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Alveolar epithelial cells of neonates are directly exposed to aspirated meconium during meconium aspiration syndrome (MAS). This study was designed to investigate the influence of quantity and time of meconium exposure on the cell viability and caspase activity in type II human alveolar epithelial cells. Human alveolar epithelial cells were incubated with human meconium suspension at different concentrations and for different times. Cell viability and DNA fragmentation were investigated together with caspases activity and the amount of Bcl-2 protein present. We found that cell viability was significantly lower in cells exposed to a higher concentration of meconium. This was also true for cells exposed to meconium for longer. Significantly higher DNA fragmentation, an approximately two- to fivefold increase, was observed in cells that had been exposed to higher (5% and 10%) concentration of meconium compared to those treated with lower (0.1% and 1%) concentrations (P < 0.05). The activity of most apoptotic initiators (caspase 2, 8, 9, 10) and effectors (caspase 3, 6) were found to be significantly higher in cells subject to greater meconium exposure compared to cells with no or minor meconium exposure. The level of Bcl-2 was also found to be significantly decreased in meconium-exposed cells (P < 0.05). In conclusion, human meconium would seem to induce direct cell death as well as caspase-dependent apoptosis in alveolar epithelial cells; the amount and period of exposure to meconium are crucial factors in this process. Thus, removing aspirated meconium should alleviate lung cell damage in neonates and improve the outcome with MAS., (Copyright 2010 Wiley-Liss, Inc.)

Background: It has been shown that the concentration of serum free thyroxine (FT(4)) is independently associated with atrial fibrillation (AF), even in euthyroid persons. This study investigated the effect of a high-normal level of FT(4) on recurrence after catheter ablation of AF., Methods and Results: The 244 consecutive patients with paroxysmal AF and who underwent circumferential pulmonary vein isolation (PVI) were prospectively enrolled. Exclusion criteria included prior or current thyroid dysfunction on admission, amiodarone medication for 3 months before admission. After a mean follow-up of 416+/-204 (91-856) days, the recurrence rates were 14.8%, 23.0%, 33.3%, 38.7% from the lowest FT(4) quartile to the highest FT(4) quartile, respectively (P=0.016). After adjustment for age, sex, left atrial diameter, and PVI, there was an increased risk of recurrence in the subjects with the highest FT(4) quartile compared with those with the lowest quartile (hazard ratio 3.31, 95% confidence interval 1.45-7.54, P=0.004). As a continuous variable, FT(4) was also an independent predictor of recurrence (hazard ratio 1.10, 95% confidence interval 1.02-1.18, P=0.016)., Conclusions: Patients with high-normal thyroid function were at an increased risk of AF recurrence after catheter ablation.

Background: Recent studies suggest that bone marrow adipose tissue might play a role in the pathogenesis of osteoporosis. There are inconsistent findings on the relationship among marrow fat content, bone mineral density and apparent diffusion coefficient (ADC). This study aimed to prospectively explore the efficacy of MR spectroscopy (MRS) and diffusion-weighted MR imaging (DWI) in detecting vertebral marrow changes in postmenopausal women with varying bone densities., Methods: Both MRS and DWI of the lumber spine were performed in 102 postmenopausal women (mean age, (67.3 +/- 6.5) years; range, 55 - 83 years), who underwent dual X-ray absorptiometry. Marrow fat content and ADC were compared and correlated among three groups: 24 with normal bone density, 31 with osteopenia and 47 with osteoporosis., Results: Vertebral marrow fat content was significantly increased in the osteoporotic group ((65.60 +/- 7.68)%, P < 0.001) and the osteopenic group ((57.68 +/- 6.45)%, P < 0.001), when compared with the normal bone density group ((51.67 +/- 3.27)%). ADC values were significantly decreased in the osteoporotic group ((0.39 +/- 0.03) x 10(-3)mm(2)/s, P < 0.001) and in the osteopenic group ((0.42 +/- 0.02) x 10(-3)mm(2)/s, P < 0.001), when compared with the normal bone density group ((0.47 +/- 0.03) x 10(-3)mm(2)/s). The marrow fat content negatively correlated with both bone density (r = -0.731, P < 0.001) and marrow ADC (r = -0.572, P < 0.001). The bone density positively correlated with the ADC values (r = 0.802, P < 0.001)., Conclusions: Postmenopausal women experience a corresponding increase in vertebral marrow fat content as the bone density decreases. Marrow fat content and ADC correlate to the bone density. MRS and DWI may indirectly assess the early bone marrow changes in postmenopausal women.

Background: This study aims to describe significant left atrial appendage activation following ablation of persistent atrial fibrillation, and explore its relationship with aggressive septal ablation., Methods and Results: Significant left atrial appendage activation delay was found in 23 out of 201 patients undergoing persistent atrial fibrillation ablation. Of them, 14 were found in their index procedures, of whom septal line ablation was performed in nine (odds ratio 15.2, 95% confidence interval 4.6-50.8, P < 0.001). Another nine were found during their redo procedures (including two with biatrial activation dissociation), all of whom received extensive left septal complex fractionated electrograms ablation in their prior procedures (P = 0.002). Electrocardiograph showed split P wave with the latter component merged into the QRS wave. Activation mapping demonstrated the earliest breakthrough of the left atrium changed to coronary sinus in 18 (85.7%) patients. After 1 month, the mitral A wave velocity was 18.2 +/- 17.0 cm/s, and decreased significantly as compared with preablation (20.2 +/- 19.1 vs 58.2 +/- 17.9 cm/s, P = 0.037) in patients undergoing redo procedures. Fourteen (60.9%) remained arrhythmia-free during follow-up for 10.6 +/- 6.2 months., Conclusion: Septal line ablation and extensive septal complex fractionated electrograms ablation are correlated with significant left atrial activation delay or even biatrial activation dissociation, and should be performed with prudent consideration.

Aim: To prospectively investigate the role of MR spectroscopy (MRS) and diffusion-weighted magnetic resonance imaging (DWI) in assessing vertebral marrow changes in postmenopausal women with osteoporosis., Materials and Methods: Seventy-eight postmenopausal women (mean age 63.7+/-3.5 years; range 55-81 years), who underwent dual-energy x-ray absorptiometry of the spine, were divided into three bone density groups (24 with normal, 25 with osteopaenic, and 29 with osteoporotic) based on T score. Both MRS and DWI of the L3 vertebral body were performed to calculate the marrow fat content and apparent diffusion coefficient (ADC). The results were compared between three groups and correlated with BMD., Results: Vertebral marrow fat content was significantly increased in the osteoporotic group (59.97+/-5.78%), when compared with that of the osteopaenic group (53.04+/-7.66%, p=0.001) and the normal bone density group (48.79+/-7.1%, p<0.001). ADC values in the osteoporotic, osteopaenic, and normal bone density groups were 0.39+/-0.02x10(-3)mm(2)/s, 0.41+/-0.02x10(-3)mm(2)/s, and 0.47+/-0.03x10(-3)mm(2)/s, respectively, with statistically significant difference (P<0.001). A statistically significant positive correlation between T scores and ADC existed (r=0.835, p<0.001). The vertebral marrow fat content was negatively correlated to the bone density (r=-0.639, p<0.001) and to marrow ADC (r=-0.554, p<0.001)., Conclusion: The postmenopausal women with osteoporosis exhibited a corresponding increase in vertebral marrow fat content as the bone density decreased. Marrow fat content and ADC were related to the bone density. MRS and DWI are helpful in evaluating the bone marrow changes in postmenopausal women.

