Comparing Strategies for Critical Congenital Heart Disease Newborn Screening.

OBJECTIVES: An extended newborn critical congenital heart disease (CCHD) screening program using oximetry has been implemented in Taipei, Taiwan since April 2014. This study was conducted to investigate the test accuracy and efficiency of this screening protocol. METHODS: This study analyzed data from 30 birthing facilities representing 87.9% of live births in Taipei. Positive screening was defined as oxygen saturation <95% in either extremity or a preductal-postductal oxygen saturation difference of >3%. This study cohort was used to retrospectively estimate outcomes on the basis of different CCHD screening protocols. RESULTS: During the study period, 93 058 of 94 204 (98.8%) infants who had no prenatal suspicion were screened. The referral rate was 0.17% (156/93 058), and up to 90% of test-positive infants were referred within 48 hours of life. Forty-two CCHD cases without prenatal suspicion were detected and 97.6% were diagnosed within 72 hours of life. Of the screened newborns, 4 CCHD cases passed the screening. The false positive and false negative rates were 0.12% and 0.04%, respectively. In addition, applying our database to Spanish and updated American Academy of Pediatrics screening strategies led to more CCHD case detection. CONCLUSIONS: The Taipei protocol provided an efficient and effective screening referral system in a community setting. For optimal efficiency, we advocated the updated American Academy of Pediatrics algorithm/Spanish recommendation with a modification of immediate referral if oxygen saturation ≤90% in either extremity. The updated protocol would be practicable for nationwide screening in Taiwan and could also be applied to other regions with similar medical care systems.

Bibliometric-Based Evaluation of the Neuromarketing Research Trend: 2010-2021.

Neuromarketing has become a new and important topic in the field of marketing in recent years. Consumer behavior research has received increasing attention. In the past decade, the importance of marketing has also been recognized in many fields such as consumer behavior, advertising, information systems, and e-commerce. Neuromarketing uses neurological methods to determine the driving forces behind consumers' choices. Various neuroscience tools, such as eye movements, have been adopted to help reveal how consumers react to particular advertisements or objects. This information can be used as the basis for new advertising campaigns and brand promotions. To effectively explore the research trends in this field, we must understand the current situation of neuromarketing. A systematic bibliometric analysis can solve this problem by providing publishing trends and information on various topics. In this study, journals that focused on neuromarketing in the field of marketing between 2010 and 2021 were analyzed. These journals were core journals rated by the Association of Business Schools with three or more stars. According to the data analysis results, neuromarketing has 15 main journals with relevant papers. Based on the data collected by the Web of Science (WOS), this study mainly collected 119 references and analyzed the most productive countries, universities, authors, journals, and prolific publications in the field of neuromarketing via Citespace. Through the analysis of knowledge maps, this study explored the mapping of co-citation, bibliographic coupling (BC), and co-occurrence (CC). Moreover, the strongest citation bursts were used to study popular research at different time stages and analyze the research trends of neuromarketing research methods and tools. This study provides an overview of the trends and paths in neuromarketing, which can help researchers understand global trends and future research directions.

The Linkage between Ethical Leadership, Well-Being, Work Engagement, and Innovative Work Behavior: The Empirical Evidence from the Higher Education Sector of China.

In this study, we investigate the relationship between ethical leadership (EL), work engagement (WE), well-being, and innovative work behavior (IWB). The significance of these variables has increased in the current era when the influence of technology is exponentially increasing in the education sector. We investigate the role of ethical leadership in determining innovative work behavior. Moreover, we investigate the moderating effect of WB in the relationship between EL and WE. We also examine the mediating impact of WE in the relationship between EL and IWB. We used a questionnaire survey approach to collect data. The target population of this study was the academic personnel, i.e., senior professors, lecturers, and supporting staff associated with the higher education sector located in Zhejiang Province, China. Data were collected in two phases. In the first phase, we sent 300 research questionnaires and received 251 responses. In the second phase, after a three-month interval, we sent 200 questionnaires and received 162 responses. However, over the two phases, we collected a total of 413 questionnaires; 43 were discarded. Therefore, for analysis, we used 370 questionnaires. The data were analyzed using the structural equation modeling through SmartPLS 3.2.2. First, in the direct relationship, results confirm that EL positively influences the IWB. Secondly, WB has a positive and moderating relationship between EL and IWB. Thirdly, we address the relationship between EL and WE. The outcome indicates that there is a positive and significant relationship. Fourth, the results of this study indicate that there is positive and significant relationship between WE and IWB. Finally, the outcomes imply that WE positively mediates between EL and IWB. Ethical leadership and well-being are important for innovative work behavior that supports managers in introducing a supportive workplace environment that promotes good interpersonal relationships with subordinates. Therefore, a good interpersonal relationship between managers and subordinates enhances the work quality. So, ethical leaders provide a supportive work environment to all subordinates regarding their work.

