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This article covers the salient and updated themes of the Japanese Pediatric Guidelines for the Treatment and Management of Asthma (JPGL) 2020 published by the Japanese Society of Pediatric Allergy and Clinical Immunology. In the 2020 guidelines, five new clinical questions (CQs) have been added to address the 12 CQs regarding the treatment of childhood asthma. "Infant and preschool asthma" is diagnosed when young children (6 years of age) have three or more episodes of clear expiratory wheezing, which continue for more than 24 h, and symptom improvement can be observed after beta-2 agonist inhalation. In children without clear improvement, diagnostic therapeutic trial for the duration of 1 month with controller treatment can be used. Since long-term management is initiated, the treatment level is adjusted based on the current control status and the management of risk factors, with the provision for holistic care. This underscores the smooth transition of pediatric patients into adult services. There are several differences between the JPGL and the guidelines of other countries. Further evidence is obtained as the utility of the newly proposed management plans should be evaluated in the Japanese population.

Allergenicity to heated egg yolks is known to be low in hen's egg allergy. However, there are few reports concerning the safety of an oral food challenge (OFC) with boiled egg yolks. This study aimed to determine the safety of a boiled egg yolk OFC and the clinical characteristics of patients who were OFC-positive.We retrospectively examined the data of patients who underwent an OFC with one boiled egg yolk at Miyagi Children's Hospital between January 2013 and December 2020. Patients were included if they had a history of immediate symptoms due to hen's egg or positive specific IgE levels to egg yolk or egg white.Among 600 patients, 15.0% were positive for OFC, only one patient required an intramuscular adrenaline injection, and 70% of OFC-positive patients had gastrointestinal symptoms.Boiled egg yolk OFC had a low symptom induction rate; however, when symptoms were induced, gastrointestinal symptoms were most commonly observed. Given the low risk of developing severe symptoms, we conclude that the likelihood of safely performing an OFC is high.

Background There are expanding indications for oral food challenges (OFCs). Although several studies have examined the risk of OFCs, little has been reported on allergic reactions during OFCs depending on the indication. This study assessed the prevalence, severity, and treatment of allergic reactions depending on the indication for OFCs. Methods We performed a prospective multicenter study between March 2012 and May 2013. Severity of symptoms elicited by OFCs was classified according to grading of anaphylaxis that ranges from grade 1 (most mild) to grade 5 (most severe). Results A total of 5062 cases (median age, 3.8 years; males, 65.2%) were analyzed. Allergic reactions were elicited in 2258 (44.6%) OFCs, of which 991 (43.9%) were classified as grade 1, 736 (32.6%) were classified as grade 2, 340 (15.1%) were classified as grade 3, and 191 (8.5%) were classified as grade 4-5. Epinephrine was administered in 7.1% (n = 160) of positive OFCs. Among the top three most common food allergens (hen's egg, cow's milk, and wheat), severity differed significantly depending on the indication for OFC, and adjusted standardized residuals indicated that severity of allergic reactions was higher for the indication to assess threshold level for oral immunotherapy. In addition, the prevalence of epinephrine use was highest for the indication to determine safe intake quantity. Conclusions Our study suggested that prevalence, severity, and treatment of allergic reactions differ depending on the indication for OFC. Further studies are needed to determine differences in risks depending on the indication for OFC.

Maintenance therapy of atopic dermatitis (AD) with frequent exacerbations needs proactive use of topical corticosteroids or topical calcineurin inhibitors. However, it can be difficult for children in an unfavorable family environment. Home-visit nursing service (HVNS) plays an important role in delivering care to people who need medical help at home. We report a boy in a difficult family situation who received HVNS to successfully manage AD.

