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Lue HC, Chen LR, Lin MT, Chang LY, Wang JK, Lee CY, Wu MH. Epidemiological features of Kawasaki disease in Taiwan, 1976-2007: results of five nationwide questionnaire hospital surveys. Pediatr Neonatol 2014; 55:92-6. [PMID: 24120536 DOI: 10.1016/j.pedneo.2013.07.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 06/21/2013] [Accepted: 07/09/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) affects mainly children younger than 5 years of age, leading to coronary artery lesions, and even to life-threatening myocardial infarction. In Taiwan, KD was encountered for the first time in 1976; then, it continued to occur in increasing numbers. METHODS For the survey of epidemiological features of KD in Taiwan, we conducted five nationwide questionnaire hospital surveys in 1987, 1992, 1994, 2001, and 2008, respectively. In each survey, a special questionnaire form, together with a request letter and diagnostic guidelines for KD, was sent to the chairman of the Department of Pediatrics of all hospitals with 100 or more beds in Taiwan. RESULTS KD patients increased to a total of 14,399 patients by 2007, with the highest number of 1018 in 2001, and the highest incidence of 66.24 per 100,000 children < 5 years of age in 2006. Of the 14,399 patients, the male-to-female ratio ranged from 1.5 to 1.7. Of these patients, 57.6-65.2% were < 2 years of age, 23.3-26.6% were 2-4 years of age, and 11.4-15.8% were ≥ 5 years of age. Coronary artery lesions were noted in 20.2-31.5% of patients. Fourteen cases expired, documenting that the fatality rate decreased from 0.4% to 0.03% during the 31 years from 1976 to 2007. CONCLUSION In Taiwan, KD was encountered for the first time in 1976, and it continued to occur, reaching the highest annual incidence of 66.24 per 100,000 children < 5 years of age in 2006. In Taiwan, the first emergence of KD came in 1976; the annual increment of the incidence rate was lower (2.41 in Taiwan vs. 4.17 Japan), and no significant KD outbreak was observed in Taiwan.
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Chen CA, Chen SY, Wang JK, Tseng WYI, Chiu HH, Chang CI, Chiu IS, Chen YS, Yang MC, Lu CW, Lin MT, Wu MH. Ventricular geometric characteristics and functional benefit of mild right ventricular outflow tract obstruction in patients with significant pulmonary regurgitation after repair of tetralogy of Fallot. Am Heart J 2014; 167:555-61. [PMID: 24655705 DOI: 10.1016/j.ahj.2013.12.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 12/28/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Right ventricular (RV) outflow tract obstruction (RVOTO) might protect the RV from adverse remodeling caused by significant pulmonary regurgitation (PR) in patients with repaired tetralogy of Fallot (rTOF), but the underlying mechanisms and influences on exercise tolerance remain unclear. This study sought to investigate the impacts from mild RVOTO on ventricular remodeling and exercise capacity in rTOF. METHODS Eighty-five rTOF patients with a PR fraction ≥20% were assessed with cardiac magnetic resonance, cardiopulmonary exercise test, and echocardiography. Patients with a peak RVOT pressure gradient 20-50 mmHg were considered to have mild RVOTO (n = 29), while those with a gradient <20 mmHg had isolated PR (n = 56). RESULTS Comparing to patients with isolated PR, patients with combined PR and mild RVOTO had smaller RV and RVOT dimension, better RV and left ventricular (LV) ejection fraction (EF), and superior exercise capacity. PR severity and RV mass/volume ratio were similar between these 2 groups. LVEF coupled with RVEF only in patients with isolated PR. In multivariate analysis, smaller RVOT dimension was independently related to smaller RV dimension (P < .001) and higher RVEF (P = .005). Furthermore, mild RVOTO was independently associated with higher peak oxygen consumption (P = .014) and oxygen uptake efficiency slope (P = .005). CONCLUSIONS Patients with combined PR and mild RVOTO had better RV remodeling and exercise capacity compared to those with isolated PR. Our findings confirm the benefits from mild residual RVOTO support a policy of conservative RVOTO relief at repair.
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Lue HC, Chen LR, Lin MT, Chang LY, Wang JK, Lee CY, Wu MH. Estimation of the incidence of Kawasaki disease in Taiwan. A comparison of two data sources: nationwide hospital survey and national health insurance claims. Pediatr Neonatol 2014; 55:97-100. [PMID: 23890670 DOI: 10.1016/j.pedneo.2013.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 04/15/2013] [Accepted: 05/24/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD), first described by Dr. Tomisaku Kawasaki in 1967, was found for the first time in Taiwan in 1976. It continued to occur in increased numbers. For the study of incidence rates and epidemiological features of KD, we conducted five nationwide hospital surveys (NHS) in 1987, 1992, 1994, 2001 and 2008, respectively. We estimated also the annual incidence rates of KD during 1996-2007, based on the National Health Insurance (NHI) database, which had been implemented since 1995, covering 98% of the population in Taiwan. METHODS The annual incidence rates of KD during the twelve years, from1996 to 2007, estimated by the NHS and the NHI claims were compared, analyzed and discussed. RESULTS During 1996-2007, a total of 9,938 cases of KD were reported by the Departments of Pediatrics of all hospitals surveyed, and a total of 11,849 cases of KD were claimed in the NHI database. The annual number of cases and incidence rates of KD based on NHI claims constantly surpassed those by the NHS. The ratio of the two incidence rates varied from 1.10 to 1.33. They were well correlated (r = 0.902, p < 0.001) with a linear equation, NHI = 16.07 + 0.93*NHS. The changes in annual incidence rate by the NHI were mean 1.149, p = 0.07, 95% CI -0.082 - 2.382, and those by the NHS were mean 1.562, p <0.001, CI 0.656 - 2.468. CONCLUSION The annual incidence rates of KD can be estimated by the NHI claims and by the classic NHS. The values estimated by the NHI claims constantly outnumbered those by the NHS. Some pitfalls involved in the NHI claims are discussed.
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Chen CW, Su WJ, Wang JK, Yang HL, Chiang YT, Moons P. Physical self-concept and its link to cardiopulmonary exercise tolerance among adolescents with mild congenital heart disease. Eur J Cardiovasc Nurs 2014; 14:206-13. [DOI: 10.1177/1474515114521926] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 01/09/2014] [Indexed: 01/04/2023]
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Chiu SN, Shao PL, Wang JK, Chen HC, Lin MT, Chang LY, Lu CY, Lee PI, Huang LM, Wu MH. Severe bacterial infection in patients with heterotaxy syndrome. J Pediatr 2014; 164:99-104.e1. [PMID: 24112867 DOI: 10.1016/j.jpeds.2013.08.051] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/10/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the incidence of sepsis in patients with heterotaxy syndrome. STUDY DESIGN From our institutional database, we identified patients with heterotaxy syndrome and other complex congenital heart disease (CHD) born between 2001 and 2011. Severe bacterial infection was defined as sepsis with positive culture result or infection with abscess formation. RESULTS We enrolled 95 patients with heterotaxy syndrome (88 with right atrial isomerism and 7 with left atrial isomerism) and 142 patients with complex CHD. With 1026 person-years follow-up, the 5-year survival was 52% and 65.7% in heterotaxy and complex CHD groups, respectively (P = .239). Community-acquired severe bacterial infection occurred only in heterotaxy syndrome (13 episodes in 10 patients, 3 of whom had spleen noted at imaging study) with 2- and 5 years cumulative severe bacterial infection rate of 9.6% and 14.5%, respectively. The overall mortality rate of those with community-acquired severe bacterial infection was 31%. Pneumococcus and Citrobacter freundii were the most common pathogens. Nosocomial severe bacterial infection occurred in 33.3% of all patients and 12.5% of all procedures. The rates (0.59 and 0.52/100 hospitalization days in heterotaxy and complex CHD group) and the pathogens of nosocomial severe bacterial infection were similar between heterotaxy and complex CHD groups. CONCLUSIONS Patients with heterotaxy syndrome are at high risk for community-acquired severe bacterial infection and also have high mortality rate whether the spleen is present or not. The risk of nosocomial severe bacterial infection seems similar to that of patients with other complex CHD.
