Clinical Study of Prevalence of Antibiotic Resistance of Escherichia coli in Urinary Tract Infection in Children: A 9-year Retrospective, Single Center Experience

PURPOSE: The aim of this study was to determine the prevalence of antibiotic susceptibility and resistance of Escherichia coli in urinary tract infections (UTIs) in children. METHODS: We retrospectively reviewed the clinical records of 212 inpatients aged 18 years or younger with UTIs treated at the Pediatric Department of Dongguk University Gyeongju Hospital between January 2008 and December 2016. For comparison, patients were divided into three groups according to age as follows: group 1, ≤1 month; group 2, >1 month to ≤12 months; and group 3, ≥13 months. The antibiotic resistance rates from January 2008 to December 2012 (study period 1) and from January 2013 to December 2016 (study period 2) were analyzed statistically by group. RESULTS: As the patient age increased, the antibiotic resistance rate to ampicillin (P=0.013), levofloxacin (P=0.050), piperacillin/tazobactam (TZP) (P<0.001), and trimethoprim/sulfamethoxazole (P=0.002) increased. The frequency of extended spectrum beta-lactamase producing E. coli showed a significant difference from 5 cases (4.6%) in study period 1 and 16 cases (15.8%) in study period 2 (P=0.007). The antibiotic resistance rate of E. coli was compared between the two time periods and we found that the antibiotic resistance rate to cefotaxime was significantly increased from 5.4% to 16.8% (P=0.008) and that to TZP was significantly decreased from 40.5% to 7.9% (P<0.001). CONCLUSION: Over the past 9 years, the resistance rate to cefotaxime has increased but the resistance rate to TZP has decreased. Thus, it is important to continue to investigate the antibiotic resistance rates of bacteria in the community.

Clinical Study of Prevalence of Antibiotic Resistance of Escherichia coli in Urinary Tract Infection in Children: A 9-year Retrospective, Single Center Experience

PURPOSE: The aim of this study was to determine the prevalence of antibiotic susceptibility and resistance of Escherichia coli in urinary tract infections (UTIs) in children. METHODS: We retrospectively reviewed the clinical records of 212 inpatients aged 18 years or younger with UTIs treated at the Pediatric Department of Dongguk University Gyeongju Hospital between January 2008 and December 2016. For comparison, patients were divided into three groups according to age as follows: group 1, ≤1 month; group 2, >1 month to ≤12 months; and group 3, ≥13 months. The antibiotic resistance rates from January 2008 to December 2012 (study period 1) and from January 2013 to December 2016 (study period 2) were analyzed statistically by group. RESULTS: As the patient age increased, the antibiotic resistance rate to ampicillin (P=0.013), levofloxacin (P=0.050), piperacillin/tazobactam (TZP) (P<0.001), and trimethoprim/sulfamethoxazole (P=0.002) increased. The frequency of extended spectrum beta-lactamase producing E. coli showed a significant difference from 5 cases (4.6%) in study period 1 and 16 cases (15.8%) in study period 2 (P=0.007). The antibiotic resistance rate of E. coli was compared between the two time periods and we found that the antibiotic resistance rate to cefotaxime was significantly increased from 5.4% to 16.8% (P=0.008) and that to TZP was significantly decreased from 40.5% to 7.9% (P<0.001). CONCLUSION: Over the past 9 years, the resistance rate to cefotaxime has increased but the resistance rate to TZP has decreased. Thus, it is important to continue to investigate the antibiotic resistance rates of bacteria in the community.

RSV Outbreak at a Single Postpartum Care Center in Gyeongsangbukdo / 대한주산의학회잡지

PURPOSE: We performed an analysis of the RSV outbreak in a postpartum center in Gyeongsangbukdo to provide preliminary data for health and hygiene management of postpartum care centers. METHODS: All of 22 newborns who were transferred to our hospital from a postpartum care center from December 2014 to January 2015 showed positive for RSV by viral culture and enrolled in the study group. To identify early symptoms in RSV infected newborn in the nursery 31 infants (1 month to 24 month of age) who were hospitalized in our hospital due to RSV infection during the same period were selected as control group and clinical symptoms were compared with the study group. A retrospective study was also performed on the newborns who were cared and not transferred to our hospital in the postpartum care center, as well as the facilities offered by the center. RESULTS: All of 22 neonatal patients who were transferred to our hospital had early symptoms of rhinorrhea and cough compared to control group. Rhinorrhea appeared 4.2±2.0 days before the admission, and cough occurred 1.0±1.1 days after rhinorrhea. The level of infection control specified by the law for general facilities relating to postpartum care centers was applied to the postpartum center, RSV infection was not controlled. Strict hand washing, individual equipment such as stethoscopes and exclusion of visitors with respiratory symptoms were done and infected neonates were segregated in separate air circulation system and cared by nurse-infant ratios from 1:1 to 1:2 depending on the needs of the individual neonates. Additional transmission was not observed after transfer to our hospital CONCLUSION: Neonates with cough and rhinorrhea were initial symptom for RSV infection in the postpartum center and should be evaluated for RSV infection during high risk season. Current guideline or support for infection control in postpartum center should be reevaluated for RSV infection control.

