Ultrasonographic measurements of femoral vessel diameter in neonates weighing less than 2.5 kg.

BACKGROUND: Cannulation in low birth weight (LBW) neonates using larger sheaths could increase the risk of vascular injury. This study investigated the relationship between body weight (BW) and diameter of femoral vessels in LBW neonates and whether BW can be used to predict femoral vessel diameter. METHODS: The cohort included 100 neonates weighing < 2.5 kg (.57-2.42 kg) with a gestational age of 24-39 weeks. Vascular ultrasonography was used to measure diameters of the bilateral femoral arteries (FA) and veins (FV). The cohort was divided into four groups according to weight: group-A, 2-2.49 kg (n = 28); group-B, 1.5-1.99 kg (n = 38); group-C, 1-1.49 kg (n = 21); and group-D, < 1 kg (n = 13); or according to BSA: group-A, BSA > .16 m2 (n = 25); group-B, .13-.16 m2 (n = 40); group-C, .1-.13 m2 (n = 22); and group-D, < .1 m2 (n = 13). RESULTS: The median vessel diameters (mm) in groups A-D according to weight were FA, 1.96, 1.86, 1.78, and 1.53, and FV, 2.30, 2.28, 2.13, and 1.87, respectively. The median vessel diameters (mm) in groups A-D according to BSA were FA, 1.96, 1.86, 1.76, and 1.53, and FV, 2.30, 2.28, 2.05, and 1.87, respectively. There were positive correlations between BW and femoral vessel diameter (correlation coefficient: .56 and .55 between BW and FA and FV, respectively) (p < 0.001), and between BSA and femoral vessel diameter (correlation coefficient: .56 and .55 between BSA and FA and FV, respectively) (p < 0.001). CONCLUSIONS: BW is a predictor of femoral vessel diameter in LBW newborns. This finding may help to avoid using larger sheath in smaller vessels.

Urine catecholamines in children with severe Enterovirus A71 infection: comparison with paediatric septic shock.

Purpose: Hypercatecholaminemia-related heart failure has been proposed as the main cause of enterovirus A71-related (EV-A71) early mortality. The purpose of this study was to measure urine catecholamine concentrations in severe EV-A71-infected children. Methods: A total of 35 children, aged 2.5 ± 2.1 years, were divided into three groups. Group I: 15 septic shock patients, group II: 17 EV-A71-stage-2 patients, and group III: 3 EV-A71-stage-4 patients. The laboratory results, cardiac biomarkers and urine catecholamine concentrations were statistically analysed. Results: Group I had the highest C-reactive protein (CRP) levels and group II had the lowest B-type natriuretic peptide (BNP) and its N-terminal prohormone among the groups (p = 0.039, <0.01 and <0.01, respectively). Group III patients had significantly higher urine catecholamine and troponin-I values among the groups. If urine epinephrine (Epi) >134 ug/gCr, norepinephrine (NE) >176 ug/gCr and vanillylmandelic acid (VMA) >11.7 mg/gCr were used as the cutoff points to differentiate groups II and III, the sensitivities and specificity were all 100%. Conclusions: The significantly elevated urine catecholamine concentrations in EV-A71-stage-4 patients support the hypothesis that hypercatecholaminemia-related heart failure is involved in severe EV-A71 infection. Urine catecholamines could be used as reliable biomarkers for differentiation of severe EV-A71 infection with or without heart failure and septic shock.

Mid-term follow-up study of neonatal isolated aberrant right subclavian artery.

BACKGROUND: Aberrant right subclavian artery is the most common congenital aortic arch anomaly. There are a few reports concerning the clinical manifestations and follow-up of this CHD detected by echocardiographic screening. METHODS: A total of 1737 full-term neonates, with a male-to-female ratio of 900:837, received echocardiographic screening. Neonates with or without isolated aberrant right subclavian artery were studied during infancy. RESULTS: Among the 1737 cases, a total of 15 (0.86%) female-predominant neonates, with a male-to-female ratio of 6:9, had isolated aberrant right subclavian artery. They were compared with 20 age- and gender-matched normal neonates. There were no significant differences in maternal age, gestational age, or para gravity between the two groups, except for birth size (birth length- and weight-for-age percentiles, p = 0.006 and 0.045, respectively), which was smaller in the aberrant right subclavian artery group. Although there were no significant differences in developmental history, gastrointestinal, or respiratory symptoms, neonates with aberrant right subclavian artery had a higher incidence of mild developmental delay and feeding difficulty than normal infants (21 versus 0%, p = 0.061; 36 versus 20%, p = 0.264, respectively). The growth rates of body length and weight during infancy were not significantly different between the two groups. CONCLUSIONS: Echocardiography can be applied as a first-line investigation in the diagnostic work-up for aberrant right subclavian artery. Neonates with aberrant right subclavian artery had a smaller size at birth, although growth rates were not significantly different from those of normal infants. This study does not support an active surgical policy for asymptomatic infants with isolated aberrant right subclavian artery. A larger study and longer follow-up of affected infants is recommended.

