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Inhalation of formaldehyde leads to rapid absorption by the respiratory airway, followed by metabolism by erythrocytes and the enzymes formaldehyde dehydrogenase and aldehyde dehydrogenase. [...]formaldehyde has an estimated biologic half-life of about 1–2 minutes (1). [...]inhaled formaldehyde may cause irritation and inflammation of the respiratory system (1). In addition to the cumulative irritant effect, formaldehyde as a small molecule is known to conjugate with large protein molecules in serum (such as albumin), thus provoking the formation of specific IgE antibodies, in turn leading to mast cell degranulation associated with the allergic response (9, 10). [...]formaldehyde exposure can influence the immune response, thereby increasing T-helper cell type 2 polarization through an adjuvant effect (9, 10). [...]our results demonstrated that exposure to formaldehyde in school classrooms was significantly associated with rhinitis, peripheral olfactory dysfunction, increased pharmacologically reversible nasal obstruction, small airway impairment, and elevated FeNO (Figure 1). [...]mitigation strategies for reducing exposure to formaldehyde are warranted for school environments to prevent these problems in vulnerable children.

ObjectivesLiterature suggests an inconsistent, but largely inverse, association between asthma and risk of glioma, which is primarily due to methodological inconsistency in sampling frame and ascertainment of asthma. The objective of the study was to clarify the association between asthma and risk of glioma by minimising methodological biases (eg, recall and detection bias).DesignA population-based case–control study.SettingGeneral population in Olmsted County, Minnesota, USA.ParticipantsAll eligible biopsy-proven incident glioma cases (1995–2014) and two sets of controls among residents matched to age and sex (first set: community controls without glioma; second set: MRI-negative controls from the same community).MethodsThe predetermined asthma criteria via medical record review were applied to ascertain asthma status of cases and controls. History of asthma prior to index date was compared between glioma cases and their matched controls using conditional logistic regression models. Propensity score for asthma status was adjusted for multivariate analysis.ResultsWe enrolled 135 glioma cases (median age at index date: 53 years) and 270 controls. Of the cases, 21 had a history of asthma (16%), compared with 36 of MRI controls (27%) (OR (95% CI) 0.48 (0.26 to 0.91), p=0.03). With MRI controls, an inverse association between asthma and risk of glioma persisted after adjusting for the propensity score for asthma status, but did not reach statistical significance probably due to the lack of statistical power (OR (95% CI) 0.48 (0.21 to 1.09); p=0.08). Based on comparison of characteristics of controls and cases, community controls seem to be more susceptible to a detection bias.ConclusionsWhile differential detection might account for the association between asthma and risk of glioma, asthma may potentially pose a protective effect on risk of glioma. Our study results need to be replicated by a larger study.

Objective. To investigate the repeatability and safety of measuring impulse oscillation system (IOS) parameters and the point of wheezing during bronchoprovocation testing of preschool children. Methods. Two sets of methacholine challenge were conducted in 36 asthma children. The test was discontinued if there was a significant change in reactance (Xrs5) and resistance (Rrs5) at 5 Hz (Condition 1) or respiratory distress due to airway obstruction (Condition 2). The repeatability of PC80_Xrs5, PC30_Rrs5, and wheezing (PCw) was assessed. The changes in Z-scores and SD-indexes from prebaseline (before testing) to postbaseline (after bronchodilator) were determined. Results. For PC30_Rrs5, PC80_Xrs5, and PCw for subjects, PC80_Xrs5 showed the highest repeatability. Fifteen of 70 tests met Condition 2. The changes from pre- and postbaseline values varied significantly for Rrs5 and Xrs5. Excluding subjects with Z-scores higher than 2SD, we were able to detect 97.1% of bronchial hyperresponsiveness during methacholine challenge based on the change in Rrs5 or Xrs5. A change in IOS parameters was associated with wheezing at all frequencies. Conclusion. Xrs5 and Rrs5 have repeatability comparable with FEV1, and Xrs5 is more reliable than Rrs5. Clinicians can safely perform a challenge test by measuring the changes in Rrs5, Xrs5, and Z-scores from the prebaseline values.