RSV Outbreak at a Single Postpartum Care Center in Gyeongsangbukdo / 대한주산의학회잡지

PURPOSE: We performed an analysis of the RSV outbreak in a postpartum center in Gyeongsangbukdo to provide preliminary data for health and hygiene management of postpartum care centers. METHODS: All of 22 newborns who were transferred to our hospital from a postpartum care center from December 2014 to January 2015 showed positive for RSV by viral culture and enrolled in the study group. To identify early symptoms in RSV infected newborn in the nursery 31 infants (1 month to 24 month of age) who were hospitalized in our hospital due to RSV infection during the same period were selected as control group and clinical symptoms were compared with the study group. A retrospective study was also performed on the newborns who were cared and not transferred to our hospital in the postpartum care center, as well as the facilities offered by the center. RESULTS: All of 22 neonatal patients who were transferred to our hospital had early symptoms of rhinorrhea and cough compared to control group. Rhinorrhea appeared 4.2±2.0 days before the admission, and cough occurred 1.0±1.1 days after rhinorrhea. The level of infection control specified by the law for general facilities relating to postpartum care centers was applied to the postpartum center, RSV infection was not controlled. Strict hand washing, individual equipment such as stethoscopes and exclusion of visitors with respiratory symptoms were done and infected neonates were segregated in separate air circulation system and cared by nurse-infant ratios from 1:1 to 1:2 depending on the needs of the individual neonates. Additional transmission was not observed after transfer to our hospital CONCLUSION: Neonates with cough and rhinorrhea were initial symptom for RSV infection in the postpartum center and should be evaluated for RSV infection during high risk season. Current guideline or support for infection control in postpartum center should be reevaluated for RSV infection control.

Alexander Disease

Alexander disease (ALXD) is a rare demyelinating disease of the white matter of the brain that is caused by a mutation in the glial fibrillary acidic protein (GFAP) gene. The overexpression of GFAP in astrocytes induces a failure in the developmental growth of the myelin sheath. The neurodegenerative destruction of the myelin sheath of the white matter is accompanied by an accumulation of abnormal deposits of Rosenthal fibers in astrocytes, which is the hallmark of ALXD. The disease can be divided into four groups based on the onset age of the patients: neonatal, infantile, juvenile, or adult. Early-onset disease is more severe, progresses rapidly, and results in a shorter life span than late-onset cases. Magnetic resonance imaging and genetic tests are mostly used for diagnostic purposes. Pathological tests of brain tissue for Rosenthal fibers are definitive diagnostic methods. Therapeutic strategies are being investigated. Ceftriaxone, which is an enhancer of glial glutamate transporter (GLT-1) expression, is currently in clinical trials for the treatment of patients with ALXD. To date, there are no clinically available treatments. The cause, pathology, pathophysiology, inheritance, clinical features, diagnosis, and treatment of ALXD will be reviewed comprehensively.

Small Bowel Obstruction Caused by an Aberrant Congenital Band in a Child / 대한소아소화기영양학회지

Small bowel obstruction due to congenital band is not only rare in children, but also difficult to diagnose, because common symptoms such as vomiting and abdominal pain are observed in patients. In order to prevent a fatal result, an anomalous congenital band should be considered in the discriminative diagnosis of intestinal obstruction in children who have no previous experience of operation or intraperitoneal inflammation. This report presents a 4-year-old boy who was admitted with abdominal pain and nonbilious vomiting for a day. The initial suspicion was for acute gastroenteritis. However, after further investigation and performance of surgery, the intestinal obstruction associated with a congenital band was confirmed. No recurrence was observed during the 8-month follow-up period. Thus early confirmation based on radiologic study is a crucial factor for the diagnosis of small bowel obstruction caused by a congenital band.

