suggest that propolis extracts may be a potential novel therapeutic agent for asthma.

Premature with trichomoniasis: report of one case.

We report a case of an extremely-low-birth-weight premature infant with Trichomonas vaginalis infection of the vagina and urinary tract. Her mother is also infected with Trichomonas vaginalis but is asymptomatic. The patient's illness started as an asymptomatic pyuria and later on at early infancy developed profuse malodorous vaginal discharge. Her vaginal discharge was positive for Trichomonas vaginalis, both on wet mount and Papanicolaou smear, and the infection responded well to treatment with metronidazole. Infants with recurrent vaginal discharge presenting beyond the neonatal period may be attributed to T. vaginalis infection.

Axillary supernumerary breast in a female adolescent: report of one case.

Polythelia and polymastia usually occur along the embryonic milk lines extending from the axilla to the groin. Polymastia in female patients has been reported to manifest during pregnancy or lactation. We report a 14-year-old adolescent with axillary supernumerary breasts. She had painful axillary swelling during menstrual period. The mass in the right axilla was excised with pathologic report of supernumerary breasts with fibrocystic change. When a mass is located along the milk line, the possibility of the presence of breast tissue should be considered.

Umbilical vein catheter malposition: report of one case.

A male premature newborn was diagnosed as respiratory distress syndrome shortly after birth. Umbilical arterial and venous catheters were inserted. The position of the umbilical venous catheter was erroneous roentgenographically, but return of blood was noted when the catheter was pull back to below the diaphragm. After fluid infusion via the catheter, swelling of buttock, scrotum and bilateral thighs with pitting edema over the abdominal wall and lower back, and increased body weight were noted the next day. The abdomen was distended without bluish discoloration. Laboratory studies showed neither anemia nor hypoalbuminemia. Blood pressure was 42/28 mmHg. The abdominal reoentgenogram showed bowel gas pattern suggesting the presence of fluid within the peritoneal cavity. The catheter of the umbilical vein was removed. Repeat abdominal reoentgenogram the following day showed resorption of the fluid. The infant was gavage fed. The catheter perforated the umbilical vein and went into the retroperitoneal area. This complication is rare. This case is presented with a review of the literature, concluding that if there are uncertainties about the location of the catheter, verification should include having blood returned from the umbilical venous catheter and taking lateral and frontal films before fluid infusion starts.

Infectious endocarditis in pediatric patients: analysis of 19 cases presenting at a medical center.

BACKGROUND/PURPOSE: Infectious endocarditis (IE) is a rare, but potentially fatal disease in pediatric patients. In this study, we reviewed the symptoms and signs, etiology, laboratory findings and outcomes of IE patients over the past 10 years. METHODS: Patients (< 18 years old) with definite IE according to the modified Duke criteria, or patients with positive pathological findings, between September 1998 and September 2008 were included in the study. The etiology, symptoms and signs, laboratory findings and outcomes were collected via chart review. RESULTS: Nineteen cases (13 boys and 6 girls) ranging in age from 2.5 months to 18 years (mean = 7.98 years; median = 5 years) were included. Nine out of 17 cases (52.9%) had microscopic hematuria and two out of three (66.7%) cases showed elevated rheumatoid factor levels. Seventeen (89.5%) had fever and seven (36.8%) had major vessel embolic events. Blood cultures yielded Staphylococcus aureus in seven cases, and viridans Streptococci in two cases. The other three cases had Pneumococcus, Pseudomonas aeruginosa and Candida albicans. Two patients died and one was discharged in a critical condition. Two of the seven (28.6%) patients with a positive blood culture for S. aureus died, three (42.9%) had an embolic event and one (14.3%) had central nervous system complications (intracranial hemorrhage). The initial C-reactive protein levels in the blood culture-positive group were significantly higher than those in the blood culture-negative group (p = 0.035). CONCLUSION: S. aureus is one of the most common etiologies in IE patients, while viridans Streptococcus accounts for fewer cases than suggested by previous studies. IE caused by S. aureus seems to carry a higher risk of mortality, and embolic events are associated with increased mortality.

Short-term outcomes of a near-full PBL curriculum in a new Taiwan medical school.

Problem-based learning (PBL), which incorporates principles of adult learning, is an important innovation in medical education. The use of PBL in health professional curricula is becoming more widespread. The curriculum design and the ways of implementing PBL are different among schools. More evidence is needed before a full PBL curriculum can be successfully implemented in an Asian medical school. Fu Jen Medical School is the first school in Taiwan to adopt a near-full PBL approach for the 3rd and 4th year curriculum (the medical education in Taiwan is mostly a 7-year undergraduate program). Fu Jen Medical School launched the interdisciplinary case-based, small group learning and integrated curriculum in 2002. This study investigated the short-term outcomes of this PBL curriculum, evaluated from several aspects. First, the self-directed learning readiness of the medical students before and after they entered the PBL curriculum was investigated using the Self-Directed Learning Readiness Scale (SDLRS). Second, semi-structured qualitative interviews were conducted with 5th and 6th year medical students and clinical instructors to understand the impact of PBL on the learning of clinical medicine. Finally, the passing rates in the Taiwan Medical Licensure Examination were compared with those of other medical schools in Taiwan. After 1 year of PBL, medical students at Fu Jen Medical School showed significant increases in the total SDLRS score, and in the subscores for learning strategy and self-assessment. These changes persisted until the end of 2 years of PBL. Students in their clinical years claimed that they were more active in learning, and had better learning skills and confidence in self-directed learning as compared with students from lecture-based curricula. PBL helps their clinical reasoning process, self-directed learning abilities and the use of knowledge in basic science to explain the clinical problem. On the other hand, the students thought that PBL had limited breadth and depth in clinical medicine and could not give them enough confidence in facing the national licensure examination. The initial batches of medical students (students from the first three cohorts) had the highest passing rate for Part 1 (basic sciences in medicine) and students from the first two cohorts had a 100% passing rate for Part 2 (clinical medicine) of the Taiwan Medical Licensure Examination. A near-full PBL curriculum in Asian medical schools is feasible and could encourage students to improve their self-directed learning abilities, learn adequate knowledge in basic sciences, and experience positive effects on learning clinical medicine. Better preparation of students for integrated learning of basic and clinical sciences are still needed, as is an emphasis on tutor training to improve the effectiveness of tutorial discussions.