Rapid Method for The Gas Chromatographic Quantitative Analysis to Determinate Safrole in Commercial Essential Oils.

Safrole is a well-known carcinogenic agent that is present in camphor trees. In this study, a gas chromatographic method was established to quantitate the levels of safrole in essential oils using n-decyl alcohol as an internal standard. The method used a nonpolar column and was able to detect concentrations of safrole as low as 5 µg/ml in the samples. Following addition of 2-10 mg of safrole into 1 g of essential oil extracted from Stout Camphor wood (Cinnamomum kanehirai Hayata) or 1-10 mg of safrole into 1 g of essential oil extracted from Small-flower Camphor wood (Cinnamomum micranthum Hayat), the recovery rates of safrole were determined. With direct injection of samples into the gas chromatograph, the results showed that the recovery was more than 96.1%, with a coefficient of variation below 5.6%. We then analyzed 23 commercially available Stout Camphor and other essential oil samples and found that 21 of them contained safrole in the range of 37.65-355.07 mg/g. In addition, in the heavier essential oil distilled from Small-flower Camphor wood, the safrole level was up to 642.98 mg/g. Our results demonstrated that most camphor essential oils on the market have a carcinogenic potential due to their high safrole levels.

Smartphone applications (apps) for heart rate measurement in children: comparison with electrocardiography monitor.

Heart rate (HR) measurement is essential for children with abnormal heart beats. The purpose of this study was to determine whether HR measurement by smartphone applications (apps) could be a feasible alternative to an electrocardiography (ECG) monitor. A total of 40 children, median age of 4.3 years, were studied. Using four free smartphone apps, pulse rates were measured at the finger (or toe) and earlobe, and compared with baseline HRs measured by ECG monitors. Significant correlations between measured pulse rates and baseline HRs were found. Both correlation and accuracy rate were higher in the earlobe group than the finger/toe group. When HR was <120 beats per min (bpm), the accuracy rates were not different between the two different measuring sites for each app (median of 65 vs 76%). The accuracy rates in the finger/toe group were significantly lower than those in the earlobe group for all apps when HR was ≥ 120 bpm (27 vs 65%). There were differences among apps in their abilities to measure pulse rates. Taking children's pulse rate from the earlobe would be more accurate, especially for tachycardia. However, we do not recommend that smartphone apps should not be used for routine medical use or used as the sole form of HR measurement because the results of their accuracy are not good enough.

Asymptomatic Right Ventricular Perforation by a Temporary Transvenous Pacing Lead in an Infant.

UNLABELLED: A 3-month-old male infant received transvenous temporary pacemaker for acquired complete atrioventricular block. However, a right ventricle perforation by the pacing lead was found incidentally when the patient was receiving permanent pacemaker implantation nineteen days after temporary pacing. There was no pacemaker dysfunction, active bleeding or hemopericardium. The temporary pacing lead was extracted and the site of perforation was sutured. This case is unique because of the patient's unusual clinical presentation, and we suggested that echocardiography should be performed cautiously to check the pacing catheter tip daily, even if asymptomatic and/or normal function of pacemaker. KEY WORDS: Complete atrioventricular block; Right ventricle perforation; Transvenous pacing lead.

Pyuria is not always sterile in children with Kawasaki disease.

BACKGROUND: Although Kawasaki disease (KD) often presents with sterile pyuria, bacterial pyuria (urinary tract infection [UTI]) occasionally occurs. METHODS: This was a retrospective cohort study of 285 children with KD diagnosed between 1995 and 2005. Among these patients, a total of 210 patients underwent routine urine tests and 75 children underwent urine culture tests. This study was conducted to investigate the incidence, clinical manifestations, management and outcome of KD with pyuria. RESULTS: The incidence of pyuria was 29.5% (62/210). Among the 75 children undergoing urine culture tests, 34 had sterile pyuria (45.3%), eight had bacterial pyuria (10.7%), two had UTI without pyuria (2.7%) and 31 had neither pyuria nor UTI (41.3%). When pyuria was used as a predictor of KD with UTI, the positive and negative predictive values were 19% and 93.9%, respectively. There were no significant differences in demographic data, clinical presentations, laboratory results, duration of fever, ratio of resistant KD or risk level, except in the nitrite test, between both groups. CONCLUSIONS: Pyuria was not always sterile in patients with KD. Although there was no different clinical phenotype or coronary outcome in KD patients with or without UTI, we suggest that UTI should be considered and evaluated in KD patients with pyuria, a positive nitrite test or a positive result of urine culture. If UTI is definitively diagnosed, the patient should be treated for a UTI as well as for KD and complete post-UTI work-up is recommended.

Effect of exercise on asymptomatic children with an isolated aberrant subclavian artery.