Increased Seizure Susceptibility and Up-regulation of nNOS Expression in Hippocampus Following Recurrent Early-life Seizures in Rats

This study aimed to determine the long-term change of seizure susceptibility and the role of nNOS on brain development following recurrent early-life seizures in rats. Video-EEG recordings were conducted between postnatal days 50 and 60. Alterations in seizure susceptibility were assayed on day 22 or 50 using the flurothyl method. Changes in nNOS expression were determined by quantitative immunoblotting on day 50. On average, rats had 8.4+/-2.7 seizures during 10 daily 1 hr behavioral monitoring sessions. As adults (days 50-60), all rats displayed interictal spikes in the hippocampus and/or overlying cortex. Brief electrographic seizures were recorded in only one of five animals. Rats appeared to progress from a period of marked seizure susceptibility (day 22) to one of lessened seizure susceptibility (day 50). Up-regulation of nNOS expression following early-life recurrent seizures was observed on day 50. In conclusion, these data suggested that recurrent early-life seizures had the long-term effects on seizure susceptibility late in life and up-regulatory nNOS expression on the hippocampus during brain development, and nNOS appeared to contribute to the persistent changes in seizure susceptibility, and epileptogenesis.

Transmission of Seasonal Outbreak of Childhood Enteroviral Aseptic Meningitis and Hand-foot-mouth Disease

This study was conducted to evaluate the modes of transmission of aseptic meningitis (AM) and hand-foot-mouth disease (HFMD) using a case-control and a case-crossover design. We recruited 205 childhood AM and 116 HFMD cases and 170 non-enteroviral disease controls from three general hospitals in Gyeongju, Pohang, and Seoul between May and August in both 2002 and 2003. For the case-crossover design, we established the hazard and non-hazard periods as week one and week four before admission, respectively. In the case-control design, drinking water that had not been boiled, not using a water purifier, changes in water quality, and contact with AM patients were significantly associated with the risk of AM (odds ratio [OR]=2.8, 2.9, 4.6, and 10.9, respectively), while drinking water that had not been boiled, having a non-water closet toilet, changes in water quality, and contact with HFMD patients were associated with risk of HFMD (OR=3.3, 2.8, 6.9, and 5.0, respectively). In the case-crossover design, many life-style variables such as contact with AM or HFMD patients, visiting a hospital, changes in water quality, presence of a skin wound, eating out, and going shopping were significantly associated with the risk of AM (OR=18.0, 7.0, 8.0, 2.2, 22.3, and 3.0, respectively) and HFMD (OR=9.0, 37.0, 11.0, 12.0, 37.0, and 5.0, respectively). Our findings suggest that person-to-person contact and contaminated water could be the principal modes of transmission of AM and HFMD.

Predictive factors for severe infection among febrile infants younger than three months of age / 소아과

PURPOSE: This study investigated the predictive factors for identifying infection-prone febrile infants younger than three months. METHODS: We conducted a retrospective study of 167 infants younger than three months with an axillary temperature >38degrees C who were hospitalized between 2006 and 2008. If they met any of the following criteria, positive blood culture, CSF WBC > or =11/mm3 or positive CSF culture, urinalysis WBC > or =6/HPF and positive urine culture, WBC > or =6/HPF on microscopic stool examination or positive stool culture, they were considered at high risk for severe infection. Infants with focal infection, respiratory infection or antibiotic administration prior to admission to the hospital were excluded. We evaluated the symptoms, physical examination findings, laboratory data, and the clinical course between the high risk and low risk groups for severe infection. RESULTS: The high-risk group included 77(46.1%) infants, and the most common diagnosis was urinary tract infection (51.9%). Factors, such as male sex, ESR and CRP were statistically different between the two groups. But, a multilinear regression analysis for severe infection showed that male and ESR factors are significant. CONCLUSION: We did not find the distinguishing symptoms and laboratory findings for identifying severe infection-prone febrile infants younger than three months. However, the high-risk group was male and ESR-dominated, and these can possibly be used as predictive factors for severe infection.

