Right Atrial Strain in Preterm Infants With a History of Bronchopulmonary Dysplasia.

BACKGROUND: Few studies have utilized right atrial (RA) strain to evaluate right ventricular (RV) diastolic dysfunction in preterm infants with bronchopulmonary dysplasia (BPD). We aimed to evaluate the associations of RA strain with BPD severity and respiratory outcomes in preterm infants with BPD. METHODS: We retrospectively studied 153 infants with BPD born before 32 weeks of gestational age at CHA Bundang Medical Center. Peak longitudinal right atrial strain (PLRAS) was obtained using velocity vector imaging and compared among infants across BPD severity. Conventional echocardiographic parameters and clinical characteristics were also evaluated. RESULTS: In infants with severe BPD, mean gestational age (27.4 ± 2.1 weeks) and mean birth weight (971.3 ± 305.8 g) were significantly smaller than in those with mild BPD (30.0 ± 0.9 weeks, 1,237.3 ± 132.2 g) and moderate BPD (29.6 ± 1.3 weeks, 1,203.2 ± 214.4 g). PLRAS was significantly lower in infants with severe BPD (26.3 ± 10.1%) than in those in the moderate BPD group (32.4 ± 10.9%) or mild BPD group (31.9 ± 8.3%). Tricuspid E/e' and maximum RA volume index were similar across BPD severity. A decrease in PLRAS was significantly correlated with increased duration of mechanical ventilation duration; however, tricuspid E/e' and maximum RA volume index were not. CONCLUSIONS: Evaluating PLRAS with other parameters in infants with BPD might detect RV diastolic dysfunction. Longer follow-up and larger study populations may elucidate the association between PLRAS and respiratory outcomes in infants with BPD.

Refining Patient-Centered Measures of End-of-Life Care Quality for Children With Cancer.

PURPOSE: There are no existing quality measures (QMs) to optimize end-of-life care for children with cancer. Previously, we developed a set of 26 candidate QMs. Our primary objective in this study was to achieve stakeholder consensus on priority measures. METHODS: We conducted an iterative, cross-sectional electronic survey, using a modified Delphi method to build consensus among clinician and family stakeholders. In each of the two rounds of surveys, stakeholders were asked to rate QMs on a 9-point Likert scale, on the basis of perceived importance. Health care professionals were additionally asked to rate measures on perceived feasibility. After each round, we computed median scores on importance and feasibility of measurement, retaining QMs with median importance scores ≥ 8. RESULTS: Twenty-five participants completed both rounds of the survey. In round 1, participants were asked to rate 26 QMs; nine QMs, including QMs pertaining to health care use, were removed because of median importance scores < 8. Two new measures were proposed for consideration in round 2, on the basis of participant feedback. Following round 2, 17 QMs were ultimately retained. QMs related to symptom screening and palliative care consultation were rated highly in importance and feasibility. QMs related to communication were rated highly important, yet less feasible. Measuring whether a patient's needs were heard by their health care team was rated among the least feasible. CONCLUSION: Childhood cancer stakeholders prioritized QMs pertaining to patient-reported outcomes, deeming measures of health care resource use less important. Future research should seek to develop novel tools for quality assessment to enhance feasibility of implementing priority measures.

High Thermal Stability, High Tensile Strength, and Good Water Barrier Property of Terpolyester Containing Biobased Monomer for Next-Generation Smart Film Application: Synthesis and Characterization.

This research synthesizes novel copolyester (PCITN) containing biobased isosorbide, 1,4-cyclohexandimethanol, terephthalic acid, and 2,6-naphthalene dicarboxylic acid and characterize its properties. The PCITN copolyester was extruded into film, and its performance properties including: tensile strength, Young's modulus, thermal, dimensional stability, barrier (water barrier), and optical (birefringence and transmittance) were analyzed after uniaxial stretching. The films have higher Tg, Tm, dimensional stability, and mechanical properties than other polyester-type polymers, and these performance properties are significantly increased with increasing stretching. This is due to the increased orientation of molecular chains inside the films, which was confirmed by differential scanning calorimetry (DSC), X-ray diffraction (XRD), and birefringence results. Good water barrier (0.54%) and lower birefringence (△n: 0.09) of PCITN film compared to poly(ethylene terephthalate) (PET), poly(ethylene 2,6-naphthalate) (PEN), and polyimide (PI) films, used as conventional substrate materials for optical devices, make it an ideal candidate as performance material for next-generation flexible devices.

