, Kwan Chang Kim, Young Mi Hong Elevated pulmonary pressure and right ventricular (RV) dysfunction are the hallmarks of pulmonary vascular disease in animal models and human patients with pulmonary arterial hypertension (PAH). Monocrotaline models of PAH are widely used to study the pathophysiology of PAH. The purpose of this study was to evaluate the severity of PAH rat model by tissue Doppler imaging (TDI).
PAH was induced in Sprague-Dawley rats by monocrotaline (M) group. The peak systolic (s'), early diastolic (e'), and late diastolic myocardial velocities (a') were measured using TDI at basal segments. Tricuspid annular plane systolic excursion (TAPSE) was measured in the 4-chamber view. Velocity of a tricuspid regurgitation (TR) jet was measured to estimate the pulmonary artery pressure to assess the severity of PAH.
Decrease in the RV shortening fraction and ejection fraction were observed in the M group compared with the control (C) group. RV e' velocity and s' velocity were significantly lower in the M group compared with the C group. The TAPSE was significantly lower in the M group compared with the C group (1.26±0.22 mm vs. 2.83±0.34 mm). The TR velocity was significantly higher in the M group compared with the C group (4.48±0.34 m/sec vs. 1.23±0.02 m/sec).
TAPSE is an easily obtainable, widely recognized and clinically useful echocardiographic parameter of global RV function in the PAH rat model. We recommend that TDI would be a helpful diagnostic tool to evaluate the RV function in PAH rat model.
, Kwan Chang Kim, Young Mi Hong Simvastatin has been reported to attenuate the development of pulmonary hypertension through increased apoptosis as well as reduced proliferation of smooth muscle cells in obstructive vascular lesions. Microarray experiment can accomplish many genetic tests in parallel. The purpose of this study is to evaluate altered expressions of gene in rat hearts with monocrotaline (MCT)-induced pulmonary arterial hypertension after simvastatin treatment.
Six-week-old male rats were grouped as follows: control group (C group, saline injection), M group (MCT 60 mg/kg), and S group (MCT 60 mg/kg plus 10 mg/kg/day simvastatin by gavage during 28 days). Body weight, right ventricular pressure and right ventricular/left ventricle+septum ratio in each group were measured. The rats were sacrificed after 28 days. Total RNA was extracted from the rat heart tissue and microarray analysis was performed.
Administration of simvastatin significantly inhibited the progression of right ventricular hypertrophy at day 28 in the S group than in the M group. Compared with the C group, MCT was associated with a significant difference in expression of genes related to biosynthesis and with the regulation of heart contraction rate. Simvastatin treatment resulted in a significantly changed expression of genes about the regulation of progression through cell cycle and system development compared to the M group. The expressions of nitric oxide synthase and brain natriuretic peptide were significantly decreased after simvastatin treatment.
Administration of simvastatin exerted inhibitory effects on right ventricular hypertrophy during the development of MCT-induced pulmonary arterial hypertension in rats. Simvastatin changes the expression of genes associated with various functions.
, Yi Kyung Kim, Ji Eun Ban, Sejung Sohn, Young Mi Hong Adenovirus infection, which has been known to mimic Kawasaki disease (KD), is one of the most frequent conditions observed during differential diagnosis when considering KD. Accordingly, it is essential to being able to differentiate between these two diseases. Therefore, we performed multiplex reverse transcriptase- polymerase chain reaction and tissue-Doppler echocardiography to distinguish between adenovirus patients and KD patients.
A total of 113 adenoviral infection patients (female 48, male 65) diagnosed from January 2010 to June 2016 were evaluated. We divided adenoviral infection patients into two groups: group 1, which consisted of individuals diagnosed with KD according to the KD American Heart Association criteria (n=62, KD with adenovirus infection); and group 2, which comprised individuals only diagnosed with adenovirus infection (n=51). Laboratory data were obtained from each patient including N-terminal pro-brain natriuretic peptide. Echocardiographic measurements were compared between two groups. In addition, reverse transcriptase-polymerase chain reaction was performed using nasopharyngeal secretions to diagnose adenoviral infection.
