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Objective: Linkage between allergy and increased immune response activation in Tourette syn- drome (TS) has been reported. We performed a matched case-control study to evaluate correlation between allergic diseases and TS. Methods: Data in this case-control study were from the Taiwan National Health Insurance Research Database. The sample comprised 845 2- to 18-year-old patients with newly diagnosed TS in 2003-2007 and 3378 controls frequency matched with cases on age, sex, and urbanization level. Uncon- ditional logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) of the association between allergic disease (e.g., allergic rhinitis, atopic dermatitis, asthma, and allergic conjunctivitis), the number of allergic comorbidities, and TS. Results: The majority (76.0%) of incident TS cases were boys; the 4 allergic diseases strongly correlated with higher risk of TS. In a model simultaneously considering all 4 allergic diseases, subjects with allergic rhinitis showed double the risk of TS (adjusted OR 2.18, 95%CI 1.83-2.59; p < 0.0001); adjusted ORs were 1.82, 1.61, and 1.33, respectively, for asthma (95% CI 1.47-2.24; p < 0.0001), dermatitis (95%CI 1.32-1.95; p < 0.0001), and allergic conjunctivitis (95% CI 1.13-1.57; p < 0.001). Risk increased with number of comorbidities (p < 0.0001); this association was positively modified by age (p < 0.0001). Conclusions: Our data showed significant correlation between allergic diseases and TS. Risk also increased with number of allergic comorbidities and with age. Further studies on the mechanism of neuro- immunology of TS are required.

The aim of this study was to evaluate the effects of cortical bone thickness and trabecular bone elastic modulus on the strain in the bone surrounding an immediately loaded implant. We also examined the correlations between bone structure and the following indices of primary implant stability: insertion torque value (ITV), Periotest value (PTV), and implant stability quotient (ISQ).The ITV, PTV, and ISQ were measured in 24 artificial jaw bone models representing cortical bone with four thicknesses (0, 1, 2, and 3 mm) and trabecular bone with four elastic moduli (137, 47.5, 23, and 12.4 MPa). Two loading conditions were applied (force of 130 N applied vertically and at 45° laterally), and the strains in the crestal region were measured by rosette strain gauges with a data acquisition system.When the cortical bone thickness and the elastic modulus of trabecular bone decreased, the bone strains increased by 10.3-52.1% and 39-73.1%, respectively, for vertical loading and by 35-62% and 42.4-56.2% for lateral loading. The cortical bone thickness has a stronger correlation (R(2) =0.95-0.71) with ITV, PTV, and ISQ than the elastic modulus of trabecular bone (R(2) =0.89-0.59).The initial stability at the time of implant placement is influenced by both the cortical bone thickness and the elastic modulus of trabecular bone; however, these parameters are not totally linearly correlated with ITV, PTV, and ISQ. The placement of an immediately loaded implant in cases with thin cortical bone and/or weak trabecular bone can induce extreme bone strains and may increase the risk of implant failure.

To simplify the methods of transcatheter mapping and ablation in the pediatric patients with left posterior fascicular tachycardia.While in sinus rhythm, the fascicular potential can be mapped at the posterior septal region (1 - 2 cm below inferior margin of orifice of coronary sinus vein), which display a biphasic wave before ventricular wave, and exist equipotential lines between them. When the fascicular potential occurs 20 ms later than the bundle of His' potential, radiofrequency was applied. Before applying radiofrequency, catheter position must be observed using double angle viewing (LAO 45°RAO 30°), and it should be made sure that the catheter is not at His' bundle. If the electrocardiogram displays left posterior fascicular block, the correct region is identified and ablation can continue for 60 s. Electrocardiogram monitoring should continue for 24 - 48 hours after operation, and notice abnormal repolarization after termination of ventricular tachycardia. Aspirin [2 - 3 mg/(kg·d)] was used for 3 months, and antiarrhythmic drug was discontinued. Surface electrocardiogram, chest X-ray and ultrasound cardiography were rechecked 1 d after operation. Follow-up was made at 1 month and 3 months post-discharge. Recheck was made half-yearly or follow-up was done by phone from then on.Fifteen pediatric patients were ablated successfully, and their electrocardiograms all displayed left posterior fascicular block after ablation. None of the patients had recurrences during the 3 to 12 months follow-up period. In one case, the electrocardiogram did not change after applying radiofrequency ablation and the ventricular tachycardia remained; however, on second attempt after remapping, the electrocardiogram did change. The radiofrequency lasted for 90 seconds and ablation was successful. This case had no recurrences at 6 months follow-up.Transcatheter ablation of the fascicular potential in pediatric patients with left posterior fascicular tachycardia can simplify mapping, reduce operative difficulty and produce a distinct endpoint for ablation.

To evaluate the efficacy of interventional therapy for complex congenital heart defects patients with un-repaired or postoperative residual lesions.Between March 1998 and April 2009, 42 patients (12 females), mean age 6 years (5 months to 30 years) received interventional therapy, 17 cases underwent occlusion of major aorto-pulmonary collateral arteries (MAPCAs), 15 underwent device closure of residual ventricular or atrial septal shunting, 12 underwent balloon angioplasty (n = 10) and stenting (n = 2) for stenosis of the anastomosis of vessels or branched pulmonary arteries.Twenty-three MAPCAs were performed in 17 patients without residual shunting. One patient died of multiple organ failure after intervention therapy and the remaining patients discharged without complication, successful device closure was performed in 15 patients and there was minimal residual shunting in 1 patient. There were no severe arrhythmias such as complete atrio-ventricular block during and post procedure. Exercise capacities were significantly improved in 12 patients underwent balloon angioplasty or stenting. Pressure gradients were significantly decreased and there was no aneurysmal or thromboembolic formation post procedure.Interventional therapy is a safe and effective therapy option for treating complex congenital heart defects patients with un-repaired or postoperative residual lesions.

