Mental health in Japanese children during school closures due to the COVID-19.

BACKGROUND: Changes in relationships, sleep rhythms, and physical activity caused by school closures instituted to curb the spread of COVID-19 influenced children's mental health. We explored changes in children's daily life and effects on their mental health during school closures. METHODS: Participants included elementary and junior high school students 9 years of age and older seen in the outpatient clinic during school closures and were required to complete the Japanese version of WHO Five Well-Being Index (WHO-5-J). The results were compared with those of students seen after schools reopened. RESULTS: Participants included 78 students in the school closure group and 113 in the school reopening group. Although those in the closure group devoted more time to family and sleep, their sleep rhythms, eating habits, and physical activities were disrupted. Although there were no significant differences between the two groups in total WHO-5-J scores, single WHO-5-J items such as activity and vigor and interest were significantly worse and rest was significantly better in the school closure group. CONCLUSION: Although school closures resulted in elementary and junior high school students spending more time with family and sleeping, their sleep rhythms, eating habits, and physical activities were disrupted. As the children's living environment changed, they felt less active and vigorous and had difficulty finding things that interested them. However, their sleep improved and overall, the number of children with potential mental health problems did not change.

Evaluating the mental health of children in a local hospital outpatient clinic.

BACKGROUND: The 30-item Questionnaire for Triage and Assessment (QTA30) is a standardized triage and assessment tool for assessing pediatric psychosomatic disorders. It is estimated that one in 10 children in Japan experience difficulties in their school life. Using the QTA30 we evaluated mental health in children at an outpatient clinic in a local hospital. METHODS: All elementary and junior high school students (≥9 years) who visited our institution between December 1 2019 and March 31 2020 were asked to complete the QTA30. RESULT: A total of 372 children responded. Half of the children with a psychosomatic disorder and 9% of children with other chronic disorders were suspected to have poor mental health. Suspected poor mental health was associated with higher odds of female gender (odds ratio [OR]: 1.89, 95% confidence interval [CI]: 1.07-3.39), junior high school students (OR: 3.73, 95% CI: 2.11-6.73), and not enjoying exercise (OR: 2.13, 95% CI: 1.16-3.9). The mean ± standard deviation total QTA30 score was significantly worse in children with psychosomatic disorders (38.0 ± 19.1) among children with other chronic diseases; however, only the score in children with central precocious puberty (27.4 ± 13.7) showed no difference. CONCLUSION: Based on our survey, the percentage of children suspected to have mental health problems manifesting as non-psychosomatic chronic disorders was similar to the proportion of children suspected to experience difficulties with their school life. Pediatricians should carefully consider the possibility of mental health problems when children are seen in regular visits to the outpatient clinic.

Volume measurement of the left ventricle in children using real-time three-dimensional echocardiography: comparison with ventriculography.

OBJECTIVES: Recently, a real-time three-dimensional echocardiography (RT3DE) volume scanning technique was developed and used clinically. For precise ventricular volumetry, independent of mathematical assumptions, imaging techniques such as three-dimensional echocardiography are required in children with heart disease. This study evaluated whether RT3DE is suitable for left ventricular volumetry in children, and whether left ventricular volumes measured by RT3DE correlate sufficiently well with those measured by left ventriculography (LVG). METHODS: Twenty-five children with heart disease, 17 boys and 8 girls aged from 8 months to 18 years (mean age 5.9 +/- 5.3 years), underwent cardiac catheterization at our institution. RT3DE was performed within 30 min after LVG using the Philips SONOS 7500 ultrasound system with an electronic sector probe consisting of a X 4 matrix phased array transducer (center frequency of 2-4 MHz). Ultrasound images of the ventricle were calculated offline using TomTec 4D Cardio-View RT 1.2 software. Left ventricular volumes by LVG were calculated using Siemens Hicor T.O.P. Finally, the left ventricular volumes by RT3DE and LVG were compared. RESULTS: Left ventricular volumes measured by RT3DE correlated and agreed well with those measured by LVG(r = 0.996, Y = 0.566 + 0.964 X, mean difference -0.29 +/- 1.90ml; left ventricular end-systolic volume, r = 0.979, Y=-0.187 + 0.897 X, mean difference -6.76 +/- 10.58ml; left ventricular end-diastolic volume). CONCLUSIONS: RT3DE is suitable for left ventricular volumetry in children. There was a good correlation between RT3DE and LVG, but the volume of left ventricular end-diastolic volume estimated by RT3DE was smaller than that by LVG.

Volume measurement of a pediatric ventricular phantom model using three-dimensional echocardiography.