We aim to examine the characteristics of the symptoms induced by exercise provocation tests following allergen consumption in patients who have undergone oral immunotherapy (OIT).Patients who were positive for exercise provocation tests in Miyagi Children's Hospital from April 2012 to January 2019 were retrospectively analyzed. Patients were classified into food-dependent exerciseinduced anaphylaxis (FDEIA) group and post-OIT-FDEIA group.Six patients in the FDEIA group and 19 patients in the post-OIT-FDEIA group were analyzed. There were no significant differences in age, sex, and number of complications between the FDEIA and post-OIT-FDEIA groups, except for level of total serum immunoglobulin E. The median time from the start of exercise to onset of symptoms was 20 min in the FDEIA group and 25 min in the post-OIT-FDEIA group. The rate of adrenaline administration in post-OIT-FDEIA group was significantly lower. The median time from exercise to onset of severe symptoms requiring adrenaline was 32.5 min in the FDEIA group and 25 min in the post-OIT-FDEIA group.These data suggest that FDEIA and post-OIT-FDEIA patients can exhibit similar clinical symptoms, and all symptoms occurred in 60 minutes after exercise.

Oral immunotherapy (OIT) for food allergy requires exercise restrictions following the regular consumption of allergens to prevent immediate symptoms. We investigated the efficacy and the safety of exercise provocation tests to assess exercise tolerance after consumption of allergens following OIT.This study was based on data from patients who underwent exercise provocation tests with consumption of their allergen after OIT in Miyagi Children's Hospital between April 2012 and March 2019. The results of exercise provocation tests and patients' characteristics were retrospectively analyzed.Fifteen out of 91 patients were positive for exercise provocation tests. The positive rates were 12% (4/33) with egg, 15% (5/34) with cow's milk, and 25% (6/24) with wheat. Intramuscular adrenaline injections were administered to two patients with allergies to egg, one with cow's milk, and one with wheat.Following OIT, the assessment using exercise provocation tests should be performed prior to termination of exercise restriction because some patients remain intolerant to exercise.

Hen's egg is the most common allergen in IgE-mediated food allergy among children in Japan. Although the majority of patients with egg allergy can eat heated egg yolk safely because of its low allergenicity, severely allergic patients show an immediate-type reaction to heated egg yolk. We hypothesized that patients with hyperresponsiveness to boiled egg yolk may have difficulty in acquiring tolerance to egg. The purpose of this study was to examine the prognosis of patients with hyperresponsiveness to boiled egg yolk. Data from 121 patients with egg allergy who underwent oral food challenge (OFC) with boiled egg yolk between January 2012 and December 2013 were analyzed retrospectively. The proportion of patients who could consume heated whole egg 3 years after OFC was 15.4% in the OFC-positive group and 75.8% in the OFC-negative group. Hyperresponsiveness to boiled egg yolk in early life might lead to prolonged egg allergy in children. This finding might aid in the selection of an appropriate population requiring practical immunotherapy.

Background: In September 2015, Japan experienced an unusual increase in acute asthma hospitalizations of children that coincided with an enterovirus D68 (EV-D68) epidemic. The objective of this study is to investigate whether EV-D68 had a causal relationship with the spike in asthma hospitalizations. Methods: A nation-wide retrospective survey of asthma hospitalizations of children was performed for the period from January 2010 through October 2015. The Japanese Society of Pediatric Allergy and Clinical Immunology asked its affiliated hospitals to report monthly numbers of hospitalizations, ICU admissions and mechanical ventilations due to acute asthma exacerbation. The data were retrieved from medical databases using predefined search criteria: diagnosis of asthma or asthmatic bronchitis, admission, and age

Regardless of interaction with less frequent imitative caregivers, infants can obtain the vowels of the caregivers' mother tongues by finding the correspondence between their own vowels and the caregivers' vowels. This paper proposes a learning method based on auto-mirroring bias (AMB) with a self-evaluation mechanism to find such correspondence. AMB is the robot's anticipation of being imitated by its caregiver and has a role of narrowing the candidates for the correspondence. The self-evaluation mechanism biased by AMB works as outlier (incorrect mapping) rejection, expecting that the outliers appear less consistently than the correct mappings do in the interaction. Results from several computer simulations with real sound wave recording from a human experimenter show that the robot could successfully achieve being imitated by the proposed method even if interacting with a caregiver who would seldomly imitate its utterances.