Comprehensive Investigation of the Behavior of Polyurethane Foams Based on Conventional Polyol and Oligo-Ester-Ether-Diol from Waste Poly(ethylene terephthalate): Fireproof Performances, Thermal Stabilities, and Physicomechanical Properties.

The chemical recycling of postconsumer poly(ethylene terephthalate) (PET) bottles to produce highly thermally stable polyurethane foam (r-PUF) with excellent flame-retardant (FR) performance could be applied on an industrial scale to create a sustainable recycling industry. The advantage of oligo-ester-ether-diol obtained from waste PET glycolysis is its application in r-PUF, generating a durable foam with excellent fire resistance at rather low loadings of phosphorus-nitrogen FRs (P-N FRs), especially in high moisture environments. Compared to polyurethane foam from commercial polyol (c-PUF), r-PUF is notably more thermally stable and efficient in terms of flame retardancy, even without adding FRs. By incorporating 15 php diammonium phosphate (DAP) as a P-N FR, r-PUF/DAP self-extinguished 5 s after the removal of the 2nd flame application with a limited oxygen index value of 24%. However, for c-PUF, a much higher DAP (30 php) loading did not exhibit any rating in the vertical burning test. The aromatic moiety in the oligo-ester-ether-diol structure strongly enhanced the compressive strength and thermal stability. The positive outcomes of this study also confirmed that the r-PUF/DAP prepared from oligo-ester-ether-diol not only satisfied the fire safety requirements of polymer applications but also contained a high percentage of postconsumer PET, which could help reduce the amount of recycled polymer materials and improve waste management.

Novel Oligo-Ester-Ether-Diol Prepared by Waste Poly(ethylene terephthalate) Glycolysis and Its Use in Preparing Thermally Stable and Flame Retardant Polyurethane Foam.

Rigid polyurethane foam (PUF) was successfully prepared from a novel oligo-ester-ether-diol obtained from the glycolysis of waste poly(ethylene terephthalate) (PET) bottles via reaction with diethylene glycol (DEG) in the presence of ZnSO4·7H2O. The LC-MS analysis of the oligodiol enabled us to identify 67 chemical homologous structures that were composed of zero to four terephthalate (T) ester units and two to twelve monoethylene glycol (M) ether units. The flame retardant, morphological, compression, and thermal properties of rigid PUFs with and without triphenyl phosphate (TPP) were determined. The Tg values showed that TPP played a role of not only being a flame retardant, but also a plasticizer. PUF with a rather low TPP loading had an excellent flame retardancy and high thermal stability. A loading of 10 wt % TPP not only achieved a UL-94 V-0 rating, but also obtained an LOI value of 21%. Meanwhile, the PUF without a flame retardant did not achieve a UL-94 HB rating; the sample completely burned to the holder clamp and yielded a low LOI value (17%). The fire properties measured with the cone calorimeter were also discussed, and the results further proved that the flame retardancy of the PUF with the addition of TPP was improved significantly. The polymeric material meets the demands of density and compression strength for commercial PUF, as well as the needs of environmental development. The current study may help overcome the drawback of intrinsic high flammability and enlarge the fire safety applications of materials with a high percentage of recycled PET.

Sequential Changes in Left Ventricular Systolic Myocardial Deformation Mechanics in Children with Recurrent Kawasaki Disease.

