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Left posterior fascicular ventricular tachycardia (LPFVT) is extremely rare in neonates. We described a 17-day-old girl with LPFVT who was initially misdiagnosed as supraventricular tachycardia (SVT). Eventually, she was successfully treated by amiodarone infusion followed by oral amiodarone with propranolol for 9 months, and LPFVT spontaneously resolved after a 1-year follow-up. This case report illustrated the basic principles and caveats in differential diagnosis of LPFVT in the neonatal age group. With proper diagnosis and therapy, neonatal LPFVT might regress in the first year of life.

Background Kawasaki disease (KD) is a medium vessel vasculitis that typically occurs in children aged between 6 months and 5 years. It is extraordinarily rare in the neonatal period. KD-related systemic artery aneurysms (SAAs) have never been reported in neonates. Case presentation A male infant was transferred to our institution for persistent high-grade fever lasting 16 days. Symptoms started at day 14 of life, and he was admitted to a children’s hospital on the second day of fever. Physical examination at the time found no signs suggestive of KD. The only laboratory parameters which were of significance were values suggestive of systemic inflammation. However, his fever persisted and inflammatory markers continued to rise despite 2 weeks of antibiotic therapy. KD as a noninfectious cause of fever was considered when he came to our institution, and echocardiographic findings of left and right medium coronary artery aneurysms (CAAs) confirmed our suspicions. Full-body magnetic resonance angiography also revealed bilateral axillary artery aneurysms. Administration of intravenous gamma globulin resulted in rapid improvement. His fever resolved on the next day and CAAs and SAAs regressed to normal at 6 months and 3 months after diagnosis, respectively. Conclusion This unique case of incomplete KD highlights the importance of considering KD in neonates with unexplained prolonged fever and reinforces the need to remain vigilant for SAAs in KD.

BACKGROUND: Coronary artery aneurysms (CAAs) are a well-known complication of Kawasaki disease (KD), but there are no data on incidence or outcomes of systemic artery aneurysms (SAAs) in the current era. METHODS: From April 1, 2016, to March 31, 2019, we screened for SAAs in 162 patients with KD at risk for SAAs with magnetic resonance angiography or peripheral angiography and analyzed incidence and early outcomes of SAAs. RESULTS: Twenty-three patients had SAAs, demonstrating an incidence of 14.2% (23 of 162) in patients who were screened at 1 month after onset. The proportion of patients with SAAs was estimated to be 2% (23 of 1148) of all patients with KD. The median age at onset of KD with SAAs was 5 months. All patients with SAAs had CAAs, with z scores >8. Of patients with giant CAAs, 38.6% (17 of 44) had SAAs. A total of 129 SAAs occurred in 17 different named arteries. The most common sites for SAAs were the axillary (18.6%), common iliac (12.4%), and brachial (11.6%) arteries. During a median follow-up time of 6 months, 92.9% (79 of 85) of SAAs had some degree of regression, with 80% (68 of 85) of SAAs returning to normal. The overall regression rate was higher for medium to large SAAs than for medium to giant CAAs. CONCLUSIONS: Although the incidence of SAAs may not be as dramatically reduced as we expected compared with previous data, SAAs have a high regression rate during short-term follow-up.

OBJECTIVES: Pulse oximetry (POX) has been confirmed as a specific screening modality for critical congenital heart disease (CCHD), with moderate sensitivity. However, POX is not able to detect most serious and critical cardiac lesions (major congenital heart disease [CHD]) without hypoxemia. In this study, we investigated the accuracy and feasibility of the addition of cardiac auscultation to POX as a screening method for asymptomatic major CHD. METHODS: A multicenter prospective observational screening study was conducted at 15 hospitals in Shanghai between July 1, 2012, and December 31, 2014. Newborns with either an abnormal POX or cardiac auscultation were defined as screen positive. All screen-positive newborns underwent further echocardiography. False-negative results were identified by clinical follow-up, parents’ feedback, and telephone review. We assessed the accuracy of POX plus cardiac auscultation for the detection of major CHD. RESULTS: CHD screening was completed in all 15 hospitals, with a screening rate of 94.0% to 99.8%. In total, 167 190 consecutive asymptomatic newborn infants were screened, of which 203 had major CHD (44 critical and 159 serious). The sensitivity of POX plus cardiac auscultation was 95.5% (95% confidence interval 84.9%–98.7%) for CCHD and 92.1% (95% confidence interval 87.7%–95.1%) for major CHD. The false-positive rate was 1.2% for detecting CCHD and 1.1% for detecting major CHD. CONCLUSIONS: In our current study, we show that using POX plus cardiac auscultation significantly improved the detection rate of major CHD in the early neonatal stage, with high sensitivity and a reasonable false-positive rate. It provides strong evidence and a reliable method for neonatal CHD screening.