The mechanism of infant vowel development is a fundamental issue of human cognitive development that includes perceptual and behavioral development. This paper models the mechanism of imitation underlying caregiver-infant interaction by focusing on potential roles of the caregiver's imitation in guiding infant vowel development. Proposed imitation mechanism is constructed with two kinds of the caregiver's possible biases in mind. The first is what we call ?sensorimotor magnets,? in which a caregiver perceives and imitates infant vocalizations as more prototypical ones as mother-tongue vowels. The second is based on what we call ?automirroring bias,? by which the heard vowel is much closer to the expected vowel because of the anticipation being imitated. Computer simulation results of caregiver-infant interaction show the sensorimotor magnets help form small clusters and the automirroring bias shapes these clusters to become clearer vowels in association with the sensorimotor magnets.

It is a formidable issue how robots can show behaviors to be considered as the corresponding human's ones since the body structure is different between robots and humans. As a simple case for such a correspondence problem, this paper presents a robot that learns to vocalize vowels through the interaction with its caregiver. Inspired by the findings of developmental psychology, we focus on the roles of maternal imitation (i.e., imitation of the robot voices by the caregiver) since it could play a role to instruct the correspondence of the sounds. Furthermore, we suppose that it causes unconscious anchoring in which the imitated voice by the caregiver is performed unconsciously, closely to one of his/her own vowels and hereby helps to make the robot's utterances to be more vowel-like. We propose a method for vowel learning with an imitative caregiver, under the assumptions that the robot knows the desired categories of the caregiver's vowels, and the rough estimate of mapping between the region of sounds th...

IL-3 is a potent priming cytokine for human basophils, inducing an increase of mediator release after stimulation. The mechanism of IL-3 priming of the basophil response to FcεRI aggregating stimuli remains unknown. We explored the regulation of several elements of IgE-mediated signaling by a short priming with IL-3. Early signaling events such as phosphorylation of Syk, Shc, linker for activation of T cells, and the calcium signal were not statistically affected by acute IL-3 priming. Downstream in the signaling cascade, a point of up-regulation was found at the level of Raf-1-Mek-Erk. Although the phosphorylation of Raf-1 was not changed by IL-3 priming, IL-3-primed anti-IgE-stimulated basophils showed a strong synergism for Mek and Erk phosphorylation when compared with either IL-3 or anti-IgE alone; pre-exposure to IL-3 induced a final 13-fold average increase over anti-IgE-induced Erk phosphorylation (6-fold above the sum of anti-IgE and IL-3 alone). The kinetics, dose response, and pharmacologic characteristics of the IL-3 priming of stimulus-induced Erk phosphorylation support the involvement of a yet unknown mechanism that is independent of IL-3-induced Erk and PI3K activation. This type of preactivation can be mimicked by incubation with the Ser-Thr kinase inhibitors, Ro-81–3220, or bisindoylmaleimide II.

Background Syk kinase is probably an early necessary tyrosine kinase involved in IgE-mediated secretion from human basophils. Causal testing of the role of syk kinase in the secretion requires a selective pharmacological agent. Piceatannol has previously been used to demonstrate the causal role of syk in secretion but its selectively has recently come into question. Objective To determine whether piceatannol inhibits IgE-mediated signalling events in a manner consistent with its putative inhibitory effects on syk kinase and at concentrations relevant to its inhibition of mediator release. Methods Human basophils were examined for the effects of piceatannol on mediator release or various signalling steps. Results We show that while piceatannol has an IC50 for inhibition of IgE-mediated histamine release of 3–5 µm, these same concentrations inhibit secretion of phorbol 12-myristate 13-acetate (PMA)-induced histamine release (as previously shown) and leukotriene C (LTC)4 release induced by fMLP. Concentrations of piceatannol up to 100 µm also did not inhibit IgE-mediated phosphorylation of shc, a immediate downstream target of syk kinase. Similar concentrations also did not inhibit IgE-mediated cytosolic calcium elevations, another downstream signal thought to be dependent on syk kinase. In contrast, piceatannol did modify the cytosolic calcium response that follows stimulation with formyl methionyl-leucyl-phenylalanine (fMLP). Conclusion Taken together with published studies using other cell types, we conclude that piceatannol does not inhibit secretion from human basophils by inhibiting the activity of syk kinase.