Research Landscape of Artificial Intelligence and e-Learning: A Bibliometric Research.

While an increasing number of organizations have introduced artificial intelligence as an important facilitating tool for learning online, the application of artificial intelligence in e-learning has become a hot topic for research in recent years. Over the past few decades, the importance of online learning has also been a concern in many fields, such as technological education, STEAM, AR/VR apps, online learning, amongst others. To effectively explore research trends in this area, the current state of online learning should be understood. Systematic bibliometric analysis can address this problem by providing information on publishing trends and their relevance in various topics. In this study, the literary application of artificial intelligence combined with online learning from 2010 to 2021 was analyzed. In total, 64 articles were collected to analyze the most productive countries, universities, authors, journals and publications in the field of artificial intelligence combined with online learning using VOSviewer through WOS data collection. In addition, the mapping of co-citation and co-occurrence was explored by analyzing a knowledge map. The main objective of this study is to provide an overview of the trends and pathways in artificial intelligence and online learning to help researchers understand global trends and future research directions.

MiR-421 inhibition protects H9c2 cells against hypoxia/reoxygenation-induced oxidative stress and apoptosis by targeting Sirt3.

BACKGROUND: MicroRNAs (miRNAs) are involved in myocardial ischemia-reperfusion injury. miRNA-421 (miR-421) plays a significant role in the initiation of apoptosis and myocardial infarction. However, the molecular regulation of miR-421 in myocardial ischemia-reperfusion injury requires further elucidation. METHODS: An in vitro hypoxia/reoxygenation model was established, and the expression levels of miR-421 and Sirtuin-3 (Sirt3) in H9c2 cells were quantified using quantitative real-time polymerase chain reaction. Flow cytometry was employed to measure the effects of miR-421 on myocardial apoptosis induced by hypoxia/reoxygenation. The activity of lactate dehydrogenase and superoxide dismutase and levels of malondialdehyde were measured. The binding sites of miR-421 on Sirt3 were predicted using TargetScan software. A luciferase reporter assay was used to validate the direct targeting of Sirt3 with miR-421. Protein expression levels of Sirt3 and its downstream proteins were evaluated using Western blot analysis. RESULTS: Exposure of H9c2 cells to hypoxia/reoxygenation led to increased apoptosis, levels of malondialdehyde and lactate dehydrogenase, and decreased levels of superoxide dismutase. miR-421 knockdown resulted in decreased apoptosis, levels of lactate dehydrogenase and malondialdehyde, and increased superoxide dismutase levels in H9c2 cells. Hypoxia/reoxygenation significantly decreased the relative expression levels of Sirt3. Down-regulation of Sirt3 resulted from overexpression of miR-421, which directly targeted Sirt3. Knockdown of miR-421 up-regulated Sirt3 expression, inhibited activation of the Jun N-terminal kinase/activator protein 1 pathway and caspase 9/3-dependent cell death. CONCLUSION: The miR-421-Sirt3-Jun N-terminal kinase/activator protein 1 axis is a novel molecular mechanism that accommodates hypoxia/reoxygenation-induced oxidative stress and apoptosis and provides a new direction for the study and treatment of hypoxia/reoxygenation.

Loss of GRB2 associated binding protein 1 in arteriosclerosis obliterans promotes host autophagy / 中华医学杂志(英文版)

BACKGROUND@#Arteriosclerosis obliterans (ASO) is a major cause of adult limb loss worldwide. Autophagy of vascular endothelial cell (VEC) contributes to the ASO progression. However, the molecular mechanism that controls VEC autophagy remains unclear. In this study, we aimed to explore the role of the GRB2 associated binding protein 1 (GAB1) in regulating VEC autophagy.@*METHODS@#In vivo and in vitro studies were applied to determine the loss of adapt protein GAB1 in association with ASO progression. Histological GAB1 expression was measured in sclerotic vascular intima and normal vascular intima. Gain- and loss-of-function of GAB1 were applied in VEC to determine the effect and potential downstream signaling of GAB1.@*RESULTS@#The autophagy repressor p62 was significantly downregulated in ASO intima as compared to that in healthy donor (0.80 vs. 0.20, t = 6.43, P < 0.05). The expression level of GAB1 mRNA (1.00 vs. 0.24, t = 7.41, P < 0.05) and protein (0.72 vs. 0.21, t = 5.97, P < 0.05) was significantly decreased in ASO group as compared with the control group. Loss of GAB1 led to a remarkable decrease in LC3II (1.19 vs. 0.68, t = 5.99, P < 0.05), whereas overexpression of GAB1 significantly led to a decrease in LC3II level (0.41 vs. 0.93, t = 7.12, P < 0.05). Phosphorylation levels of JNK and p38 were significantly associated with gain- and loss-of-function of GAB1 protein.@*CONCLUSION@#Loss of GAB1 promotes VEC autophagy which is associated with ASO. GAB1 and its downstream signaling might be potential therapeutic targets for ASO treatment.