Summary Background Several pioneering studies have provided evidence for the introduction of universal pulse oximetry screening for critical congenital heart disease. However, whether the benefits of screening reported in studies from high-income countries would translate with similar success to low-income countries is unknown. We assessed the feasibility and reliability of pulse oximetry plus clinical assessment for detection of major congenital heart disease, especially critical congenital heart disease, in China. Methods We did a pilot study at three hospitals in Shanghai to assess the accuracy of pulse oximetry plus clinical assessment for detection of congenital heart disease. We made a data collection plan before recruitment. We then undertook a large, prospective, and multicentre screening study in which we screened all consecutive newborn babies (aged 6–72 h) born at 18 hospitals in China between Aug 1, 2011, and Nov 30, 2012. Newborn babies with positive screen results (either an abnormal pulse oximetry or abnormal clinical assessment) were referred for echocardiography within 24 h of screening. We identified false-negative results by clinical follow-up and parents' feedback. We calculated sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios for pulse oximetry alone, and in combination with clinical assessment, for detection of major and critical congenital heart disease. Findings In the pilot study, 6785 consecutive newborn babies were screened; 46 of 49 (94%) cases of asymptomatic major congenital heart disease and eight of eight (100%) cases of asymptomatic critical disease were detected by pulse oximetry and clinical assessment. In the prospective multicentre study, we screened 122 738 consecutive newborn babies (120 707 asymptomatic and 2031 symptomatic), and detected congenital heart disease in 1071 (157 critical and 330 major). In asymptomatic newborn babies, the sensitivity of pulse oximetry plus clinical assessment was 93·2% (95% CI 87·9–96·2) for critical congenital heart disease and 90·2% (86·4–93·0) for major disease. The addition of pulse oximetry to clinical assessment improved sensitivity for detection of critical congenital heart disease from 77·4% (95% CI 70·0–83·4) to 93·2% (87·9–96·2). The false-positive rate for detection of critical disease was 2·7% (3298 of 120 392) for clinical assessment alone and 0·3% (394 of 120 561) for pulse oximetry alone. Interpretation Pulse oximetry plus clinical assessment is feasible and reliable for the detection of major congenital heart disease in newborn babies in China. This simple and accurate combined method should be used in maternity hospitals to screen for congenital heart disease. Funding Key Clinical Research Project sponsored by Ministry of Health, Shanghai Public Health Three-Year Action Plan sponsored by Shanghai Municipal Government, and National Basic Research Project of China.

Shone's complex is a rare and severe type of congenital left-sided obstructive lesion of multiple cardiovascular levels. This report aims to present the authors' experience diagnosing atypical Shone's complex using echocardiography. Atypical Shone's complex was diagnosed for 38 consecutive patients (18 boys and 20 girls, ages 1 day to 15 years) using echocardiography. All the diagnoses were confirmed by cardioangiography, surgery, or both. Among the congenital left-sided obstructive lesions, four levels of obstruction coexisted in 3 cases (7.9%), three levels in 10 cases (26.3%), and two levels in 25 cases (65.8%). Supra-annular mitral stenosis caused by a supravalvular mitral ring was diagnosed in 1 case. Mitral valvular stenosis was diagnosed in 24 cases including a parachute mitral valve (4 cases), a double-orifice mitral valve (1 case), and partly fused thickened mitral valvular leaflets (19 cases). Subaortic stenosis was diagnosed in 10 cases including circumferential membranous subaortic stenosis (1 case), tunnel-type subaortic narrowing (2 cases), and asymmetric obstructive fibrous ridge below the aortic valve (7 cases). Aortic stenosis was diagnosed in 25 cases including the bicuspid aortic valve (12 cases), the hypoplasia aortic annulus (3 cases), and partly fused or thickened tri-leaflet aortic valves (10 cases). Supra-aortic stenosis was diagnosed in 6 cases including the localized type (4 cases) and the diffused type (2 cases). Coarctation of the aorta was diagnosed in 26 cases. Of these, focal coarctation was described in 15 cases, long segment coarctation in 7 cases, and dysplastic isthmus and/or descending aorta in 4 cases. Secondary changes in Shone's complex manifested as left atrial dilation (26 cases), left ventricular hypertrophy (26 cases), and pulmonary hypertension (19 cases). Echocardiography plays an important role in the diagnosis of atypical Shone's complex, in comprehensive evaluation of the number, position, morphology, and severity of left-sided obstructions.

Background: This study aimed to test the hypothesis that alteration of left ventricular (LV) torsional mechanics occurs in patients after repair of tetralogy of Fallot (TOF) and is associated with right ventricular (RV) volume overload and changes in LV configuration. Methods and Results: Fifty-five TOF patients aged 19.0±8.1 years and 27 age-matched healthy controls were studied. The LV and RV volumes were measured using 3-dimensional echocardiography while LV geometry was quantified by the diastolic eccentricity index (EI). The LV peak systolic torsion and systolic twisting and diastolic untwisting velocities were determined by speckle tracking. Compared with controls, patients had significantly greater RV end-systolic (P

Left ventricular (LV) dysfunction is 1 of the major determinants of late adverse clinical outcomes in patients after surgical repair of tetralogy of Fallot (TOF). The aim of this study was to test the hypothesis that LV myocardial deformation is impaired in patients after TOF repair and related to right ventricular (RV) dilation and exercise capacity. Longitudinal, radial, and circumferential LV myocardial deformation was determined using speckle-tracking echocardiography in 23 postoperative patients with TOF and compared to that of 23 age-matched controls. Relations between LV strain and strain rate (SR) and RV volumes and exercise parameters were determined in patients. Compared to controls, patients had reduced global LV longitudinal, radial, and circumferential strain (all p values0.05). Patients with significantly increased RV end-systolic volume (2 SDs higher than normal; n = 17) had reduced global LV circumferential strain (p = 0.048) and SR (p = 0.038), but similar longitudinal and radial speckle-tracking echocardiographic parameters, compared to those without (n = 6). RV end-systolic volume was correlated inversely with global LV circumferential strain and SR (r = -0.58, p = 0.004, and r = -0.58, p = 0.005, respectively), while RV end-diastolic volume was correlated only with global LV circumferential strain (r = -0.43, p = 0.047). In patients, the LV ejection fraction was correlated with global LV circumferential strain (r = 0.54, p = 0.01) and SR (r = 0.66, p = 0.001) but not with longitudinal or radial speckle-tracking echocardiographic parameters. Using multivariate analysis, global LV circumferential SR (beta = 0.66, p = 0.001) and male gender (beta = 0.46, p = 0.012) were identified as independent predictors of peak oxygen consumption. In conclusion, the negative impact of RV dilation on LV function relates to its influence on LV circumferential strain and SR in patients after TOF repair.