Previous studies have indicated a redundancy in the effects of the cytokines, IL-3, IL-5, and nerve growth factor (NGF) on acute priming of human basophils. In the current study, we have examined the effects of these three cytokines on 18-h priming for leukotriene C4 generation, their ability to induce FcεRIβ mRNA expression, or their ability to sustain basophil viability in culture. We also examine a variety of the signaling steps that accompany activation with these cytokines. In contrast with the ability of IL-3 to alter secretagogue-mediated cytosolic calcium responses following 18-h cultures, 18-h treatment with IL-5 or NGF did not affect C5a-induced leukotriene C4 generation or alter C5a-induced intracellular Ca2+ concentration elevations. IL-3 and IL-5, but not NGF, induced FcεRIβ mRNA expression and all three improved basophil viability in culture with a ranking of IL-3 > IL-5 ≥ NGF. All three cytokines acutely activated the extracellular signal-regulated kinase pathway and the signaling elements that preceded extracellular signal-regulated kinase and cytosolic phospholipase A2 phosphorylation, consistent with their redundant ability to acutely prime basophils. However, only IL-3 and IL-5 induced Janus kinase 2 and STAT5 phosphorylation. This pattern of signal element activation among the three cytokines most closely matched their ability to induce expression of FcεRIβ mRNA. Induction of the sustained calcium signaling that follows overnight priming with IL-3 appeared to be related to the strength of the early signals activated by these cytokines but the relevant pathway required was not identified. None of the signaling patterns matched the ability of the cytokines to promote basophil survival.

IgE-mediated down-regulation of secretion from basophils and mast cells is an important component of the overall cellular response that determines the ultimate extent of mediator release. The down-regulatory process that occurs during active secretion has also been associated with the methodological phenomenon called desensitization, but the mechanisms underlying desensitization are not understood. A variety of studies have suggested that activation of protein kinase C (PKC) results in down-regulation of IgE-mediated secretion so we have examined the effect of the PKC inhibitors Ro-31-8220 (3-[1-[3-amidinothio)propyl-1H-indol-3-yl]-3-(1-methyl-1H-indol-3- yl) maleimide) and bis-indolylmaleimide II on desensitization in human basophils. At concentrations that have been shown previously to inhibit PKC-mediated functions in basophils completely, these two drugs had no effect on IgE-mediated desensitization. We did find, however, that the src-family kinase inhibitors PP1 [4-amino-5-(4-methylphenyl)-7-(t-butyl)pyrazolo[3,4-d]pyrimidine] and PP2 [4-amino-5-(4-chlorophenyl)-7-(t-butyl)pyrazolo[3, 4-d]pyrimidine] inhibited desensitization as well as secretion. These data suggest that PKC has little role in down-regulating the IgE-mediated basophil response. However, like the activation signaling cascade, the desensitization process is dependent on the activation of src family kinases.