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Wang JK, Chen SJ, Hsu JY, Lin SM, Lin MT, Chiu SN, Chen CA, Wu MH. Midterm follow-up results of transcatheter treatment in patients with unroofed coronary sinus. Catheter Cardiovasc Interv 2013; 83:243-9. [DOI: 10.1002/ccd.25185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/11/2013] [Accepted: 08/25/2013] [Indexed: 11/09/2022]
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Chiu SN, Lin LY, Wang JK, Lu CW, Chang CW, Lin MT, Hua YC, Lue HC, Wu MH. Long-term outcomes of pediatric sinus bradycardia. J Pediatr 2013; 163:885-9.e1. [PMID: 23623512 DOI: 10.1016/j.jpeds.2013.03.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 03/04/2013] [Accepted: 03/19/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To delineate the long-term outcomes and mechanisms of pediatric sinus bradycardia. STUDY DESIGN Participants with sinus bradycardia who were identified from a survey of 432,166 elementary and high school students, were enrolled 10 years after the survey. The clinical course, heart rate variability, and hyperpolarization-activated cyclic nucleotide-gated potassium channel 4 (HCN4) gene were assessed. RESULTS A total of 104 (male:female was 60:44; prevalence, 0.025%) participants were observed to have sinus bradycardia at age 15.5 ± 0.2 years with a mean heart rate of 48.4 ± 0.4 beats per minute; 86 study participants (83%) responded to clinical assessment and 37 (36%) underwent laboratory assessment. Athletes composed 37.8% of the study participants. During the extended 10-year follow-up, 15 (17%) of the participants had self-limited syncopal episodes, but none had experienced life-threatening events. According to Holter recordings, none of the participants had heart rate <30 beats per minute or a pause longer than 3 seconds. Compared with 67 age- and sex-matched controls, the variables of heart rate based on the spectral and time domain analysis of the participants with sinus bradycardia were all significantly higher, indicating higher parasympathetic activity. The results of mutation analysis were negative in the HCN4 gene in all of our participants. CONCLUSIONS The long-term outcomes of the children and adolescents with sinus bradycardia identified using school electrocardiographic survey are favorable. Parasympathetic hyperactivity, instead of HCN4 gene mutation, is responsible for the occurrence of sinus bradycardia.
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Chen CA, Tseng WYI, Wang JK, Chen SY, Ni YH, Huang KC, Ho YL, Chang CI, Chiu IS, Su MYM, Yu HY, Lin MT, Lu CW, Wu MH. Circulating biomarkers of collagen type I metabolism mark the right ventricular fibrosis and adverse markers of clinical outcome in adults with repaired tetralogy of Fallot. Int J Cardiol 2013; 167:2963-8. [PMID: 22999338 DOI: 10.1016/j.ijcard.2012.08.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/21/2012] [Accepted: 08/31/2012] [Indexed: 11/26/2022]
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Chiu SN, Lin JL, Tsai CT, Yu CC, Lu CW, Chang CW, Chang CC, Wang JK, Wu MH. Radiofrequency Catheter Ablation of Atrial Tachyarrhythmias in Adults with Repaired Congenital Heart Disease: Constraints from Multiple and New Arrhythmic Foci. ACTA CARDIOLOGICA SINICA 2013; 29:347-356. [PMID: 27122729 PMCID: PMC4804902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 02/06/2013] [Indexed: 06/05/2023]
Abstract
BACKGROUND Radiofrequency catheter ablation (RFCA) for atrial tachyarrhythmias in postoperative congenital heart disease (CHD) patients has a low success rate and a high recurrence rate. This study explores the reasons for these constraints. METHODS A total of 49 consecutive postoperative CHD patients who received RFCA for atrial tachyarrhythmias between 1993 and 2010 were enrolled. RESULTS Overall, there were 86 RFCA procedures performed, 32 with the conventional method and 54 using CARTO-guided mapping. The interval between the operation and the first ablation was 13 years. Isthmus-dependent atrial flutter (AFL) was the most common type of tachycardia (37, 76%), followed by intra-atrial re-entry tachycardia (IART; 37%), and ectopic atrial tachycardia (EAT; 31%). By applying CARTO-guided mapping, the success rate was elevated compared to that of conventional ablation (84% vs. 56%, p = 0.006), but there was no improvement in the recurrence rate (22% vs. 28%, p = 0.75). Multiple atrial tachyarrhythmias occurred in 26 (53%) patients, and 17 presented during the initial electrophysiological study. The presence of multiple arrhythmias during the initial study predicted ablation failure or multiple ablations (11/17 vs. 3/32, p < 0.001). Among the 15 patients with new tachyarrhythmias, EAT and IART predominated. However, applying antiarrhythmia agents immediately following ablation may decrease arrhythmia recurrence (1/10 vs. 14/25, p = 0.02). CONCLUSIONS Although electroanatomical mapping improves the results of RFCA in atrial tachyarrhythmias, the recurrence rate remains high because of multiple and new atrial tachyarrhythmias. Therefore, short-term pharmacological treatment following RFCA for positive remodeling should be considered. KEY WORDS Ablation; Antiarrhythmia agents; Atrial tachyarrhythmia; Congenital heart disease; Multiple arrhythmias.
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Chen MR, Ko YC, Chiu IS, Chiu YP, Wang JK, Wu MH. Comparison of bilateral pulmonary arterial level and diameter in transposition of the great arteries. Pediatr Cardiol 2013; 34:1175-80. [PMID: 23377492 DOI: 10.1007/s00246-012-0624-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 12/26/2012] [Indexed: 11/30/2022]
Abstract
In normal anatomy, the left pulmonary artery (LPA) is usually situated higher than the right pulmonary artery (RPA); however, transposition of the great arteries (TGA), the LPA is not always situated higher than the RPA. This study was performed to clarify the relative position of the RPA and the LPA in transposition of the great arteries (TGA) as well as the implications. We reviewed 101 angiograms of patients with TGA (age 4.1 ± 1.2 months). The width of the RPA, the LPA, and the pulmonary trunk (PT) were measured just before their first branch in the frontal view. They were classified into four groups according to the ratio between the RPA and the PT (RPA/PT). The initial courses of the LPA and the RPA were compared and defined according to their height in the frontal view, and the preferential flow (or not) to the RPA was recorded. The equation of hydrodynamics was applied to evaluate the bifurcation angle. Both PAs were the same size in all cases. Forty-eight patients (47.5 %) had a RPA/PT diameter ratio < 0.49. The LPA coursed higher than the RPA in the majority of cases (81 [80.2 %]); in a minority of cases the LPA and RPA were at the same level (6 [5.9 %]); and in some cases the RPA coursed higher than the LPA (14 [13.9 %]). Patients with a high degree of PA hypoplasia tended to have both PAs at the same level or a higher-positioned RPA. Autopsy (1 of 3 cases) showed a posterior ridge against the bronchus in the higher RPA. Hydrodynamic calculation showed that the greater the angle between the RPA/PT, the greater the preferential flow. Preferential flow to the RPA in TGA did not necessarily result in LPA hypoplasia before its first branch. Higher RPA position relative to the LPA was associated with greater flow in it against the posterior bronchus. This situation was more prevalent in patients with severe PA hypoplasia.
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Wang CC, Chen SJ, Wu ET, Chen CA, Chiu SN, Lin MT, Lu F, Huang SC, Wu MH, Wang JK. Lower airway anomalies in children with CATCH 22 syndrome and congenital heart disease. Pediatr Pulmonol 2013; 48:587-91. [PMID: 22997194 DOI: 10.1002/ppul.22674] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 07/13/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE CATCH 22 syndrome is a medical acronym for multiple abnormalities, especially cardiac defect. The patients with congenital heart disease (CHD) usually have more complicated post-surgery course. METHODS We reviewed 4-year experience in our hospital to define the lower airway anomalies and the clinical implications in patients with CATCH 22 syndrome and CHD. From 2004 to 2007, 18 patients who underwent computed tomography for planning of cardiovascular treatment were enrolled. Detection of airway anomalies were performed on computed tomography. RESULTS Characteristic dysmorphic facial features were noted in 8 out of 18 patients (44%). Ten patients (55.6%) had mild to moderate tracheal or bronchial stenosis. Five patients (28%) had tracheomalacia or bronchomalacia. Comparing to control group, patients received the first major surgery with a median hospital stays of 42 days in study group had a significantly longer hospital stay (42 vs. 16, P = 0.005) and longer duration of ventilator usage (16 vs. 4, P = 0.014). The difference of the mean position of the carina on computed tomography image between study groups and control groups was about three-quarters of a vertebral body height (P < 0.05). CONCLUSIONS Patients with CATCH 22 syndrome and CHD had a shorter length of trachea compared to that of the age-matched similar CHD. The incidence of associated lower airway anomalies in CHD children with CATCH 22 syndrome was higher. It may lead to longer time of ventilator support after surgery as well as total hospital stays than those of CHD without CATCH 22 syndrome.