AIM The relationship was investigated between endothelial progenitor cells (EPCs) level and arterial functions in the convalescence of Kawasaki disease (KD). METHODS Sixty-three children were divided into coronary artery lesion (CAL) group (group 1, n = 21), non-CAL group (group 2, n = 20) and control group (group 3, n = 22). EPCs were examined by flow cytometry and arterial functions (flow-mediated dilation [FMD], carotid artery stiffness index [SI]) were measured by ultrasound. RESULTS From group 1 to group 3, FMD was 4.5%+/- 1.5%, 9.5%+/- 2.8% and 12.1%+/- 2.3% (p < 0.01 between any two groups); carotid artery SI was 4.10 +/- 0.44, 3.81 +/- 0.50 and 3.59 +/- 0.46 (group 1 vs. group 2, p < 0.05; group 1 vs. group 3, p < 0.01; group 2 vs. group 3, p = 0.142) and the number of EPCs was 2.0 +/- 0.6/microL, 4.2 +/- 0.8/microL, 4.5 +/- 0.7/microL (p < 0.01 for group 1 vs. group 2 and group 1 vs. group 3; group 2 vs. group 3, p = 0.292). Multiple linear regressions analysis and correlation analysis identified that FMD and carotid artery SI were significant determinants of EPCs level and were all independently correlated with EPCs level. CONCLUSIONS Our results indicate decreased EPCs are associated with arterial dysfunction in patients with CAL in the convalescence of KD. Our findings suggest EPCs may have a role in alteration of arterial functions.

OBJECTIVE. We tested the hypothesis that single-nucleotide polymorphisms of inflammatory genes C-reactive protein (CRP) and tumor necrosis factor α (TNF-α) may exert influence on susceptibility to Kawasaki disease and its arterial sequelae. METHODS. We analyzed the CRP +1444 C→T and TNF-α −308 G→A polymorphisms in 167 patients aged 8.9 ± 4.1 years with a history of Kawasaki disease (73 with and 94 without coronary aneurysms) and 124 healthy control subjects. For patients with Kawasaki disease, we further determined whether these single-nucleotide polymorphisms were associated with coronary aneurysms, carotid arterial stiffening, and intima-media thickness. RESULTS. Genotypic and allelic frequencies of CRP +1444 for T carrier and TNF-α −308 for A carrier were significantly higher in patients than in control subjects. The genotypic and allelic distributions did not differ between patients with and those without coronary aneurysms; however, patients with CRP +1444 CT/TT genotype compared with those with a CC genotype and patients with TNF-α −308 GA/AA genotype compared with those with a GG genotype had significantly greater carotid arterial stiffness and intima-media thickness. Carriers of both CRP +1444 T allele and TNF-α −308 A allele had the highest susceptibility to Kawasaki disease and a significant trend of increased arterial stiffness and intima-media thickness compared with those who carried either 1 or none of the rare alleles. Multiple linear regression analysis identified CRP +1444 allele carrier as a significant determinant of both carotid stiffness and carotid intima-media thickness and TNF-α −308 A allele carrier as a determinant of only intima-media thickness. CONCLUSIONS. Our findings suggest that CRP +1444 C→T and TNF-α −308 G→A polymorphisms are associated with predisposition to Kawasaki disease and, in patients with Kawasaki disease, increased carotid arterial stiffness and intima-media thickness in the long-term.

Recent data suggest potential benefits of cardiac resynchronization therapy in the management of right ventricular (RV) dysfunction in congenital heart disease. The aim of this study was to determine the nature, prevalence, and functional implications of mechanical RV dyssynchrony in patients after Senning or Mustard procedures for transposition of the great arteries. Twenty-eight patients (mean age 21.1 +/- 3.5 years) at 19.9 +/- 3.2 years after atrial switch operations and 29 healthy controls were studied. The times from the onset of QRS to peak systolic strain (T epsilon) at the base of and the mid RV free wall, the ventricular septum (VS), and the left ventricular (LV) free wall were determined using tissue Doppler echocardiography. Intraventricular mechanical delay was defined as Delta T epsilon(RV-VS) and interventricular mechanical delay as Delta T epsilon(RV-LV). In patients, the magnitude of RV intra- and interventricular mechanical delay was correlated with cardiac magnetic resonance-derived RV volumes and ejection fractions (n = 26) and treadmill exercise testing parameters (n = 20). Compared with controls, patients had significantly longer Delta T epsilon(RV-VS) (48.1 +/- 50.9 vs 17.0 +/- 16.1 ms, p0.001) and Delta T epsilon(RV-LV) (63.1 +/- 49.5 vs 19.0 +/- 12.9, p0.001). Nine patients (32%) exhibited RV dyssynchrony (Delta T epsilon(RV-VS)49 ms, control mean +/- 2SD), and 16 patients (57%) showed interventricular dyssynchrony (Delta T epsilon(RV-LV)45 ms). In patients, RV intra- and interventricular mechanical delay was correlated negatively with the RV ejection fraction (both r = -0.42, p = 0.03) and percentage predicted maximum oxygen consumption (r = -0.50, p = 0.03, and r = -0.52, p = 0.02, respectively) and positively with minute ventilation/carbon dioxide production slope (r = 0.49, p = 0.03, and r = 0.56, p = 0.01, respectively). In conclusion, RV dyssynchrony is common in young adults after atrial switch operations and is associated with RV systolic dysfunction and impaired exercise performance.