Activation of the NADPH oxidase-derived oxidant burst of polymorphonuclear leukocytes (PMNs) is of critical importance in inflammatory disease. PMN-derived superoxide (O(2)) can be scavenged by nitric oxide (NO( small middle dot)) with the formation of peroxynitrite (ONOO(-)); however, questions remain regarding the effects and mechanisms by which NO( small middle dot) and ONOO(-) modulate the PMN oxidative burst. Therefore, we directly measured the dose-dependent effects of NO( small middle dot) and ONOO(-) on O(2) generation from human PMNs stimulated with phorbol 12-myristate 13-acetate using EPR spin trapping. Pretreatment with low physiological (microm) concentrations of NO( small middle dot) from NO( small middle dot) gas had no effect on PMN O(2) generation, whereas high levels (> or =50 microm) exerted inhibition. With ONOO(-) pretreatment, however, a biphasic modulation of O(2) generation was seen with stimulation by microm levels, but inhibition at higher levels. With the NO( small middle dot) donor NOR-1, which provides more sustained release of NO( small middle dot) persisting at the time of O(2) generation, a similar biphasic modulation of O(2) generation was seen, and this was inhibited by ONOO(-) scavengers. The enhancement of O(2) generation by low concentrations of ONOO(-) or NOR-1 was associated with activation of the ERK MAPKs and was blocked by their inhibition. Thus, low physiological levels of NO( small middle dot) present following PMN activation are converted to ONOO(-), which enhances O(2) generation through activation of the ERK MAPK pathway, whereas higher levels of NO( small middle dot) or ONOO(-) feed back and inhibit O(2) generation. This biphasic concentration-dependent regulation of the PMN oxidant burst by NO( small middle dot)-derived ONOO(-) may be of critical importance in regulating the process of inflammation.

Cross-linking of IgE or a bacterial product (f-Met-Leu-Phe; FMLP) induces the release of leukotriene C4 (LTC4) and histamine in human basophils. However, the signaling mechanisms in human basophils are only partially understood. It has been demonstrated that extracellular signal-regulated kinases (ERK1/2) specifically regulate the pathway for LTC4 generation, but not for histamine release and interleukin-4 production. More recent studies have suggested that tyrosine kinase (syk)-mediated phosphorylation of shc is responsible for the ras-ERK cascade via the formation of shc-Grb2-Sos2 following stimulation with anti-IgE antibody, but not FMLP, in human basophils. However, while characterizing the role of phosphatidylinositol (PI)-3 kinase in signaling pathways leading to basophil mediator release, it was noted that this pathway might also regulate p21ras activation. Anti-IgE antibody, but not FMLP, resulted in phosphorylation of p85 (regulatory subunit of PI3 kinase), suggesting activation of PI3 kinase. Inhibition of PI3 kinase by selective inhibitor (LY294002) abolished anti-IgE antibody- but not FMLP-induced phosphorylation of MEK1 (MAPK kinase/ERK kinase) and ERKs while inhibiting LTC4 generation as well as histamine release. IgE-mediated activation of ras (upstream of MEK-ERK) was also inhibited. But, further upstream, phosphorylation of syk and of shc and inducible association between shc and Grb2 were not affected. Furthermore, the IgE-mediated cytosolic calcium response ([Ca++]i) was also diminished. These results suggest that functional responses may be dependent on the activity of PI3 kinase, which regulates at least 2 important signaling pathways: by regulating activation of ras for the MEK-ERK pathway and the increase in [Ca++]i.

Background: T H 1 and T H 2 cytokines are thought to regulate allergic inflammation. Objective: Two key regulatory cytokines, IL-4 and IFN-γ, were examined for their effects on cytokine production by cultured human mast cells (CHMCs). Methods: CHMCs were obtained by culturing cord blood–derived CD34 + cells in the presence of stem cell factor and IL-6 for 14 to 16 weeks. CHMCs were passively sensitized with human myeloma IgE and supplemented with or without IL-4 or IFN-γ. After the sensitization, CHMCs were stimulated with anti-FcϵRIα mAb. Concentrations of secreted cytokines were measured by using ELISA, and cytokine messenger RNA was analyzed by using quantitative competitive RT-PCR. Results: IL-4 profoundly enhanced FcϵRI-mediated production of macrophage inflammatory protein (MIP) 1α, IL-8, and GM-CSF. For example, the enhancement by IL-4 (10 ng/mL) of the production of MIP-1α, IL-8, and GM-CSF was 25-, 7-, and 90-fold, respectively, after 6 hours. IL-4 also enhanced levels of FcϵRI-induced cytokine messenger RNA but to a lesser degree. In contrast, IFN-γ inhibited FcϵRI-induced production of MIP-1α, IL-8, and GM-CSF. For example, the inhibition by IFN-γ (10 ng/mL) of FcϵRI-mediated production of MIP-1α, IL-8, and GM-CSF was 80%, 75%, and 95%, respectively. IFN-γ also suppressed FcϵRI-induced messenger RNA expression of these cytokines. Neither IL-4 nor IFN-γ affected the kinetics of cytokine production by CHMCs. Conclusion: These data suggest that IL-4 and IFN-γ may influence allergic reactions by modulating human mast cell cytokine production. (J Allergy Clin Immunol 2000;106:141-9.)