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Yang MC, Yang CC, Chen CA, Wang JK. Takayasu arteritis presenting with acute heart failure. J Am Coll Cardiol 2013; 61:1302. [PMID: 23500331 DOI: 10.1016/j.jacc.2012.09.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 09/12/2012] [Accepted: 09/25/2012] [Indexed: 10/27/2022]
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Mao HL, Mao HL, Wang JK, Liu JX, Yoon I. Effects of Saccharomyces cerevisiae fermentation product on in vitro fermentation and microbial communities of low-quality forages and mixed diets. J Anim Sci 2013; 91:3291-8. [PMID: 23572258 DOI: 10.2527/jas.2012-5851] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Two experiments were conducted to investigate the effects of a Saccharomyces cerevisiae fermentation product (XP, Diamond V, Cedar Rapids, IA) on in vitro ruminal fermentation of single forage and mixed diets. In Exp. 1, an in vitro test was used to determine the effects of various concentrations (0, 1, 2, and 3 g/L) of XP on ruminal fermentation of the major forage sources of China (rice straw, RS; corn stover, CS; corn silage without grain, CSNG; and corn silage with grain, CSG). Total VFA reached a peak at 1 g/L XP for RS, CSNG, and CSG and increased linearly (P < 0.01) for CS. The molar proportion of acetate decreased and propionate increased linearly (P < 0.01) with an increasing amount of XP for RS, CS, and CSNG. Microbial protein (MCP) increased linearly (P < 0.01) with an increasing level of XP for RS, and it reached peak values at 1 and 2 g/L XP for CSG and CSNG, respectively. Fungi population was increased (P < 0.05) with 1 g/L XP for all forages except CSNG. The population of Ruminococcus flavefaciens increased (P < 0.05) at 1 or 2 g/L XP for RS, CSNG, and CSG. In Exp. 2, the effects of 3 concentrations of XP (0, 1, and 2 g/L) were tested on in vitro ruminal fermentation of 3 mixed diets with various ingredient combinations: 1) CSC (corn:soybean meal:corn stover = 33:22:45), 2) CSCC (corn:soybean meal:corn stover:corn silage = 33:22:22.5:22.5), and 3) CSCCA (corn:soybean meal:corn stover:corn silage:alfalfa = 33:22:19:21:5). Total VFA concentrations were influenced by diets (P < 0.01) and were enhanced linearly by increasing concentrations of XP (P < 0.01). The molar proportion of acetate was reduced (P < 0.01), but the propionate proportion was enhanced with increasing concentrations of XP (P < 0.01). Ammonia N was decreased and MCP was increased by the addition of XP (linear, P < 0.01; quadratic, P < 0.05). The fungi population was greater with XP addition (quadratic, P < 0.01). The percentage of R. albus was affected by diets (P < 0.01), the level of XP (linear and quadratic, P < 0.01), and their interaction (P < 0.01). From these 2 in vitro studies, it is inferred that the addition of XP could improve the rumen fermentation of forages and mixed diets by stimulating the number of fiber-digesting rumen microbes, especially fungi populations.
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Yeh SJ, Chen HC, Lu CW, Wang JK, Huang LM, Huang SC, Huang SK, Wu MH. Prevalence, mortality, and the disease burden of pediatric congenital heart disease in Taiwan. Pediatr Neonatol 2013; 54:113-8. [PMID: 23590956 DOI: 10.1016/j.pedneo.2012.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 06/15/2012] [Accepted: 06/26/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In Taiwan, the incidence of congenital heart diseases (CHDs) and severe CHDs was 13.08 and 1.51 per 1000 live births, respectively. This study further elucidates the prevalence and mortality of pediatric CHD patients in Taiwan. METHODS From the National Health Insurance database 2000-2010, we retrieved the data of CHD patients (aged 0-18 years). Mortality data were obtained from the national death statistics. RESULTS In total, 45,119 pediatric CHD patients were identified, given the prevalence at 918.0 per 100,000 (107.1 for severe CHD and 853.8 for simple CHD). Ventricular septal defect, ostium secundum-type atrial septal defect, patent ductus arteriosus, pulmonary stenosis, and tetralogy of Fallot were the five most frequently diagnosed CHDs. In those aged 0-6 years, the prevalence was 1233.7 per 100,000 (123.5 for severe CHD and 1149.6 for simple CHD). The age-specific prevalence of both simple and severe CHDs declined rapidly after the age of 10 years. From the death registry, we noted that more than 90% of CHD-related deaths occurred before the age of 5 years. The probability of cardiac death in CHD patients during infancy was 4.5%, with the cumulative probability reaching 5.44%, 5.68%, and 6.04% by the ages of 5, 10, and 20 years, respectively. CONCLUSION Because most CHD deaths occurred within the first 5 years of life (mainly during infancy), the relatively low prevalence of CHDs in the population aged 0-18 years (918/100,000; 74% for those between 0 years and 6 years of age) and the rapid decline in the age-specific prevalence of CHD after the age of 10 years was attributed to noncompliance of the children to medical follow-up after they began schooling.
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Chiu HH, Wu MH, Wang JK, Lu CW, Chiu SN, Chen CA, Lin MT, Hu FC. Losartan added to β-blockade therapy for aortic root dilation in Marfan syndrome: a randomized, open-label pilot study. Mayo Clin Proc 2013; 88:271-6. [PMID: 23321647 DOI: 10.1016/j.mayocp.2012.11.005] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 11/08/2012] [Accepted: 11/15/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the tolerability and efficacy of the investigational use of the angiotensin II receptor blocker losartan added to β-blockade (BB) to prevent progressive aortic root dilation in patients with Marfan syndrome (MFS). PATIENTS AND METHODS Between May 1, 2007, and September 31, 2011, 28 patients with MFS (11 males [39%]; mean ± SD age, 13.1±6.3 years) with recognized aortic root dilation (z score >2.0) and receiving BB (atenolol or propranolol) treatment were enrolled. They were randomized to receive BB (BB: 13 patients) or β-blockade and losartan (BB-L: 15 patients) for 35 months. RESULTS In the BB-L group, aortic root dilation was reduced with treatment, and the annual dilation rate of the aortic root was significantly lower than that of the BB group (0.10 mm/yr vs 0.89 mm/yr; P=.02). The absolute aortic diameters at the sinus of Valsalva, annulus, and sinotubular junction showed similar trends, with a reduced rate of dilation in the BB-L group (P=.02, P=.03, and P=.03, respectively). Five patients (33%) treated with BB-L were noted to have a reduced aortic root diameter. However, the differences between the groups regarding changes in aortic stiffness and cross-sectional compliance were not statistically significant. CONCLUSION This randomized, open-label, active controlled trial mostly based on a pediatric population demonstrated for the first time that losartan add-on BB therapy is safe and provides more effective protection to slow the progression of aortic root dilation than does BB treatment alone in patients with MFS. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00651235.
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Chiu HH, Wang JK, Chen YS, Chiu IS, Chang CI, Lin MT, Lu CW, Chiu SN, Chen CA, Wu MH. Long-Term Outcomes of Native Coarctation of the Aorta after Balloon Angioplasty or Surgical Aortoplasty in Newborns and Young Infants Less Than 3 Months of Age. ACTA CARDIOLOGICA SINICA 2013; 29:168-174. [PMID: 27122701 PMCID: PMC4804779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 12/26/2012] [Indexed: 06/05/2023]
Abstract
BACKGROUND Balloon angioplasty of native coarctation of the aorta, though effective, is frequently associated with early restenosis, repeated interventions and aneurysm formation, especially in very young patients. However, available long-term data are limited. METHODS From Jan. 1986 to Dec. 2007, eighty-eight patients with simple aortic coarctation, isolated or associated with patent ductus arteriosus or ventricular septal defect, and survived angioplasty (n = 17) or surgery (n = 71) within 3 months of age in National Taiwan University Hospital were enrolled. RESULTS The average length of follow-up was 10.1 ± 5.1 years. The long-term outcomes between these two groups were comparable in hypertension, left ventricular outflow tract obstruction, and aortic aneurysm. Patients in the angioplasty group had a greater likelihood of reintervention (64.7% vs. 42.3%, p = 0.096) and repeated reintervention (29.4% vs. 7.0%, p = 0.027) as compared with surgery group. The 10-year freedom from reintervention was 35.3% and 59.2% in the angioplasty and surgery group, respectively (p = 0.046); there were no deaths reported in that 10-year span. Patients with angioplasty and those with patent ductus arteriosus were more likely to require surgical aortoplasty at reintervention. CONCLUSIONS The long-term outcomes of aortic coarctation in newborns and young infants after balloon angioplasty were effective and beneficial. However, those outcomes were accompanied by concomitant higher risks of reintervention and surgical reintervention, particularly in those with patent ductus arteriosus. KEY WORDS Aortic operation; Coarctation; Infant; Outcomes.