BACKGROUND: Sequential changes in left ventricular (LV) systolic function over time in patients with recurrent episodes of Kawasaki disease (KD) remain unclear. METHODS: Twenty-five children with recurrent KD were retrospectively studied. Using conventional echocardiographic parameters and myocardial deformation analysis, systolic LV function in children in initial and recurrent KD episodes were compared with separate control groups, comprising 15 controls each. Recurrent KD was defined as occurring at an interval of ≥2 months between the initial and recurrent episodes. RESULTS: The interval range between initial and recurrent episodes of KD was 3-103 months. In children with KD, 8 (32%) were <1 year of age at the initial episode, 10 (40%) had a recurrence within 1 year of the initial episode, and 4 (16%) and 5 (20%) were intravenous immune globulin nonresponders in initial and recurrent episodes, respectively. In both the initial and recurrent episodes of KD, the mean LV longitudinal peak systolic ε was all within normal range. However, when compared to controls, mean LV longitudinal peak systolic ε was decreased in patients with KD in the acute phases of both the initial and recurrent episodes. When compared to controls, mean LV longitudinal peak systolic ε was decreased in patients with KD in the convalescent phase of the recurrent episodes. CONCLUSIONS: Subclinical decreases in myocardial systolic deformation, as evidenced by decreased LV longitudinal peak systolic ε, may persist in children in the convalescent phase of recurrent KD; further studies involving larger numbers of patients may be needed for verification.

Long Term Outcomes of Left Atrial Reservoir Function in Children with a History of Kawasaki Disease.

BACKGROUND: Decreased left atrial (LA) reservoir function is reported to be associated with elevated left ventricular (LV) end diastolic pressure and LV diastolic dysfunction. Echocardiographic parameters that reflect LA reservoir function include LA total emptying fraction [(maximum LA volume - minimum LA volume) / maximum LA volume], peak LA longitudinal strain (PLALS) at systole, and LA stiffness index (E/E´/PLALS). We aimed to investigate the long-term outcomes of LV diastolic function in children with a history of Kawasaki disease (KD) (KDHx group) by assessing LA reservoir function. METHODS: Retrospectively, echocardiograms performed at a mean follow-up period of 5 years after the acute phase of KD in 24 children in the KDHx group were compared to those from 20 normal control subjects. LA total emptying fraction, PLALS, LA stiffness index, LV peak longitudinal systolic strain (ε), and strain rate (SR) were evaluated with conventional echocardiographic parameters. RESULTS: The mean age at long term follow-up echocardiography in children in the KDHx group was 6.8 years. Five children (20.8%) had coronary artery lesions (CALs) in the acute stage of KD. No children showed CALs at a mean follow-up period of 5 years after the acute phase of KD. There were no significant differences in the conventional echocardiographic parameters and in LA total emptying fraction, PLALS, LA stiffness index, LV peak longitudinal systolic ε, and SR, between the children in the KDHx and control group. CONCLUSION: LV diastolic function assessed by LA reservoir function parameters at long-term follow-up in children in the KDHx group appears to be favorable.

Clinical Utility of Left Atrial Strain in Children in the Acute Phase of Kawasaki Disease.

BACKGROUND: We aimed to evaluate the diagnostic utility of peak left atrial longitudinal strain (PALS) during left ventricular (LV) systole to differentiate children in the acute phase of Kawasaki disease (aKD) from controls. We also aimed to compare the diagnostic utility of PALS with those of conventional echocardiographic indices of diastolic function. METHODS: Retrospectively measured PALS, LV longitudinal peak systolic strain, and strain rate obtained via velocity vector imaging were compared in a derivation cohort comprising 95 aKD and 67 controls. The utility of PALS in differentiating aKD from controls was compared with those of E/E', E/A, and maximum left atrial volume index (LAVImax). Derived cutoffs from receiver operating characteristic curves were validated in a separate validation cohort comprising 37 aKD and 19 controls. RESULTS: In the derivation cohort, PALS was significantly decreased in aKD as compared with in controls. For differentiating aKD from controls, PALS outperformed E/E', E/A, and LAVImax. However, cutoffs of PALS (≤40% and ≤39%, before and after adjusting for the presence of significant mitral regurgitation and LV systolic dysfunction, respectively), like those of E/E', E/A, and LAVImax, showed low sensitivity and poor discriminative ability for differentiating aKD from controls. In the validation cohort, for differentiating aKD from controls, both cutoffs of PALS showed low sensitivity, like those of E/E', E/A, and LAVImax. CONCLUSION: In aKD, impaired left atrial reservoir function could be detected as decreased PALS. For differentiating aKD from controls, PALS outperforms E/E', E/A, and LAVImax. However, like E/E', E/A, and LAVImax, PALS as a single parameter is limited in its clinical utility to differentiate aKD from controls because of its low sensitivity and poor discriminative ability.