Human basophils secrete histamine and leukotriene C4 (LTC4) in response to various stimuli, such as Ag and the bacterial product, FMLP. IgE-mediated stimulation also results in IL-4 secretion. However, the mechanisms of these three classes of secretion are unknown in human basophils. The activation of extracellular signal-regulated kinases (ERKs; ERK-1 and ERK-2) during IgE- and FMLP-mediated stimulation of human basophils was examined. Following FMLP stimulation, histamine release preceded phosphorylation of ERKs, whereas phosphorylation of cytosolic phospholipase A2 (cPLA2), and arachidonic acid (AA) and LTC4 release followed phosphorylation of ERKs. The phosphorylation of ERKs was transient, decreasing to baseline levels after 15 min. PD98059 (MEK inhibitor) inhibited the phosphorylation of ERKs and cPLA2 without inhibition of several other tyrosine phosphorylation events, including phosphorylation of p38 MAPK. PD98059 also inhibited LTC4 generation (IC50 = ∼2 μM), but not histamine release. Stimulation with anti-IgE Ab resulted in the phosphorylation of ERKs, which was kinetically similar to both histamine and LTC4 release and decreased toward resting levels by 30 min. Similar to FMLP, PD98059 inhibited anti-IgE-mediated LTC4 release (IC50, ∼2 μM), with only a modest effect on histamine release and IL-4 production at higher concentrations. Taken together, these results suggest that ERKs might selectively regulate the pathway leading to LTC4 generation by phosphorylating cPLA2, but not histamine release or IL-4 production, in human basophils.

The expression of protein kinase C (PKC) isozymes in human basophils and the regulation of PKC isozymes during basophil activation by phorbol 12-myristate 13-acetate (PMA) ± ionomycin, f-met-leu-phe (FMLP), and anti-IgE antibody were examined. In human basophils (> 98% purity), PKCβΙ, βΙΙ, δ, and  were expressed, PKC was difficult to detect, and PKCγ and η were undetectable. In unstimulated basophils, PKCβI and βII were found primarily in the cytosol fraction (95% ± 3% of total and 98% ± 1%, respectively). Within 5 minutes of stimulation with PMA (100 ng/mL), both PKCβI and βII were translocated to the membrane fraction (85% ± 4% and 83% ± 6%, respectively). In resting cells, 48% ± 3% and 61% ± 10% of PKCδ and , respectively, existed in the membrane fraction. Within 1 minute of stimulation with PMA, 90% ± 6% of PKC was found in the membrane fraction, however, no translocation of PKCδ was apparent. Stimulation with FMLP caused modest translocation (≈20%) of all PKC isozymes by 1 minute, whereas stimulation with anti-IgE antibody led to no detectable changes in PKC location throughout a 15-minute period of measurement. However, concentrations of PMA and ionomycin that alone caused no PKC translocation and little histamine release, together caused significant histamine release but no apparent PKC translocation. Studies with bis-indolylmaleimide analogs showed inhibition of PMA-induced, but not anti–IgE-induced, histamine release. These pharmacological studies suggest that PKC does not play a prodegranulatory role in human basophil IgE-mediated secretion.© 1998 by The American Society of Hematology.