Background: Extensive atrial fibrillation (AF) ablation is associated with an increased success rate of catheter ablation in chronic AF patients and an increased rate of atrial tachycardia (AT) during the procedure. The mechanism of these ATs varies in previous studies. Our study aimed to report the mechanism of organized AT occurring during the stepwise ablation procedure of chronic AF., Methods: A prospective cohort of 86 consecutive patients who underwent an ablation procedure for chronic atrial fibrillation (CAF) was investigated. The stepwise procedure was performed in the following order: circumferential pulmonary vein ablation, complex fractionated atrial electrograms ablation, mapping and ablation of AT. The endpoint was noninducibility of AF/AT after sinus rhythm (SR) was restored or the procedure time was beyond 6 hours., Results: Sixty-nine (80%) of patients converted to SR via AT. A total of 179 sustained ATs were observed in 69 patients during the procedure. There were 81% (n = 145) macroreentrant ATs which included 65 perimitral circuits, 48 peritricuspid tachycardia and 32 roof dependent circuits, 12% (n = 21) localized reentrant and 7% (n = 13) focal ATs. Thirty (15%) patients experienced significant left atrium (LA) and LA appendage (LAA) conduction delay or dissociation in the procedure or during the follow-up period., Conclusions: Most CAF patients converted to SR via ablation of organized AT occurring during the stepwise procedure. The mechanism of most of these ATs was macro-reentry.

Background: Immunotherapy has been widely used in the treatment of allergic diseases. We evaluated the clinical efficacy of specific immunotherapy with extracts of Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinae (Df) in children with asthma., Methods: All 40 children had moderate-to-severe asthma and positive allergen tests for Dp and Df. All required daily medication. They were randomly assigned to two groups: Half of them received immunotherapy with subcutaneous injections of Dp and Df extracts, while the other half were not given immunotherapy. Participants were followed up for more than 6 months., Results: Children in both groups had apparent improvements in medication use and symptoms after 6 months. The mean medication scores declined from 3.6 +/- 1.14 to 1.7 +/- 0.66 in the immunotherapy group (p < 0.01) and from 3.35 +/- 0.87 to 2.4 +/- 1.09 in the control group (p < 0.01). There was a significant difference between the two groups (mean difference 0.95; p < 0.01). The symptom score improved in the immunotherapy group from 2.65 +/- 0.98 to 1.20 +/- 1.00 (p < 0.01) and in the control group from 2.55 +/- 0.99 to 1.40 +/- 0.88 (p < 0.01), with a significant difference between the two groups (mean difference 0.3; p < 0.01). The number of office visits in the immunotherapy group was greater than that of the controls, but the frequencies of emergency room visits and hospitalization decreased., Conclusion: Our study showed that specific immunotherapy with Dp and Df was beneficial for asthmatic children.

Background: Spirometry is a valuable technique for evaluating pulmonary function, but there were few normative reference values for young children in Taiwan, and none for the last 10 years. The objective of our study was to establish updated reference values and equations for children aged 6-11 years in northern Taiwan., Methods: A total of 309 healthy children (153 boys and 156 girls) were enrolled in the present study. The data of at least 3 trials for each child were collected, and the highest values analyzed. The analyzed pulmonary function parameters were focused on forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow rate (PEF), forced expiratory flow between 25% and 75% expired volume (FEF25-75), and the ratio of FEV1/FVC., Results: The results revealed that there were mostly no significant differences between boys and girls, and the standing height (H, cm) was the factor with the highest correlation with the pulmonary function parameters. Regression equations of the major pulmonary function parameters for both boys and girls were obtained: FVC = -2.690 + 0.0330H; FEV1 = -2.559 + 0.0311H; PEF = -300.231 + 3.938H; FEF25-75 = -3.218 + 0.0425H (p < 0.001)., Conclusion: Our study determined the updated normative values and reference equations for Chinese children aged 6-11 years living in northern Taiwan. These values can be used as normative reference values to evaluate pulmonary function in diseased children with the same ethnicity and lifestyle.

Background: The objective of this retrospective cohort study was to compare the patent ductus arteriosus (PDA) closure rate with different routes (intravenous and enteral) of indomethacin treatment and neonatal outcomes., Methods: Infants with a birthweight < 1,000 g born between July 1997 and June 2007 at Taipei Veterans General Hospital and who received indomethacin treatment for PDA were included in the study. Outcome measures were ductal closure rate and neonatal outcomes., Results: Of 41 extremely-low-birth-weight infants with PDA, 3 infants had spontaneous closure and 3 died before treatment. Of the remaining 35 infants, 13 received enteral ethanol solution of indomethacin and 22 received the intravenous (IV) form. The total closure rates of the IV and enteral groups were 81.8% and 76.9%, respectively. There were no significant differences in the incidence of impaired renal function, necrotizing enterocolitis, chronic lung disease or severe retinopathy of prematurity between the 2 groups., Conclusion: Our results suggest that ethanol-based indomethacin is an effective alternative to IV indomethacin for the pharmacological closure of PDA in extremely-low-birth-weight infants.

This study sought to assess the impact of body mass index (BMI) on the risk of left atrial (LA)/left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF) before catheter ablation. From January 2007 to March 2008, 433 consecutive patients with nonvalvular AF were enrolled. Patients with valvular heart disease, deep vein thrombosis, or pulmonary embolism were excluded. All patients underwent transesophageal echocardiography. Twenty-six of 433 patients (6.0%) had LA/LAA thrombus and the patients with thrombus had a significantly higher BMI (27.9 +/- 3.1 vs 26.0 +/- 3.3 kg/m(2), p = 0.005). The area under the receiver operating characteristic curve of BMI predicting thrombus was 0.662. With a cut-off point of 27.0 kg/m(2), the sensitivity and specificity of BMI for the diagnosis of thrombus were 69.2% and 83.1%, respectively. The incidence of LA/LAA thrombus was 10.6% in patients with BMI > or =27.0 kg/m(2) versus only 3.0% for patients with BMI <27.0 kg/m(2) (p = 0.001). In multivariable analysis, BMI > or =27.0 kg/m(2) (odds ratio 4.02, 95% confidence interval 1.19 to 13.55, p = 0.025), Cardiac Failure, Hypertension, Age, Diabetes, Stroke Doubled score > or =2, and nonparoxysmal AF were independent risk factors of LA/LAA thrombus. In conclusion, BMI > or =27.0 kg/m(2) is an independent risk factor of LA/LAA thrombus in patients with AF.

Background: Metabolic syndrome (MetS) and atrial fibrillation (AF) are causally related. This study aimed to determine the prevalence of MetS in patients with AF in the absence of structural heart disease from a tertiary hospital in China., Methods: In a single center, 741 inpatients with AF in the absence of structural heart disease prior to catheter ablation were retrospectively reviewed. Among them, 588 (79.4%) patients had paroxysmal AF. Subgroup analyses were performed in paroxysmal AF and persistent/permanent AF., Results: MetS was found in 343 (46.3%) patients (200 males, 143 females); 0, 1, 2, 3, 4, 5 components of the MetS were found in 59 (8.0%), 140 (18.9%), 199 (26.9%), 203 (27.4%), 103 (13.9%) and 37 (5.0%) patients, respectively. The prevalences of overweight/obesity, high blood pressure, high glucose level, high triglyceride level and low high density lipoproteins cholesterol level were 53.8%, 47.6%, 23.2%, 40.6% and 72.1%, respectively. The prevalence of MetS was not significantly different between the paroxysmal AF group and the persistent/permanent AF group (44.6% vs 52.9%, P = 0.064). The five components of MetS except overweight/obesity (69.3% vs 49.8%, P < 0.001) were not significantly different between the aforementioned two groups. The left atrium diameter increased with the sum of the MetS components. The left atrium diameter in the MetS group was significantly higher than that in the non-MetS group both in patients with paroxysmal AF and in patients with persistent/permanent AF., Conclusions: The prevalence of MetS in patients with AF prior to catheter ablation is high. Further study and prevention are needed.