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Wang CC, Wang JK, Hsu JY, Chen CA, Wu MH. Isolated Pulmonary Arteriovenous Fistula in a Patient with Recurrent Stroke. ACTA CARDIOLOGICA SINICA 2013; 29:107-109. [PMID: 27122693 PMCID: PMC4804969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 04/25/2012] [Indexed: 06/05/2023]
Abstract
UNLABELLED Paradoxical embolism is a risk factor for cryptogenic stroke in young adults, and can be primarily attributed to the presence of patent foramen ovale (PFO). Although contrast echocardiography may facilitate diagnosis, it would be difficult to distinguish a PFO from a pulmonary arteriovenous fistula (PAVF), which could also result in paradoxical embolism. We report a 46-year-old woman with recurrent ischemic stroke, who was scheduled for PFO closure because of a right-to-left shunt detected by contrast echocardiography. The diagnosis turned out to be a PAVF confirmed by angiography. Thereafter, coil embolization of this PAVF was performed successfully. KEY WORDS Embolic stroke; Patent foramen ovale; Pulmonary arteriovenous fistula; Right-to-left shunt.
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Wu LA, Chang CI, Wang JK, Shih TTF, Wu MH, Chen SJ. Reference curves for the aortic area by age. Acad Radiol 2013; 20:16-24. [PMID: 22963725 DOI: 10.1016/j.acra.2012.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 07/18/2012] [Accepted: 08/02/2012] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to establish reference curves and formulas for aortic cross-sectional area in patients from infancy to young adulthood. MATERIALS AND METHODS Patients (aged 2 days to 18.1 years) who underwent electrocardiographically gated cardiac computed tomography between May 2004 and December 2011 were retrospectively examined. These patients were further divided into a group of normal controls (without aortic disease) and a group with coarctation of aorta. In the group of normal controls, the cross-sectional area of the aorta was measured at six locations: the sinotubular junction, distal ascending aorta, proximal arch, distal arch, aortic isthmus, and descending aorta (DAO). Interobserver and intraobserver variability, gender differences, the relationship between aortic cross-sectional areas and age, and the ratio to the DAO were also examined. The area ratio to the DAO was also examined in the group with coarctation of the aorta. RESULTS A total of 65 patients and 365 measurable aortic segments were included in the analysis (55 normal controls and 10 patients with coarctation of aorta). Interobserver and intraobserver variability was limited (aside from measurements of the sinotubular junction). There were no gender differences in age and the cross-sectional areas of the different aortic segments. In the group of normal controls, the cross-sectional area of each aortic segment was highly correlated with age (all >0.90, P < .001). The reference curves and formulas for aortic cross-sectional area by age were also determined for further clinical use. In the normal controls, the <95% confidence intervals of the ratios of aortic isthmus to DAO, distal arch to DAO, and proximal arch to DAO were approximately 0.6, 0.8, and 1.0, respectively. In addition, in the group with coarctation, all area ratios of aortic isthmus to DAO were <0.6, which was significantly different from the group of normal controls (P < .001). The area ratios of distal arch to DAO and proximal arch to DAO were also significantly different between two groups (P < .001 for both). CONCLUSIONS Measurement of aortic area was reproducible. The established reference curves and formulas and minimal area ratios were convenient for further clinical use.
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Yeh SJ, Chen HC, Lu CW, Wang JK, Huang LM, Huang SC, Huang SK, Wu MH. National database study of survival of pediatric congenital heart disease patients in Taiwan. J Formos Med Assoc 2012; 114:159-63. [PMID: 25678178 DOI: 10.1016/j.jfma.2012.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 10/07/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND/PURPOSE The incidence of congenital heart disease (CHD) and severe CHD is 13.08 and 1.51/1000 live births, respectively, in Taiwan, which has had national health insurance since 1995 and child health indices similar to those in the US. This study sought to further elucidate the fatality of CHD patients and their survival from a national database. METHODS From the national health insurance database 2000-2010, we retrieved data from CHD patients who were diagnosed at age <6 years. The survival status at discharge was ascertained for estimation of survival. RESULTS In total, 18,843 pediatric CHD patients were identified. The overall prevalence of CHD was 1288 per 100 000 live-births. Severe CHD (tetralogy of Fallot (4.4%), transposition of the great arteries (1.6%) and double outlet right ventricle (1.1%)) accounted for 11.5% of all cases. The 1-month/5-year survival in simple and severe CHD was 99.1%/97.5% and 90.2%/76.4%, respectively (p < 0.0001). The Kaplan-Meier survival at 5 years of age was lowest for hypoplastic left heart syndrome (19.7%), followed by transposition of the great arteries (66.7%), double outlet right ventricle (69.0%), and common ventricle (66.0%). The 5-year survival of the birth cohort in the same study period was 99.3%. CONCLUSION This national database study revealed that the survival of children with simple CHD was still slightly lower than that of the general population and the survival of severe CHD patients, though only accounting for one-tenth of CHD cases, remained unsatisfactory. Such survival profiles are similar to those from Western reports and warrant a refined and dedicated medical care program for children with CHD.
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Chen CW, Chen YC, Su WJ, Wang JK, Lee PC, Beckstead JW. Social-cognitive determinants of exercise behaviour among adolescents with mild congenital heart disease. Eur J Cardiovasc Nurs 2012; 12:368-76. [PMID: 23045305 DOI: 10.1177/1474515112460797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nowadays, most adolescents with mild congenital heart disease (CHD) undergo medical or surgical correction in early childhood for their congenital anomalies. There is a need to examine the determinants of exercise behaviour among adolescents (CHD) who are able to exercise. AIMS The aims of this study were to examine determinants of exercise among adolescents with mild CHD, including personal beliefs about exercise, interpersonal influences on exercise, and availability of physical environments for exercise, based on social-cognitive theory. METHOD A repeated-measures study was conducted at three medical centres in Taiwan. All participants, 126 adolescents with CHD aged 12 to 18 years, had a cardiologist's recommendation of exercise with no limits or limits only on vigorous exercise. Self-administered questionnaires were completed during a summer vacation and again in the fall semester of school along with a 7-day exercise log. The data were analysed using structured equation modelling. RESULTS The effect of interpersonal influences on total exercise and moderate-to-vigorous exercise was mediated by personal exercise beliefs. Peer influences had significant effects on moderate-to-vigorous exercise through the mediator of perceived exercise self-efficacy. There was no significant difference in the determinants of exercise behaviour during two periods. Personal exercise beliefs, particularly perceived exercise self-efficacy, played the most important role in determining the performance of moderate-to-vigorous exercise. CONCLUSIONS The social-cognitive determinants may serve as a clinical reference for promoting exercise among adolescents with mild CHD.
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Hargrave PA, Fong SL, Hugh McDowell J, Mas MT, Curtis DR, Wang JK, Juszczak E, Smith DP. The partial primary structure of bovine rhodopsin and its topography in the retinal rod cell disc membrane. Neurochem Int 2012; 1C:231-44. [PMID: 20487738 DOI: 10.1016/0197-0186(80)90063-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The amino-terminal 39 amino acids of bovine rhodopsin have the sequence where both carbohydrate attachment sites (CHO) contain GlcNAc(3)Man(3). This region of rhodopsin's sequence is exposed at the internal membrane surface of the rod cell disc membrane. Rhodopsin's carboxyl-terminal 40 amino acids have the sequence where amino acid 1? is the carboxyl-terminal amino acid of rhodopsin. Serines and threonines in the sequence 6? ? 15? are phosphorylated by rhodopsin kinase in a light-dependent reaction. Trypsin can digest native rhodopsin, in the disc membrane at and thermolysin can hydrolyze bonds , and . Limited proteolysis by thermolysin at a site internal in the molecule has been exploited in order to prepare rhodopsin as two large fragments, F1 and F2. Cysteine(33)?, is highly reactive in the dark and is modified by N-ethylmaleimide and several alkylating agents. The carboxyl-terminal region 1?-39? reacts with the membrane-impermeable nitrene from N-(4-azido-2-nitrophenyl)-2-aminoethyl sulfonate and is therefore exposed at the external (cytoplasmic) surface of the disc membrane. 1-azldopyrene, a hydrophobic nitrene precursor, is being used to map those regions of the rhodopsin sequence which are located in a hydrophobic environment.