[Effects and influential factors of rapid prototyping technology in dental restorations].

PURPOSE: To explore the effects and influential factors of rapid prototyping technology in dental restorations. METHODS: From May 2013 to November 2014 in our hospital, 120 patients were divided into experimental group and conventional group. Patients in the experimental group were treated by rapid prototyping technology, while patients in the conventional group were treated by routine methods. The effects of the two groups were compared using SPSS 17.0 software package. RESULTS: The effective rate of the experimental group was significantly higher than that of the conventional group (P<0.05). Complications in the experimental group were significantly lower than those in the conventional group (P<0.05). CONCLUSIONS: Rapid prototyping technology can be used in the treatment of patients with dentition defects with satisfactory results and fewer adverse reactions.

Mechanochemically Activated Oxidative Coupling of Indoles with Acrylates through C-H Activation: Synthesis of 3-Vinylindoles and ß,ß-Diindolyl Propionates and Study of the Mechanism.

Construction of 3-vinylindoles (3) and ß,ß-diindolyl propionates (4) through solvent-free C-H functionalization has been explored under high-speed ball-milling conditions. The reaction selectivity is influenced by the catalyst dramatically: Pd(OAc)2 provides 3 in moderate to good yields, whereas PdX2 (X = Cl, I) affords 4 as the major products. The reaction mechanism has been further studied by using electrospray ionization mass spectrometry, implicating the dimeric palladium complex A as the key intermediate in an explanation of the selectivity.

Development of a Newborn Screening Program for Critical Congenital Heart Disease (CCHD) in Taipei.

BACKGROUND: Early detection of critical congenital heart disease (CCHD) can significantly reduce morbidity and mortality among newborns. We investigate the feasibility of implementing a community-based newborn CCHD screening program in Taipei. METHODS: Twelve birthing facilities in Taipei participated in a trial screening program between October 1, 2013, and March 31, 2014. Newborns underwent pulse oximetry at 24-36 h old, with probes attached to the right hand and one lower limb. Any screening saturation ≥95% in either extremity, with an absolute difference of ≤3% between the right hand and foot, was accepted as a screening pass. A screening result was considered as a fail if the oxygen saturation was <95% at either probe site, on 3 separate occasions, each separated by 30 min or the first result was <95% at either probe site, and any subsequent oxygen saturation measurement was <90%. Public health nurses would follow up all missed or refused cases. RESULTS: Of the 6,387 live births, 6,296 newborns (coverage rate: 6,296/6,387 = 98.6%) underwent appropriate pulse oximetry screening. Sixteen newborns (0.25%) were reported to have a failed screening result. Five of these screen positive newborns were confirmed with CCHD; two of them were diagnosed solely attributed to the failed screening results. The false-positive rate was 0.18%. Implementing a 6-month screening program for CCHD produced good case detection rate, while using efficient screening and referral systems. CONCLUSION: This program was successful in integrating screening, referral and public health tracking systems. The protocol outlined in this report could provide a community-based model for worldwide implementation.

Efficacy and Safety of Transthoracic Echocardiography Alone in Transcatheter Closure of Secundum-Type Atrial Septal Defects in Adults.