A full-term female baby was admitted to our hospital at the postnatal age of 37 days with generalized vesiculopapular, crateriform skin lesions. Physical examination revealed a well-nourished baby without fever, hepatosplenomegaly or lymphadenopathy. Laboratory examination was normal except for thrombocytosis (platelet count, 970 x 10(3)/microL). All studies for herpes simplex virus, including culture, polymerase chain reaction and IgM, were negative except for an antigen test from the vesicles for herpes simplex virus type 1, which was positive. Chest X-ray showed increased reticulogranular infiltration over bilateral lung fields and some osteolytic lesions at the left parietal bone. Skin biopsy revealed infiltration of Langerhans cells and eosinophils, plus positive CD1a and S-100 stains. The diagnosis was reconfirmed by a second hospital and chemotherapy was given. In this case report, the differential diagnoses of neonatal vesiculopapular skin lesions, and the classification and outcome of neonatal Langerhans cell histiocytosis are presented.

Background: The objective of this study was to construct a model for predicting the risk of serious bacterial infection (SBI) in febrile infants., Methods: A total of 135 febrile infants younger than 3 months of age who met the inclusion criteria were assessed on the following: physical appearance, complete blood count, serum C-reactive protein (CRP), urinalysis, stool smears for white blood cell (WBC) count if diarrhea was apparent, and blood and urine cultures. Chest X-rays were performed if respiratory symptoms were evident. Cerebrospinal fluid was analyzed if central nervous system infection was suspected., Results: Of the 135 infants, 34 were diagnosed with SBI. Data from 99 infants were used to construct a model for predicting SBI by multivariate logistic regression. Sex (male), spun urine WBC count (>or= 10 per high-powered field [400x]) and CRP (>or= 3.6 mg/L) were significantly related to SBI. A probability cut-off of 0.265 was selected, where values below and above the cut-off reflected low and high SBI risk respectively. Data from the remaining 36 infants were used to test model validity. Both sensitivity and specificity were 77.8% for predicting SBI using this model., Conclusion: These findings suggest that sex, serum CRP concentration and spun urine WBC count can be used to accurately predict SBI in febrile infants aged less than 3 months of age.

This study was performed to assess changes in pulmonary function test (PFT) and pulmonary outcome after transcatheter closure of atrial septal defect (ASD) in pediatric patients. A total 55 pediatric patients undergoing transcatheter ASD closure received PFT at baseline (day before ASD closure), and at 3 days and 6 months after procedure. Forced vital capacity (FVC), forced expired volume in 1 sec (FEV(1)), FEV(1) to FVC ratio (FEV(1)/FVC), peak expiratory flow (PEF), and mean forced expiratory flow during the middle half of FVC (FEF(25-75)) were measured. Individually, subjects were classified by spirometry as normal, obstructive or restrictive, to evaluate the effect of transcatheter closure on pulmonary outcome. These 55 children had significantly reduced mean PEF and FEF(25-75) (84 +/- 24%, P = 0.040 and 76 +/- 22%, P = 0.010, respectively) at baseline, with FEF(25-75) reduced significantly at 3 days and 6 months (78 +/- 24%, P = 0.010 and 81 +/- 24%, P = 0.040, respectively) after transcatheter closure. Six months after transcatheter closure of ASD, significant improvement was observed in mean FVC (94 +/- 19% vs. 98 +/- 15%, P = 0.034) and FEV(1) (90 +/- 20% vs. 96 +/- 19%, P = 0.008). Assessed individually, better pulmonary outcome was found in patients without pulmonary hypertension (PH) (chi(2) = 8.333, P = 0.044). PFT disturbance was observed in significant flow limitation in the peripheral airway of ASD patients. Improved PFT was found after transcatheter closure and better pulmonary outcome was observed in patients without PH. ASD children need monitoring pulmonary function and should receive transcatheter closure before PH develops.

Spirometry is a well-known technique for evaluating pulmonary function, but few studies have focused on preschool children. The aim of this study was to determine reference values of forced spirometric parameters in young Chinese children, aged 3-6 years, in Taiwan. Spirometric measurements were performed at day care centers by experienced pediatricians. Of 248 children without a history of chronic respiratory illness, at least two valid spirometric attempts were obtained from 214 children (109 boys and 105 girls; age: 36-83 [mean = 61] months; height: 90-131 [mean = 111] cm). Values of forced expiratory volume in 1 sec (FEV1) and 0.5 sec (FEV(0.5)), forced vital capacity (FVC), peak expiratory flow rate (PEF), forced expiratory between 25% and 75% FVC (FEF(25-75)), and forced expiratory flow rate at 25%, 50%, and 75% of FVC (FEF(25), FEF(50), and FEF(75)) were derived and analyzed. There were significant positive correlations between study parameters and body height, body weight, and age. Height was the most consistently correlated measurement in both boys and girls. Although boys tended to have higher spirometric values than girls, we found significant differences only in FVC and FEV1 between boys and girls aged 6 years. The regression equations of each parameter were obtained. In conclusion, spirometric pulmonary function tests are feasible in 3- to 6-year-old children. The obtained values and regression equations provide a reference for Chinese preschool children and may be of value in evaluating pulmonary function of children with respiratory problems in this age group.

Background and Purpose: Subcutaneously implanted central venous access devices (SICVADs) are a common route of intravascular access for pediatric patients with cancer. This study was performed to evaluate the risk for SICVAD-related infection in a large consecutive series of unselected children with cancer in a single medical center., Methods: The medical charts of 209 pediatric patients with cancer who received a SICVAD from January 1, 2001 to December 31, 2005 were retrospectively reviewed, and the patients were followed-up until June 30, 2006. The demographics, clinicopathologic features, and infectious complications were collected for analysis., Results: There were 137,924 SICVAD days (median, 660 days; range, 16-1962 days). The rate of SICVAD-related infections was 0.15 episodes/1000 SICVAD days. There were 21 episodes of SICVAD-related infection among 17 patients, 18 were bloodstream infection among 14 patients and the other 3 were local infection among 3 patients. Sixteen SICVADs were removed, 13 were associated with bloodstream infection and 3 with local infection. Young age (<2 years) was associated with a high risk for SICVAD-related infection. Staphylococcal spp. and fungi were the most common pathogens associated with SICVADs., Conclusions: The rate of SICVAD-related infection in children with cancer was low. Children younger than 2 years had a higher risk for SICVAD-related infection than older children. Fungi play an important role in SICVAD-related infection.

Purpose: Certain cytokines play important roles in the pathophysiology of meningitis. The main purpose of this study was to investigate if the levels of interleukin-6 (IL-6) and interleukin-12 (IL-12) in cerebrospinal fluid (CSF) could be diagnostic predictors of bacterial meningitis in children., Methods: CSF was obtained from 95 patients suspected with meningitis. These cases were classified to the bacterial meningitis (n = 12), aseptic meningitis (n = 41), and nonmeningitis (n = 42) groups. The levels of IL-6 and IL-12 in CSF were measured using the enzyme-linked immmunosorbent assays test., Results: The CSF IL-6 levels in the bacterial meningitis group (45.2 +/- 50.0 pg/ml) were significantly higher than those in the aseptic meningitis group (12.9 +/- 10.2 pg/ml) and the nonmeningitis group (6.5 +/- 7.8 pg/ml; p < 0.05). The CSF IL-12 levels in the bacterial meningitis group (69.8 +/- 67.1 pg/ml) were significantly higher than those in the aseptic meningitis group (22.9 +/- 10.8 pg/ml) and the nonmeningitis group (15.3 +/- 11.2 pg/ml; p < 0.05). With regard to diagnosis, the measurement of CSF IL-6 and IL-12 levels showed sensitivities of 96% and 96%, respectively, and specificities of 51% and 75%, respectively., Conclusion: It is suggested that the CSF IL-6 and IL-12 levels are useful markers for distinguishing bacterial meningitis from aseptic meningitis.