Gene transfer of the Escherichia coli purine nucleoside phosphorylase (PNP) results in potent cytotoxicity after administration of the prodrug fludarabine phosphate (F-araAMP). Here, we have tested whether application of this strategy in the context of replication-competent retrovirus (RCR) vectors, which can achieve highly efficient tumor-restricted transduction as well as persistent expression of transgenes, would result in effective tumor inhibition, or, alternatively, would adversely affect viral replication. We found that RCR vectors could achieve high levels of PNP expression concomitant with the efficiency of their replicative spread, with significant cell killing activity in vitro and potent therapeutic effects in vivo. In U-87 xenograft models, replicative spread of the vector resulted in progressive transmission of the PNP transgene, as evidenced by increasing PNP enzyme activity with time after vector inoculation. On F-araAMP administration, high efficiency gene transfer of PNP by the RCR vector resulted in significant suppression of tumor growth and extended survival time. As the RCR mediates stable integration of the PNP gene and continuous expression, an additional round of F-araAMP administration resulted in further survival benefit. RCR-mediated PNP suicide gene therapy thus represents a highly efficient form of intracellular chemotherapy, and may achieve effective antitumor activity with less systemic toxicity.

To summarize the experience in diagnosis and treatment of arrhythmogenic right ventricular cardiomyopathy (ARVC) in children.A total of 14 children (7 females and 7 males) with ARVC were involved. The cases underwent electrocardiography, echocardiography, cardiac CT or MRI examinations. All cases were treated with sotalol or amiodarone in combination with propranolol. In 2 cases with drug-refractory ventricular extrasystoles, catheter ablation treatment was performed. In 6 cases with obvious impaired ventricular function, additional pharmacological therapy including vasodilators, diuretics, and digitalis were given.Ventricular extrasystoles occurred in all 14 cases and ventricular tachycardia in 8 cases. Ten cases showed Epsilon wave on electrocardiography. All 14 cases had enlarged right ventricle and reduced right ventricular ejection fraction. CT or MRI examination showed right ventricular dilatation and a thinned wall of right ventricle in 10 cases. Ventricular extrasystoles or tachycardia disappeared in 7 cases and was reduced in 4 cases after treatment. The two children receiving catheter ablation treatment did not present ventricular extrasystoles or tachycardia in a 3-month follow-up. The heart function was improved in the 6 children with obvious impaired ventricular function after pharmacological therapy.The clinical manifestations are diverse in children with ARVC. A definite diagnosis of ARVC should be based on a combination of electrocardiography and echocardiography examinations. Pharmacological therapy is effective partially. Catheter ablation treatment appears to be a promising option in patients with drug-refractory ventricular extrasystoles.

To explore safety, indications and advantages of mapping and ablation of arrhythmia in children guided by Carto and Ensite system.Guided by Carto system, radiofrequency catheter ablation (RFCA) was performed on 8 pediatric patients with tachycardia whose mean age was (6.2 + or - 1.7) years, mean weight was (18.0 + or - 2.0) kg. Guided by Ensite system, RFCA was performed on 10 pediatric patients with arrhythmia, 8 of them were ablated guided by Ensite Array system: 6 cases with premature ventricular contractions (PVCs), 2 cases with right atrial tachycardia, their mean age was (11.3 + or - 1.2) years, and mean weight (40.0 + or - 5.0) kg. The other two cases with W-P-W syndrome were ablated guided by Ensite Navx system.Guided by Carto system, 8 cases were successfully mapped and ablated: 6 cases had incision atrial tachycardia, 1 case had left atrial tachycardia and 1 case had right atrial tachycardia. In 1 case with incision atrial tachycardia the condition recurred after 3 months, and was ablated again successfully. Guided by Ensite Array system, 6 cases with PVCs (in 2 originating from the right ventricular inflow tract and in 4 originating from the right ventricular outflow tract) and 2 cases with right atrial tachycardia were successfully mapped and ablated, PVCs of the first 6 cases were reduced from (32 333 + or - 4509) 24 h to (0-4)/24 h after ablation. In 1 case with automatic atrial tachycardia, mapping could not be done by Ensite Array system, because P wave could not be identified from T wave. Single bolus of adenosine 20 mg was given within 30 s to let ventricles stop for 2 s (cardio-ventricular pacing standby) until T wave vanished, mapping and ablation were operated again successfully, but another atrial tachycardia occurred 1 day later. Guided by Ensite Navx system, 2 cases with W-P-W syndrome were successfully ablated, operation under X-rays lasted for 8 and 10 min. In none of the 9 patients the disease recurred after follow-up for 6 months.Carto system is suitable for mapping and ablation in pediatric patients with continuous tachycardia, especially with incision atrial tachycardia; Ensite Array system fits children older than 10 years with right heart discontinuous arrhythmia; and Ensite NavX system can set up model and display endocardial anatomic structure quickly. Compared with two-dimensional mapping system, the three-dimensional mapping system (Carto and Ensite) can display the origin of arrhythmia and activation sequence clearly, decrease difficulty of operation efficiently and diminish operation time under X-ray.

The objective of this study was to evaluate bone density changes around the teeth during orthodontic treatment by using cone beam computed tomography (CBCT). CBCT was used to measure the bone densities around six teeth (both maxilla central incisors, lateral incisors, and canines) before and after 7 months of orthodontic treatment in eight patients. In addition, each root was divided into three portions (cervical, intermediate, and apical) to determine whether the bone density change varied with tooth level. The mean reduction in bone density around the measured teeth was 24% after orthodontic treatment. The bone density reduction around teeth was largest for the upper-right and upper-left central incisor (29% and 26%, respectively) and ranged from 20% to 23% for the other four teeth. The mean bone density reduction did not differ significantly between the cervical, portion, and apical portions of the teeth (26%, 22%, and 24%, respectively). CBCT is useful for evaluating bone density changes around teeth during orthodontic treatment. The bone density around the teeth reduced significantly after the application of orthodontic forces for 7 months.