Objective: To evaluate the role of transoesophageal echocardiography and problems related to safety during the surgical repair of congenital cardiac malformations in children. Methods: We examined the transoesophageal recordings made in 350 children with congenital cardiac diseases, aged from 2 months to 17 years and 9 months, with a median age of 2.7 years, tracings having been taken both before and after cardiopulmonary bypass. All patients had been scanned by transthoracic echocardiography before the operative procedures. Results: Preoperative transoesophageal echocardiography added additional findings, or changed the diagnoses made using transthoracic echocardiography, in 33 cases (9.4%), among which the findings had therapeutic significance in 23 cases (6.6%) that altered the planned surgical procedures. Residual problems or sequels were detected by postoperative transoesophageal echocardiography in 57 cases (16.3%), with 13 patients (3.7%) requiring instant intervention or return to bypass for modifications of the surgical procedures. We encountered no severe complications due to the performance of transoesophageal echocardiography. Mild complications occurred in only 2 patients (0.6%). Conclusions: Transoesophageal echocardiography is a useful tool with which to determine the strategies for treatment in the perioperative period, and to improve the quality of surgical procedures in children with congenital cardiac diseases. Complications were few, but still deserved careful attention to detail.

Background Real-time three-dimensional echocardiography (RT-3DE) has made revolutionized improvements of cardiac imaging during the past few years. However, there is no standard examination method for RT-3DE so far. This study aimed to establish the diagnostic method of RT-3DE and evaluate its application in the diagnosis of complex congenital heart diseases (CHD). Methods Fifty patients with complex CHD were examined by RT-3DE with modes of Live 3DE and Full Volume. A series of novel volumetric views combined with Van Praagh sequential segmental approach were introduced to reveal the pathological morphology of the hearts, which were compared with the findings of two-dimensional echocardiography (2DE), angiography and cardiac surgery. Results In 50 patients, 190 image acquisitions of Full Volume were performed at several acoustic windows including subcostal, apical and parastemal regions. Among them, 94.2% (179/190) of image acquisitions were successful. Most sectional volumetric views could be clearly displayed in 92.6% of the successful image acquisitions. However, sectional volumetric views could not be clearly displayed in 7.4%, which was mainly due to poor perspective conditions of examination location, improper instrument multi-parameter setting and insufficient information of whole heart captured in Full Volume acquisitions. As compared with surgical findings and angiography, RT-3DE made correction to the diagnoses in 2 cases including 1 with corrected transposition of the great arteries and the other with single atrium and mitral cleft. The diagnoses initially made by 2DE for these 2 patients were double outlet right ventricle with transposition of the great arteries and complete atrio-ventricular septal defect. Conclusions RT-3DE can clearly display the pathological morphology of complex CHD by a series of novel volumetric views combined with sequential segmental approach through providing more spatial informative cardiovascular structures, which provides a practical method for RT-3DE diagnosis.

Anaemia in pregnancy is a major public health problem in China. Anaemia in pregnant women may be related to dietary intake of nutrients. To examine the relationship between iron status and dietary nutrients, a cross-sectional study in pregnant women was carried out. The intake of foods and food ingredients were surveyed by using 24-h dietary recall. Blood haemoglobin, haematocrit, serum iron, serum ferritin, transferrin and soluble transferrin receptor were measured in 1189 clinically normal pregnant women in the third trimester of pregnancy. The results showed that the average daily intake of rice and wheat was 504.2 g in the anaemia group and 468.6 g in the normal group. Carbohydrates accounted for 63.69% and 63.09% of energy in the anaemia and normal groups, respectively. Intake of fat was very low; 18.38% of energy in anaemia group and 19.23% of energy in normal group. Soybean intake was 109.4 g/day and 63.6 g/day in the anaemia and normal groups, respectively (P < 0.001). There were lower intakes of green vegetables (172.1 g/day) and fruits (154.9 g/day) in the anaemia group than in the normal group (246.2 g/day green vegetables (P < 0.001) and 196.4 g/day fruit (P < 0.001)). Intakes of retinol and ascorbic acid were much lower in the anaemia than in the normal group (P < 0.001). In the anaemia group, vitamin A intake was only 54.76% of the Chinese recommended daily allowance (RDA) and ascorbic acid intake was 53.35% of the Chinese RDA. Intake of total vitamin E was 14.55 mg/day in the anaemia group compared with 17.35 mg/day in the normal group (P < 0.016). Moreover, intake of iron in pregnant women with anaemia was slightly lower than that in the normal group. Comparison of iron status between the anaemia and normal groups found serum iron in women with anaemia at 0.89 microg/L, which was significantly lower than 1.09 microg/L in the normal group (P < 0.001). There were lower average values of ferritin (14.70) microg/L) and transferrin (3.34 g/L) in the anaemia group than in the normal group (20.40 microg/L ferritin (P < 0.001) and 3.44 g/L transferrin (P < 0.001)). Soluble transferrin receptor was significantly higher (32.90 nmol/L) in the anaemia than in the normal group (23.58 nmol/L; P < 0.001). The results of this study indicate that anaemia might be attributed to a low iron intake, a low intake of enhancers of iron absorption and a high intake of inhibitors of iron absorption from a traditional Chinese diet rich in grains.