Background: Metabolic syndrome (MetS), as well as several risk factors of cardiovascular diseases, is known to be associated with atrial fibrillation (AF), but its impact on the recurrence of AF after catheter ablation has not been explored., Methods and Results: The data for 654 consecutive AF patients who underwent an index circumferential pulmonary vein ablation were retrospectively analyzed. Of them, 323 (49.4%) had MetS according to the modified National Cholesterol Education Program-Adult Treatment Panel III criteria and Chinese ethnic criteria. After a mean follow-up of 470+/-323 (91-1,245) days, patients with MetS had a significantly higher incidence of AF recurrence (43.7%) compared with non-MetS patients (30.5%, P<0.001). Univariate analysis revealed that nonparoxysmal AF, left atrial size, MetS and body mass index were predictors of AF recurrence. Multivariate analysis revealed that MetS (hazard ratio =1.64, 95% confidence interval (CI) 1.07-2.49, P=0.022) and nonparoxysmal AF (hazard ratio =1.57, 95% CI 1.15-2.14, P=0.004) were independent predictors of AF recurrence. The major complications rate did not differ between the MetS and the non-MetS groups (1.86% vs 2.42%, P=0.621)., Conclusions: MetS diagnosed prior to AF ablation is an independent predictor of AF recurrence.

Cytokine-mediated interactions among inflammatory cells may contribute to pathogenesis of allergic asthma. To understand the role of soluble interleukin-10 (IL-10) and transforming growth factor-beta (TGF-beta) on the disease activity and regulation in asthma, changes in serum concentrations of IL-10 and TGF-beta elaborated by activated T-lymphocyte before and after prednisolone therapy with clinical improvement were determined. Circulating levels of IL-10 and TGF-beta in sera from 16 normal control subjects and in sera from 22 allergic asthmatic children with acute exacerbation and in stable condition were respectively detected by commercially available enzyme-linked immunosorbent assay kits. The mean concentrations of serum IL-10 in asthmatics with acute exacerbation (6.77 +/- 4.08 pg/mL) and during stable condition (5.14 +/- 1.17 pg/mL) were lower than that in control subjects (7.15 +/- 4.72 pg/mL). However, the difference was not statistically significant among these three study groups. The mean concentration of serum TGF-beta in stable asthmatics (40.73 +/- 15.95 pg/mL) was significantly higher than that in asthmatics with acute exacerbation (27.64 +/- 3.66 pg/mL; p < 0.05) and that in healthy control group (28.77 +/- 8.35 pg/mL; p < 0.05), while there was no statistical difference between the latter two groups. This study provides further evidence that serum TGF-beta, rather than IL-10, may play a role in regulation of disease activity and serve as an indicator for clinical control of allergic asthmatics.

Background and Purpose: Enterovirus is the most common pathogen of human illness, but data on epidemiology and laboratory diagnosis of enterovirus from Taiwan are rare. We reviewed hospital records to determine the types of enterovirus isolated and the adequacy of the laboratory diagnostic methods., Methods: This retrospective study reviewed hospital records, laboratory results, and medical records of patients infected with enterovirus visiting Taipei Veterans General Hospital, Taipei, Taiwan, during a 5-year period from January 2001 through December 2005. The review included analysis of cell counts and biochemistry of cerebrospinal fluid (CSF)., Results: 290 strains were isolated. After rhinoviruses were excluded, 288 strains of enteroviruses were included for evaluation. Coxsackievirus A accounted for 18.8% of isolates. Among coxsackievirus B serotypes B2, B3 and B5, 79/94 isolates (84.0%) replicated in human larynx carcinoma (HEP2) cells, while 42/74 serotype B4 isolates (56.8%) grew in rhabdomyosarcoma (RD) cells. Growth of echovirus in RD and Madin-Darby canine kidney (MRC-5) cells occurred for 23/34 positive isolates (68.0%). Twenty four patients had well-documented cell count and biochemistry of CSF. A predominance of polymorphonuclear cells and increasing protein level of the central nervous system, together with empiric antibiotic therapy, was noted in 15/24 of patients (62.5%)., Conclusion: Use of multiple cell media and sampling of multiple sites remain the best methods for recovery of enterovirus. To improve the effectiveness of enterovirus isolation and avoid unnecessary use of antibiotics, increased use of rapid, sensitive laboratory diagnostic methods, such as polymerase chain reaction, may be appropriate.

Background: Though the pathology of optic pathway tumor is mostly pilocytic astrocytoma, the benign tumor behaves like malignant tumor because total resection is not feasible. Adjuvant chemotherapy might be a reasonable strategy for management of these low grade tumors which keep growing. We evaluate the responsiveness of optic pathway tumor to cisplatin-based chemotherapy., Methods: Patients with unresectable and progressive optic pathway tumors received conventional chemotherapy including cisplatin, etoposide, and vinblastine were enrolled in this study from 1992 to 2007. Patients treated with radiotherapy previously were excluded. Brain MRI was performed every 3 months to evaluate the objective response to chemotherapy., Results: There are seven girls and nine boys enrolled in this study. The median age at diagnosis was 30 months old (range from 3 months to 11 years old). The median follow-up duration was 81.5 months (range from 24 months to 14.5 years). The pathology showed pilocytic astrocytomas in 11 patients, astrocytoma in one patient, and anaplastic astrocytomas in two patients. The 6-month progression-free survival (PFS) is 100%, 12-month PFS is 81.3%, 3-year PFS is 71.4% and 5-year PFS is 55.5% respectively. The toxicity of the cisplatin-based chemotherapy showed mild bone marrow suppression in 13 patients (81.3%), infection in nine patients (56.3%), gastrointestinal discomfort in seven patients (43.8%), renal insufficiency in two patient (12.5%), cerebral salt wasting syndrome with hyponatremia in one patient (6.25%) and high pitch hearing loss in two patients (12.5%)., Conclusion: Cisplatin-based chemotherapy is an effective regimen for control of progressive optic pathway tumors.

Background: Viral gastroenteritis is a common acute infectious disease in infants and young children. This study compared the incidence and clinical features of childhood norovirus (NV) and rotavirus (RV) gastroenteritis in Taiwan., Methods: Stool specimens were collected from children with acute gastroenteritis aged 6 months to 14 years who were treated at the Children's Medical Center of Taipei Veterans General Hospital between January 2004 and March 2005. The incidence, clinical manifestations, and laboratory findings of childhood NV gastroenteritis were analyzed and compared with those of patients with RV gastroenteritis. Patients with underlying diseases associated with diarrhea or those diagnosed with bacterial gastroenteritis were excluded. Stool specimens were tested for NV and RV using enzyme immunoassay (EIA). NV genogroups were determined by reverse-transcriptase polymerase chain reaction., Results: Among the 201 patients included in this study, NV was detected in 44 (21.9%) by 1 or more tests (22 by EIA). Five of these isolates were genogroup I (11.3%), and 39 were genogroup II (88.7%). Fifty-two (25.9%) specimens had a positive EIA result for RV. Compared with NV, patients with RV gastroenteritis had a significantly higher percentage of diarrhea (94 vs. 69%, p < 0.001), fever (82 vs. 26.2%, p < 0.001), and longer hospital stay (3.81 vs. 2.93 days, p = 0.048). Laboratory studies showed significantly higher liver enzymes and C-reactive protein levels in patients with RV infection. In contrast, white blood cell counts were significantly higher in patients with NV infection., Conclusion: Norovirus is one of the leading agents of acute gastroenteritis in children in Taiwan, and genogroup II is the predominant type.