Environmental tobacco smoke (ETS) exposure might increase the risk for childhood asthma, and we hypothesized the effect may be modified by the phase II genes NAD(P)H: quinone oxidoreductase 1 (NQO1) and glutathione S-transferase (GST) M1. To investigate the genetic and environmental associations with asthma, GSTM1 and NQO1 functional polymorphisms and ETS were analyzed in a two-staged cross-sectional study among elementary schoolchildren in Taiwan. Multiple logistic regression analysis revealed a significant association between the Ser allele of the NQO1 Pro187Ser polymorphism and asthma (OR=1.6, 95% CI 1.3-1.8). Although GSTM1 genotype itself was not significantly associated with asthma (OR=1.0, 95% CI 0.8-1.1), the GSTM1 genotype modified the association between the NQO1 polymorphism and asthma in children exposed to ETS (p=0.0002). The NQO1 gene might be involved in the development of asthma, especially in children carrying the GSTM1 null genotype who are exposed to ETS.

To assess the feasibility of transcatheter intervention for critical pulmonary arterial valve stenosis and atresia with intact ventricular septum in neonates.From June 2006 to January 2008, 13 neonates (9 with critical pulmonary arterial valve stenosis, 4 with pulmonary arterial valve atresia) underwent transcatheter intervention(one of them was premature neonate). Ten of the patients were boys and 3 were girls. The mean age was (17.4 +/- 10.7) days. The mean weight was (3.4 +/- 0.8) kg. All the patients received prostaglandin E(1) infusion to dilate the ductus arteriosus before and during the procedure. Valvuloplasty was performed using a low-profile balloon (2.5 - 4.0 mm in diameter), and then a balloon approximately 1.0-1.2 times the annulus diameter was applied. In patients with pulmonary atresia, the valve was perforated with a radiofrequency wire, and then valvuloplasty was performed.Twelve patients (92%) were successfully treated with transcatheter intervention. Right ventricular systolic pressure decreased by 50% [from (120.1 +/- 17.0) mm Hg (1 mm Hg = 0.133 kPa) to (58.8 +/- 7.7) mm Hg, P0.001], and the ratio of the right ventricular systolic pressure to systemic systolic pressure decreased by 44% [from (1.6 +/- 0.2) to (0.9 +/- 0.1), P0.001]. The right ventricular angiography showed that the pulmonary valves were opened. The ratio of the balloons to annulus were (1.1 +/- 0.1) (the maximal balloon size range from 6 to 12 mm). The procedure lasted for a mean of (127.5 +/- 32.6) minutes. The duration of fluoroscopy was (25.2 +/- 7.2) minutes. Complications occurred in 4 patients (30%). Hemopericardium occurred in 2 patients, hypoxia in 1 patient and supraventricular tachycardia in 1 patient. One (8%) patient died. The follow-up periods were (7.2 +/- 6.4) months. Three patients had moderate to severe residual pulmonary stenosis. One of them underwent a second balloon dilation at 3 months of follow-up. The other two were waiting for the second dilation. Nine patients had mild to moderate residual pulmonary stenosis. All patients had mild pulmonary regurgitation. Ductus arteriosus was naturally closured in 11 patients, and nearly closured in 1 patient.Transcatheter intervention for critical pulmonary stenosis and atresia with intact ventricular septum in neonates is safe and effective. Some patients may require repeat balloon valvuloplasty.

To evaluate the early complications during and after transcatheter closure of perimembranous ventricular septal defects (PMVSDs) in children.A total of 223 patients received transcatheter closure of PMVSDs from March 2002 to December 2005 in our hospital were included in this retrospective study.The overall complications rate was 26.9% (60/223). Major complications occurred in 9 patients (4.0%) including III degrees atrioventricular block (AVB) in 2 (0.9%), hemolysis in 3 (1.3%) and surgical interventions in 4 patients (1.8%) because of device malposition (1), mild aortic regurgitation (2) and device embolization (1) and all 4 patients recovered without further complications. The 2 patients with III degrees AVB were completely recovered to normal sinus rhythm after 7 days treatment with temporary pacemaker and corticosteroid. Hemolysis in 3 patients disappeared after corticosteroid treatment. Minor complications occurred in 51 patients (22.8%) including bundle branch block (BBB) in 37 (16.6%), first-degree AVB in 2 (0.9%), second-degree AVB in 1 (0.4%), new-onset mild aortic regurgitation in 5 (2.2%) and new-onset mild to moderate tricuspid regurgitation in 6 patients (2.6%). Except for right bundle branch blocks, other BBBs were treated with albumin and corticosteroid and completely recovered. No treatment was applied for new-onset valve regurgitations. There was no death in all 223 patients.Early complications post PMVSDs in children are mostly minor with good prognosis and the prognosis for major complications post PMVSDs is good after proper treatment.

To observe the effects of transcatheter closure method for treating congenital coronary artery fistula (CAF) in children.Twenty-three children with CAF received transcatheter closure. Under anesthesia, heart catheterization and selective coronary angiography were performed to show the CAF size and relationship with normal coronary artery. CAF with the narrowest inner diameter3 mm (n = 16) were occluded with coil device, and CAF with narrowest inner diameter3 mm (n = 7) were closed with Amplatzer duct or VSD occluder.Transcatheter closure was successfully performed in 21 cases and failed in 2 cases (CAF is too tortuous in one case and right CAF outlet near the right coronary artery main stem in another case) and CAF were closed by surgery in these 2 patients. No residual shunt or other complications were observed during the 3 months to 3 years follow up.Transcatheter closure was an effective and mini-traumatic method for CAF treatment in children.