PURPOSE: Volume measurement of the ventricle is necessary to evaluate cardiac function. Accurate volume measurement of the ventricle by three-dimensional (3D) echocardiography will mark a new step in pediatric cardiovascular diagnosis and treatment. We studied volume measurement of a pediatric ventricular model using 3D echocardiography. METHODS: The ultrasonic diagnostic setup used in this study comprised a Philips Sonos 7500 ultrasound system with an electronic sector probe of a ×4 matrix phased array transducer. The ventricular model was made from a latex surgical glove. The tip of the third finger of the glove was cut off and fixed to a manifold. The ventricular model was gently placed in a reservoir filled with water. Volumes of physiological saline solution ranging from 2 ml to 50 ml in 2-ml increments were injected into the ventricular model and examined. Twenty-five ultrasound images of the ventricular model were obtained using 4D Cardio View RT 1.2 software. RESULTS: There was excellent correlation and agreement between the injected volumes and the calculated volumes (Y = -0.539 + 1.005X, r = 0.997, four cut plane; Y = -0.191 + 1.006X, r = 0.997, eight cut plane). Thus, accurate volume measurement of the ventricular model by 3D echocardiography was confirmed. CONCLUSIONS: Our study demonstrated that 3D echocardiography is highly accurate for volume measurement in a pediatric ventricular model (for volumes of 2 to 50 ml) under static conditions.

Efficacy of iodine-123-15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid single photon emission computed tomography imaging in detecting myocardial ischemia in children with Kawasaki disease.

To evaluate its efficacy in detecting myocardial ischemia in children, iodine-123-labeled 15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid (BMIPP) myocardial single photon emission computed tomography (SPECT) imaging was performed in 16 pediatric patients with Kawasaki disease (KD, 11 male, 5 female; mean age and range: 13 years 8 months and 8 years 11 months to 17 years 7 months). Five children with chest pain and no cardiac disease were studied as controls (2 male, 3 female; mean age and range: 13 years 4 months and 9 years 4 months to 17 years 11 months). Selective coronary angiography was also performed in the 16 patients to evaluate the location of coronary stenosis and coronary aneurysms. The SPECT images were expressed as polar maps (Bull's eye maps) and the 'defect' area was defined as where the uptake of BMIPP was less than the standardized BMIPP images of the 5 control children. In the 16 patients, 33 segments had coronary aneurysms and 10 (10/33: 30.3%) had significant coronary stenosis on selective coronary angiography. Nine of the 10 (90%) segments with significant coronary stenosis showed a defect on the BMIPP image whereas only 6 of the 23 (26.1%) segments without coronary stenosis showed a defect on BMIPP imaging. The sensitivity of BMIPP SPECT imaging for detection of coronary stenosis was 90% (9/10) and its specificity was 73.9% (17/23), whereas the sensitivity of (201)Tl SPECT imaging was 80% (8/10) and its specificity was 60% (14/23). There was no significant difference between the BMIPP and 201Tl SPECT images in either the sensitivity or specificity for the detection of coronary stenosis. In the present series, only one case had discordant BMIPP uptake (BMIPP uptake < (201)Tl uptake) in which there was a large coronary aneurysm and re-canalization after complete obstruction at segment 1 of the right coronary artery. This discordant BMIPP uptake reflects the possibility of ischemic but viable myocardium after re-canalization of a large aneurysm in KD. In conclusion, BMIPP SPECT imaging is useful for detecting the areas of ischemic myocardium caused by coronary artery stenosis in children with KD.

Left atrial tachyarrhythmia in fetal lambs.

To evaluate the hemodynamic effect of rapid left atrial pacing on fetal circulation, a fetal supraventricular tachyarrhythmia model was made and the aortic pressure, central venous pressure, and left and right ventricular outputs were measured in ten fetal lambs. Under maternal anesthesia, the uterus was opened, and under local anesthesia, catheters were inserted into thefetal superior vena cava and ascending aorta through a neck incision. Pacing leads were then sutured onto the fetal left atrial appendage via left thoracotomy. Ventricular output was estimated using echocardiography by a transuterine approach. Fetal hemodynamics were observed without pacing (control), and at the pacing rates of 200, 300, 350, and 400/min. The aortic pressure decreased when the left atrium was paced at 300/min or more and the central venous pressure increased when the left atrium was paced at 350/min or more. The left and right ventricular outputs decreased when the left atrium was paced at 350/min or more. The left ventricular output was 215+/-54 mL/kg per minute at control, 205+/-60 mL/kg minute when paced at 200/min, 178+/-58 mL/kg per minute when paced at 300/min, but decreased to 164+/-44 mL/kg per minute when paced at 350/min and to 149+/-57 mL/kg per minute when paced at 400/min. The right ventricular output was 338+/-66 mL/kg per minute at control, 336+/-95 mL/kg per minute when paced at 200/min, 273+/-91 mL/kg per minute when paced at 300/min, but decreased to 256+/-80 mL/kg per minute when paced at 350/min and to 202+/-76 mL/kg per minute when paced at 400/min. Fetal circulatory failure was initially confirmed when the left atrium was paced at 300/min in this left atrial tachyarrhythmia model.

Optimal ventricular pacing rate in fetal lambs with complete atrioventricular block.