OBJECTIVE: An aberrant subclavian artery (aSCA) is the most common congenital anomaly of the aortic arch. Most cases are asymptomatic and found incidentally.This study was conducted to estimate the occult exercise-induced oesophago-tracheal compression (EIETC) in children with isolated aSCA found by screening echocardiography. METHODS: A total of 42 asymptomatic children with isolated aSCA, aged from 6.8 to 16 years, were studied in 2007. Barium oesophagography, echocardiography and magnetic resonance angiography or computed tomography were used to confirm this anomaly. In order to estimate the occult EIETC, we conducted a protocol of pulmonary function tests (PFTs), a feeding test and a treadmill exercise test (TET) on the patients. RESULTS: All of the children could be diagnosed by both barium oesophagography and echocardiography. Six (14%) patients had a globus sensation before testing. None had a history of inspiratory stridor, failure to thrive or dysphagia. No complications developed in this study.An additional patient had a globus sensation after TET, but none had dysphagia, chest pain, dizziness or dyspnoea. Response to exercise was normal, feeding tests were normal and there were no significant changes in the results of PFTs or the grade of respiratory impairment after exercise. CONCLUSIONS: Based on the function tests used, there is no evidence of EIETC and cardiopulmonary deficits in the patients with isolated aSCA. These findings support the known concept not to operate asymptomatic patients with an isolated aSCA found incidentally by screening echocardiography and that there is no increased risk of cardiopulmonary decompensation under defined exercise.

Elastin gene study of infants with isolated congenital ductus arteriosus aneurysm.

OBJECTIVE: To investigate whether isolated congenital ductus arteriosus aneurysm (DAA) is caused by loss of function of mutations in the elastin gene (ELN), we screened the elastin gene, which has been proposed as a candidate gene in DAA. METHODS AND RESULTS: A total of 2249 full-term neonates received echocardiographic screening. Newborns with isolated DAA were divided into two groups: those with large DAA (> or = 10 mm) and small DAA (< 10 mm). ELN gene study was performed randomly for newborns with DAA. There were 186 (8.3%) newborns with DAAs. Among them, 29 had large and 157 had small DAA detected by 2DE. Maximum internal diameter of the DAAs ranged from 6.6 to 14.0 mm (8.3 +/- 1.2 mm). All cases were asymptomatic. Fifteen newborns with large DAA and 14 with small DAA received ELN gene analysis. Among them, 4 infants had single nucleotide variations, including nucleotide 212 C --> T in 2, 278 C --> T in one, and 1232 T --> C in one. We considered the possibility that these might be a neutral single nucleotide polymorphism rather than a mutation. CONCLUSIONS: The incidence of congenital DAA and clinical presentations were consistent with those of our previous report. Based on our findings, the ELN gene can be excluded as a candidate gene in DAA. We consider the presence of DAA may be a normal variant of ductus arteriosus in full-term infants.

Antiplatelet prenylflavonoids from Artocarpus communis.

Four flavonoids, dihydroartomunoxanthone (1), artomunoisoxanthone (2), cyclocomunomethonol (3) and artomunoflavanone (4), together with three known compounds, artochamins B (5), D and artocommunol CC (6) were isolated from the cortex of the roots of Artocarpus communis. The structures of 1-4 were determined by spectroscopic methods. The antiplatelet effects of the flavonoids, 1-3, 5 and 6 on human platelet-rich plasma (PRP) were evaluated. Of the compounds tested in human PRP, compounds 1, 5 and 6 showed significant inhibition of secondary aggregation induced by adrenaline. It is concluded that the antiplatelet effect of 1, 5 and 6 is mainly owing to an inhibitory effect on thromboxane formation.

Plasma B-type natriuretic peptide study in children with severe enterovirus 71 infection: a pilot study.

OBJECTIVES: Severe enterovirus 71 (EV71) infections in children can result in acute heart failure. B-type natriuretic peptide (BNP) is a good biomarker of myocardial stress. The purpose of this study was to use plasma BNP for the detection of EV71 infection with cardiac involvement. METHODS: Patients with severe EV71 infections and healthy control subjects were studied: group 1 (n=30), normal controls; group 2 (n=20), EV71 infection with central nervous system involvement; and group 3 (n=3), EV71 infection with cardiopulmonary failure. The demographic and laboratory data including plasma BNP levels were analyzed statistically. RESULTS: All group 2 patients recovered completely without neurological sequelae, and all group 3 patients survived without cardiac complications. Group 3 patients had higher troponin I, MB fraction of creatine kinase, and BNP levels than patients of the other groups. The median BNP values were <5 pg/ml in group 1, 9.5 pg/ml in group 2, and 238 pg/ml in group 3. Using a BNP cut-off value of 100 pg/ml to identify cases with severe EV71 infection and acute heart failure, the sensitivity and specificity were both 100%. CONCLUSIONS: Children with severe EV71 infections have varying degrees of myocardial stress. Plasma BNP would be a sensitive and reliable biomarker for the detection of cardiac involvement in children with severe EV71 infections.

New prenylflavonoids from Artocarpus communis.

Five new prenylflavonoids, artocommunols CA (1), CB (2), CC (3), CD (4), and CE (5), were isolated from the cortex of the roots of Artocarpus communis, along with the known compound cyclomorusin. The structures of 1-5 were determined by spectral methods.