To discuss the treatment of arrhythmia occurs in the process of transcatheter closure of perimembranous ventricular septal defects (VSD) in pediatric patients.182 cases (mean age: 6.2 +/- 3.3 years) with membranous VSD underwent transcatheter occlusion procedure. Two different devices were used: the Amplatzer membranous VSD occluder in 81 patients and the domestic-made device in 101 patients. Electrocardiogram of all patients was recorded before and during closure and at one day after the procedure, and Holter monitoring was performed one week after the procedure.Perioperation arrhythmia occurred in thirty-one patients (17%). Second- or third-degree atrioventricular bundle (AVB) was noted during the procedure in four patients. Normal AV conduction recovered spontaneously before the catheters were withdrawn in three cases and another patient underwent surgical repair. In the other twenty-seven patients, arrhythmia was first documented between one day and one week after the procedure. Third-degree AVB was found in three (1.6%) children after the procedure and underwent the temporary pacemaker (TPM) was implanted, two of them recovered to normal sinus rhythm within one week, another patient underwent elective surgery to remove the occluder and repair the defect. Other arrhythmias were: left bundle-branch block (n = 3), right bundle-branch block (n = 12), second-degree AVB (n = 2), sinus tachycardia (n = 6).In properly selected cases of perimembranous VSD, the transcatheter closure is safe and effective by using appropriate devices. During and after the procedure, closure of VSD can be associated with some kinds of arrhythmia, such as A-V block, more intensive observation and follow-up were therefore needed.

To document the five-year follow-up results of transcatheter Amplatzer duct occluder (ADO) occlusion of patent ductus arteriosus (PDA) in children and to assess the safety and effectiveness of this method for PDA closure.A retrospective cohort study was completed in patients with PDA underwent transcatheter closure by the ADO in Guangdong Cardiovascular Institute from April 1998 to December 2003.Transcatheter closure of PDA with ADO was attempted in 250 children patients. The median age was 5.3 years and median weight was 15.1 kg. The PDAs were from 1.8 mm to 11.0 mm (median 4.2 mm) in the narrowest diameter, of which 52 were larger than 5 mm (20.0%). All PDAs were occluded with 4 approximately 14 mm ADO through 6F (n = 205) or 7F (n = 45) sheaths. Devices were successfully implanted in 245 patients (98.0%). The Qp/Qs decreased from 1.90 +/- 0.60 to 1.03 +/- 0.21 (P0.05). All shapes of the PDA could be closed. Late complication occurred in five patients, including hemolysis in three patients and the los of the pulse of femoral artery in two patients. Follow-up after device implantation was accomplished in 205 patients (82.0%). The incidence of residual shunt at follow-up periods of 1 d, 1 m, 6 m, 12 m, 24 m, 36 m, 48m and 60 m after device occlusion was 9.2%, 2.8%, 1.2%, 0.8%, 0, 0, 0 and 0, respectively. Five patients (2.0%) required re-intervention to treat residual shunt with or without hemolysis. Event-free rates were 98.0% at one year and five years.This long-term follow-up result confirmed the safety and effectiveness of ADO closure of PDAs in children.

The aim of this study was to develop a new perimembranous VSD occluder and to evaluate it.The shape of VSD occluder was designed as fabric frame "I" shape that comprised two types: symmetric and asymmetric. The safety, efficacy, feasibility and complication were tested in 22 animal models and in 58 VSD patients in clinical trial. The device were compared with Amplatzer occluder in this study.The new perimembranous VSD occluder was passed the national material test. In animal study, artificial VSD were all occluded by using the new devices with no complication in follow up except one pig expresented wound infection. In clinical trial, all 58 VSD cases were healing with the new device. One patient suffered with atria-ventricular block 5 days after procedure and was free from AV block with medicine therapy. Compared with Amplatzer perimembranous VSD occluder, the new devices had lower frequency of residual shunt.The new perimembranous VSD occluder is a safe and effective perimembranous VSD interventional apparatus, and the effect of the new occluders seems not worse than that of the Amplatzer ones.

To study the clinical technology of transcatheter closure of secundum atrial septal defects (ASD) with Amplatzer device in younger and lower body weight children.The transcatheter closure of ASD using Amplatzer septal occluder (ASO) was performed in 165 children under 5 years of age (75 boys and 90 girls) with secundum ASD from Aug 1998 to May 2004. The age of the cases ranged from 2 to 5 (mean 3.7 +/- 1.1) years. The body weight ranged from 9 to 18 (mean 12.6 +/- 2.3) kg. The ratio of pulmonary circulation quantity to the systemic circulation quantity (Qp/Qs) was 3.2 +/- 1.9. All the patients underwent clinical examination, X-ray, electrocardiography (ECG) and echocardiography (Echo) for diagnosis of secundum ASD. The transthoracic echocardiography (TTE) was used to detect and measure the defect of the patients and even trans-esophageal echocardiography (TEE) had to be used when it was necessary. With Echo and X-ray guidance, the measuring balloon was used in the body and outside the body to determine the balloon-stretch diameters of ASD, and proper occluders were selected accordingly for the patients for interventional treatment of ASD.The devices were implanted successfully in 163 (98.8%) cases. One failure occurred in a case in whom the device moved into the left atrium after release, and the other failure was that the position of the device was uncertain because of temporary unavailability of a special transducer for TEE. Surgical operations were performed for these two cases. The stretch diameter of ASD was from (8 - 30) mm, (mean 18.3 +/- 5.1) mm. The size of device was selected according to the stretch diameter of ASD. The diameter of the occluders selected was from (8 - 30), (mean 18.6 +/- 5) mm in this series. The occlusion procedure was monitored by fluoroscopy and TTE and in 5 cases (3%) by TEE. The diameter of right ventricle was improved within 2 days after occlusion from (mean 16.4 +/- 4.9) mm to (mean 12.6 +/- 3.8) mm, (p0.01). One hundred and forty seven cases belonged to the simple secundum ASD(89%). Thirteen cases who were complicated with other cardiac deformity were treated successfully with different interventional procedure. Six cases had multiple openings and three of these cases had tumour-like changes of the atrial septum which were closed completely just by one occluder. In only one case small quantity of residual shunt remains. No other severe complication was found in this group. About 100 cases (60%) had large ASD, so the procedure was more difficult in those cases.The clinical effectiveness of treatment of ASD in children under 5 years of age with Amplatzer occluders was satisfactory and therefore this therapeutic procedure is feasible for this age group of patients. Nevertheless, we do not recommend to use the technique for infants and children under 2 years of age. Strict selection of indications and proper size of occluder and good cardiologic and surgical settings are among the basic factors for successful interventional occlusion of ASD in young children.