Eighty iron-deficient, nonpregnant female workers were randomly assigned to ferrous sulphate (60 or 120 mg Fe/d) or placebo treatment for 12 wk. Energy expenditure was estimated during 3 d by heart rate (HR) recording. Production efficiency (PE) was calculated as the ratio of productivity to energy expenditure. In the iron-treated group mean hemoglobin (Hb) increased from 114 to 127 g/L (P < 0.001), mean serum ferritin increased from 9.7 to 30.0 micrograms/L (P < 0.001), and mean free erythrocyte protoporphyrin decreased from 1.01 to 0.49 mumol/L (P < 0.001). Mean HR at work decreased from 95.5 to 91.1 beats/min (P < 0.001), which was inversely correlated with the change in Hb (r = -0.60, P < 0.001). PE increased significantly in the iron-treated group (P < 0.001) and its change paralleled the change in Hb (r = 0.58, P < 0.001). The results show that iron supplementation enabled these women to do the same work at a lower energy cost.

Background The hypertrophic myocardium, myocardial fiber disarray, and endocardial fibroelastosis in pulmonary atresia and intact ventricular septum (PAIVS) may provide anatomic substrates for restrictive filling of the right ventricle. Hypothesis Restrictive right ventricle (RV) physiology is related to RV fibrosis and exercise capacity in patients after biventricular repair of PAIVS. Methods A total of 27 patients, age 16.5 ± 5.6 years, were recruited after biventricular repair of PAIVS. Restrictive RV physiology was defined by the presence of antegrade diastolic pulmonary flow and RV fibrosis assessed by late gadolinium enhancement (LGE) cardiac magnetic resonance. Their RV function was compared with that of 27 healthy controls and related to RV LGE score and exercise capacity. Results Compared with controls, PAIVS patients had lower tricuspid annular systolic and early diastolic velocities, RV global longitudinal systolic strain, systolic strain rate, and early and late diastolic strain rates (all P < 0.05). A total of 22 (81%, 95% confidence interval: 62%–94%) PAIVS patients demonstrated restrictive RV physiology. Compared to those without restrictive RV physiology (n = 5), these 22 patients had lower RV global systolic strain, lower RV systolic and early diastolic strain rates, higher RV LGE score, and a greater percent of predicted maximum oxygen consumption (all P < 0.05). Conclusion Restrictive RV physiology reflects RV diastolic dysfunction and is associated with more severe RV fibrosis but better exercise capacity in patients after biventricular repair of PAIVS. Copyright © 2010 Wiley Periodicals, Inc.

We tested the hypothesis that diastolic ventricular interaction occurs after atrial switch operation for transposition of the great arteries (TGA) and that subpulmonary LV diastolic function is influenced by septal geometry.Twenty-nine patients (male 19) after atrial switch operation for TGA aged 20.8 ± 4.1 years and 27 healthy controls were studied. Two-dimensional longitudinal systolic strain, systolic (SRs), early diastolic (SRe), and late diastolic (SRa) strain rates of both ventricles were determined using speckle tracking echocardiography. Early diastolic trans-atrioventricular velocity (E) and myocardial early diastolic myocardial velocity (e) at the ventricular free wall-annular junction were measured. Geometry of the morphologic left ventricle was quantified by the diastolic eccentricity index (EI).In both systemic and subpulmonary ventricles, SRe and SRa were significantly lower and trans-atrioventricular E/e ratios higher in patients than controls (all p0.001). In patients, RV SRe correlated with left ventricular (LV) SRe (r=0.49, p=0.008), and RV SRa correlated with LV SRa (r=0.46, p=0.01). Significant leftward shifting of the septum in patients was reflected by the greater LV EI (p0.001). In patients, LV EI correlated with age- and sex-adjusted z score of LV end-diastolic volume. As a group, LV EI correlated negatively with LV SRe (r=-0.62, p0.001) and LV SRa (r=-0.51, p0.001), and positively with mitral E/e ratio (r=0.33, p=0.02).Systemic RV diastolic dysfunction occurs after atrial switch operation and correlates with subpulmonary LV diastolic dysfunction. The observed diastolic ventricular interaction may potentially be mediated through alteration of septal geometry.

Background: Increasing data suggest that parameters of myocardial deformation are strong indices of ventricular systolic and diastolic function. We sought to determine myocardial deformation of the left ventricle and assess relationship of deformation rates with myocardial iron load in patients with beta-thalassemia major. Methods: The left ventricular longitudinal, circumferential, and radial myocardial deformation was determined using speckle tracking echocardiography in 42 thalassemia patients aged 24.4 ± 6.4 years. The results were compared with those of 38 age-matched controls. The rates of longitudinal and circumferential deformation were correlated with cardiac T2* magnetic resonance findings. Results: Compared with controls, patients had significantly greater global systolic radial strain (P = 0.001), but similar global systolic longitudinal (P = 0.12) and circumferential strain (P = 0.84). On the other hand, patients had significantly lower longitudinal systolic strain rate (SR) (P = 0.019), longitudinal early diastolic SR (P = 0.036), and circumferential early diastolic SR (P = 0.04) than controls. The cardiac T2* findings correlated positively with longitudinal (r = 0.44, P = 0.004) and circumferential early diastolic SR (r = 0.37, P = 0.019), but not with the respective systolic SRs and left ventricular ejection fraction (all P > 0.05). Patients with iron overload (T2*< 20 msec), compared to those without, had significantly lower longitudinal (1.45 ± 0.33/sec vs. 1.76 ± 0.27/sec, P = 0.002) and circumferential (1.01 ± 0.31/sec vs. 1.22 ± 0.31/sec, P = 0.03) early diastolic SR. Conclusions: Patients with beta-thalassemia major have reduced longitudinal systolic SR, longitudinal early diastolic SR, and circumferential early diastolic SR. The rates of diastolic deformation in the longitudinal and circumferential dimensions are inversely related to myocardial iron overload. (Echocardiography 2010;27:253-259)