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Chen CW, Chen YC, Gau BS, Wang JK, Hung YT, Jwo JC. Exercise Behavior in Adolescents With Mild Congenital Heart Disease. J Cardiovasc Nurs 2012; 27:317-24. [DOI: 10.1097/jcn.0b013e31821efda7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chen CA, Wang JK, Lue HC, Hua YC, Chang MH, Wu MH. A shift from underweight to overweight and obesity in Asian children and adolescents with congenital heart disease. Paediatr Perinat Epidemiol 2012; 26:336-43. [PMID: 22686385 DOI: 10.1111/j.1365-3016.2012.01293.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Western countries, obesity is a common problem in children with congenital heart disease (CHD). However, this problem may have racial difference, and little is known about the shift of this trend as patients grow up. The present study sought to investigate the prevalence and trends of being underweight, overweight and obesity in an Asian CHD cohort using a 5-year citywide school survey database. METHODS Patient group consisted of 705 first grade elementary school students (children) and 219 first grade senior high school students (adolescents), while 18753 healthy children and 15014 healthy adolescents served as controls. Body mass index (BMI) percentile was calculated to define underweight (BMI < 15(th) percentile) and overweight (BMI 85(th) -95(th) percentile)/obesity (BMI ≥ 95(th) percentile). RESULTS In CHD children, the prevalence of underweight and overweight/obesity was 21.0% (control 16%, P < 0.001) and 14.5% (control 19.8%, P < 0.001), respectively. Children with moderate to severe CHD, especially cyanotic CHD, were more underweight and less overweight/obese than children with non-cyanotic CHD. The prevalence of underweight (23.3%) and overweight/obesity (26.5%) in CHD adolescents became close to that in controls. From childhood to adolescence, different shifts in BMI distribution were noted; controls became more underweight and overweight/obese for males and more underweight and less overweight/obese for females, while CHD patients became more overweight/obese for both genders, including cyanotic CHD. CONCLUSIONS In this Asian CHD cohort, we demonstrates a shift of BMI distribution from more underweight and less overweight/obese compared with healthy children, to a pattern similar to that in healthy adolescents.
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Lu WY, Huang SC, Chen SJ, Jhuang JY, Chen YC, Wang JK, Wu MH, Chen CA. Giant congenital left atrial aneurysm in an 11-year-old boy. Circulation 2012; 125:1818-20. [PMID: 22492949 DOI: 10.1161/circulationaha.111.057810] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kwon YJ, Kang BH, Bae SY, Seo JH, Kim JY, Lee EA, Wang JK, Lee YM, Go KJ, Pyo HJ, Lee JB. CALCIUM REQUIREMENT AFTER PARATHYROIDECTOMY (PTX) IN SECONDARY HYPERPARATHYROIDISM (2° HPT). Kidney Res Clin Pract 2012. [DOI: 10.1016/j.krcp.2012.04.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Liu TY, Chen Y, Wang HH, Huang YL, Chao YC, Tsai KT, Cheng WC, Chuang CY, Tsai YH, Huang CY, Wang DW, Lin CH, Wang JK, Wang YL. Differentiation of bacteria cell wall using Raman scattering enhanced by nanoparticle array. JOURNAL OF NANOSCIENCE AND NANOTECHNOLOGY 2012; 12:5004-8. [PMID: 22905567 DOI: 10.1166/jnn.2012.4941] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We have fabricated surface-enhanced Raman scattering (SERS) substrates based on arrays of silver nanoparticles grown on porous anodic alumina templates. Using this nanotechnology platform, label-free and high-speed detection of bacteria are achieved. SERS spectra of various bacteria including Staphylococcus Aureus (Gram-positive bacterium), Klebsiella Pneumoniae (Gram-negative bacterium), and Mycobacterium Smegmatis (Mycobacterium) were recorded. The highly reproducible SERS-based technological platform is capable of differentiating different kinds of bacteria by PCA, LDA, clustering analysis, and SVM methods, which provides promising opportunity for biosensing of clinical microbes.
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Fu CM, Wang JK, Lu CW, Chiu SN, Lin MT, Chen CA, Chang CI, Chen YS, Chiu IS, Wu MH. Total anomalous pulmonary venous connection: 15 years' experience of a tertiary care center in Taiwan. Pediatr Neonatol 2012; 53:164-70. [PMID: 22770104 DOI: 10.1016/j.pedneo.2012.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 06/16/2011] [Accepted: 06/27/2011] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Total anomalous pulmonary venous connection (TAPVC) is a rare congenital heart disease in which the connection between the pulmonary vein (PV) and left atrium needs to be surgically created. This study investigated the spectrum and outcome of a Taiwanese cohort. METHODS Isolated TAPVC cases were identified from our institutional database between 1995 and 2009. We reviewed the medical chart and conducted telephone interviews with those lost to follow-up. RESULTS There were 78 patients (52% male). The anomalous drainage sites were mainly supracardiac type (42.3%) and cardiac type (39.8%). Before operation, PV stenosis was found in 100% of infracardiac type, and in 69.7% of supracardiac type. Among the 75 patients undergoing operation, the surgical mortality was 9% (7/75). Perioperative arrhythmias (mainly of atrial origin) occurred in 35% of the patients. Of the 68 patients who survived the first operation, 28 (41%) developed pulmonary vein restenosis. Half of them progressed to severe PV stenosis, which required reintervention or resulted in mortality. Preoperative PV stenosis was the most significant predictor for postoperative PV restenosis and PV re-intervention. For the cohort, the 1-year and 5-year survivals were 78.9% and 74.2%, respectively, and the predictor for survival was again preoperative PV stenosis. CONCLUSION The surgical mortality of isolated TAPVC is now low. Preoperative PV stenosis not only increased the risk of late PV restenosis and its reintervention, but also the overall mortality. The spectrum of PV drainage, per se, was not associated with worse outcome. PV restenosis remained the most important issue after correction of TAPVC.
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Wei SH, Fan PC, Kuo PH, Chiou LC, Wang JK. Calcitonin Gene-Related Peptide and Size of the Atrial Septal Defect in New-Onset Migraine After Transcatheter Closure: Results of a Preliminary Study. Headache 2012; 52:985-92. [DOI: 10.1111/j.1526-4610.2012.02152.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lin MT, Wang JK, Chen YS, Lee WJ, Chiu HH, Chen CA, Chiu SN, Wu ET, Lu CW, Huang SC, Chen SJ, Chiu IS, Chang CI, Wu MH. Detection of pulmonary arterial morphology in tetralogy of Fallot with pulmonary atresia by computed tomography: 12 years of experience. Eur J Pediatr 2012; 171:579-86. [PMID: 22083156 DOI: 10.1007/s00431-011-1621-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 10/27/2011] [Indexed: 10/15/2022]
Abstract
UNLABELLED Our aim was to evaluate the feasibility of using computed tomography (CT) to define the pulmonary artery anatomy in patients with tetralogy of Fallot and pulmonary atresia (TOF-PA). We retrospectively reviewed 110 patients with TOF-PA between 1995 and 2008. Those who received cardiac catheterization and surgery within 3 months of their CT examinations were enrolled. Based on Dr. Somerville's classification, the pulmonary arterial pattern was determined, including identifiable pulmonary trunk (type I), the presence of both left and right pulmonary arteries without trunk (II), only left or right pulmonary artery present (III), and absent intrapericardial pulmonary arteries (IV). The accuracy of both imaging modalities was evaluated with operation findings as the golden standard. The effective radiation doses and adverse events were also recorded. In the 64 eligible patients (median age, 23 months), CT and catheterization demonstrated accurate pulmonary arterial morphology in 60 (60/64) and 53 (53/64) TOF-PA patients, respectively. Thirty-two of 35 type I patients were correctly identified by CT, whereas 26 were correctly identified by catheterization (p = 0.03). Of the 20 type II TOF-PA patients, 19 were diagnosed by CT, whereas 18 were diagnosed by catheterization. CT and catheterization both successfully defined six type III and three type IV patients. The median calculated radiation doses caused by CT and catheterization were 4.5 and 5.6 mSv, respectively (p > 0.05). CONCLUSIONS For patients with TOF-PA, CT could accurately delineate pulmonary arterial morphology with the same level of accuracy as cardiac catheterization. Therefore, CT can be considered a reasonable diagnostic alternative for such patients.