Background and Purpose: Brain abscess is an uncommon intracranial suppuration, especially in children. We reviewed the records of children with brain abscess admitted to Taipei Veterans General Hospital, Taipei, Taiwan, and analyzed data on presenting symptoms, predisposing factors and outcomes., Methods: Information was obtained retrospectively from medical records of children diagnosed with brain abscess. Demographic data, presenting symptoms, predisposing factors, sites of abscess, infectious organisms, treatment regimen, and prognosis were collected and analyzed., Results: Twenty cases of brain abscess within an 11-year period were included in this study. Fever, seizure and focal neurological deficits were the most common presenting symptoms. Cyanotic congenital heart disease (CCHD), present in 35% of patients, was the most common predisposing factor. Staphylococcus aureus was the most common pathogen. Approximately two-thirds of cases followed up had some form of seizure disorder sequelae; such sequelae were more common in patients with the initial presentation of seizure., Conclusion: CCHD was the most common predisposing factor for brain abscess in children, and a high level of seizure disorder sequelae was noted. Children suffering from brain abscess, whose initial presentation reveals seizure, are at increased risk of further seizure disorder.

Neonatal adrenal hemorrhage presenting as an abdominal mass in the newborn is not uncommon. However, judging the nature of a suprarenal mass is sometimes difficult, especially when the structure is more complex with unusual clinical course. We report a male newborn with neonatal adrenal hemorrhage presenting as a multiloculated cystic mass. The margins between the mass and left kidney were indistinct. All laboratory data including complete blood cell count, serum electrolytes, liver function, renal function, blood sugar, alpha-fetoprotein, beta-human chorionic gonadotropin, urinalysis, and 24-hour urine vanillylmandelic acid were within normal limits. Serial sonographic follow-up revealed failure to decrease in size without change in echogenicity. Surgical exploration was performed to exclude the possibility of malignancy. This case highlights the diagnostic problems that arise when a space-occupying lesion is found near or at the adrenal gland in the neonate. We suggest that early surgical intervention for the suprarenal mass without sufficient evidence of malignancy would not be prudent.

Background and Objective: Recent advances in multi-slice computed tomography (MSCT) have allowed an improved analysis of left atrial (LA) and left atrial appendage (LAA) anatomy prior to catheter ablation of atrial fibrillation (AF). However, data regarding the ability of MSCT to identify LA/LAA thrombus are limited. This prospective study compared the efficacy of 64-slice contrast-enhanced computed tomography (64CCT) with transesophageal echocardiography (TEE) of the heart in the identification of LA/LAA thrombus., Materials and Methods: One-hundred and seventy consecutive patients scheduled for first-time catheter ablation of paroxysmal (n = 120) or persistent (n = 50) AF were enrolled for study. Each patient underwent non-gated 64CCT and TEE of the heart for exclusion of LA/LAA thrombus prior to ablation procedure., Results: Fourteen cases (8.2%) of LA/LAA thrombi were interpreted by 64CCT (ten false-positive, four true positive), whereas 11 actual thrombi (6.5%) were detected by TEE (seven false-negative by 64CCT) in the same population. Maximal dimension of TEE identified thrombi did not differ between the false-negative by 64CCT group and the true-positive group (17 +/- 6 vs. 18 +/- 5 mm P = 0.677). Results indicated 64CCT sensitivity = 36.4%, specificity = 93.7%, positive predictive value = 28.6%, and negative predictive value = 95.5% in the detection of LA/LAA thrombus. The Kappa value in evaluating the agreement between 64CCT and TEE for detection of LA/LAA thrombus was 0.267., Conclusion: Compared to gold standard TEE, 64CCT was shown to be less reliable in the detection of LA/LAA thrombus prior to catheter ablation in patients with AF.

Hypertension is an uncommon but significant problem in high-risk neonates and infants, and the spectrum of potential causes is broad. Here, we describe an extremely premature infant (birth weight, 728 g; gestational age, 27 weeks) with multiple complications and hypertension. During admission, umbilical artery catheters were used for a period of time, and he suffered from respiratory distress syndrome, intraventricular hemorrhage, pulmonary hemorrhage, patent ductus arteriosus, pericardial effusion, heart failure, repeated sepsis, anemia, thrombocytopenia, chronic lung disease, and progressive liver damage. He was treated with multiple medications, including erythropoietin, indomethacin, epinephrine, dopamine, aminophylline, multiple antibiotics, amphotericin B, and total parenteral nutrition. Hypertension was first noted when he was 41 days old, with spontaneous remission. It then recurred, reaching higher than 100 mmHg when he was almost 4 months old. After stopping erythropoietin, hypertension subsided for a short period of time and went up again. Multiple factor-related hypertension in this premature infant was considered. Related literature on hypertension in premature infants is reviewed. In conclusion, multiple factors can influence blood pressure and may induce hypertension in high-risk premature infants. Thus, blood pressure should be closely monitored in high-risk premature infants. Judicious use of all medications and interventions are crucial to decrease the incidence of hypertension in high-risk premature infants.

Objective: To investigate the effect of combination of irbesartan and amiodarone in elderly patients with paroxysmal atrial fibrillation., Methods: Ninety-one patients with paroxysmal atrial fibrillation were randomly divided into 2 groups: Group I (amiodarone group, n=45) and Group II (amiodarone plus Irbesartan group, n=46).After 18 month follow-up, the maintenance rate of sinus rhythm was measured in the 3rd, 6th, 9th, 12th, and 18th months, and the left atrial diameter (LAD) was measured before the treatment and 6th, 12th, and 18th months after the treatment., Results: There was no difference in the maintenance rate of sinus rhythm between Group I and Group II in the 3rd month. The maintenance rate of sinus rhythm in Group I was 72.1%, 65.1%, 60.5%, and 55.8% in the 6th, 9th, 12th, and 18th months, and the rate in the Group II was 88.6%, 86.4%, 81.8%, and 79.5%. They both had significant difference (P<0.05). At 12 months after the treatment, LAD in Group I was significantly larger than that of Group II (P<0.05)., Conclusion: The combination of irbesartan and amiodarone is more effective than amiodarone alone for sinus rhythm maintenance, and may restrain the enlargement of the left atrium.

Background: Radiofrequency catheter ablation (RFCA) for curing atrial fibrillation (AF) is often followed by early recurrence and delayed cure, so the present study investigate the predictive factors this in patients with chronic AF., Methods and Results: Ninety-two consecutive patients (70 males; mean age, 58.7+/-6.4 years) with chronic AF who underwent RFCA for treatment of symptomatic AF were enrolled. Early recurrence of AF (ERAF) occurred in 45 patients after ablation. Not achieving AF termination could predict ERAF (odds ratio (OR) 0.95; 95% confidence interval (CI) 0.84-1.13; p=0.02) in multivariate analysis. During a follow-up of 12+/-11 (range, 5-25) months, delayed cure occurred in 35.6% (16/45) of the patients with ERAF. Left atrial size and AF termination during ablation were related to delayed cure. AF termination was the only independent predictive factor for delayed cure (OR 1.47; 95% CI 1.05-1.87; p=0.02)., Conclusion: Not achieving AF termination is the only independent predictor of ERAF. Among patients with ERAF, those with a smaller left atrium and AF termination have a higher probability of delayed cure. AF termination can independently predict delayed cure. These results emphasize the importance of AF termination during ablation for patients with chronic AF.