Purpose Lipopolysaccharide-binding protein (LBP) is a 65-kDa acute phase protein, derived from the liver, which is present in high concentrations in plasma. Data regarding the association between circulating plasma LBP levels and obesity-related biomarkers in the pediatric population are scarce. We aimed to determine whether there was a difference in plasma LBP levels between overweight/obese and normal-weight adolescents and to assess the correlation of circulating LBP levels with anthropometric measures and obesity-related biomarkers, including insulin resistance, liver enzyme levels, and lipid profiles. Methods The study included 87 adolescents aged 12–13 years; 44 were overweight/obese and 43 were of normal-weight. We assessed anthropometric and laboratory measures, including body mass index (BMI), blood pressure, insulin resistance, liver enzyme levels, and lipid profiles. Plasma LBP levels were measured using an enzyme-linked immunosorbent assay. Results The mean age of the participants was 12.9±0.3 years. Circulating plasma LBP levels were significantly increased in overweight/obese participants compared with those in normal-weight participants (7.8±1.9 µg/mL vs. 6.0±1.6 µg/mL, P<0.001). LBP levels were significantly and positively associated with BMI, systolic blood pressure, aspartate aminotransferase, alanine aminotransferase, total cholesterol, low density lipoprotein-cholesterol, fasting glucose and insulin, and insulin resistance as indicated by the homeostatic model assessment of insulin resistance (HOMA-IR) (all P<0.05). In multivariate linear regression analysis, BMI and HOMA-IR were independently and positively associated with plasma LBP levels. Conclusion LBP is an inflammatory biomarker associated with BMI and obesity-related insulin resistance in adolescents. The positive correlation between these parameters suggests a potentially relevant pathophysiological mechanism linking LBP to obesity-related insulin resistance in adolescents.

Purpose Chest radiography is often performed on patients hospitalized with typical clinical manifestations of bronchiolitis. We aimed to determine the proportion of subjects with pathologic chest radiographic findings and the clinical predictors associated with pathologic chest radiographic findings in young children admitted with the typical presentation of bronchiolitis. Methods We obtained the following data at admission: sex, age, neonatal history, past history of hospitalization for respiratory illnesses, heart rate, respiratory rate, the presence of fever, total duration of fever, oxygen saturation, laboratory parameters (i.e., complete blood cell count, high-sensitivity C-reactive protein [hs-CRP], etc.), and chest radiography. Results The study comprised 279 young children. Of these, 26 had a chest radiograph revealing opacity (n=24) or atelectasis (n=2). Multivariate logistic regression analysis showed that after adjustment for confounding factors, the clinical predictors associated with pathologic chest radiographic findings in young children admitted with bronchiolitis were elevated hs-CRP level (>0.3 mg/dL) and past history of hospitalization for respiratory illnesses (all P<0.05). Conclusion The current study suggests that chest radiographs in young children with typical clinical manifestations of bronchiolitis have limited value. Nonetheless, young children with clinical factors such as high hs-CRP levels at admission or past history of hospitalization for respiratory illnesses may be more likely to have pathologic chest radiographic findings.

Herein, we report a rare case of hemolytic anemia with reticulocytopenia following intravenous immunoglobulin therapy in a young infant treated for Kawasaki disease. A 2-month-old boy presented with fever lasting 3 days, conjunctival injection, strawberry tongue, erythematous edema of the hands, and macular rash, symptoms and signs suggestive of incomplete Kawasaki disease. His fever resolved 8 days after treatment with aspirin and high dose infusion of intravenous immunoglobulin. The hemoglobin and hematocrit decreased from 9.7 g/dL and 27.1% to 7.4 g/dL and 21.3%, respectively. The patient had normocytic hypochromic anemia with anisocytosis, poikilocytosis, immature neutrophils, and nucleated red blood cells. The direct antiglobulin test result was positive, and the reticulocyte count was 1.39%. The patient had an uneventful recovery. However, reticulocytopenia persisted 1 month after discharge.

Purpose Bronchopulmonary dysplasia (BPD) is characterized by inflammation with proteolytic damage to the lung extracellular matrix. The results from previous studies are inconsistent regarding the role of proteinases and antiproteinases in the development of BPD. The aim of the present study was to investigate whether matrix metalloproteinase (MMP)-8, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-2, and TIMP-1 levels in the serum of preterm infants at birth are related to the development of BPD. Methods Serum was collected from 62 preterm infants at birth and analyzed for MMP-8, MMP-9, TIMP-2, and TIMP-1 by using enzyme-linked immunosorbent assay. MMPs and TIMPs were compared in BPD (n=24) and no BPD groups (n=38). Clinical predictors of BPD (sex, birth weight, gestational age, etc.) were assessed for both groups. The association between predictors and outcome, BPD, was assessed by using multivariate logistic regression. Results Sex, birth weight, and mean gestational age were similar between the groups. BPD preterm infants had significantly lower TIMP-2 levels at birth compared with no BPD preterm infants (138.1±23.0 ng/mL vs. 171.8±44.1 ng/mL, P=0.027). No significant difference was observed in MMP-8, MMP-9, and TIMP-1 levels between the two groups. Multivariate logistic regression analysis indicated that the TIMP-2 levels were predictive of BPD after adjusting for sex, birth weight, gestational age, proteinuric preeclampsia, and intraventricular hemorrhage (β=-0.063, P=0.041). Conclusion Low TIMP-2 serum levels at birth may be associated with the subsequent development of BPD in preterm infants.