Right Atrial Deformation Mechanics in Children with Adenotonsillar Hypertrophy.

BACKGROUND: Children with significant adenotonsillar hypertrophy (ATH) may show right ventricular (RV) dysfunction. We aimed to evaluate RV dysfunction in such children before adenotonsillectomy by evaluating peak longitudinal right atrial (RA) strain (PLRAS) in systole. PLRAS, electrocardiogram (ECG) and conventional echocardiographic parameters were compared to distinguish children with significant ATH with sleep-related breathing disorder (ATH-SRBD) from controls. METHODS: Fifty-six children (23 controls and 33 children with ATH-SRBD without symptoms of heart failure) were retrospectively studied. Preoperative echocardiograms and ECGs of children with ATH-SRBD who underwent adenotonsillectomy were compared to those of controls. Available postoperative ECGs and echocardiograms were also analyzed. RESULTS: Preoperatively, prolonged maximum P-wave duration (Pmax) and P-wave dispersion (PWD), decreased PLRAS, and increased tricuspid annulus E/E' were found in children with ATH-SRBD compared to those of controls. From the receiver operating characteristic curves, PLRAS was not inferior compared to tricuspid annulus E/E', Pmax, and PWD in differentiating children with ATH-SRBD from controls; however, the discriminative abilities of all four parameters were poor. In children who underwent adenotonsillectomy, echocardiograms 1.2 ± 0.4 years after adenotonsillectomy showed no difference in postoperative PLRAS and tricuspid annulus E/E' when compared with those of the preoperative period. CONCLUSIONS: Impaired RA deformation was reflected as decreased PLRAS in children with ATH-SRBD before adenotonsillectomy. Decreased PLRAS in these children may indicate subtle RV dysfunction and increased proarrhythmic risk. However, usefulness of PLRAS as an individual parameter in differentiating preoperative children with ATH-SRBD from controls was limited, similar to those of tricuspid annulus E/E', Pmax, and PWD.

Progression of Right Ventricular Systolic Dysfunction Detected by Myocardial Deformation Imaging in Asymptomatic Preterm Children.

BACKGROUND: To detect progression of right ventricular (RV) systolic dysfunction (RVSD) in asymptomatic preterm children from infancy to 24-month corrected age, using velocity vector imaging (VVI). METHODS: Retrospective study comparing sequential RV longitudinal peak systolic strain (LPSS) from 24 children born at < 33 weeks of gestational age and 10 term infants recruited as controls, obtained at a mean of 4-month (first exam) and 24-month corrected age (second exam). RESULTS: In 7/24 (29.2%) of preterm children, RV LPSS of < 16%, defined as RVSD, was detected at the second exam; 5/7 of these children had RV LPSS > 16% at the first exam, and only 2/7 of these children had a history of moderate or severe bronchopulmonary dysplasia. CONCLUSION: In asymptomatic preterm children, routine echocardiographic screening using VVI could detect RVSD which could progress from 4-24 month corrected age.

Association of Toll-like receptor 2-positive monocytes with coronary artery lesions and treatment nonresponse in Kawasaki disease.