To investigate the associations of maternal and grandmaternal smoking before, during, and after pregnancy with childhood asthma.We conducted a case-control study nested within the Children's Health Study in southern California. The case patients consisted of 338 children with asthma that had been diagnosed in the first 5 years of life, and 570 control subjects were countermatched on in utero exposure to maternal smoking within grade, sex, and community of residence.Detailed maternal and household smoking histories and other asthma risk factor information was obtained by telephone interview.The participation rates were 72.3% and 82.5%, respectively, for control subjects and case patients. In utero exposure to maternal smoking was associated with increased risk for asthma diagnosed in the first 5 years of life (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.0 to 2.3), and for persistent asthma (OR, 1.5; 95% CI, 1.0 to 2.3). The associations did not differ in children with early transient asthma compared to those with early persistent asthma. Relative to never-smokers, children whose mothers smoked throughout the pregnancy had an elevated risk of asthma in the first 5 years of life (OR, 1.6; 95% CI, 1.0 to 2.6). Children of mothers who quit smoking prior to the pregnancy showed no increased risk (OR, 0.9; 95% CI, 0.5 to 1.5). We were unable to assess the association of smoking cessation during pregnancy because very few mothers were reported to have done so (15%). Asthma risk did not increase in a monotonic pattern with smoking intensity during pregnancy. Postnatal secondhand smoke exposure was not independently associated with asthma. Grandmaternal smoking during the mother's fetal period was associated with increased asthma risk in her grandchildren (OR, 2.1; 95% CI, 1.4 to 3.2).Maternal and grandmaternal smoking during pregnancy may increase the risk of childhood asthma.

In children with congenital heart diseases who have undergone surgical interventions, postoperative arrhythmias frequently complicate the clinical course. "Incisional" atrial tachycardia or flutter is one of the most common forms of postoperative arrhythmias in these patients and can lead to significant morbidity and even mortality. The aim of this study was to investigate how to use antiarrhythmic drugs and the CARTO system to treat these cases.There were 12 patients with "incisional" atrial tachycardia or flutter complicating surgery for congenital heart diseases in this study (3 patients with correction of tetrology of Fallot, 3 with atrial septal defect repair, 2 with ventricular septal defect repair, 1 with switch, 1 with repair of Ebstein's anomaly, 1 with total anomalous pulmonary venous drainage, and 1 with atrial septal closure with the Amplatzer septal occlusion). Patients whose body weight was less than 10 kg or those who did not wish to accept ablation were treated with antiarrhythmic drugs, including digitoxin, propranolol, metoprolol and cordarone. CARTO system was used to map 6 patients whose body weight was more than 10 kg and who agreed with accepting ablation for atrial tachycardia and flutter. Radio-frequency ablation was performed in these 6 cases including two cases of "incisional" atrial tachycardia and 4 of atrial flutter.(1) The antiarrhythmic drug was successful in 6 patients with "incisional" atrial tachycardia. (2) Six patients including 2 children with "incisional" atrial tachycardia and 4 children with atrial flutter were successfully ablated. But one case of "incisional" atrial tachycardia relapsed after 3 months of ablation. This case, however, was successfully ablated again later. No further relapse was observed during the 2 - 24 months of follow-up.Ablation of "incisional" atrial tachycardia and flutter is the first choice to treat the patients whose body weight is more than 10 kg and those who agree with accepting ablation by CARTO system. Drug therapy of "incisional" atrial tachycardia and flutter is palliative and it is the only selection to treat the patients whose body weight is less than 10 kg or those who do not wish to accept ablation procedure.

Summary Background Particulate pollution is associated with the occurrence of asthma and allergy. The model pollutant, diesel exhaust particles, can participate with allergens in starting and exacerbating allergic airway diseases in part by production of reactive oxygen species. Glutathione-S-transferases (GSTs) can metabolise reactive oxygen species and detoxify xenobiotics present in diesel exhaust particles. We tested the hypothesis that null genotypes for gstm1 and gstt1, and gstp1 codon 105 variants (I105 and V105) are key regulators of the adjuvant effects of diesel exhaust particles on allergic responses. Methods Patients sensitive to the ragweed allergen were challenged intranasally with allergen alone and with allergen plus diesel exhaust particles in a randomised order at separate visits. Nasal allergen-specific IgE, histamine, interleukin 4, and interferon γ concentrations were measured before and 24 h after challenge. Findings Individuals with GSTM1 null or the GSTP1 I105 wildtype genotypes showed enhanced nasal allergic responses in the presence of diesel exhaust particles. Compared with patients with a functional GSTM1 genotype, GSTM1 null patients had a significantly larger increase in IgE (median 102·5 U/mL [range 1·0–510·5] vs 45·5 U/mL [1·5–60·6], p=0·03) and histamine (14·0 nmol/L [–0·2–24·7] vs 7·4 nmol/L [1·2–12·3], p=0·02) after diesel exhaust particles plus allergen challenge. The I105 GSTP1 genotype was associated with an increase in IgE (120·3 U/mL [6·7–510·5] vs 27·7 U/mL [–1·5–60·6], p=0·03) and histamine (13·8 nmol/L [3·1–24·7] vs 5·2nmol/L [–0·2–19·6], p=0·01) after challenge with diesel exhaust particles and allergens. The diesel exhaust particles enhancement was largest in patients with both the GSTM1 null and GSTP1 I/I genotypes. Interpretation GSTM1 and GSTP1 modify the adjuvant effect of diesel exhaust particles on allergic inflammation.