To determine whether amounts of vitamin D lower than recommended doses are effective in preventing rickets, 256 term infants from two northern and two southern cities in China were studied in a randomized trial of vitamin D supplementation (100, 200, or 400 IU/day) during the first 6 months of life. Cord blood and 6-month blood samples were collected and radiographs were obtained at 3 to 5 days and at 6 months of age. Cord serum 25-hydroxyvitamin D concentrations were lower in the north than in the south (5 vs 14 ng/ml (12.5 vs 35.0 nmol/L); p less than 0.01). Wrist ossification centers were less likely to be present at birth in the northern children than in the southern children (p = 0.009) and were more likely to be present in infants born in the fall who had higher cord serum concentrations of 25-hydroxyvitamin D (p = 0.04). Serum 25-hydroxyvitamin D concentrations were lower in northern children 6 months of age than in southern children (p = 0.005) and were higher with an increasing supplemental dosage of vitamin D (p less than 0.001), particularly in infants in the north. None of the infants had rickets at 6 months of age. Because of the low serum 25-hydroxyvitamin D concentrations, especially among infants in the north, it may be prudent to supplement the diet with vitamin D at a dose of 400 IU/day.

The purpose of this study is to investigate the effect of taurine on the human fetal brain cells proliferation with the method of pure cerebral neuronal culture free of glial cells, grown in a serum-free environment. We found that taurine was necessary for neuronal survival, neurite extension. Taurine, on the other hand, has the trophic effect on the human fetal brain cells proliferation determined by [ 3 H]-thymidine incorporation. These results establish taurine as a putative human fetal brain neurontrophic factor in the process of human brain development.

This study aimed to test the hypothesis that right ventricular (RV) volume overload may result in left ventricular (LV) systolic dysfunction through induction of LV systolic dyssynchrony after tetralogy of Fallot (TOF) repair. Sixty patients with TOF repair were studied at 14.3 +/- 7.2 years after TOF repair. Real-time 3-dimensional echocardiographic data sets were acquired for measurement of LV and RV volumes and derivation of ejection fractions and pulmonary regurgitant volume. The LV systolic dyssynchrony index (SDI) was derived from the dispersion of time to minimum regional volume using a 16-segment model. The results were compared with those of 29 healthy controls. LV SDI was significantly higher in patients than controls (7.4% +/- 2.0% vs 3.0% +/- 0.9%, p0.001). The prevalence of LV mechanical dyssynchrony (SDI4.7%) in patients was 93% (95% confidence interval 87% to 100%). The time to minimum regional volume was significantly longer in all of the 6 basal segments and the midposterior segment (all p0.05) in patients than controls. Multivariate analysis identified RV end-diastolic volume (beta = 0.58, p0.001), LV ejection fraction (beta = -0.38, p0.001), and LV end-diastolic volume (beta = 0.26, p = 0.002) as significant correlates of LV SDI. In conclusion, in patients after TOF repair, RV volume overload has a negative effect on LV systolic function through induction of global LV mechanical dyssynchrony.

To determine the usefulness of new two-dimensional strain indices, based on speckle tracking imaging, for assessment of systemic right ventricular (RV) function after an atrial switch operation for transposition of the great arteries.Cross-sectional study.Tertiary paediatric cardiac centre.26 patients, mean (SD) age 21.0 (3.6) years at 19.9 (3.2) years after an atrial switch operation, and 27 age-matched controls were studied. Two-dimensional imaging at the four-chamber view was obtained with tracing of the entire RV endocardial border. The RV global longitudinal strain (GLS) and GLS rate were derived using automated software (EchoPAC, GE Medical) and correlated with tissue Doppler-derived RV isovolumic acceleration (IVA), and, in the patient cohort, with cardiac magnetic resonance-derived RV ejection fraction.Intra- and interobserver variability for measurement of GLS, as determined from the mean (SD) of differences in two consecutive results from 20 studies, were 0.06 (1.39)% and 0.24 (1.77)%, respectively. Compared with controls, patients had lower RV GLS (17.1 (1.9)% vs 26.3 (2.9)%, p0.001), a reduced GLS rate (0.78 (0.11)/s vs 1.33 (0.23)/s, p0.001), lower RV IVA (1.10 (0.36) m/s(2) vs 1.56 (0.53) m/s(2), p0.001) and increased RV myocardial performance index (0.52 (0.09) vs 0.38 (0.09), p0.001). Both RV GLS and GLS rate correlated positively with RV IVA (r = 0.43, p = 0.001 and r = 0.46, p0.001, respectively), and negatively with RV myocardial performance index (r = -0.65, p0.001 and r = -0.57, p0.001, respectively). In patients, the GLS rate correlated positively with RV ejection fraction (r = 0.62, p = 0.001).Two-dimensional RV GLS and GLS rate are new, potentially useful indices for assessment of systemic RV function.