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Yang HL, Chen YC, Wang JK, Gau BS, Chen CW, Moons P. Measuring knowledge of patients with congenital heart disease and their parents: validity of the ‘Leuven Knowledge Questionnaire for Congenital Heart Disease’. Eur J Cardiovasc Nurs 2012; 11:77-84. [DOI: 10.1177/1474515111429662] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chiu SN, Wang JK, Chen HC, Lin MT, Wu ET, Chen CA, Huang SC, Chang CI, Chen YS, Chiu IS, Chen CL, Wu MH. Long-Term Survival and Unnatural Deaths of Patients With Repaired Tetralogy of Fallot in an Asian Cohort. Circ Cardiovasc Qual Outcomes 2012; 5:120-5. [DOI: 10.1161/circoutcomes.111.963603] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chen CA, Chien YH, Hwu WL, Lee NC, Wang JK, Chen LR, Lu CW, Lin MT, Chiu SN, Chiu HH, Wu MH. Left ventricular geometry, global function, and dyssynchrony in infants and children with pompe cardiomyopathy undergoing enzyme replacement therapy. J Card Fail 2011; 17:930-6. [PMID: 22041330 DOI: 10.1016/j.cardfail.2011.07.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 07/21/2011] [Accepted: 07/28/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Enzyme replacement therapy (ERT) for infantile-onset Pompe disease effectively reduces the left ventricular (LV) mass. This study sought to explore detailed process of LV reverse remodeling after ERT with the use of tissue Doppler and stain rate imaging. METHODS AND RESULTS Nine infants and children with Pompe cardiomyopathy undergoing ERT for ≥1 year, as well as 36 healthy control subjects, were studied. Global systolic and diastolic function was evaluated by peak systolic and early-diastolic velocity at mitral annulus. Temporal systolic and diastolic dyssynchrony was evaluated by the coefficient of variation of the time from the QRS complex to peak systolic and early-diastolic strain rate among 12 LV segments. All pre-ERT patients had impaired global systolic and diastolic function as well as increased regional dyssynchrony (P < .001 for each of all). During the regression of LV hypertrophy, all of these functional indices improved (P for trend <.001), with temporal diastolic dyssynchrony being a significant factor linking to LV mass index in multivariate analysis (P < .001). CONCLUSIONS ERT improved global LV function and dyssynchrony in Pompe patients. The relationship between LV mass and temporal diastolic dyssynchrony during reverse remodeling suggested a pathophysiologic role of dyssynchrony in Pompe cardiomyopathy.
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Chiu SN, Huang SC, Chang CW, Chen YS, Chen HC, Lin MT, Chen CA, Wang JK, Wu MH. The role of mechanical-electrical interaction in ventricular arrhythmia: evidence from a novel animal model for repaired tetralogy of Fallot. Pediatr Res 2011; 70:247-52. [PMID: 21623255 DOI: 10.1203/pdr.0b013e318225fd8b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary regurgitation and prolonged QRS duration of right bundle branch (RBB) block are common in repaired tetralogy of Fallot (TOF) and increase the risk of sudden death. We sought to establish an animal model to reflect both abnormalities. Twenty-one canines: group I (n = 7) received a surgical right ventricular outflow tract (RVOT) transannular patch plus pulmonary valve destruction; group II (n = 5) received RBB ablation and sham operation; and group III (n = 9) received combined interventions. Serial electrophysiological data were obtained up to 1 y. Procedure mortality was 27.6%. At 1 y, although severe pulmonary regurgitation was documented in most dogs in groups I (71%) and III (100%), progressive RVOT dilatation was noted in group III. RBB block was present in all dogs in groups II and III. However, the increments of QRS duration, QTc, JTc, and QT dispersion progression between 1 mo and 1 y were all greatest in group III. Ventricular arrhythmia events were frequent in group III (median 3.3/mo) but uncommon in groups I and II (median 1/mo). We have created a novel animal model that adequately reflects both the hemodynamic and electrophysiological characteristics of repaired TOF patients and can be applied to examine the risk of ventricular arrhythmias.
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Lin MT, Chen YS, Huang SC, Chiu HH, Chiu SN, Chen CA, Wu ET, Chiu IS, Chang CI, Wu MH, Wang JK. Alternative approach for selected severe pulmonary hypertension of congenital heart defect without initial correction — Palliative surgical treatment. Int J Cardiol 2011; 151:313-7. [DOI: 10.1016/j.ijcard.2010.05.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 05/30/2010] [Indexed: 10/19/2022]
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Lee CJ, Lin MT, Wu KL, Wang JK. Right ventricular aneurysm and large coronary arteriovenous fistula in a 3100 g infant. Eur Heart J 2011; 32:1688. [DOI: 10.1093/eurheartj/ehr012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Yeh SM, Wu CH, Chen SY, Lan C, Chen CA, Lu CW, Chiu HH, Wu MH, Wang JK, Chang CI, Chiu IS, Chen YS, Lai JS. Do Different Data Processing Methods Distort Minute Ventilation - Carbon Dioxide Production Relationship (VE/VCO2 slope)? Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000402133.33810.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Chiu SN, Chiu HH, Wang JK, Lin MT, Chen CA, Wu ET, Lu CW, Wu MH. Increased microvolt T-wave alternans in patients with repaired tetralogy of Fallot. Int J Cardiol 2011; 159:220-4. [PMID: 21420183 DOI: 10.1016/j.ijcard.2011.02.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 01/19/2011] [Accepted: 02/25/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Microvolt T wave alternans (MTWA) is an indicator of repolarization heterogeneity and a predictor of ventricular arrhythmia in adults with ischemic or dilated cardiomyopathy. Its implication in patients with repaired tetralogy of Fallot (TOF) is still unclear. This study sought to define the changes and the clinical implication of MTWA in these patients. METHODS Treadmill examination with modified moving average beat analysis (MMA) for MTWA was performed in 101 repaired TOF patients (60.4% male). Data from 103 age- and sex-matched subjects with normal hearts served as controls. RESULTS The age at latest follow-up was 20.0 ± 10.6 years. Total repair (60.4% received a transannular right ventricular outflow patch) was performed at a mean age of 4.8(± 5.8) years. After excluding 11 patients with indeterminate data, the MTWA data in 90 TOF patients revealed higher values than those in the control (25.1 ± 14.0 vs. 17.6 ± 9.2 μV, p<0.001). The values were best correlated to the presence of severe pulmonary regurgitation (p=0.006). Ten (9.9%) patients experienced late ventricular arrhythmic events. They tended to have higher MTWA values than those without (34.0 ± 16.5 vs. 24.2 ± 13.5 and p=0.053). Although the MTWA per se would not predict the late arrhythmia events better than QRS duration alone, the positive and negative predictive values increased slightly after adding the MTWA to QRS duration. CONCLUSIONS MTWA, as measured by MMA, increased in repaired TOF patients particularly in those with severe pulmonary regurgitation and late arrhythmia events. To predict late ventricular arrhythmia, MTWA however was not superior to QRS duration alone.
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Chen CA, Liao SC, Wang JK, Chang CI, Chiu IS, Chen YS, Lu CW, Lin MT, Chiu HH, Chiu SN, Hua YC, Lue HC, Wu MH. Quality of life in adults with congenital heart disease: biopsychosocial determinants and sex-related differences. Heart 2010; 97:38-43. [PMID: 20978017 DOI: 10.1136/hrt.2010.200709] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the quality of life (QoL) in adults with congenital heart disease (ACHD) and to explore the sex-related differences and biopsychosocial determinants in an Asian cohort. DESIGN Prospective cross-sectional clinical study. SETTING One tertiary medical centre in Taiwan. PATIENTS AND METHODS The QoL of ACHD (≥20 years) was investigated using the Taiwanese version of the QoL questionnaire designed by the WHO, which assesses four domains of QoL (physical, psychological, social and environmental). Personality, psychological distress and family support were assessed using the Maudsley Personality Inventory, Brief Symptom Rating Scale, and the Family APGAR score, respectively. RESULTS A total of 289 patients (age 33.2 ± 10.6 years; 36% men) were studied. ACHD women had significantly lower QoL scores in the physical and psychological domains compared to the age-matched general population, whereas no differences were observed between ACHD men and the general population. Multivariate analysis showed that female gender was associated with poorer physical QoL; the sex difference in the psychological QoL was mediated by psychological distress. Interaction analysis showed that the effect of family support on the psychological domain of QoL may be different by sex. The determinants of QoL varied between different domains. Extroversion personality trait, psychological distress and family support were common determinants of most domains of QoL. CONCLUSIONS In ACHD, female gender was associated with poor physical and psychological QoL. The common denominators for QoL were primarily personality trait, psychological distress and family support, but not disease severity.