BACKGROUND: On-site transthoracic echocardiography (TTE) to guide the transcutaneous closure of secundum-type atrial septal defects (ASDs) in the catheterization laboratory remains unclear, especially in adults. METHODS: Between 2005 and 2012, a total of 82 adults underwent transcutaneous closure of ASDs. The initial 15 cases underwent the procedure with both on-site transesophageal echocardiography (TEE) and TTE monitoring. Since January 2008, a total of 67 patients underwent on-site TTE alone to guide the procedure. RESULTS: Among the 82 adult patients who underwent a transcutaneous closure of the secundum-type ASD procedure, all had successful closure of the defects, and no periprocedural adverse complications occurred. No statistical significance was observed in the successful complete shunt closure rate between the TEE plus TTE and TTE groups during sequential follow-up (postprocedure 24 hour [87% vs. 92%],1 month [93% vs. 95%], 3 month [93% vs. 97%], and 12 month [93% vs. 97%], P > 0.05, respectively) nor was a significant difference observed between the two groups, including decreased right ventricular dimension (29.5 ± 3.3 vs. 32.0 ± 4.9 mm, 26.5 ± 3.0 vs. 28.7 ± 4.6 mm, 26.2 ± 3.1 vs. 28.2 ± 4.8 mm, and 25.6 ± 2.8 vs. 27.7 ± 4.7 mm, P > 0.05, respectively) or increased left ventricular end-diastolic dimension (41.1 ± 2.0 vs. 42.6 ± 3.0 mm, 44.3 ± 2.7 vs. 45.5 ± 3.1 mm, 44.2 ± 2.8 vs. 45.4 ± 3.1 mm, 44.9 ± 2.7 vs. 45.8 ± 2.6 mm, P > 0.05, respectively) before the procedure, and at the 3-, 6-, and 12-month follow-up evaluations. CONCLUSION: This study showed that TTE guidance alone may be considered efficacious and safe as TEE during a transcutaneous ASD occlusion procedure in select adults.

Current recommendations for the Japanese encephalitis vaccine.

Japanese encephalitis (JE) is a mosquito-borne flavivirus infection and an important cause of encephalitis in most of Asia and parts of the western Pacific. Most people infected with the JE virus (JEV) are asymptomatic or seemingly suffer from a nonspecific, flu-like illness; in others, JE can cause illness ranging from fever and headache to severe encephalitis. Although it can cause significant morbidity and mortality, JE is a vaccine-preventable disease, and vaccination programs have proven most effective in preventing and diminishing the burden of disease. Such JE vaccines have been available for decades with four types of JE vaccines-live attenuated SA14-14-2 vaccine, inactivated mouse brain-derived vaccine (JE-MB), inactivated Vero cell culture vaccine (JE-VC), and live attenuated chimeric vaccine (IMOJEV)-and are currently used in most countries. In some Asian countries such as Japan, China, Taiwan, Korea, and Thailand, immunization programs have been conducted for children and so the ongoing incidence of JE has declined considerably in recent decades. Until quite recently, the primary JE vaccine in use internationally has been the JE-MB, which is now commonly replaced by cell culture-based vaccines.

Can probiotics be used to treat allergic diseases?

Probiotics are proprietary formulations of specific microorganisms and quantified populations of live bacteria that are intended to confer a health benefit on the host. These different strains and combinations of microorganisms have a wide and varying range of clinical and immunologic capacities that can modify intestinal microbial populations in ways that can benefit the host. The enhanced presence of probiotic bacteria in the intestinal microbiota has been found to correlate with protection against atopy. The prevalence of allergic diseases such as asthma, allergic rhinitis, and atopic dermatitis has increased sharply over the past 2-3 decades in many countries, and allergies are now the most common chronic disease among children throughout the world. In the past few years, probiotics have been advocated for the management of allergic diseases in many parts of the world. So far, probiotics have shown more promise, albeit limited, in the primary prevention of allergic disease rather than in the treatment of established disease.

2014 Guidelines of Taiwan Society of Cardiology (TSOC) for the Management of Pulmonary Arterial Hypertension.

UNLABELLED: Pulmonary hypertension (PH) is a hemodynamic and pathophysiologic condition, defined as a mean pulmonary arterial pressure exceeding 25 mmHg at rest. According to the recent classifications, it is grouped into pulmonary arterial hypertension (PAH), heart-related, lung-related, thromboembolic, and miscellaneous PH. In the past two decades, tremendous advances have occurred in the field of PH. These include (1) development of clinical diagnostic algorithm and a monitoring strategy dedicated to PAH, (2) defining strong rationales for screening at-risk populations, (3) advent of pulmonary specific drugs which makes PAH manageable, (4) recognition of needs of having proper strategy of combining existing pulmonary specific drugs, and/or potential novel drugs, (5) pursuit of clinical trials with optimal surrogate endpoints and study durations, (6) recognition of critical roles of PH/right ventricular function, as well as interdependence of ventricles in different conditions, especially those with various phenotypes of heart failure, and (7) for rare diseases, putting equal importance on carefully designed observation studies, various registries, etc., besides double blind randomized studies. In addition, ongoing basic and clinical research has led to further understanding of relevant physiology, pathophysiology, epidemiology and genetics of PH/PAH. This guidelines from the working group of Pulmonary Hypertension of the Taiwan Society of Cardiology is to provide updated guidelines based on the most recent international guidelines as well as Taiwan's domestic research on PH. The guidelines are mainly for the management of PAH (Group 1) ; however the majority of content can be helpful for managing other types of PH. KEY WORDS: Pulmonary arterial hypertension; Taiwan guidelines.