Conjunctival injection, cervical lymphadenopathy, polymorphous skin rash, abnormalities of the lip or oral mucosa and abnormalities of extremities were significantly higher in group 1 than group 2. Moreover, group 1 had significantly higher C-reactive protein and alanine aminotransferase levels, as well as lower platelet counts and albumin levels than group 2. Coronary artery diameter was significantly greater in group 1 than group 2.
In patients with adenoviral infection with unexplained prolonged fever, echocardiography and C-reactive protein can be used to differentiate KD with adenoviral infection from adenoviral infection alone.
, Ji Hyen Lee, Young Mi Hong, Hae Soon Kim This study was conducted to determine the prevalence of hypertension in adolescents and to find the relationship between an increase of body mass index and waist circumference (WC) and blood pressure (BP).
Four hundred twenty-nine adolescents between the ages of 15 and 18 at high school in Seoul were enrolled and their anthropometric data and body composition were measured. BP was measured by oscillometric devices at least twice. Hypertension was defined according to the normative BP reference for Korean children and adolescents.
The prevalence of prehypertension and hypertension was 14.0%, 9.2% in boys and 9.0%, 10.2% in girls. The prevalence of prehypertension and hypertension was 9.0%, 6.0% in the normal body mass index group, 14.6 %, 16.7% in the overweight group, 21.7%, 29.8% in the obese group. The prevalence of systolic hypertension was 3.6% in the normal group, 12.5% in the overweight group and 29.8% in the obese group. However, the prevalence of diastolic hypertension had significant differences between the groups, which were 3.3% in the normal group, 6.3% in the overweight group and 4.3% in the obese group. According to WC, the prevalence of hypertension was 6.2% in the below 75th percentile WC group, 22.2% in the75th to 90th percentile WC group and 25.6% in ≥90th percentile WC group. The risk of hypertension was 5.55 times higher in the obese group and 2.04 times higher in the overweight group, 3.93 times higher in ≥90th percentile of WC group.
The risk of hypertension is markedly increased with obesity in high school students.
Citations
, Yoon Suk Lee, Sang Won Lee, Sejung Sohn, Young Mi Hong Kawasaki disease (KD) is the self-limited and multisystem vasculitis which accompanies many complications. Ophthalmic findings in KD are bilateral conjunctival injection, iridocyclitis, superficial keratitis, vitreous opacities and subconjunctival hemorrhage. Optic disc swelling is a rare ophthalmic complication in KD. We describe a 3-year-old boy who presented with 7 days of fever, both conjunctival injection without discharge, and right cervical lymph node enlargement of more than 1.5 cm. He was diagnosed as incomplete KD. He had no ocular symptom except bilateral conjunctival injection. On ophthalmic examination, he was diagnosed by anterior uveitis with optic disc swelling. The brain magnetic resonance imaging was performed and revealed no evidence of increased intracranial pressure. Echocardiography revealed the dilated right coronary artery up to 3.4 mm. Fever subsided and optic disc swelling was completely improved after intravenous immunoglobulin (2 g/kg) treatment. Optic disc swelling is a rare ophthalmic complication in KD.
Citations
, Yikyung Kim, Kwan Chang Kim, Sejung Sohn, Young Mi Hong Spontaneously hypertensive rats (SHR) are frequently used as rat models of essential hypertension. The mechanism for the development of hypertension is complicated and it is unknown. The renin-angiotensin system (RAS) plays a key role in the control of blood pressure. Microarrays are a powerful tool for studying genetics. The purpose of this study was to investigate changes of gene expression in the heart tissues of SHR after losartan treatment to provide basic data that is useful in the early diagnosis of hypertension and gene treatment.
Rats were divided into three groups: the control (C) group; the hypertension (H) group (SHR), and the losartan (L) group; treated with losartan (10 mg/kg/day) in SHR. Rats were sacrificed at week 5 and microarray analysis was performed.