PURPOSE: Activation of Toll-like receptor 2 (TLR2) present on circulating monocytes in patients with Kawasaki disease (KD) can lead to the production of proinflammatory cytokines and interleukin-10 (IL-10). We aimed to determine the association of the frequency of circulating TLR2+/CD14+ monocytes (FTLR2%) with the outcomes of KD, as well as to compare FTLR2% to the usefulness of sIL-10. METHODS: The FTLR2% in patients with KD was measured by flow cytometry. Serum levels of IL-10 (sIL-10) were determined in 31 patients with KD before the initial treatment with intravenous immunoglobulin (IVIG) and in 21 febrile controls by using enzyme-linked immunosorbent assay. Patients were classified as having coronary artery lesions (CALs) based on the maximal internal diameters of the proximal right coronary artery and proximal left anterior descending coronary artery one month after the initial diagnosis. RESULTS: We found that FTLR2% greater than 92.62% predicted CALs with 80% sensitivity and 68.4% specificity, whereas FTLR2% more than 94.61% predicted IVIG resistance with 66.7% sensitivity and 71.4% specificity. Moreover, sIL-10 more than 15.52 pg/mL predicted CALs and IVIG resistance with 40% and 66.7% sensitivity, respectively, and 73.7% and 76.2% specificity, respectively. CONCLUSION: We showed that measuring FTLR2% before the initial treatment could be useful in predicting CAL development with better sensitivity than sIL-10 and with results comparable to sIL-10 results for the prediction of IVIG resistance in patients with KD. However, further studies are necessary to validate FTLR2% as a marker of prognosis and severity of KD.

Outcomes of Left Ventricular Function According to Treatment Response for a Patent Ductus Arteriosus in Preterm Infants.

BACKGROUND: To evaluate the outcomes of left ventricular (LV) function according to treatment response for a hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants. METHODS: Echocardiograms of 21 preterm infants born at gestational age < 31 weeks obtained at term-equivalent age were retrospectively studied. Among preterm infants with a hsPDA, 9 underwent ligation after failure of pharmacological closure (ligation group) and 6 experienced successful pharmacological closure (medication group). Six preterm infants without hsPDA (no-hsPDA group) were studied as controls. LV peak longitudinal systolic strain (ε) of each infant was retrospectively obtained from echocardiograms using velocity vector imaging, along with neonatal outcomes. RESULTS: Pharmacological closures were attempted at postnatal day 2-3. In the ligation group, the median postnatal age at ligation was 20 days. In the ligation group, LV peak longitudinal systolic ε was significantly decreased at term-equivalent age compared to the other groups. Between the medication and no-hsPDA groups, LV peak longitudinal systolic ε did not differ significantly. Among the neonatal outcomes, infants who experienced necrotizing enterocolitis (NEC) showed significantly decreased LV peak longitudinal systolic ε compared to the infants who did not experience NEC . CONCLUSION: We speculate that in preterm infants with an hsPDA, in cases of medical treatment failure, early PDA ligation at less than 20 days of postnatal age would be beneficial for preserving LV systolic function.

Clinically useful predictors of resistance to intravenous immunoglobulin and prognosis of coronary artery lesions in patients with incomplete kawasaki disease.

BACKGROUND AND OBJECTIVES: The prevalence of incomplete Kawasaki disease (iKD) is progressively increasing. We aimed to retrospectively investigate the predictors of intravenous immunoglobulin (IVIG) resistance in iKD patients and compare them with those of IVIG resistance in complete Kawasaki disease (cKD) patients. We also compared the prognosis of coronary artery lesions (CALs) between the IVIG non-responders and responders in both iKD and cKD groups. SUBJECTS AND METHODS: A total of 234 cKD and 77 iKD patients were treated with IVIG between February 2009 and April 2012. Among these 311 patients, we reviewed the data of 77 iKD patients and 75 age-matched cKD patients. RESULTS: Patients with iKD having an elevated neutrophil count {percentage of segmented neutrophils (SEG%) ≥79.0} were at risk of IVIG resistance, while patients with cKD having SEG% ≥79.25 and serum total bilirubin (TB) ≥0.56 mg/dL were at risk of IVIG resistance as shown by multivariable logistic regression analysis. Fractional changes of laboratory data before and after IVIG treatment showed that Creactive protein (CRP) and N-terminal B type natriuretic peptide (NT-proBNP) levels were significantly elevated in IVIG non-responders of the iKD group, whereas erythrocyte sedimentation rate was significantly elevated in IVIG non-responders of the cKD group. Among the patients who had CALs at 10 months after the start of illness, the z scores of coronary arteries were higher in IVIG non-responders of the iKD group, when compared with IVIG non-responders of the cKD group. CONCLUSION: Elevated SEG%, changes in CRP and NT-proBNP levels may help in early detection of IVIG resistance in patients of the iKD group, which may aid in predicting the prognosis of CALs in these patients. Further studies with a larger number of patients are warranted.