Serum glutamic-oxaloacetic transaminase (GOT) levels were determined in 214 infants (133 males and 81 females) with atopic dermatitis during their first visit to the Department of Allergy, National Children's Hospital, Tokyo, Japan. Compared with the normal hospital range, their levels were found to be significantly higher, a tendency which was more conspicuous in lower age groups. We carried out a 13C-methacetin breath test (MBT), administering the stable-isotope-labeled compound to 11 children with higher serum GOT values and 5 within the normal range to investigate hepatic metabolism of methacetin in infants with atopic dermatitis. 13C-methacetin was given orally, and the 13CO2 level in the breath was determined immediately before and after administration, by mass spectrometry. Compared to the normal controls, the atopic infants demonstrated significantly lower 13CO2 peak excretion and delayed peak time. The clearance rate of 13CO2 was also decreased. These results suggest some relationship between atopic dermatitis and liver function in infants.

Although many food-allergic children experienced the Great East Japan Earthquake, little was known about the effects of the disaster on them.Using a questionnaire survey, we studied 194 patients with food allergy in Miyagi Prefecture, who were hospitalized for the oral food challenge test after the earthquake. This survey consists of items related to the damage to home, means of gathering information, lack of allergen-free foods, exacerbation of atopic dermatitis or bronchial asthma, etc.At the earthquake, most of the patients lived around Sendai city. Lifeline disruptions, communication breakdown, and goods shortage occurred in almost all family. Immediately after the earthquake, it was difficult to continue the food elimination diet. Asthmatic attack occurred in 14% of food-allergic children with bronchial asthma. Exacerbation of eczema was seen in 60% of food-allergic patients with atopic dermatitis. Almost all guardians of atopic dermatitis children think that it was because the shower was unavailable after the earthquake.It is necessary to supply food-allergic patients with the specific food elimination diet, and atopic dermatitis patients with the shower facilities as soon as possible after the natural disaster occurs.

An afebrile 8-year-old Japanese girl was referred with hypotensive shock and respiratory distress. She presented with a cough of 1-week duration followed by lethargy, dyspnea, and anuria, with which she was admitted to a previous hospital. She was intubated and given intravenous catecholamines, which did not improve her symptoms. Then, she was transferred to our hospital. Physical examination revealed a right arm blood pressure of 128/64 mm Hg and a left arm blood pressure of 94/56 mm Hg while on 4.6 μg/kg per min of dopamine and dobutamine. However, no blood pressure was obtained in the lower limbs. The heart sounds were distant with no murmur audible. Coarse crackles were prominent in both lungs. Laboratory data showed the following values: creatine kinase of …

Mother-infant vocal communication is a sort of mystery of human cognitive development since they can communicate although their body structures and therefore their utterable areas are different. This paper proposes a method that aids unconscious guidance in mutual imitation for infant development based on a biasing element with two different kinds of modules. The first is based on the normal magnet effect in perceiving heard vocal sounds as the listenerpsilas own vowels (perceptual magnet) and also includes another magnet effect for imitating vocal sounds that resemble the imitatorpsilas vowels (articulatory magnet). The second is based on what we call ldquoauto mirroring bias,rdquo by which the heard vowel is much closer to the expected vowel because the otherpsilas utterance is an imitation of the listenerpsilas own utterance. Computer simulation results of mother-infant interaction show the validity of the proposed bias. Finally future issues are discussed.

The previous approach to vowel imitation learning between a caregiver and an infant (robot) has assumed that the robot can segment the caregiverpsilas utterance into its phoneme category, where the caregiver always imitates the robot utterance. However, in real situations, the caregiver does not always imitate the robot utterance, nor the robot does have the phoneme category (no segmentation capability). This paper presents a method to solve these issues, a weakly-supervised learning along with auto-regulation, that is active selection of action and data with underdeveloped classifier. To cope with not-always imitation problem, a weakly-supervised learning method is applied that is capable to handle incompletely segmented samples (not perfectly imitated voices). Further, the regulation classifier of the imitated voices is recursively applied in order to select good vocal primitives and to segment caregiverpsilas imitated voices that improve the performance of the classifier itself. The simulation results are shown and the future issues are given.