Iron-deficiency or anemia in pregnancy is a major public health problem in China. This cross-sectional study was carried out to observe the association between iron status and multiple vitamin levels of Chinese pregnant women in the third trimester. We measured iron, ascorbic acid, retinol, folate and vitamin B12 in serum, and riboflavin in urine specimens of 1,163 pregnant women in four sites throughout rural and city areas in China. Based on hemoglobin concentrations (Hb), the subjects were divided into an anemia group with Hb110 g/L or Hbor = 100 g/L as severe anemia group, and nonanemia group with Hbor = 110 g/L. Results showed that 41.58% of the population with serum iron700 microg/L and 51.04% of the population with ferritin12 microg/L in the anemia group, percentages that were much higher than those in the nonanemia group. Relationships between five vitamins and hemoglobin concentrations of all subjects were observed. There was a lower level of serum ascorbic acid (291.05 microg/dL) in the Hbor = 100 g/L group than in the Hbor = 120 g/L group (487.79 microg/dL) (p0.001). Serum levels of vitamin B12 and folate were 445.67 pg/mL and 5.94 ng/mL in the Hbor = 100 g/L group, whose levels were much lower than the levels of 502.01 pg/mL (p0.012) and 8.07 ng/mL (p0.010) respectively in the Hbor = 120 g/L group. Further, cross-sectional analysis showed positive correlations between abnormal hematological results and prevalences of vitamin deficiencies. The subjects with iron-deficiency anemia had much higher rates of vitamin C, folate and vitamin B12 deficiencies than those in the nonanemic subjects, and especially in the deficient rates of ascorbic acid and folate in the anemia (Hb110 g/L) group, which reached 64.04% and 22.70% respectively. Moreover, we observed that the decreasing trends of hemoglobin concentrations were accompanied by the decreases of serum levels of vitamin A, ascorbic acid, folate and vitamin B12. In conclusion, multiple vitamin deficiencies, especially ascorbic acid, retinol and folic acid, may be associated with anemia or iron deficiency in pregnant women in the last trimester. The study suggested that anemic pregnant women in China should be supplemented with iron and multiple vitamins simultaneously.

The purpose of this study was to investigate the effect of taurine on human fetal brain neuron cell proliferation and differentiation using a glial-free, pure cerebral neuronal culture grown in a serum-free environment. We found that taurine was necessary for neuronal survival and neurite extension. Taurine, on the other hand, has a trophic effect on the human fetal brain cell, promoting both proliferation and differentiation. Results showed that DNA synthesis of the neurons was increased in a dose-dependent manner when neurons were cultured in the medium containing taurine (100–6400 μM). The protein content of neuronal cells was also significantly increased in the neurons treated with taurine as compared to the control. At day 15, the expression of neuron-specific enolase (NSE) was only detected in the neurons cultured in the medium containing taurine. These results establish taurine as a putative human fetal brain neurontrophic factor in the process of human brain development.

In theory, sunshine exposure is sufficient to maintain normal vitamin D concentrations for the optimal growth of newborn infants. To determine whether season of birth, latitude (north v. south) and increasing dosages of vitamin D supplements would influence the growth rate for the first 6 months of life, 255 healthy fall-and spring-born infants from two northern and two southern cities in China were randomly assigned to receive either 100, 200, or 400 IU of vitamin D a day. The study showed that season of birth and dose of vitamin D did not affect the growth rate of infants born in the same latitude, but a significant difference was found in the gain in length over the 6-month period between infants from the north and infants from the south (P = 0.0001). Regional differences among the Chinese people, other than sunshine exposure, may have influenced the difference in length gain.

The present study investigates the prevalence and type of anaemia in Chinese female cotton mill workers. The prevalence of anaemia is reported in 447 non-pregnant female workers aged between 19 and 45 years. The mean value for haemoglobin (Hb) was 123 (SD 15) g/l and 150 of the total 447 subjects had Hb values below 120 g/l; thus 34% of the population was anaemic according to World Health Organization (WHO, 1975) criteria. The mean value for free erythrocyte protoporphyrin (FEP) was 419 (SD 215) μg/l; 55% of the total population had FEP values higher than 350 μg/l and 72% among the anaemic subjects. Serum ferritin (SF) was tested in all the women with a Hb value less than 120 g/l and 71 % of them had SF values below 12·0 μg/ls. Eighty women diagnosed as either Fe deficient or with Fe-deficient anaemia were selected for a diagnostic supplementation trial. They were randomly assigned to FeSO4(60 or 120 mg Fe/d) or placebo treatment for 12 weeks. Fe supplementation increased mean Hb values from 114 to 127 g/l (P< 0·001) and SF levels from 9·7 to 30·0 μg/l (P< 0·001), and decreased mean FEP values from 570 to 277 μg/l (P< 0·001). The response rate of Hb in the whole Fe-treated group or Fe-treated subjects with an Hb level less than 120 g/1 was 90 % or 92 % respectively. These findings indicate that the type of anaemia in this population was mainly Fe deficiency. It was also found that in this population the severity of anaemia, not the prevalence, was significantly related to the use of intra-uterine devices (IUD).

Protein requirements of Chinese male adults were determined by nitrogen balance methods. Their average age, body weight, and height were 37.9 (24–44) yr. 64.3 (51.5–74.0) kg and 173 (157–180) cm respectively in the first group, and 30.2 (24–41) yr, 67.7 (56.6–70.0) kg and 171 (170–176) cm respectively in the second group. Ten subjects in the first group were studied for 70 days for N balance responses at graded protein intake of 0.42, 0.60, 0.73, 0.90 and 1.05 g/kg/day on Chinese mixed diet, during five experimental periods respectively. Each period was ten days which was preceded by one day of low protein diet, and with three days of free choice diet after each experimental period. Six subjects in the second group were given a mixed diet at a protein level of 0.93 g/kg/day for three months. In the first group, all subjects were in negative N balance at protein intakes of 0.42, 0.60 and 0.73 g/kg/day and all were in positive N balance at 1.05 g/kg/day. Most of the subjects were in positive N balance at 0.90 g/kg/day. Linear regression analysis of N balance response of individual subjects showed that, at zero N balance, required intakes of individuals ranged from 129.4 to 192.5 N mg/kg/day with the mean of the group of 147.7±18.6 mg N per kilogram a day of 0.92±0.12 g protein/kg/day. Five of the subjects of the second group were in positive N balance and the sixth was near zero balance with an intake of 150.2±2.5 mg N/kg/day or 0.93±0.02 g protein/kg/day. The results obtained indicate the mean protein requirement of these subjects based on the linear regression analysis of N balance response of individuals was 147.7±18.6 mg N/kg/day or 0.92±0.12 g protein/kg/day. If 97.5% of a like population is to be covered, the allowance should be 1.16 g protein/kg/day.