102 gene expressions including the genes associated with cell proliferation such as
According to microarray analysis, there was significant gene expression change in SHR compared with normal rats as well as significant gene expression changes after losartan treatment in SHR.
Two-dimensional and color doppler echocardiography were performed on 54 newborn infants (20:full-term, 21:premature, 13:asphyxated) three times to estimate tricuspid regurgitation and pulmonary artery flow. The results were as follows :
1) Peak velocity of tricuspid regurgitation was significantly highest in asphyxated newborn, and it was significantly decreased as increasing age in three groups.
2) The percent of duration of tricuspid regurgitation was not significantly different among three groups, but they were significantly decreased as increasing age in three groups.
3) RA/LA area ratio was not significantly different among three groups, but it was signiacantly decreased as increasing age in three groups.
4) Peak flow velocity, acceleration time, acceleration time/ejection time ratio of pulmonary artery were not significantly different among three groups, but they were significantly increased as increasing age in three groups.
5) Preejection poriod/acceleration time ratio of pulmonary artery was not significantly different but it was significantly decreased as increasing age in three groups.
In conclusion, pulmonary artery pressure was normally decreased within 1~2 days by applying the Bernoulli equation to Doppler ultrasound measurement of peak flow velocity of tricuspid regurgitation.
The technique may be useful in prediction of pulmonary hypertension and treatment of persistent fetal circulation or cardiopulmonary distress.
, Eun Chul Chung The purpose of this study is to determine the utility of cardiac cine-MRI in the measurement of left ventricular volume and cardiac output. The results of cardiac cine-MRI were compared with those obtained by 2-dimensional echocardiography in 19 normal pediatric subjects.
The results are as follows:
1) The mean values of the parameters(end-diastolic volume, end-systolic volume, ejection fraction, stroke volume, stroke index, cardiac output, and cardiac index) which were calculated by cardiac cine-MRI, demonstrated excellent agreement with the results of 2-dimensional echocardiography(p>0.05).
2) Significant linear correlation was made when each parameter was compared between 2-dimensional echocardiography and cardiac cine-MRI(p<0.05).
3) End-diastolic and end-systolic volume which were estimated by 2-dimensional echocardiography and cardiac cine-MRI, were significantly increased according to increasing age or body weight(p<0.05).
The results of the study indicate that cardiac cine-MRI is likely to become a useful diagnostic modality to evaluate anatomic abnormalities in congenital and acquired cardiac diseases and to measure left ventricular volume and cardiac functions.
Citations
The purpose of this study is to establish normal values for left ventricular volume and cardiac output, which might be used for evaluating patients with congenital heart disease or coronary artery disease.
Two dimensional and Doppler echocardiography were performed in 111 pediatric normal subjects.
Age ranged form newborn to 15 years.
The results are as follows:
1) Left ventricular end-diastolic volume ranged from 6.3 to 73.7ml and left ventricular end systolic volume ranged from 1.1 to 16.0ml
Left ventricular volume increased with advancing age or body weight.
2) Ejection fraction ranged from 78.3 to 83.5%. Lower limit of 5% of ejection fraction ranged from 69.3 to 73.1%.
3) Aortic flow integral was not significantly increased according to advancing age of body weight, but measurement of aortic diameter showed a steady increase with advancing age or body weight.
4) Cardiac output ranged from 0.68 to 4.3l/min.
Cordiac output increased significantly with advancing age or body weight. Echocardiography is a best noninvasive diagnostic tool to assess left ventricular function and cardiac output.
One hundred and 66 normal subjects were studied by two dimensional pulsed Doppler echocardiography to estimate velocity within heart and great vessels. Velocities were obtained at a beam flow intercept angle close to 0°in ascending aorta, main pulmonary artery, tricuspid and mitral valve orifice.
Quantative angle corrected peak flow velocities were generally lower on the right side than on the left side of the heart. Differences in tricuspid(mean 58.3cm/sec) versus mitral (mean 70.8cm/sec) value orifice and pulmonary(mean 75.7cm/sec) versus ascending aorta (mean 111.7cm/sec) were significant(p<0.05). Only signifcant relationship between mitral valve velocity and body surface area was noted, but there was no significant difference between other value velocity and age or body surface area.