Assessment of parental understanding of epilepsy and effects of educational programs in an epilepsy camp / 소아과

PURPOSE: To assess parental knowledge and understanding of epilepsy including social stigma and evaluate the effects of educational programs on parents in an epilepsy camp. METHODS: We conducted an epilepsy camp on August 23-24, 2008, at Gyeongsan. Twenty families with an epileptic child each participated in the camp. We performed a survey before and after the camp to obtain data concerning parental understanding of epilepsy and the effects of the camp-based educational programs on the parents. The data were analyzed with SPSS 14.0 using frequency analysis. RESULTS: The parents were sufficiently knowledgeable about epilepsy before the camp, and their knowledge and understanding of epilepsy improved further after the camp. Both perceived stigma and enacted stigma against epilepsy were found in 30.0% of the parents. The perceived stigma decreased to 15.0% after the camp. CONCLUSION: This study suggests that social approaches such as epilepsy camps are effective in improving parental knowledge and understanding about epilepsy as well as decreasing their perceived social stigma.

Assessment of parental understanding of epilepsy and effects of educational programs in an epilepsy camp / 소아과

PURPOSE: To assess parental knowledge and understanding of epilepsy including social stigma and evaluate the effects of educational programs on parents in an epilepsy camp. METHODS: We conducted an epilepsy camp on August 23-24, 2008, at Gyeongsan. Twenty families with an epileptic child each participated in the camp. We performed a survey before and after the camp to obtain data concerning parental understanding of epilepsy and the effects of the camp-based educational programs on the parents. The data were analyzed with SPSS 14.0 using frequency analysis. RESULTS: The parents were sufficiently knowledgeable about epilepsy before the camp, and their knowledge and understanding of epilepsy improved further after the camp. Both perceived stigma and enacted stigma against epilepsy were found in 30.0% of the parents. The perceived stigma decreased to 15.0% after the camp. CONCLUSION: This study suggests that social approaches such as epilepsy camps are effective in improving parental knowledge and understanding about epilepsy as well as decreasing their perceived social stigma.

A Study of Clinical Features and Prognosis of Neonatal Seizures

PURPOSE: Neonatal seizures are relatively common and the symptoms are clinically different from those in older children and adults. The goal of this study is to help understand neonatal seizures by analyzing the etiology, clinical features, method of diagnosis and prognosis of the affected patients in our hospital. METHODS: Twenty six cases with neonatal seizures who were admitted to the neonatal intensive care unit, Dongguk University Hospital from January 1999 to October 2008 were retrospectively reviewed. They were evaluated with risk factors, neurologic examinations, laboratory data, neuroimaging studies, EEG findings, seizure types, response to treatment, and outcomes. RESULTS: Subtle seizure came out to be the most common seizure type(9 patients: 34.6 %). The cause of neonatal seizures were hypoxic-ischemic encephalopathy(9 patients: 34.6 %), intracranial hemorrhage(8 patients: 30.8%), electrolyte imbalance(8 patients: 30.8%), meningitis(7 patients: 26.9%). Nineteen out of 25 patients showed abnormal lesion on neuroimaging studies such as intracranial hemorrhage, periventricular leukomalacia, brain infarction, etc. Abnormal EEG findings were noted in 19 patient(73.1%). Phenobarbital was tried as a first line antiepileptic drug and phenytoin was added if it failed to control seizures. The overall outcome was relatively good except for those with abnormal EEG findings. CONCLUSION: Neonatal seizures signify underlying diseases. Recognition of etiology is often helpful in prognosis and treatment. Neuroradiological and EEG findings are important in predicting neurologic outcomes in newborns with seizures.

Incidence and Risk Factors for Cystic Periventricular Leukomalacia in Premature Low Birth Weight Infants

PURPOSE: While the survival rate of preterm infants in the neonatal intensive care unit is increasing, the neurological complication such as cerebral palsy is still a serious problem. This study is to determine the incidence of cystic periventricular leukomalacia (cPVL) observed among preterm low birth weight infants and its risk factors. METHODS: The medical records of infants (under 37 weeks of gestational age and under 2,500 g of birth weight) delivered from June 2003 to May 2006 were reviewed with special reference to cPVL. Maternal factors, labor and delivery characteristics and neonatal parameters were collected. It is inquired of whether the already known perinatal and neonatal risk factors such as prematurity, birth weight, intrauterine infection, mode of delivery, breech presentation, postnatal resuscitation and intubation, antenatal steroid, administration of surfactant and early onset of sepsis can be attributed to cPVL incidence of given infants. RESULTS: Ventilator care was offered to 7 infants, and surfactant was applied to 6 infants among 10 infants who has cPVL. The incidence of cPVL is 7.2%. The risk factors like low Apgar score at 1 minute, twin, use of epinephrine or dopamine, postnatal administration of surfactant and ventilator care have statistical meaning (P<0.05). CONCLUSION: The incidence of cPVL is higher in the cases of low Apgar score at 1 minute, twin, delivery room resuscitation, respiratory distress syndrome and ventilator care. These risk factors should be controlled with special attention to their influences on the brain. By way of regular follow-up, careful observation of neurological problem must be given to infants required of epinephrine, dopamine and ventilator care.