Meconium aspiration syndrome (MAS) may result in considerable morbidity and mortality in newborn infants. The current standard treatment is still in need of improvement for the most severe patients. We report 3 cases with devastating MAS that was successfully treated with therapeutic lung lavage. These cases were all delivered in local obstetrics clinics or hospitals with meconium-stained amniotic fluid and non-vigorous appearance at birth. However, no endotracheal suction was performed when they were born. All of them suffered from severe hypoxia and unstable vital signs despite there being high ventilatory settings when they were transferred to the tertiary medical center. Therapeutic lung lavage with diluted surfactant (Survanta, 5 mg/mL, 30 mL/kg in 2 aliquots) was performed within 24 hours of age. Bloody fluid (about 40-50% of total lavage amount) was recovered in all 3 cases. Although brief desaturation and bradycardia were observed during the procedures, 2 of them tolerated the procedures well and improved soon after lavage. The other patient received lung lavage in a relatively unstable condition and needed chest tapping to relieve bilateral pleural effusion. Their respiratory condition improved after the procedures, and they were all discharged within 1 month without major respiratory complications. These successful experiences are compatible with previous animal studies and other case reports with different lavage protocols. We conclude that therapeutic lung lavage may improve the outcome in newborn infants with severe MAS, and there were no significant adverse side effects observed. Before performing lung lavage, stabilization and optimal support may prevent unexpected results during and after lavage.

Background: To study the role played by eosinophil cationic protein (ECP) in patients with Mycoplasma pneumonia infection., Methods: Pediatric patients aged 4 to 14 years old were divided into 3 groups, each consisting of 30 patients. Group 1 comprised patients with known M. pneumoniae infection. Group 2 comprised patients with asthma who were in a stable condition with no infection, acute asthma exacerbation or steroid use in the last 2 months. Group 3 consisted of healthy children and was designated the control group. The level of ECP in patients' serum was measured by an ECP radioimmunoassay kit., Results: There were 90 children enrolled in this study; 59 (65.56%) were boys and 31 (34.44%) were girls. Mean serum ECP levels between males and females was not significantly different (p = 0.544). The variance of serum ECP levels decreased as patient age increased, but there was no relationship between serum ECP level and patient age (gamma = 0.118, p = 0.267). Serum ECP levels were similar in both the M. pneumoniae-infected and asthma groups; serum ECP levels in the control group were less than the levels seen in the other 2 groups. The difference in serum ECP levels among the 3 groups was statistically significant (p < 0.001)., Conclusion: Both the children who had M. pneumoniae infection and the children with asthma had significantly increased serum ECP levels compared to normal healthy children. The elevated ECP levels found in the serum of patients with M. pneumoniae infection may be associated with damage to the respiratory epithelium and accelerated hypersensitivity in the respiratory system. Decreasing the serum level of ECP may potentially be a method of relieving symptoms in patients with M. pneumoniae infection. Additional studies are warranted to further validate this conclusion.

The aim of the present study was to assess the relationship between serum eosinophil cationic protein levels and the severity of exercise-induced bronchoconstriction in asthmatic children. The 48 asthmatic children were divided into exercise-induced bronchoconstriction group and non-exercise-induced bronchoconstriction group. In the exercise-induced bronchoconstriction group, the post-exercise serum eosinophil cationic protein levels were significantly increased as compared with the pre-exercise serum eosinophil cationic protein levels. These results suggested that eosinophil cationic protein may serve as a possible contributor to the pathophysiology of exercise-induced bronchoconstriction in asthmatic children.

Penicillium and Aspergillus species are prevalent airborne fungi. It is imperative to identify and characterize their major allergens. Alkaline and/or vacuolar serine proteases are major allergens of several prevalent Penicillium and Aspergillus species. They are also major immunoglobulin (Ig) E-reacting components of the most prevalent airborne yeast, Rhodotorula mucilaginosa, and the most prevalent Cladosporium species, C. cladosporioides. IgE cross-reactivity has been detected among these major pan-fungal serine protease allergens. In addition, the alkaline serine protease of P. chrysogenum (Pen ch 13) induces histamine release from basophils of asthmatic patients, degrades the tight junction protein occludin, and stimulates release of proinflammatory mediators from human bronchial epithelial cells. In addition to induction of IgE and inflammatory airway responses, the alkaline serine protease allergen of A. fumigatus (Asp f 13) has synergistic effects on Asp f 2-induced immune response in mice. Studies of these serine protease major allergens elucidate the diverse allergic disease mechanisms and facilitate the development of better therapeutic strategies.

Objective: To investigate the incidence, type, and predictors of asymptomatic relapse of atrial tachy-arrhythmia (ATa) after circumferential pulmonary vein isolation (CPVI) in patients with atrial fibrillation (AF)., Methods: Forty-eight consecutive patients with AF underwent CPVI and were followed up. Forty-eight hours Holter recording was performed 1, 3, and 6 months respectively after the initial CPVI procedure. Predictors of asymptomatic ATa relapse were determined by Logistic regression analysis for eight variables as follows: age, gender, AF type, existence of organic heart disease, diameter of left atria, left ventricular ejection fraction, procedure time, and heart rate variability after the procedure., Results: Complete Holter data were acquired in 42 patients, 26 males and 16 females, aged: 58 +/- 14, including 25 patients with paroxysmal AF and 17 with non-paroxysmal AF. The standard deviations of R-R interval (SDNN) of the non-paroxysmal AF group was 92 ms +/- 19 ms, significantly longer than that of the paroxysmal AF group (78 ms +/- 15 ms, P = 0.011). The incidence of asymptomatic ATa recurrence rates 1, 3 and 6 months after CPVI were 8%, 12%, and 8% respectively in paroxysmal AF group and 23.5%, 29.4%, and 35.3% respectively in the non-paroxysmal AF group. The incidence of asymptomatic ATa recurrence 6 months after CPVI in the non-paroxysmal AF group was significant higher than that in the paroxysmal AF group (P < 0.05). AF was the dominant arrhythmia among the asymptomatic recurrence ATa, while atrial tachycardia constituted the major arrhythmia of the symptomatic recurrent ATa., Conclusion: (1) Asymptomatic ATa relapse is common among the patients undergoing CPVI. (2) The dominant type of asymptomatic recurrent arrhythmia is AF. (3) The independent predictors for asymptomatic ATa recurrence include non-paroxysmal AF, left atrial enlargement, and increase of SDNN.