Background: Zonulin is the endogenous protein known to control the permeability of intestinal tight junction reversibly. Zonulin is actively engaged in intestinal innate immunity and is over-expressed in autoimmune diseases where tight junction of intestine plays a pivotal role, such as celiac disease, malabsorption disorder, and type 1 diabetes. Waist-Height ratio was well known as one of indices of obesity and also Waist-Hip ratio was known of abdominal obesity. We investigated that the associations among Waist-Height, Waist-Height ratio, and the level of Zonulin by assessing obesity-related biomarkers, such as liver enzymes, lipid profiles, and insulin resistance, in a population of adolescents. Methods: The study included 198 adolescents aged 12-18 years; 92 were overweight/obese and 106 were of normal-weight. We assessed anthropometric and laboratory measures, including body mass index (BMI), BMI z-score, Waist-Height, Waist-Hip ratio, blood pressure, liver enzyme levels, lipid profiles, and insulin sensitivity. Serum Zonulin levels were measured using an enzyme-linked immunosorbent assay. Results: The mean age of the participants was 15.2±2.5 years. Circulating serum Zonulin levels were significantly increased in overweight/obese participants compared with those in normal-weight participants (P=0.042). Zonulin levels were significantly and positively associated with BMI, BMI z-score, alanine aminotransferase levels, triglyceride, fasting insulin, and insulin resistance as indicated by the homeostasis model assessment of insulin resistance (HOMA-IR) (all P<0.05). In multivariate linear regression analysis, alanine aminotransferase (P<0.0001), triglyceride (P<0.0001), and HOMA-IR (P=0.001) contributed independently to circulating Zonulin levels after controlling for the effect of BMI z-score. Zonulin levels were more strongly associated with Waist-Hip ratio rather than Waist-Height ratio. Conclusions: Zonulin was associated with indices of obesity. Waist-Hip ratio was more strongly associated with levels of Zonulin. The positive correlation between these parameters suggests putative pathophysiological mechanism linking Zonulin to metabolic dysfunction in adolescents.

Purpose. The purpose of this study was to investigate the effects of home remodeling and food allergy (FA) on the development of atopic dermatitis (AD) in children. Methods. The Modified International Study of Asthma and Allergies in Childhood questionnaire was used to survey 4,111 children recruited from 3 kindergartens and 6 elementary schools from Seongnam, Korea. Participants’ parents agreed for them to participate in physical examinations, skin prick tests, and blood tests. Results. Home remodeling in the past 12 months (adjusted odds ratio [aOR] 3.40, P=0.006), lifetime diagnosis of FA (aOR 3.95, P<0.001), parental history of AD (aOR 2.67, P=0.001), and FA (aOR 2.35, P=0.004) were independent risk factors for lifetime diagnosis of AD ever. When history of home remodeling and FA were combined, the risk for moderate-to-severe AD by scoring atopic dermatitis (SCORAD) score increased (aOR, 7.19, P=0.011, P for interaction = 0.034). Conclusion. Home remodeling, lifetime diagnosis of FA, parental history of AD, and parental history of FA were independent risk factors for AD. In addition, we observed a synergistic interaction between home remodeling and FA in the risk of moderate-to-severe AD.

Small airway hyperresponsiveness is a critical aspect in preschool children with asthmatic symptoms interms of asthma control. The aim of this study was to elucidate the relationship of changes in reactance (Xrs) and resistance (Rrs) of IOS and FEV1 with those in clinical parameters and to determine which IOS parameter is correlated with bronchial hyperresponsiveness before positive clinical endpoints. We performed the methacholine challenge test in ninety-four preschool children (4.2±1.1 years) with suspected asthma. The end of test (EOT+) was defined as one or more of the following: audible wheezing (PCw+), a fall in the oxygen saturation (w92%, PCs+) or development of respiratory symptoms (PCr+). Mean changes in FEV1, Xrs5, and Rrs5 in the EOT+ group were 39.2±14.3% (95% CI 35.1-43.2%), 176.8±78.0 (95% CI 154.9-198.8) and 53.6±30.2 (45.1-62.0), respectively. The changes of Xrs5 in three EOT+ groups exceeded 80% and were lowest in PCr+(median, 95.9, IQR;73.4 to 132.4), followed by PCw+ and PCs+. However, Rrs5 did not show greater than 40% changes in PCr+. Xrs5 showed a higher correlation with changes in saturation (r=-0.578) than Rrs5 (r=-0.426). A49% decrease in Xrs5 was the optimal point for predicting a 80% change of Xrs5 at the following step. When examining the 5 step methacholine challenge test in preschoolers, the use of clinical parameters alone as an endpoint is of little value. The reactance value of 5 Hz is a useful predictive marker for bronchial hyperresponsiveness.