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Wu MH, Chen HC, Lu CW, Wang JK, Huang SC, Huang SK. Prevalence of congenital heart disease at live birth in Taiwan. J Pediatr 2010; 156:782-5. [PMID: 20138303 DOI: 10.1016/j.jpeds.2009.11.062] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 10/01/2009] [Accepted: 11/20/2009] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the prevalence at live birth of congenital heart disease (CHD) in Taiwan. STUDY DESIGN Patients with CHD born from 2000 to 2006 were identified from National Health Insurance databases. RESULTS CHD prevalence was 13.08 per 1000 live births: 12.05 (simple, 10.53; severe, 1.51) in male infants and 14.21 (simple, 12.90; severe, 1.32) in female infants. Ventricular septal defect (VSD; 4.0) was the most common defect, followed by secundum atrial septal defect (ASDII; 3.2), patent ductus arteriosus (PDA; 2.0), pulmonary stenosis (PS; 1.2), tetralogy of Fallot (TOF; 0.63), coarctation of aorta (CoA; 0.25), transposition of great arteries (TGA; 0.21), endocardial cushion defect (ECD; 0.20), double outlet of right ventricle (DORV; 0.15), total anomalous pulmonary venous return (TAPVR; 0.11), aortic stenosis (0.09), hypoplastic left heart syndrome (HLHS; 0.062), Ebstein anomaly (0.047), and tricuspid atresia (0.046). Female predominance was observed in VSD, ASDII, PDA, and ECD; and male predominance was observed in TGA and TOF. Ratios of western prevalence to our Asian prevalence were high for HLHS (3.68-4.5), CoA (1.13-1.96), TGA (1.09-1.83), and tricuspid atresia (1.09-2.57), but low for PS (0.15-0.99), TOF (0.41-0.92), and possibly ASDII. CONCLUSIONS In this Asian population, the prevalence of CHD was at the high end of the reported range, with more PS and TOF, but fewer left-sided obstructions, TGA, and tricuspid atresia.
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Chiu HH, Wang SS, Wu MH, Wang JK. Aortitis with severe aortic regurgitation in Behcet's disease: a case report. J Formos Med Assoc 2010; 109:82-4. [PMID: 20123590 DOI: 10.1016/s0929-6646(10)60025-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Behcets aortitis is a rare, but one of the most severe complications of Behcets disease. We report a 24-year old woman who was noted initially to have aortitis and severe aortic regurgitation caused by Behcets disease. After receiving aortic valve replacement, aortoplasty and immunosuppressant therapy, her condition became stationary. As far as we are aware, she is the youngest case that has undergone surgery. The early onset of hemodynamic decompensation is considered to be related to delay in diagnosis and lack of steroid treatment.
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Ablikim M, Achasov MN, An L, An Q, An ZH, Bai JZ, Ban Y, Berger N, Bian JM, Boyko I, Briere RA, Bytev V, Cai X, Cao GF, Cao XX, Chang JF, Chelkov G, Chen G, Chen HS, Chen JC, Chen LP, Chen ML, Chen P, Chen SJ, Chen YB, Chu YP, Cronin-Hennessy D, Dai HL, Dai JP, Dedovich D, Deng ZY, Denysenko I, Destefanis M, Ding Y, Dong LY, Dong MY, Du SX, Duan MY, Fang J, Feng CQ, Fu CD, Fu JL, Gao Y, Geng C, Goetzen K, Gong WX, Greco M, Grishin S, Gu YT, Guo AQ, Guo LB, Guo YP, Han SQ, Harris FA, He KL, He M, He ZY, Heng YK, Hou ZL, Hu HM, Hu JF, Hu T, Hu XW, Huang B, Huang GM, Huang JS, Huang XT, Huang YP, Ji CS, Ji Q, Ji XB, Ji XL, Jia LK, Jiang LL, Jiang XS, Jiao JB, Jin DP, Jin S, Komamiya S, Kuehn W, Lange S, Leung JKC, Li C, Li C, Li DM, Li F, Li G, Li HB, Li J, Li JC, Li L, Li L, Li QJ, Li WD, Li WG, Li XL, Li XN, Li XQ, Li XR, Li YX, Li ZB, Liang H, Liang TR, Liang YT, Liang YF, Liao GR, Liao XT, Liu BJ, Liu CL, Liu CX, Liu CY, Liu FH, Liu F, Liu F, Liu GC, Liu H, Liu HB, Liu HM, Liu HW, Liu J, Liu JP, Liu K, Liu KY, Liu Q, Liu SB, Liu XH, Liu YB, Liu YF, Liu YW, Liu Y, Liu ZA, Lu GR, Lu JG, Lu QW, Lu XR, Lu YP, Luo CL, Luo MX, Luo T, Luo XL, Ma CL, Ma FC, Ma HL, Ma QM, Ma X, Ma XY, Maggiora M, Mao YJ, Mao ZP, Min J, Mo XH, Muchnoi NY, Nefedov Y, Ning FP, Olsen SL, Ouyang Q, Pelizaeus M, Peters K, Ping JL, Ping RG, Poling R, Pun CSJ, Qi M, Qian S, Qiao CF, Qiu JF, Rong G, Ruan XD, Sarantsev A, Shao M, Shen CP, Shen XY, Sheng HY, Sonoda S, Spataro S, Spruck B, Sun DH, Sun GX, Sun JF, Sun SS, Sun XD, Sun YJ, Sun YZ, Sun ZJ, Sun ZT, Tang CJ, Tang X, Tang XF, Tian HL, Toth D, Varner GS, Wan X, Wang BQ, Wang JK, Wang K, Wang LL, Wang LS, Wang P, Wang PL, Wang Q, Wang SG, Wang XD, Wang XL, Wang YD, Wang YF, Wang YQ, Wang Z, Wang ZG, Wang ZY, Wei DH, Wen SP, Wiedner U, Wu LH, Wu N, Wu W, Wu YM, Wu Z, Xiao ZJ, Xie YG, Xu GF, Xu GM, Xu H, Xu M, Xu M, Xu XP, Xu Y, Xu ZZ, Xue Z, Yan L, Yan WB, Yan YH, Yang HX, Yang M, Yang P, Yang SM, Yang YX, Ye M, Ye MH, Yu BX, Yu CX, Yu L, Yuan CZ, Yuan Y, Zeng Y, Zhang BX, Zhang BY, Zhang CC, Zhang DH, Zhang HH, Zhang HY, Zhang JW, Zhang JY, Zhang JZ, Zhang L, Zhang SH, Zhang XY, Zhang Y, Zhang YH, Zhang ZP, Zhao C, Zhao HS, Zhao J, Zhao J, Zhao L, Zhao L, Zhao MG, Zhao Q, Zhao SJ, Zhao TC, Zhao XH, Zhao YB, Zhao ZG, Zhemchugov A, Zheng B, Zheng JP, Zheng YH, Zheng ZP, Zhong B, Zhong J, Zhou L, Zhou ZL, Zhu C, Zhu K, Zhu KJ, Zhu QM, Zhu XW, Zhu YS, Zhu ZA, Zhuang J, Zou BS, Zou JH, Zuo JX, Zweber P. Measurements of h(c)(1P(1)) in psi' decays. PHYSICAL REVIEW LETTERS 2010; 104:132002. [PMID: 20481873 DOI: 10.1103/physrevlett.104.132002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Indexed: 05/29/2023]
Abstract
We present measurements of the charmonium state h(c)(1P(1)) made with 106x10(6) psi' events collected by BESIII at BEPCII. Clear signals are observed for psi'-->pi0 h(c) with and without the subsequent radiative decay h(c)-->gamma eta(c). First measurements of the absolute branching ratios B(psi'-->pi0 h(c)) = (8.4+/-1.3+/-1.0) x 10(-4) and B(h(c)-->gamma eta(c)) = (54.3+/-6.7+/-5.2)% are presented. A statistics-limited determination of the previously unmeasured h(c) width leads to an upper limit Gamma(h(c))<1.44 MeV (90% confidence). Measurements of M(h(c)) = 3525.40+/-0.13+/-0.18 MeV/c2 and B(psi'-->pi0 h(c)) x B(h(c)-->gamma eta(c)) = (4.58+/-0.40+/-0.50) x 10(-4) are consistent with previous results.