Targeted ultrasound imaging of apoptosis with annexin a5 microbubbles in acute Doxorubicin-induced cardiotoxicity.

BACKGROUND: The aim of this study was to assess the feasibility of targeted ultrasound imaging on apoptosis with annexin A5 microbubbles (A5MB) in acute doxorubicin-induced cardiotoxicity. METHODS: Avidinated and octafluoropropan-filled phospholipid microbubbles were conjugated with biotinylated annexin A5. To confirm the specific binding of A5MB, flow cytometry was performed with hydrogen peroxide induced apoptosis in rat aorta smooth muscle cells incubated with fluorescein-5-isothiocyanate (FITC) labeled annexin A5 and A5MB. Adult male rats were injected intraperitoneally with 5 mg/kg doxorubicin weekly for 3 weeks (n = 5). Control rats were injected with normal saline (n = 5). At 24 hours after the final treatment, triggering imaging was performed 15 min after an intravenous bolus injection of A5MB for washout of freely circulating microbubbles. After echocardiography, the heart was isolated for histological detection of apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay. RESULTS: In the in vitro tests, fluorescence intensity was low for healthy cells and high for apoptotic cells when incubated with FITC-labeled annexin A5 and A5MB. Rats treated with doxorubicin showed significant contrast opacification of the myocardium on contrast echocardiography using A5MB. However, no opacification was observed in control rats. Apoptosis was confirmed by TUNEL assay in doxorubicin treated rats. CONCLUSION: Acute doxorubicin-induced cardiomyopathy based on early apoptosis can be assessed and imaged with targeted ultrasound imaging using A5MB in rats.

Antiproliferative effects of 6-anilino-5-chloro-1H-benzo[d]imidazole-4,7-dione in vascular smooth muscle cells.

It has been known that benzimidazol-4,7-diones have antiproliferative activity against various cancer cell lines. Recently, we have also reported that these compounds strongly inhibited the proliferation of vascular smooth muscle cell (SMC) and human umbilical vein endothelial cells (HUVECs). Although benzimidazol-4,7-diones have important biological activities, the molecular mechanism of the compounds in these cells remains to be elucidated. In order to investigate the anti-proliferation mechanism of the compounds in smooth muscle cell, we selected 6-anilino-6-chloro-5-chloro-1H-benzo{d}midazole-4,7-dione (BUD-0203) among 12 benzimidazol-4,7-dione derivatives and examined its antiproliferative effects. Phosphorylation of the extracellular-signal regulated kinase (ERK) reached a maximal level at 1h after treatment with BUD-0203 and was sustained during the examined period. We also observed that phosphorylation of p38 reached a maximal level at 4h and decreased to control levels after 8h. These results showed that BUD-0203 sustainedly activated MAP kinase pathways in SMC. However, this compound did not induce cell cycle arrest in G1 or G2 phase in these cells. We also demonstrated that BUD-0203 not only induced apoptosis of SMC, but it also strongly inhibited SMC migration induced by platelet-derived growth factor (PDGF) or serum. Taken together, our experiments indicate that benzimidazol-4,7-diones induce apoptosis of smooth muscle cell via simultaneously prolonged activation of MAP kinase pathways including ERK, p38, and JNK/SAPK, similar with the apoptosis mechanism reported previously.

A case of congenital junctional ectopic tachycardia: diagnosis and successful radiofrequency catheter ablation in infancy.