Background and Purpose: To study the epidemiology, presentation and laboratory findings of Chlamydia trachomatis pneumonia in hospitalized infants younger than 6 months., Methods: Between January 2001 and December 2005, infants younger than 6 months admitted to the children's medical center of Taipei Veterans General Hospital with the diagnosis of acute bronchiolitis, bronchopneumonia or pneumonia were prospectively studied. Chest radiograph findings were reviewed in all patients. Basic laboratory examinations performed included white blood cell count and eosinophil count. C. trachomatis was detected via enzyme-linked immunosorbent assay antigen test and the titers of immunoglobulin G and immunoglobulin M by indirect immunoperoxidase assay., Results: A total of 60 infants, 32 males and 28 females, were included. C. trachomatis infection was detected in 30% of patients (18/60). The median age was 2.5 months (range, birth to 6 months). Fever was not detected in 72% of patients (13/18). Only 22% (4/18) of these patients had the characteristic staccato cough. The mean duration of symptoms before admission was 8 days (range, 1 day to 2 months). Rhinorrhea was a prodromal symptom in 67% (12/18) of patients, with a mean pre-onset duration of 7 days (range, 1 to 14 days). Eighty three percent (15/18) of the patients had tachypnea, with a mean duration of 3.2 days (range, 1 to 7 days). Conjunctivitis was noted before admission in 6 patients (33%). Only peripheral eosinophils showed statistically significant difference between Chlamydia-positive and -negative disease (p=0.046), and may be clinically useful in cases of suspected C. trachomatis infection. Mixed infection with other pathogens including adenovirus, respiratory syncytial virus, Mycoplasma pneumoniae, cytomegalovirus and Streptococcus pneumoniae was found in 27% (5/18) of patients., Conclusions: C. trachomatis is not infrequent and plays an important role in infants younger than 6 months old hospitalized due to lower respiratory tract infection.

Rotavirus infection is the most important cause of diarrheal illness in small children in both developed and developing countries. In addition to causing morbidity and mortality in children, the treatment of rotavirus gastroenteritis is a major economic burden on the health care system and families. The purpose of this study was to estimate the economic burden associated with rotavirus infection in Taiwan. To do this, we combined data on the disease burden of a rotavirus-associated hospital admission with detailed cost data for a sample of 2,600 children with diarrhea who were admitted to the hospital. The annual total social and hospital costs for rotavirus-associated admission calculated from data collected during April 1, 2001 to March 31, 2003 was US $13.3 million and US $10.4 million, respectively. On average, families spent US $294 when their child's admission was associated with rotavirus infection; this cost represents approximately 40% of the monthly salary of an unskilled or service worker. In conclusion, these data emphasize the potential for a safe and effective rotavirus vaccine to reduce the economic burden associated with rotavirus disease.

Background: Routine imaging studies following first urinary tract infection(UTI) in infancy are clinically used to identify who has vesicoureteral reflux (VUR) and acute pyelonephritis or renal scars. The potential value of these images in avoiding children acquiring renal complication and whether the children benefited from these examinations were not well justified., Methods: Analysis was undertaken of 114 infants (228 renal units) at the time of first documented UTI. All underwent renal ultrasound, voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) renal scan on admission and repeated follow-up VCUG, DMSA or both after 4-6 months if initial examinations showed abnormal at first time. The VUR on VCUG when UTI and its statistical correlations with both acute and follow-up DMSA renal scan revealing renal scar were calculated., Results: Seventeen children (14.9%) had VUR detected by VCUG. Forty-six patients (40.4%) had abnormal findings on acute DMSA renal scans (acute pyelonephritis or renal scars). The sensitivity, specificity, positive prediction rate and negative prediction rates of DMSA for VUR were 63%, 82.6%, 32.7% and 94.3%, respectively. The initial identified VUR versus renal scarring on follow-up DMSA showed little correlation., Conclusions: There is limited effectiveness of routine investigation by VCUG in infants with first confirmed UTI. VCUG may be withheld in a child who presents with first UTI before the age of one year if there has been no demonstrable abnormal DMSA scan.

Aims: To study the clinical efficacy of catheter ablation for treating patients with hyperthyroidism-related atrial fibrillation (AF)., Materials and Methods: The study involved 16 patients (12 males; age, 59.8 +/- 11.3 years) with hyperthyroidism-related AF, who had all been euthyroid for more than 3 months but still suffered from highly symptomatic and antiarrhythmia drug (AAD)-refractory AF. Circumferential pulmonary vein ablation (CPVA) guided by a 3-D mapping system was carried out to encircle the ipsilateral pulmonary veins (PVs) with a procedural endpoint of continuity of the circular lesions and PV isolation. Success was defined as the absence of any atrial tachyarrhythmia (ATa) off AADs beyond the first 3 months after the procedure., Results: CPVA was safely carried out in each of the 16 patients without any complications. PV isolation was achieved in all the treated PVs. After a mean follow-up of 15.8 +/- 11.8 (range, 6-55) months, 9 patients (56%) were free of ATa without any AADs beyond the first 3 months. AF relapsed in the remaining 7 patients, among whom 4 responded to AAD therapy and 3 were totally unresponsive., Conclusion: For patients suffering hyperthyroidism-related AF, CPVA guided by a 3-D mapping system could represent one of the therapeutic options.

Atrial fibrillation (AF) is the most common sustained arrhythmia, and treatments with anti-arrhythmia drugs (AADs) have been frustrating. Limitations of AADs prompted the development of percutaneous catheter ablation. In contrast to AADs, percutaneous catheter ablation offers the possibility of a lasting cure. The successful cure of AF by percutaneous catheter ablation comes from a widespread recognize that pulmonary vein antrum (PVA) plays an important role in the genesis and maintenance of AF, and circular ablation along the PVA can eliminate majority of AF. PVA is comprised of pulmonary vein-left atrium junctions. However, during ablation procedure, definition of PVA solely depends on angiography, and it is largely experience-dependent and there is a great deal of variation involved. Our study in patients with AF found that a unique potential with double deflections could be documented along PVA, but it cannot be recorded at PV side or LA side. Thus, we propose that documentation of PVA potentials can be used as a landmark to define PVA. Unlike angiography, documentation of PVA potentials can be objectively carried out by different operators, and the variations due to experience can be avoided.

Background and Objective: Little is known about the outcome of catheter ablation of atrial fibrillation (AF) in patients with diabetes mellitus (DM). We investigated the safety and efficacy of catheter ablation of AF in patients with DM., Materials and Methods: Thirty one patients with DM from a group of 263 consecutive patients undergoing a first-time catheter ablation of AF procedure were enrolled in a prospective study. The ablation protocol (guided by CARTO system) consisted in two continuous circular lesions around ipsilateral pulmonary veins., Results: The following clinical characteristics differed between DM and no-DM patients: age (62.0 +/- 10.8 vs. 56.1 +/- 10.6 years, P = 0.004), longer AF history (9.6 +/- 9.3 vs. 6.7 +/- 6.3 years, P = 0.024), significantly larger left atrium size (41.1 +/- 7.8 vs. 38.3 +/- 5.8 mm, P = 0.021), hypertension (58.1 vs. 35.8%, P = 0.018) and structural heart disease (67.7 vs. 43.5%, P = 0.011). Despite a similar AF recurrence rate in DM and no-DM patients (32.3 vs. 22.4%, P = 0.240), the ablation procedure was complicated in 28 patients (11 hematomas, three cardiac tamponades and three strokes) and the incidence of complications was significantly higher in DM than in no-DM patients (29.0 vs. 8.2%, respectively, P = 0.002). Multivariate analysis showed that DM was an independent risk factor for complications occurrence (odd ratio 5.936, 95% confidence interval 2.059 to 17.112, P = 0.001)., Conclusions: First catheter ablation of AF procedure in DM patients was equally efficacious than in no-DM patients. However, DM patients had a higher incidence of complications, mostly thrombotic or hemorrhagic.