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Yen TA, Chen YS, Chen CA, Wang CC, Chang CI, Wu ET, Lin MT, Wang JK, Wu MH, Chiu SN. Images in cardiovascular medicine. Fibrinolytic therapy in mechanical valve thrombosis in a one-year-old girl. Circulation 2010; 121:e244-5. [PMID: 20308622 DOI: 10.1161/cir.0b013e3181d8d5eb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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143
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Wang JK, Wu MH, Lin MT, Chiu SN, Chen CA, Chiu HH. Transcatheter Closure of Moderate-to-Large Patent Ductus Arteriosus in Infants Using Amplatzer Duct Occluder. Circ J 2010; 74:361-4. [DOI: 10.1253/circj.cj-09-0473] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Wu KL, Wang JK, Lin MT, Chen CA, Wu ET, Chiu SN, Wu MH. Left Ventricular Outflow Tract Obstruction in Complete Transposition of the Great Arteries - Echocardiography Criteria for Surgical Strategies -. Circ J 2010; 74:1214-8. [PMID: 20453388 DOI: 10.1253/circj.cj-09-0081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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145
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Wu MH, Chen HC, Wang JK, Chiu HH, Huang SC, Huang SK. Population-based study of pediatric sudden death in Taiwan. J Pediatr 2009; 155:870-874.e2. [PMID: 19683252 DOI: 10.1016/j.jpeds.2009.06.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Revised: 04/17/2009] [Accepted: 06/18/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We sought to estimate the incidence of pediatric sudden death (SD) in Taiwan. STUDY DESIGN Cases of SD were identified from National Health Insurance databases, 2000 to 2006. RESULTS In the Taiwan pediatric population (age, 0 to 18 years; 5.44 million), the neonatal, infant, postneonatal infant, and under-5 years mortality rates were 3, 6, 2.81, and 8.02 per 1000 live births, and the 1 to 18 years mortality rate was 33 per 100 000 person-years. There were 1528 SDs (59% boys). In the population 1 to 18 years, annual incidence of SD was 2.7 (95% confidence interval, 2.6 to 2.9), ranging from 0.7 (11 to 12 years) to 6.1 (1 to 2 years) per 100 000. Male predominance was noted (3.2 vs 2.2 per 100 000), particularly in groups ages 16, 17, and 18 years. The proportionate mortality ratio by SD ranged from 1.8% to 12.0% (8.9 +/- 2.2%), being lowest in the group ages 11 to 12 years. In infants, the incidence of SD was 0.36 per 1000 live births, and the proportionate mortality ratio by SD was 1.0% and 11.7% in the neonates and postneonatal infants. CONCLUSIONS The incidence of pediatric SD in Taiwan, an Asian country with a child health care index comparable with that in the United States, was within the range from Western reports and indicated male predominance and a nadir around 11 to 12 years.
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Chiu HH, Chiu SN, Hu FC, Chen CA, Lin MT, Wang JK, Chang CI, Chen YS, Chiu IS, Wu MH. Late cardiovascular complications after surgical or balloon angioplasty of coarctation of aorta in an Asian cohort. Am J Cardiol 2009; 104:1139-44. [PMID: 19801038 DOI: 10.1016/j.amjcard.2009.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 06/05/2009] [Accepted: 06/05/2009] [Indexed: 12/01/2022]
Abstract
Late cardiovascular complications after intervention for coarctation of the aorta (CoA) might be common. Such data, especially in Asian populations, are still limited. A total of 169 patients with CoA who survived balloon (n = 41) or surgical (n = 128) intervention from 1986 to 2004 were enrolled. The total follow-up was 1,776 patient-years, and the patient age at last follow-up was 14.7 +/- 8.5 years. Reintervention for recoarctation, systemic hypertension, and left ventricular outflow tract obstruction (LVOTO) was subsequently noted in 57 (34%), 36 (21.3%), and 24 (14.2%) patients, respectively, without significant differences between the balloon and surgical groups. The 20-year freedom from reintervention, systemic hypertension, and LVOTO rate was 52%, 78.6%, and 80.8% in the balloon group and 59%, 51%, and 81.9% in the surgical group, respectively. The age at CoA intervention and the aortic geometry after CoA intervention of gothic type were common risk factors for reintervention for recoarctation and late systemic hypertension. In contrast, the presence of bicuspid aortic valves and gothic arch geometry after CoA intervention increased the risk of LVOTO. Plasma renin/aldosterone activities were not elevated in those with or without systemic hypertension. In conclusion, the profile of reintervention for recoarctation and late systemic hypertension after CoA interventions in our Asian cohort with CoA was similar to that observed in white patients. Asian patients might have a lower risk of LVOTO.
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Chen CA, Wang JK, Lin MT, Lu CW, Wu KL, Chiu SN, Chiu HH, Wu ET, Lue HC, Wu MH. Dilated Cardiomyopathy After Long-Term Right Ventricular Apical Pacing in Children With Complete Atrioventricular Block: Role of Setting of Ventricular Pacing. J Card Fail 2009; 15:681-8. [DOI: 10.1016/j.cardfail.2009.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2008] [Revised: 03/26/2009] [Accepted: 04/10/2009] [Indexed: 11/28/2022]
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Olewe TM, Mwanthi MA, Wang JK, Griffiths JK. Blood Lead Levels And Potental Environmental Exposures Among Children Under Five Years In Kibera Slums, Nairobi. ACTA ACUST UNITED AC 2009; 6:6-10. [DOI: 10.4314/eajph.v6i1.45734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bozic AK, Anderson RC, Carstens GE, Ricke SC, Callaway TR, Yokoyama MT, Wang JK, Nisbet DJ. Effects of the methane-inhibitors nitrate, nitroethane, lauric acid, Lauricidin and the Hawaiian marine algae Chaetoceros on ruminal fermentation in vitro. BIORESOURCE TECHNOLOGY 2009; 100:4017-4025. [PMID: 19362827 DOI: 10.1016/j.biortech.2008.12.061] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 12/01/2008] [Accepted: 12/01/2008] [Indexed: 05/27/2023]
Abstract
The effects of several methane-inhibitors on rumen fermentation were compared during three 24h consecutive batch cultures of ruminal microbes in the presence of nonlimiting amounts of hydrogen. After the initial incubation series, methane production was reduced greater than 92% from that of non-treated controls (25.8+/-8.1 micromol ml(-1) incubation fluid) in cultures treated with nitroethane, sodium laurate, Lauricidin or a finely-ground product of the marine algae, Chaetoceros (added at 1, 5, 5 and 10 mg ml(-1), respectively) but not in cultures treated with sodium nitrate (1 mg m1(-1)). Methane production during two successive incubations was reduced greater than 98% from controls (22.5+/-3.2 and 23.5+/-7.9 micromol ml(-1), respectively) by all treatments. Reductions in amounts of volatile fatty acids and ammonia produced and amounts of hexose fermented, when observed, were most severe in sodium laurate-treated cultures. These results demonstrate that all tested compounds inhibited ruminal methane production in our in vitro system but their effects on fermentation differed.
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Wang JK, Klein HG. Red blood cell transfusion in the treatment and management of anaemia: the search for the elusive transfusion trigger. Vox Sang 2009; 98:2-11. [PMID: 19682346 DOI: 10.1111/j.1423-0410.2009.01223.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Therapeutic red blood cell (RBC) transfusion is widely utilized in the management of anaemia. Critically ill intensive care unit (ICU) patients in particular, as well as medical and haematology-oncology patients, are among the largest groups of users of RBC products. While anaemia is common in these patients, its treatment and management, including appropriate thresholds for RBC transfusion, remain controversial. We review here the function of RBCs in oxygen transport and physiology, with a view to their role in supporting and maintaining systemic tissue oxygenation. Adaptive and physiological compensatory mechanisms in the setting of anaemia are discussed, along with the limits of compensation. Finally, data from clinical studies will be examined in search of evidence for, or against, a clinically relevant transfusion trigger.
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