Previous research indicates that diesel exhaust particles (DEP) can augment allergen- driven allergic responses. In vivo nasal challenge offers a practical method to characterize variation in response to pulmonary toxicants and immunogens. We investigated the reproducibility of responses to determine whether susceptibility to DEP's adjuvant effects is intrinsic or extrinsic. Eighteen nonsmoking rhinitic volunteers with positive skin tests to ragweed were randomly assigned to allergen/placebo or allergen + DEP nasal challenge; after 30 days, the other “arm” was completed. We replicated the procedure 30 days later. Nasal washes were performed after challenge, and allergen-specific IgE and cytokines were measured by ELISA. Repeated challenge with allergen+DEP, but not allergen/placebo, produced reproducible responses for IgE, IL-4, and INF-γ. DEPs ability to enhance allergic responses was highly reproducible within individuals and was independent from response to allergen, suggesting that susceptibility to DEPs adjuvant effects is an intrinsic trait that can be quantified using combined allergen + DEP challenges.

The authors investigated the relation between children's pulmonary function and intake of fruits, vegetables, juices, and vitamins A, C, and E by examining cross-sectional data from 2,566 children in the Children's Health Study collected during 1997-1998. Low total vitamin C intake (< or =10th percentile) was associated with deficits in forced vital capacity for both boys and girls and with deficits in flows that were larger in girls (forced expiratory volume in 1 second (FEV1), -3.3%, 95% confidence interval (CI): -6.0, -0.5; forced expiratory flow between 25% and 75% of forced vital capacity (FEF(25-75)), -5.5%, 95% CI: -10.5, -0.3) compared with boys (FEV1, -2.3%, 95% CI: -4.8, 0.3; FEF(25-75), -2.4%, 95% CI: -7.4, 2.8). Low dietary vitamin E intake was associated with lower FEF(25-75) (boys: FEF(25-75), -8.9%, 95% CI: -14.2, -3.3; girls: FEF(25-75), -2.5%, 95% CI: -8.3, 3.7). Deficits in FEF(25-75) were associated with low dietary vitamin A intake in girls (FEF(25-75), -7.9%, 95% CI: -12.7, -2.8) and with low total vitamin A intake in boys with asthma (FEF(25-75), -15.6%, 95% CI: -27.6, -1.6). Low intakes of orange and other fruit juices, which were the largest source of vitamin C, were associated with deficits in forced vital capacity and FEV1 in boys. In summary, lung function levels were lower in children with inadequate dietary antioxidant vitamin intake.

Inactivation of the p16(INK4a) tumor suppressor gene and O(6)-methylguanine-DNA methyltransferase (MGMT) DNA repair gene by aberrant promoter methylation appears to be an important step in respiratory carcinogenesis after exposure to tobacco smoke and radon progeny. The determinants of aberrant promoter methylation are not well characterized. Polymorphic variants of genes of which the products are involved in pathways that modulate and repair DNA damage after carcinogen exposure may affect the occurrence of de novo promoter methylation. On the basis of their associations with risk of lung cancer, we hypothesized that functional polymorphic variants of the NADPH quinone oxidoreductase, glutathione S-transferases P1 and M1, myeloperoxidase, and XRCC1 genes are associated with p16 and/or MGMT promoter methylation in sputum from cancer-free subjects at high risk for developing lung cancer. This hypothesis was tested by conducting a cross-sectional study of 70 former uranium miners from the Uranium Epidemiological Study cohort who were at high risk for lung cancer. The polymorphic variant genotypes were characterized through PCR-RFLP on DNA isolated from peripheral lymphocytes, and the methylation status of the p16 and MGMT promoters was determined by methylation-specific PCR on DNA isolated from sputum. Subjects who had at least one GSTP1 polymorphic allele (A-to-G at bp 104) had an increased risk for MGMT methylation [odds ratio (OR), 4.8; 95% confidence interval (CI), 1.2-18.6] or for either p16 or MGMT methylation (OR, 4.4; 95% CI, 1.3-14.2). Lack of a wild-type NADPH quinone oxidoreductase allele (C at bp 609) was also associated with methylation of either p16 or MGMT (OR, 3.1; 95% CI, 1.0-9.2). These results provide the first link between germ-line functional deficits in pathways that protect the cell from tobacco- and radon-induced DNA damage, and the development of aberrant promoter methylation of the p16 and MGMT genes in the respiratory epithelium of individuals at high risk for lung cancer.