A Case of Mucinous Adenocarcinoma of the SigmoidColon in a Child / 대한소아소화기영양학회지

Colorectal carcinomas occur primarily in elderly people and are rare in children. Unlike adult colorectal carcinomas, the overall prognosis is very poor because of the usual delay in diagnosis and advanced stages at presentation or initial diagnosis, and a high incidence of aggressive tumor pathology such as mucinous adenocarcinoma. Colon cancer should not be excluded in children only based on age or barium enema results. Therefore, colonoscopy should be performed in pediatric patients with unexplained rectal bleeding and abdominal pain. We report a rare case of a child with a mucinous adenocarcinoma of the sigmoid colon in a 12-year-old boy, who presented with an abdominal mass and abdominal pain and review the medical literature.

Survey on the Awareness of Guardians of Young Infants on the Weaning of Food in Pohang and Gyeongju Area / 대한소아소화기영양학회지

PURPOSE: This study was carried out to investigate the awareness of the weaning of food using questionnaires, and the relationship with the weight gain in young infants. METHODS: From September 2005 to December 2005, we performed a survey on 141 guardians of young infants aged from 6 to 18 months, who visited the pediatric out-patient department at Dongguk University Medical Center. We calculated the total score for each responder from ten questions on the weaning of food and assessed the body weight percentile of each of the young infants. RESULTS: The most commonly reported information source for weaning food was 'the friends around' by 62 respondents (44.0%); 54 (38.3%) responded that the definition of weaning food was the preparatory step before starting a solid diet. Most used a spoon (90.8%) to feed when weaning food with a thin gruel of rice (78.7%). The time for weaning of food was before breast or infant formula feeding (55.3%). Addition of cow's milk was around 12 months (77.3%). The mean score was 6.21; however this did not show a statistically significant correlation with weight gain in young infants. CONCLUSION: The overall awareness of weaning of food has improved; however, information from doctors has decreased. Although the relationship between the awareness of weaning of food and the growth of young infants was not statistically significant, further studies on weaning of food, with larger and controlled sample sizes may provide important information.

The Experience of the 1st Daegu-Gyeongbuk Multicenter Epilepsy Camp for Children and their Parents to improve the understanding of Epilepsy

PURPOSE:This study was undertaken to announce our experience of the 1st Daegu- Gyeongbuk Multicenter Epilepsy Camp for children and their parents to improve the understanding of epilepsy. METHODS:We held the camp on February 25th to 26th, 2006 at Gyeongju. 33 families with epileptic childlend joined the camp. At the end of the camp, we performed a survey with 37 questionnaires to obtain data concerning the parents' understanding of epilepsy and the satisfaction with the camp. Data was analyzed with SPSS 10.0 program using frequency analysis. RESULTS:Parents knew about epilepsy but for some degrel still wanted to get more information about epilepsy. Parents were satisfied with the educational programs but not with the recreation programs. CONCLUSION:This study suggests that more social approaches such as an epilepsy camp is needed to provide the families with more information fot the understanding about epilepsy.

A Case of Infantile Alexander Disease Accompanied by Infantile Spasms Diagnosed by DNA Analysis

Alexander disease (AD) is a rare leukodystrophy of the central nervous system of unknown etiology. AD is characterized by progressive failure of central myelination and the accumulation of Rosenthal fibers in astrocytes, and is inevitably lethal in nature. Symptomatically, AD is associated with leukoencephalopathy with macrocephaly, seizures, and psychomotor retardation in infants, and usually leads to death within the first decade. Its characteristic magnetic resonance imaging (MRI) findings have been described as demyelination predominantly in the frontal lobe. Moreover, dominant mutations in the GFAP gene, coding for glial fibrillary acidic protein (GFAP), a principal astrocytic intermediate filament protein, have been shown to lead to AD. The disease can now be detected by genetic diagnosis. We report the Korean case of an 8-month-old male patient with AD. He was clinically characterized due to the presence of psychomotor retardation, megalencephaly, spasticity, and recurrent seizures including infantile spasms which is a remarkable presentation. Demyelination in the frontal lobe and in a portion of the temporal lobe was demonstrated by brain MRI. Moreover, DNA analysis of peripheral blood showed the presence of a R239L mutation in the GFAP gene, involving the replacement of guanine with thymine.