The prevalence of anemia was assessed in 1,481 children under 7 years of age in 16 kindergartens and nurseries in an urban and 1,757 preschool children in a remote mountain area. The average prevalence of anemia, defined as hemoglobin level below 11 g/dl, was 8.3% in the entire urban group, 16.5% in those under three years of age, and 35.9% in 7–12 month old infant. For the rural group the figures were 24.2%, 35.1% and 48.8% respectively. The average daily dietary iron intake was estimated to be 8.3 mg in the nurseries and 12.8 mg in the kindergartens in the urban area. A soft drink powder fortified with ferrous sulfate 450 mg and ascorbic acid 270 mg per 100 g was prepared. A child taking 10 g of the powder per day received of 9 mg of elemental iron and 27 mg of ascorbic acid. Thirty-nine anemic children under three years were treated with fortified soft drink powder, 16 for one month and 23 for two months. After treatment, the hemoglobin level, RBC count and hematocrit percentage increased significantly (p

In order to determine the usefulness of opaque-2 maize in the prevention of pellagra, people from the third and fifth brigades of a commune in a maize-eating district of Northwest China received opaque-2 maize in their diet and served as the experimental subjects. People from the neighboring sixth brigade ate conventional maize and served as the control subjects. After three months there were no cases of pellagra in the experimental groups, but there were three cases in the control group; the incidence was 1.8%. Prior to the study, urinary excretion values of N-methylniacinamide (N-MN) of the subjects were measured. There were no significant differences among the three brigades (P>0.05). By the conclusion of the study the differences in urinary excretion of N-MN between the experimental and control groups were highly significant: 0.21±0.02 and 0.21±0.02 mg/2 h for the experimental groups and 0.12±0.01 mg/2 h for the control group. Opaque-2 maize also was used in a study of the treatment of pellagra. Persons with pellagra were divided into three groups: Group 1 received opaque-2 maize, Group 2 received conventional maize plus niacinamide (10 mg per day), and Group 3 received conventional maize. Before treatment, the average values of the urinary excretion of N-MN of each group were not significantly different. After one month of the treatment, a loading dose of 50 mg niacinamide was administered orally. Four-hour urines were collected and analyzed for N-MN. The differences between Group 1 and Group 3 or Group 2 and Group 3 were significant. Although the results showed that opaque-2 maize could be used in the prevention and treatment of pellagra, meat, milk, and milk products should be recommended to people in all of the areas where pellagra is endemic. The planting of opaque-2 maize, however, should provide an effective means to supply utilizable niacin and is a simple, economical way to prevent pellagra for the present.

The hypothesis that breastfed infants in Beijing, China, have low vitamin D status and that sunshine exposure increases serum 25-hydroxyvitamin D (25-OHD) concentrations was tested in a randomized prospective study involving 42 healthy infants 1-8 months of age. 24 controls were exposed to the usual amount of sunshine, while the 18 cases were provided with 2 hours of sunshine/day. All infants were being breastfed without vitamin D supplementation. Serum 25-OHD concentrations at entry into the study ranged from 3-61 ng/ml and increased with age. 3 infants in each group were diagnosed as having rickets. Serum 25-OHD concentrations did not change significantly during the 2-month study period among controls, while serum 25-OHD values increased significantly in the experimental group. Final infant serum 25-OHD concentrations correlated with ultraviolet exposure scores (p.001). The estimate of ultraviolet score needed to maintain a serum 25-OHD of 11 ng/ml was 2.4 (24 minutes/day with only the face uncovered). Rickets has been reported in as many as 18% of Chinese infants and seems to especially affect those 2-4 months of age. The fact that not all infants with rickets in this study had low 25-OHD concentrations suggests 2 possibilities: 1) not all rickets is necessarily related to a vitamin D deficiency, or 2) serum 25-OHD concentrations are not the best indicator of vitamin D status. The low serum 25-OHD concentrations in many Chinese infants may be related to low maternal milk vitamin D content resulting from the lack of vitamin D food fortification. Overall, these results suggest that the diet of breastfed Chinese infants should be supplemented with orally administered vitamin D.

A high incidence of rickets among infants in the Peoples Republic of China has been reported, etiology unclear. The vit. D status of infants in China has not been investigated. The specific effect of sunshine (UV) exposure on D status in any infant is unstudied. We hypothesized that breast-fed infants in China have low vit. D status and UV exposure increases serum 25OH vit. D into the normal range. 54 breast-fed term infants 1 to 8 mos. without D supplements were randomly assigned into 2 grps. in a 2 mo. study, Sept. and Oct. (mos. of high UV exposure): controls with "usual" sun exposure; and experimental with 2 hr. sun/d. Infants received only human milk, rice soup, fruit juice and mashed vegetables and exposed mostly face and forearms. A 20 nurse team monitored UV exposure with diaries and a unique infant UV dosimeter. Only 100 μl blood samples were permissible in infants. Serum 25OHD was measured by protein binding assay after chromatography. (N 11 to 68 ng/ml). Mean maternal 25OHD was 22 ng/ml. Infant 25OHD correlated with mother's (r=0.48). Infant 25OHD ranged 3 to 61 ng/ml at entry with 20%