Identification of Th1 epitopes within molecules from the lung-stage schistosomulum of Schistosoma japonicum by combining prediction analysis of the transcriptome with experimental validation.

The lung-stage schistosomulum has been regarded as the main target of protective immunity induced by radiation-attenuated vaccines (RAV) in the mouse model of schistosomiasis, and immune mechanisms mediated by the CD4+ Th1 response play a major role in the RAV model. To identify Th1 epitopes rapidly within molecules from the lung schistosomulum of Schistosoma japonicum, in the present study we analyzed transcriptome data from normal and radiation-attenuated lung schistosomula of S. japonicum and Schistosoma mansoni. We selected six genes with high levels of expression of their transcripts as sample sequences from the lung schistosomula. From these six sequences, by using different algorithms, we predicted six promiscuous Th cell epitopes that are capable of binding to both murine and human MHC class II molecules. To validate our in silico prediction experimentally, first, the gene expressions of the six sequences in day 3 lung-stage schistosomula were assessed using reverse-transcription PCR (polymerase chain reaction) analysis. The result showed that all six sequences predicted can be expressed in normal day 3 schistosomula. Second, we measured the direct binding of the four peptides predicted above to APCs (Antigen Presenting Cells) from the BALB/c mouse strain using a fluorometric method, and found that the four peptides could bind to both I-Ad and I-Ed molecules of the mice. Finally, the proliferation and profiles of cytokine production by spleen lymphocytes from the BALB/c mice immunized with the six predicted peptides were detected in vitro using modified MTT (Methyl Thiazolyl Tetrazolium), and flow cytometry methods, respectively. The results showed that three of the six predicted peptides could induce a recall CD4+ Th1 response in vitro. These results demonstrate that potential Th1-type epitopes can be identified rapidly by a combination of in silico analysis of transcriptomes of lung-stage schistosomula with experimental validation.

[Preparation of rat model of systemic inflammatory response syndrome induced by zymosan].

OBJECTIVE: To establish a model of systemic inflammatory response syndrome (SIRS) in rats. METHODS: SD rats were intraperitoneally injected with different concentrations of zymosan suspension. The general status, temperature, white cell count, tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), interleukin-10 (IL-10) and the pathological changes of main organs were examined. RESULTS: The conditions of rats receiving zymosan doses of 750 mg/kg and 1000 mg/kg were consistent with the criteria of SIRS model; however, the mortality of 1000 mg/kg group was higher than that of 750 mg/kg group. CONCLUSION: The rat model of systemic inflammatory response syndrome has been successfully induced.

Color Doppler echocardiographic study on the incidence and natural history of early-infancy muscular ventricular septal defect.

BACKGROUND: Most small muscular ventricular septal defect (M-VSD) types have been diagnosed using color Doppler echocardiography. The purpose of this study was to understand the incidence of small M-VSD in the neonatal period and analyze the natural history of these M-VSDs. MATERIALS AND METHODS: All individuals in our study were neonates delivered at term who had a normal healthy appearance. Each accepted neonate had an examination with complete color Doppler echocardiography once before discharge. If the examination was confirmed for M-VSD, the study participants were then classified according to defect type. Further examination was arranged with color Doppler echocardiography at 1 month, 2 months, 4 months, 6 months, 9 months, and 12 months of age or until there was complete spontaneous closure. RESULTS: Among 2891 neonates, we found that 72 (24.9/1000) were diagnosed with M-VSD. Among this group, 38 were male and 34 were female. Only six infants were lost to follow-up. Fifty-four of the 66 infants (81.8%) had M-VSD closed spontaneously at 12 months' follow-up. Significantly, 33 of 37 infants (89.2%) with mid-muscular type, the most common type of M-VSD, closed within the 1(st) year of life compared with apical type (17/24:70.8%). Four of the five infants (80%) had anterior type M-VSD closed. Infants with posterior type M-VSD were not seen during this study period. CONCLUSION: Although the incidence of M-VSD was common in the neonatal period, there was also a high rate of spontaneous closure. Therefore, comparison of M-VSD appearance with the incidence of congenital heart disease in neonates had a decisive influence on analysis.