Background and Purpose: To assess the etiologic agents, presentation, laboratory findings, treatment, clinical outcome and prognostic factors of pyogenic arthritis in pediatric patients., Methods: We reviewed the medical records of patients under 18 years of age with a diagnosis of septic arthritis from January 1971 to July 2004. Information collected included clinical characteristics, laboratory data, response to therapy and outcome. An unsatisfactory clinical outcome was defined as the development of sequelae including ambulatory disability, limb-length discrepancy, chronic osteomyelitis, and abnormalities of bone growth., Results: A total of 60 children who met the criteria for diagnosis of septic arthritis were included. The etiologic agent was identified in 71.7% of the patients. Staphylococcus aureus was the most common etiologic agent in all age groups (59.0%). The erythrocyte sedimentation rate was higher than 20 mm/h in 89% of patients and soft tissue swelling was the most common radiographic finding (16.7%). Lower extremity involvement was found in 90.8% of patients and the knee joint was most commonly involved. The clinical outcome was unsatisfactory in 28.3% of patients. The duration of symptoms before the initiation of treatment was significantly longer in patients with sequelae (4.2 vs 13.1 days, p<0.01), and the neutrophil percentage in peripheral blood was also significantly higher in this group (81.5% vs 65.7%, p=0.027)., Conclusions: Delayed treatment and increased neutrophil ratio in peripheral blood were significantly associated with an increased risk of sequelae.

Objectives: Early identification of the pathogen causing acute gastroenteritis in children helps the physicians managing the disease and prevents unnecessary antibiotic treatment. C-reactive protein (CRP), interleukin (IL) 6 and IL-8 play a major role in immune responses and have been studied in a large number of infectious and noninfectious inflammatory diseases. The purpose of this study was to determine the serum IL-6 and IL-8 concentrations early in the course of acute gastroenteritis to see if these cytokines were useful diagnostic markers in differentiating viral from bacterial gastroenteritis., Methods: Interleukin 6, IL-8 and CRP were measured in 18 patients with bacterial gastroenteritis, 21 patients with viral gastroenteritis and 17 healthy children., Results: Interleukin 6 and CRP concentrations in patients with bacterial gastroenteritis were significantly higher than those in patients with viral gastroenteritis and healthy controls (P < 0.001). IL-8 concentrations in patients with viral and bacterial gastroenteritis were both increased and were not statistically different. IL-6 and IL-8 levels had diagnostic sensitivities of 79% and 50% and specificities of 86% and 67%, respectively. The combination of IL-6 and CRP had a sensitivity of 94%, specificity of 71%, a positive predictive value of 74% and a negative predictive value of 93.75%., Conclusions: Serum IL-6 may be a useful marker for early differentiation of viral and bacterial gastroenteritis in children, especially in combination with CRP.

Objective: To investigate the efficacy and safety of circumferential pulmonary vein (PV) linear ablation (CPVA) guided by 3-D mapping system in patients with chronic atrial fibrillation (CAF)., Methods: From August 2004 to November 2005, 100 consecutive patients with CAF were admitted to undergo CPVA guided by CARTO system and EnSite NavX system, the main procedure end point is electrical isolation of PVs. Success was defined as atrial tachyarrhythmia free without any antiarrhythmia drugs for at least 3 months. Clinical and procedural variables were collected, ANOVA analysis was employed to identify the risk factors predicting recurrence, P < 0.05 was considered significant., Results: After a mean of 9.7 +/- 5.7 months follow up, 70% (70/100) of patients freed from AF. ANOVA analysis identified isthmus ablation and poor left ventricular ejection fraction as the independent factors predicting success. Complications including pericardial tamponade (3 cases, 3%), stroke (1 case, 1%), asymptomatic pulmonary vein stenosis (2 cases, 2%)., Conclusion: CPVA guided by 3-D mapping system can be performed in CAF patients with an acceptable efficacy, but safety need to be improved.

Background: Pulmonary vein (PV) isolation has been developed to treat patients with atrial fibrillation (AF), and the electrophysiological endpoint of PV isolation is the disappearance or dissociation of pulmonary vein potentials (PVPs). Pulmonary vein tachycardia (PVT) is the dissociated PV rhythm with a rapid rate. However, the characteristics and significance of PVT after pulmonary vein isolation in patients with AF remains unclear., Methods: From June 2003 to June 2005, a total of 285 consecutive patients with drug refractory AF were included in this study, and they underwent segmental pulmonary vein ablation (SPVA) or circumferential pulmonary vein ablation (CPVA). PV isolation was the initial endpoint for both approaches with documenting disappearance or dissociation of PVPs. PVT was characterized as dissociated activities within PVs with a circle length (CL) of < 300 ms, and was classified into organized PVT or disorganized PVT according to the variance of CL. Systematic follow-up was conducted after initial procedures. Continuous variables were analyzed by Student's t test and categorical variables were analyzed by chi-square test., Results: Three hundred and fifteen PVs were ablated in 85 patients underwent SPVA approach, 400 circular lesions surrounding ipsilateral PVs (including 790 PVs) were produced in the rest of 200 patients received CPVA approach. Electrical isolation was achieved in all of these PVs. Of these, PVPs were abolished in 89.8% (992/1105) of the ablated PVs, dissociated PV rhythms were documented in the rest 10.2 % (113/1105) of the treated PVs. Among the 113 dissociated PV rhythms, 28 met the criteria of PVT with mean CL of (155 +/- 43) ms (2 PVTs in 2 patients received SPVA, 26 PVTs in 18 patients underwent CPVA). PVT was more frequently documented in patients underwent CPVA approach [9.0% (18/200) vs 2.3% (2/85), P = 0.04]. During the 6-month follow-up, it was indicated that no significant difference existed in AF free rate between patients with PVT and those without PVT (P = 0.75)., Conclusions: PVT dissociated from LA activations can be documented after PV isolation, especially in patients underwent CPVA approach. However, PVT does not affect the follow-up results.

Atrial fibrillation is the most common arrhythmia, however, the mechanism of atrial fibrillation is not well explained. It has been considered that inflammation plays a role in atrial fibrillation, recently. Patients undergoing coronary artery bypass graft are at high risk for developing postoperative atrial fibrillation. The peak levels of C-reactive protein (CRP) were paralleled to the incidence of postoperative atrial fibrillation. In general population, CRP was also higher in patients with atrial fibrillation than in control people. Persistent atrial fibrillation patients had a higher CRP level than paroxysmal atrial fibrillation patients. CRP was not only associated with the presence of atrial fibrillation but may also predict patients at increased risk for future development of atrial fibrillation. Why inflammation markers in atrial fibrillation are high is a puzzling problem. We hypothesized that Chlamydia pneumoniae infection is a possible cause of atrial fibrillation by initiating inflammation response. It was demonstrated that infection of endothelial cells with C. pneumoniae elicited the production of Monocyte Chemoattractant Protein-1, interleukin-1, interleukin-8, interleukin-18, tumor necrosis factor, interferon and soluble intercellular adhesion molecule. Most of these cytokines play a crucial role in inflammation response that associate with the initiating and maintenance of atrial fibrillation. There are so many pathogens that can trigger inflammation. Some evidences showed that C. pneumoniae was the most likely pathogen of atrial fibrillation. In epidemic study, the incidence of atrial fibrillation increased from younger to elder and atrial fibrillation was more common in men than in women. C. pneumoniae has the same epidemic trend as the incidence of atrial fibrillation. Hypertension, myocardial infarction and reduced lung function are predictors of atrial fibrillation. C. pneumoniae infection is high in the patients with the above diseases. C. pneumoniae was found in endomyocardial biopsy samples, which supported C. pneumoniae was the candidate pathogen, too. Chlamydia infection can cause myocardial interstitial fibrosis and inflammation cells infiltration. The pathology characters of C. pneumoniae infection are similar to that found in atrial fibrillation. Seroepidemic study should be carried out to evaluate if there is relationship between C. pneumoniae and atrial fibrillation. If the hypothesis is confirmed, macrocyclic lactone antibiotics may be used to eliminate the pathogen. It will be a new target point to treat atrial fibrillation.