It is difficult to make a definitive diagnosis of congenital junctional ectopic tachycardia (JET) in utero. We report a case in which congenial JET was suspected by fetal M-mode echocardiography. Fetal M-mode tracing of the atria and ventricle clearly showed a gradual acceleration of ventricular activity at the beginning of tachycardia, the warming-up sign of ectopic tachycardia, which was followed by simultaneous contractions of atrium and ventricle. This report also describes successful emergent radiofrequency catheter ablation of congenital JET in infancy with preservation of normal AV nodal conduction for this patient.

Elastic properties of the ascending aorta in young children after successful coarctoplasty in infancy.

BACKGROUND: Based on the hypothesis that vascular dysfunction in the ascending aorta can cause morbidity, we undertook this study on the elastic properties of ascending aorta and left ventricular (LV) function in young children who received coarctoplasty in early infancy. METHODS: Blood pressures (BP) in the right arm and ascending aortic internal diameters determined by M-mode ultrasound at rest and after exercise were measured in 25 patients (mean age, 6.4+/-3 years) and 22 control subjects (mean age, 5.8+/-2.4 years). Ascending aortic stiffness index and distensibility were calculated using BP measurements and ascending aortic internal diameters. In addition, LV parameters (systolic and diastolic function, mass index) were evaluated. RESULTS: Compared with control subjects, patients had increased stiffness index (at rest: 4.87+/-1.94 versus 3.57+/-1.19, P=0.021; after exercise: 4.33+/-1.91 versus 3.2+/-1.26, P=0.034) and decreased distensibility (at rest: 6.90+/-3.15 versus 8.72+/-2.77, P=0.02; after exercise: 5.69+/-2.39 versus 7.88+/-3.44 cm2 dyn(-1) 10(-6), P=0.023). BP and LV parameters showed no consistent differences between the two groups. In patients, distensibility was significantly correlated with systolic BP (at rest: P=0.008; after exercise: P=0.014) and pulse pressure (at rest: P=0.013; after exercise: P=0.001). CONCLUSIONS: This study suggests that vasculopathy of ascending aorta is possible in some young children despite early correction. However, long-term tracking study is needed to clarify the significance of the study.

Synthesis and biological evaluation of benzimidazole-4,7-diones that inhibit vascular smooth muscle cell proliferation.

A series of 6-arylamino-5-chloro-benzimidazole-4,7-diones were synthesized and tested for their inhibitory activity on the rat aortic smooth muscle cell (RAoSMC) proliferation. Among them, 6-arylamino-5-chloro-2-methyl-benzimidazole-4,7-diones exhibited potent antiproliferative activity. Benzimidazole-4,7-dione 2c activated SAPK/JNK signaling pathway in the RAoSMCs.

Therapeutic efficacy of meropenem for treatment of experimental penicillin-resistant pneumococcal meningitis.

With the widespread emergence of antimicrobial resistance, combination regimens of ceftriaxone and vancomycin (C+V) or ceftriaxone and rifampin (C+R) are recommended for empirical treatment of pneumococcal meningitis. To evaluate the therapeutic efficacy of meropenem (M), we compared various treatment regimens in a rabbit model of meningitis caused by penicillin-resistant Streptococcus pneumoniae (PRSP). Therapeutic efficacy was also evaluated by the final bacterial concentration in the cerebrospinal fluid (CSF) at 24 hr. Each group consisted of six rabbits. C+V cleared the CSF at 10 hr, but regrowth was noted in 3 rabbits at 24 hr. Meropenem monotherapy resulted in sterilization at 10 hr, but regrowth was observed in all 6 rabbits at 24 hr. M+V also resulted in sterilization at 10 hr, but regrowth was observed in 2 rabbits at 24 hr. M+V was superior to the meropenem monotherapy at 24 hr (reduction of 4.8 vs. 1.8 log10 cfu/mL, respectively; p=0.003). The therapeutic efficacy of M+V was comparable to that of C+V (reduction of 4.8 vs. 4.0 log10 cfu/mL, respectively; p=0.054). The meropenem monotherapy may not be a suitable choice for PRSP meningitis, while combination of meropenem and vancomycin could be a possible alternative in the treatment of PRSP meningitis.