OBJECTIVE: This study was undertaken to determine the optimum ventricular pacing rate at which the optimal cardiac function can be attained in fetal lambs with complete atrioventricular block. STUDY DESIGN: Complete atrioventricular block was created by cryosurgery in 12 fetal lambs, and the ventricle was paced randomly at rates of 60, 90, 120, 150, 180, 210, 240, and 270 beats/min. The aortic pressure, central venous pressure, and right ventricular cardiac output were measured before cryosurgery and during ventricular pacing. RESULTS: Complete atrioventricular block was created in 9 of 12 fetal lambs. Systolic aortic pressure significantly decreased at pacing rates of 60, 90 and 240 beats/min (P <.01), and central venous pressure was increased significantly at a pacing rate of 60 beats/min (P <.01) compared with the control. Right ventricular cardiac output significantly decreased at pacing rates of 60, 90, 120, 180, 210, 240, and 270 beats/min (P <.01), although no significant difference was found at the pacing rate of 150 beats/min compared with control. CONCLUSION: Ventricular pacing at a rate of 150 beats/min gave the highest aortic pressure, the lowest central venous pressure, and the highest right ventricular cardiac output in fetal lambs with complete atrioventricular block.

Factors determining peripheral pulmonary artery stenosis remodeling in children after percutaneous transluminal balloon angioplasty.

The peripheral pulmonary artery stenosis (PPS) that complicates congenital heart anomalies can improve after percutaneous transluminal balloon angioplasty (PTA), despite an initial poor response, but there is little information concerning the factors that determine such remodeling. The present study reviewed the hemodynamic and angiographic data before, immediately after, and at late follow-up after PTA for 17 lesions in 14 patients. Lesions were classified into either the (+) group (with pulmonary artery remodeling) or the (-) group (without remodeling). Remodeling was defined as an increase of more than 30% in the predictive percent of normal (%N) of the peripheral pulmonary artery diameter at late follow-up compared with the diameter immediately after PTA. Remodeling occurred in 6 of 17 lesions (35%), and the pressure gradient immediately after PTA was significantly smaller (<10 mmHg) in the (+) group than in the (-) group. Late expansion of the lesion (remodeling) occurs after PTA in some children with PPS and an adequate initial reduction in the pressure gradient favors subsequent remodeling.

Hemodynamic effect of the ventricular pacing site in fetal lambs with complete atrioventricular block.

Complete atrioventricular (AV) block in hydrops fetalis is associated with high mortality. Fetal ventricular pacing to restore ventricular rate can be an effective procedure, however, no fetal data has shown an appropriate epicardial ventricular pacing site. To evaluate the hemodynamic effect of right and left ventricular pacing in fetal lambs with complete AV block, a fetal complete AV block model was created. Aortic pressure, central venous pressure, and QRS duration were measured, and right and left ventricular output was estimated in seven fetal lambs. The uterus was opened under maternal anesthesia, and under local anesthesia, catheters were inserted into the fetal superior vena cava and ascending aorta through a neck incision. Pacing leads were then sutured onto the fetal right and left ventricular epicardium via a midline thoracotomy. Complete AV block was created by cryoablation of the AV node. Ventricular output was estimated using echocardiography by a transuterine approach. Fetal hemodynamics were observed before AV block creation (control), and after complete AV block creation with the right and left ventricular pacing set at 150/min. The right ventricular output was 320 +/- 66 mL/kg per minute at control, decreased to 243 +/- 65 mL/kg per minute during right ventricular pacing (P < 0.05), and was 254 +/- 61 mL/kg per minute during left ventricular pacing. The left ventricular output was 224 +/- 98 mL/kg per minute at control, 176 +/- 77 mL/kg minute during right ventricular pacing, and 178 +/- 67 mL/kg per minute during left ventricular pacing. Biventricular (combined ventricular) output was 544 +/- 134 mL/kg per minute at control, 419 +/- 114 mL/kg per minute during right ventricular pacing, and 432 +/- 100 mL/kg minute during left ventricular pacing. Systolic aortic pressure was 62.2 +/- 8.7 mmHg at control, 55.2 +/- 9.5 mmHg during right ventricular pacing, and 53.4 +/- 9.1 mmHg during left ventricular pacing. Central venous pressure (CVP) was 2.6 +/- 0.5 mmHg at control, 4.0 +/- 2.7 mmHg during right ventricular pacing, and 4.4 +/- 2.5 mmHg during left ventricular pacing. The QRS duration was 51 +/- 54 ms at control, but lengthened to 87 +/- 19 ms during right ventricular pacing and to 78 +/- 21 ms during left ventricular pacing (P < 0.05). In conclusion, the right ventricular output decreased during right ventricular pacing in fetal lambs with complete AV block, while it was preserved during the left ventricular pacing. Left ventricular pacing might be superior for treating hydropic fetuses with complete AV block.