To investigate the effects of dietary magnesium, potassium, and sodium on children's lung function, the authors examined cross-sectional dietary data and pulmonary function tests from 2,566 children aged 11-19 years who attended schools in 12 southern California communities during 1998-1999. During school visits, each child completed a health update questionnaire, a validated food frequency questionnaire, and spirometric lung function testing. Low magnesium and potassium intakes were associated with lower lung function. Girls with low magnesium intake had lower forced expiratory flow at 75% of the forced vital capacity (FEF 75 ) (-8.3%, 95% confidence interval: -14.8, -1.4) than did girls with higher intake; reductions were larger in girls with asthma (forced expiratory flow between 25% and 75% of the forced vital capacity (FEF 25 75 ) (-16.2%, 95% confidence interval: -22.7, -9.1) and FEF 75 (-24.9%, 95% confidence interval: -32.8, -16.1)) than in girls without asthma (FEF 25-75 (-2.0%, 95% confidence interval: -7.4, 3.8) and FEF 75 (-4.1%, 95% confidence interval: -11.3, 3.7)). Boys with low magnesium intake showed deficits in forced vital capacity (-2.8%, 95% confidence interval: -5.4, -0.2) compared with boys with higher intake. The effects of low magnesium intake did not vary substantially in boys with and without asthma. Among girls, low potassium intake was also associated with deficits in forced expiratory volume in 1 second (-2.7%, 95% confidence interval: -5.2, -0.1) and forced vital capacity (-2.4%, 95% confidence interval: -4.7, -0.1). In summary, low magnesium and potassium intakes were associated with lower lung volumes and flows.

of asthma could be caused by lupus pulmonary involvement; however, there is insufficient evidence that asthma is a result of lupus interstitial pneumonitis or pleuritis. To the best of our knowledge, a restrictive functional defect was observed in lupus pneumonitis, interstitial pulmonary fibrosis, and pleural effusion, which differed from an obstructive functional defect in asthma (7). Therefore, SLE plays an extremely important role in the development of asthma. With increasing age, other risk factors also contribute to the incidence of asthma, and the relative risk of asthma consequently decreases. Adult-onset asthma is believed to be an underestimated issue, affecting approximately 4–8% of patients older than 65 years (8). A review article by Eagan and coworkers reported that the pooled estimated incidence of adult asthma from general population cohort studies was 59 and 44 per 10,000 person-years in women and men, respectively (9). These findings were close to the incidence found in our non-SLE elderly groups. We believe a small proportion of cases are misclassified as asthma; however, these contributions should be equivalent in the two cohorts. In conclusion, the incidence of asthma may increase in patients with SLE with increasing age, and the data clearly demonstrate that IRR decreases inversely with increasing age. n

The effects of maternal smoking during pregnancy and childhood environmental tobacco smoke (ETS) exposure on asthma and wheezing were investigated in 5,762 school-aged children residing in 12 Southern California communities. Responses to a self- administered questionnaire completed by parents of 4th, 7th, and 10th grade students were used to ascertain children with wheezing or physician-diagnosed asthma. Lifetime household exposures to tobacco smoke were assessed using responses about past and current smoking histories of household members and any history of maternal smoking during pregnancy. Logistic regression models were fitted to cross-sectional data to estimate the effects of in utero exposure to maternal smoking and previous and current ETS exposure on the prevalence of wheezing and physician-diagnosed asthma. In utero exposure to maternal smoking without subsequent postnatal ETS exposure was associated with increased prevalence of physician-diagnosed asthma (OR, 1.8; 95% CI, 1.1 to 2.9), asthma with current symptoms (OR, 2.3; 95% CI, 1.3 to 4.0), asthma requiring medication use in the previous 12 mo (OR, 2.1; 95% CI, 1.2 to 3.6), lifetime history of wheezing (OR, 1.8; 95% CI, 1.2 to 2.6), current wheezing with colds (OR, 2.1; 95% CI, 1.3 to 3.4) and without colds (OR, 2.5; 95% CI, 1.4 to 4.4), persistent wheezing (OR, 3.1; 95% CI, 1.6 to 6.1), wheezing with exercise (OR, 2.4; 95% CI; 1.3 to 4.3), attacks of wheezing causing shortness of breath (OR, 2.4; 95% CI, 1.3 to 4.4) or awakening at night in the previous 12 mo (OR, 3.2; 95% CI, 1.7 to 5.8), and wheezing requiring medication (OR, 2.1; 95% CI, 1.2 to 3.7) or emergency room visits during the previous year (OR, 3.4; 95% CI, 1.4 to 7.8). In contrast, current and previous ETS exposure was not associated with asthma prevalence, but was consistently associated with subcategories of wheezing. Current ETS exposure was associated with lifetime wheezing (OR, 1.3; 95% CI, 1.1 to 1.5), current wheezing with colds (OR, 1.6; 95% CI, 1.3 to 2.0) and without colds (OR, 1.5; 95% CI, 1.1 to 1.9), wheezing with exercise (OR, 1.7; 95% CI, 1.3 to 2.2), attacks of wheezing causing shortness of breath (OR, 1.6; 95% CI, 1.2 to 2.1) or awakening at night (OR, 1.5; 95% CI, 1.1 to 2.0), and wheezing requiring medication (OR, 1.4; 95% CI, 1.1 to 1.8) or emergency room visits within the previous year (OR, 1.9; 95% CI, 1.2 to 3.0). The effects of current ETS exposure on subcategories of wheezing were most pronounced among children exposed to two or more smokers and remained significant after adjusting for maternal smoking during pregnancy. We conclude that maternal smoking during pregnancy increases the occurrence of physician-diagnosed asthma and wheezing during childhood. In contrast, current ETS exposure is associated with wheezing, but not physician-diagnosed asthma. Taken together, our findings support the hypothesis that ETS operates as a cofactor with other insults such as intercurrent infections as a trigger of wheezing attacks, rather than as a factor that induces asthma, whereas in utero exposure acts to increase physician-diagnosed asthma