These normal Doppler data should be useful for comprisons with data obtained in children with various forms of congenital heart disease that affect flow dynamics.
, Do Kyung Lee, Su Jin Cho, Young Mi Hong, Jung Hyun Kwon We aimed to compare and distinguish the characteristics of anaphylaxis and angioedema, especially with oral mucosal involvement and treatment of patients who visited the Pediatric Emergency Department.
We retrospectively analyzed patients under age 18-year-old who were diagnosed with anaphylaxis and angioedema with oral mucosal involvement and treated with epinephrine from May 2008 to May 2013 in a single Pediatric Emergency Department in Seoul, Korea. We evaluated their past history, possible triggering causes, symptoms, vital signs and treatment and discharge with education.
During the study period the total cases of anaphylaxis were 79 and angioedema with oral mucosal involvement were 218. The age of patients with anaphylaxis was significantly higher (6.6±4.9 years vs. 4.1±3.3 years). The heart rate relative to age was significantly higher in the anaphylaxis group (49.4% vs. 36.2%). After discharge from the Emergency Center, 3.8% of anaphylaxis patients were prescribed an epinephrine injection. Education to avoid the triggering factor was provided in 32.9% of anaphylaxis group and 17.4% in the angioedema group.
Besides blood pressure, we should pay attention to the heart rate in pediatric patients with severe allergic reactions. More active follow-up of anaphylaxis and angioedema with oral mucosal involvement is needed to educate parents and prescribe emergency medication.
Citations
, Jung Hyun Kwon, Hae Soon Kim, Sejung Sohn, Young Mi Hong The etiology for Kawasaki disease (KD) remains unknown, but several studies have suggested the involvement of immune dysregulation and genetic factors. The purpose of this study is to compare gene expressions before and after an infusion of intravenous immunoglobulin (IVIG) in KD patients.
Blood was obtained from both acute and sub-acute phases of 4 patients with KD and febrile control children. Blood was collected in PAXgene blood RNA tubes and RNA was extracted using a PAXgene blood RNA isolation kit. Labeled RNAs were analyzed using Roche NimbleGen human whole genome 12-plex array.
KD patients prior to IVIG injection showed more than a two-fold increase in the expression of 88 genes and more than a two-fold decrease in the expression of 98 genes compared to the control group. They also showed more than two-fold increase in the expression of 226 genes and more than a two-fold decrease in 117 genes in KD patients after IVIG treatment compared to the patients before IVIG injection. Through microarray evaluation, the expressions of genes involved in proliferation, translation, inflammatory response, immune response, cell adhesion, cell migration, cell differentiation, apoptosis, cell growth, transport, cell cycle, transcription, signal transduction and metastasis were observed.
Changes in gene expressions in pediatric patients with KD before and after IVIG were observed via microarray evaluation.
Obesity, the most common health problem facing children, is known to have been ascribed to multifactors. Our research is aimed at finding out if there exists any relation of children's obesity with their family and also with their daily habits.
The study included 145 obese children and 44 non-obese children, who visited our pediatric clinic from January 2006 to December 2008. The children were divided into three groups according to body mass index(BMI)(group I:non-obese control children, group II:children with BMI between 85 and 94 percentile, group III:children with BMI above 95 percentile). Research was performed in three groups by measuring of body weight, height and questionnaires.
There was no significant difference in sex and age. The parental BMI of the obese children were higher than those of non-obese children. Obesity of children was more highly related to maternal BMI than partenal BMI. Birth weight and birth order in the obese children showed no remarkable difference from those of non-obese children. The sleeping hours of the obese children were much longer than those of non-obese children. Television viewing hours of the obese children showed no remarkable difference from those of non-obese children. Family members with group III children had many complications which developed from obesity.
The development of obesity in children is attributed to the hereditary factors of their parents and daily habits such as sleeping hours. Therefore, family-based weight control is important to treat childhood obesity.
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