Probable Prognostic Factors among the Revealing Clinical Manifestations at Admission in Neonates with Tachypnea

PURPOSE: This study is for being aware of clinical manifestations in neonates with tachypnea; discussing the early clinical characteristics that would lead to prolonged symptoms; and investigating the predictive factors that would cause more morbid and progressive diseases other than transient tachypnea of the newborn (TTN). METHODS: Based on the medical records, we retrospectively investigated 44 neonates who were admitted to the neonatal intensive care unit in Dongguk University Hospital of Pohang for tachypnea, from March 1, 2003 to December 31, 2005. RESULTS: The patient characteristics showed male predominance of 2.6:1. Among the 44 neonates with tachypnea, TTN (24 cases, 54.5%) showed the highest incidence, followed by pneumonia (6 cases, 13.6%), idiopathic respiratory distress syndrome (5 cases, 11.4%), meconium aspiration syndrome (4 cases, 9.1%), cardiac disease (2 cases, 4.5%), sepsis (2 cases, 4.5%) and neonatal asphyxia (1 case, 2.3%). We compared TTN group with other groups including pneumonia, idiopathic respiratory distress syndrome, and meconium aspiration syndrome. We observed less incidence of premature rupture of membrane (PROM) (P<0.05); less likely to develop tachypneic symptom after 12 hours postpartum (P<0.05); shorter duration of tachypneic symptom (P<0.05); and less incidence of nasal flaring (P<0.05) in TTN group. CONCLUSION: The higher chance of pulmonary complications was observed in tachypneic neonates with either history of PROM or onset of tachypneic symptom after 12 hours postpartum. The prolonged tachypneic symptom and combined pulmonary complications were seemed to be accompanied with neonates showing nasal flaring.

A Case of Congenital Nephrogenic Diabetes Insipidus Diagnosed by DNA Analysis

Nephrogenic diabetes insipidus(NDI) is characterized by an inability to concentrate urine despite normal or elevated plasma concentrations of the antidiuretic hormone; arginine vasopressin(AVP). Polyuria with hyposthenuria, and polydipsia are the cardinal clinical manifestations of the disease. Ninety percent of congenital nephrogenic diabetes insipidus patients are males with the X-linked recessive form of the disease; the mutation is in the AVP receptor 2 gene(AVPR2), which is located in chromosomal region Xq28. We report a case of NDI who suffered from unexplained fever and failure to thrive, which has been recognized since about 3 months after birth. His genomic DNA analysis identified a novel AVPR2 gene mutation as W200C.

Bosentan Attenuates Compensatory Left Ventricular Hypertrophy Induced by Aortocaval Fistula in Rats

BACKGROUND AND OBJECTIVES: Endothelin-1 (ET-1) is increased in advanced congestive heart failure and pulmonary hypertension associated with increased pulmonary blood flow. The role of ET-1 and the protective effect of the dual endothelin receptor antagonist, Bosentan, were investigated in overcirculation-induced compensatory left ventricular (LV) hypertrophy using aortocaval fistula (AVF) rats. MATERIALS AND METHODS: Twenty one 8-week-old rats were randomized into sham control, AVF and Bosentan (100 mg/kg/day) treatment groups. Four weeks later, the cardiac hypertrophy, pulmonary artery morphometry, plasma and tissue levels of ET-1 and the immunoreactive signal of ET-1 were evaluated in the heart and lung tissues. RESULTS: Chronic AVF developed LV hypertrophy and markedly increased the plasma and tissue ET-1 levels in the heart and lung compared to those in the controls (p<0.05), and these changes were attenuated by Bosentan treatment (p<0.05). However, the wall thickness of the pulmonary arteriole did not change. In addition, the immunoreactive signal of ET-1 was increased in the heart after AVF compared with the controls, and was also slightly decreased with Bosentan treatment. However, there were no remarkable differences in the lung tissue. CONCLUSION: ET-1 was up-regulated in compensatory LV hypertrophy induced by AVF. Bosentan attenuates cardiac hypertrophy and decreases the ET-1 levels in the plasma, heart and lung. Therefore, it is speculate that chronic treatment of an ET-1 antagonist may provide an additional strategy for AVF-induced compensatory LV hypertrophy.