To investigate whether the effects of in utero exposure to maternal smoking and environmental tobacco smoke (ETS) exposure on lung function vary by sex or asthma status, we examined medical history and tobacco smoke exposure data for 5,263 participants in the Children’s Health Study. At study enrollment, parents or guardians of each subject completed a questionnaire, and lung function was measured spirometrically with maximum forced expiratory flow‐volume maneuvers. To assess the in utero effects of maternal smoking and ETS exposure on lung function, we used regression splines that accounted for the nonlinear relationship between pulmonary function, height, and age. In utero exposure to maternal smoking was independently associated with deficits in lung function that were larger for children with asthma. Boys and girls with a history of in utero exposure to maternal smoking showed deficits in maximum midexpiratory flow (MMEF) and a decrease in the FEV 1 /FVC ratio. As compared with children without asthma, boys with asthma had significantly larger deficits from in utero exposure in FVC, MMEF, and FEV 1 /FVC, and girls with asthma had larger decreases in FEV 1 /FVC. The effect of ETS exposure varied by children’s gender and asthma status. Deficits in flows associated with current ETS exposure were present in children with and without asthma but were significant only among children without asthma. Past ETS exposure was associated with reduced FEV 1 , MMEF, and FEV 1 /FVC among boys with asthma. In contrast, past ETS exposure was associated with decreased flow rates in girls without asthma. In summary, both in utero exposure to maternal smoking and ETS exposure were associated with persistent deficits in lung function. The effects of in utero exposure were greatest among children with asthma. A growing body of scientific evidence indicates that childhood environmental tobacco smoke (ETS) exposure adversely affects lung function, and especially measured indicators of flow, such as FEV 1 and maximum midexpiratory flow (MMEF) (1‐ 7). Although studies consistently associate ETS exposure with deficits in lung function, interpretation of these findings requires consideration of in utero exposure to maternal smoking, which is associated with deficits in lung function at birth that may persist into young adulthood (4, 6, 8‐15). However, remarkably few studies of the effect of ETS on lung function have investigated effects of in utero exposure to maternal smoking. The findings in studies that have investigated in utero effects on lung function are inconsistent, and the independent and joint effects of ETS and in utero exposure are uncertain. A clearer understanding of the effects of tobacco smoke exposures during the in utero and postnatal periods is needed. The inconsistency in results for the independent and joint effects of ETS and in utero exposure on lung function may arise from variation in the proportion of sensitive children in the study population. Children with asthma are particularly sensitive to effects of ETS exposure during the postnatal period, and are more prone to the acute effects of ETS than are children without asthma (2). Children with asthma who are exposed in utero to maternal smoking may have large deficits because the effects of in utero exposure on lung function may add to chronic deficits from asthma (16). Although the combination of in utero and ETS exposures may be of particular importance for children with asthma, and may explain some of the inconsistencies among studies, the effects of in utero exposure on boys and girls with asthma have not been extensively investigated. The University of Southern California Children’s Health Study (CHS), an ongoing study in California, offers an opportunity to further investigate the modifying effects of asthma and sex on deficits in lung function associated with in utero exposure to maternal cigarette smoking and childhood ETS exposures. We examined cross-sectional data from the CHS to assess the relationships between lung function, asthma, in utero exposure to maternal smoking, and ETS exposures in boys and girls, using regression spline techniques. METHODS Study Design The CHS is a 10-yr longitudinal study of schoolchildrens’ respiratory health. Details of the study design, site selection, subject recruitment, and assessment of health effects in the study are reported elsewhere (17, 18). At study entry, in the spring of 1993, a parent or guardian of each participating child provided written informed consent and completed a self-administered questionnaire on demographics, medical and family health history, indoor air exposures, and household characteristics. In the spring of 1993 and in each subsequent year of the ongoing study, each child completed an update questionnaire, and pulmonary function testing (PFT) was conducted. In the fall of 1995, a second group of fourth grade students was recruited and completed the same baseline and follow-up questionnaires and PFT as the group enrolled in 1993. Of the 5,762 children participating in the study, both baseline questionnaire data and lung function measurements were available for 5,263 (91.3%) children (approximately 68% of whom were fourth-graders with an age range of 7 to 13 yr; 16% of whom were seventh-graders with an age range of 11 to 15 yr; and 16% of whom were tenth-graders with an age range of 14 to 19 yr) (Table 1). In the study reported here, we examined cross-sectional data col

Films (with thicknesses about thousands A) of a new form of carbon allotrope, CIO also known as Fullerenes, are deposited on Si(111) substrates using ionized cluster beam deposition (ICBD) technique at low (65V) accelerating voltage V. X-ray &-20 diffraction (XRD) have been used to investigate the structural properties of C6Ofi lms, indicating hexagonal close-packed structure with strong (002) XRD assignment together with weak (100), (112) and(004) assignments. Raman spectra, X-ray photoelectron spectroscopy (XPS) and Auger electron spectroscopy (AES) are carried out to make detailed studies of the electronic properties of the films and to illustrate differences between CO films and amorphous carbon films which are deposited by ICBD at high accelerating voltage V >400V. Cio soccer-balls are found to be broken into fragments as accelerating field overtakes about 400V, indicated by the results of XPS, Raman spectra, XRD, and UV/visible absorption spectra.

C50 films, are deposited on Si(111) substrates using neutral cluster beams of fullerenes generated from a crucible with a special nozzle. X-ray diffraction (XRD) have been used to investigate the structural properties of C50 films, which indicate highly textural films as close-packed structure with strong (110) XRD assignment and 400Å for correlation length. Raman spectrum indicates the existence of stable C60 films. X-ray photoelectron spectroscopy (XPS) and Auger electron spectroscopy (AES) measurements are carried out to analyze the electronic properties of the films. The resistivity to contamination of C50 film deposited here is better than that deposited by MBE. Different kinds of oxygen contamination on the surfaces of C50 films and HDPG are detected by the results of O 1s XPS analyses.