In silico prediction of binding of promiscuous peptides to multiple MHC class-II molecules identifies the Th1 cell epitopes from secreted and transmembrane proteins of Schistosoma japonicum in BALB/c mice.

It has not so far been possible to identify rapidly and effectively the anti-schistosomiasis Th cell epitopes that are capable of simulating IFN-γ (Interferon-gamma)-mediated Th1-type protective immunity in response to radiation-attenuated schistosome cercaria. With the advance of the omics studies of schistosomes, an approach that used reverse vaccinology probably resolved the above problems. In this "proof-of-principle" study, first, we selected 31 secreted or transmembrane protein sequences sampled from sequences of the transcriptome of Schistosoma japonicum, and analyzed characteristics of these proteins by using conventional bioinformatics tools. Second, putative promiscuous Th cell epitopes within these proteins were predicted using three to four different immuno-informatics algorithms for the prediction of MHC (Major Histocompatibility Complex) class-II binding peptides. We predicted using these in silico approaches promiscuous Th cell epitopes that are capable of binding to both murine and human MHC class-II molecules. To validate our in silico prediction experimentally, BALB/c mice were immunized with the five predicted peptides, and the proliferative responses and cytokine production of lymphocytes from the immunized BALB/c mice were assessed in vitro by modified MTT (Methyl Thiazolyl Tetrazolium), ELISA (Enzyme-linked Immunosorbent Assay) and flow cytometry methods. The results showed that two of the five predicted peptides could induce a Th1-type response in vitro. These results suggest that promiscuous Th1 cell epitopes from secreted or transmembrane proteins of S. japonicum can be identified using a strategy of reverse vaccinology.

Preparation of rat model of systemic inflammatory response syndrome induced by zymosan / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To establish a model of systemic inflammatory response syndrome (SIRS) in rats.</p><p><b>METHODS</b>SD rats were intraperitoneally injected with different concentrations of zymosan suspension. The general status, temperature, white cell count, tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), interleukin-10 (IL-10) and the pathological changes of main organs were examined.</p><p><b>RESULTS</b>The conditions of rats receiving zymosan doses of 750 mg/kg and 1000 mg/kg were consistent with the criteria of SIRS model; however, the mortality of 1000 mg/kg group was higher than that of 750 mg/kg group.</p><p><b>CONCLUSION</b>The rat model of systemic inflammatory response syndrome has been successfully induced.</p>

The prevalence and clinical impact of pulmonary artery sling on school-aged children: a large-scale screening study.

BACKGROUND: Airway obstruction is a leading cause of mortality and morbidity in patients with pulmonary artery sling (PAS). Early identification of PAS is imperative for prompt initiation of appropriate treatments. OBJECTIVE: Our aim was to investigate the prevalence and clinical impact of PAS on school-aged children through a large-scale pre-sports participation cardiovascular screening (PPCVS) study. METHODS: A total of 186,213 school-aged children underwent portable two-dimensional echocardiography (2DE) study in a PPCVS study between 2001 and 2004 in Taichung City, Taiwan. We prospectively collected data on the prevalence of PSA, demographics, clinical features, tracheo-bronchial anomalies (TBA), on computed tomography (CT), pulmonary function test (PFT), follow-up data in 1 year, and clinical outcomes. RESULTS: PAS was identified in 11 children (8 males/3 females) with a median age of 13 years (range: 7.2-13.7 years). The prevalence of PAS was 1 in 17,000 school-aged children. The majority of children with PAS had recurrent broncho-pulmonary infections (90.9%) and asthmatic cough (81.8%), which had a low positive predictive value of PAS (<1%). Seven patients had diffused complete cartilaginous rings. The other four patients were found to have prominent localized external compression of the trachea or bronchus. No coexisting intracardiac anomalies were found. Two patients had mental retardation. Seven patients underwent surgical correction without mortality or major complications. After surgery, significant improvement in PFT was shown in forced expiratory volume in 1 s (FEV1) and functional vital capacity (FVC). CONCLUSIONS: This is the first study to determine the prevalence of PAS as 59 per million school-aged children by a large-scale screening using 2DE. Although the majority of children with PAS have associated TBA and impaired pulmonary function, all patients with PAS were unrecognized due to non-specific symptoms. Early identification of PAS and surgery result in significant improvement in pulmonary function.