Jou Kou Wang

Losartan Added to β-Blockade Therapy for Aortic Root Dilation in Marfan Syndrome: A Randomized, Open-Label Pilot Study

OBJECTIVE To assess the tolerability and efficacy of the investigational use of the angiotensin II receptor blocker losartan added to β-blockade (BB) to prevent progressive aortic root dilation in patients with Marfan syndrome (MFS). PATIENTS AND METHODS Between May 1, 2007, and September 31, 2011, 28 patients with MFS (11 males [39%]; mean ± SD age, 13.1±6.3 years) with recognized aortic root dilation (z score >2.0) and receiving BB (atenolol or propranolol) treatment were enrolled. They were randomized to receive BB (BB: 13 patients) or β-blockade and losartan (BB-L: 15 patients) for 35 months. RESULTS In the BB-L group, aortic root dilation was reduced with treatment, and the annual dilation rate of the aortic root was significantly lower than that of the BB group (0.10 mm/yr vs 0.89 mm/yr; P=.02). The absolute aortic diameters at the sinus of Valsalva, annulus, and sinotubular junction showed similar trends, with a reduced rate of dilation in the BB-L group (P=.02, P=.03, and P=.03, respectively). Five patients (33%) treated with BB-L were noted to have a reduced aortic root diameter. However, the differences between the groups regarding changes in aortic stiffness and cross-sectional compliance were not statistically significant. CONCLUSION This randomized, open-label, active controlled trial mostly based on a pediatric population demonstrated for the first time that losartan add-on BB therapy is safe and provides more effective protection to slow the progression of aortic root dilation than does BB treatment alone in patients with MFS. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00651235.

Trends of hypertension prevalence, awareness, treatment and control in rural areas of northern China during 1991-2011

This study aims to investigate the trends in prevalence, awareness, treatment and control of hypertension among rural residents aged 35–74 years in northern China during the country’s rapid economic development from 1991 to 2011. Two surveys, conducted in 1991and 2011, included 2196 and 1939 participants aged 35–74 years from same villages in Ji County, Tianjin of China, respectively. The prevalence of hypertension, adjusted by age and gender using the world standard population in 2000, increased 30% (39.9% vs 51.7%) between 1991 and 2011. The increase was greatest (68%) in women aged 35–44 years. Meanwhile, the prevalence of stage II hypertension increased by 75% overall, with a 4-fold increase in men aged 45–54 years. Although the awareness, treatment and control of hypertension increased significantly during the same period, they remained unacceptably poor. In conclusion, the community-based surveys showed that the prevalence of hypertension in rural residents of northern China aged 35–74 years increased rapidly over the past 20 years, and most dramatically in young women. Efforts in the primary prevention of hypertension, particularly for young women, and promoting education for hypertension awareness, treatment and control are of paramount importance in rural China.

Quality of life in adults with congenital heart disease: biopsychosocial determinants and sex-related differences

Objectives To assess the quality of life (QoL) in adults with congenital heart disease (ACHD) and to explore the sex-related differences and biopsychosocial determinants in an Asian cohort. Design Prospective cross-sectional clinical study. Setting One tertiary medical centre in Taiwan. Patients and methods The QoL of ACHD (≥20 years) was investigated using the Taiwanese version of the QoL questionnaire designed by the WHO, which assesses four domains of QoL (physical, psychological, social and environmental). Personality, psychological distress and family support were assessed using the Maudsley Personality Inventory, Brief Symptom Rating Scale, and the Family APGAR score, respectively. Results A total of 289 patients (age 33.2±10.6 years; 36% men) were studied. ACHD women had significantly lower QoL scores in the physical and psychological domains compared to the age-matched general population, whereas no differences were observed between ACHD men and the general population. Multivariate analysis showed that female gender was associated with poorer physical QoL; the sex difference in the psychological QoL was mediated by psychological distress. Interaction analysis showed that the effect of family support on the psychological domain of QoL may be different by sex. The determinants of QoL varied between different domains. Extroversion personality trait, psychological distress and family support were common determinants of most domains of QoL. Conclusions In ACHD, female gender was associated with poor physical and psychological QoL. The common denominators for QoL were primarily personality trait, psychological distress and family support, but not disease severity.

The vibrational dephasing and relaxation of CH and CD stretches on diamond surfaces: An anomaly

The temperature dependence of infrared absorption spectra of CH and CD on diamond nanocrystal surfaces has been investigated. Phase relaxation was closely examined by analyzing frequency shifts and line broadening in the spectra. Based on the model of Persson and Ryberg [Phys. Rev. B 40, 10 273 (1989)], coupling phonons responsible for the pure dephasing process were found to resonate at ω0≊1200 cm−1 for the CH stretch. By including both the phase and energy relaxation in the linewidth analysis and assuming that energy relaxes via three‐phonon emission, we estimate a pure dephasing time of T*2≊340 ps at room temperature. This value is one order of magnitude larger than the energy relaxation time, T1≊19 ps, measured by Chin et al. [Europhys. Lett. 30, 399 (1995)] on a C(111) single crystal surface. We interpret the anomalous observation to be the result of the high frequency of the coupling phonons. For the CD stretches, however, severe line broadening due to exceedingly rapid energy relaxation disallows a...

Elevated Blood Pressure, Obesity, and Hyperlipidemia

OBJECTIVES To investigate the association of blood pressure elevation with body mass index (BMI) and total cholesterol levels in children who screened positive for proteinuria, glucosuria, and/or hamaturia. STUDY DESIGN From 1992 to 2000, a mass urine screening program was conducted annually for nearly 3,000,000 students aged 6 to 18 years. Of 99,350 students with positive results on urine tests, further examination found 17,548 students (17.7%) had blood pressure elevation. A case-control analysis was performed with randomly selected subjects with normal blood pressure who were frequency matched by sex and age. RESULTS The adjusted odds ratio for blood pressure elevation in obese students was 3.45 (95% CI, 3.20-3.72), compared with students of normal weight. The odds ratio for blood pressure elevation increased to 6.15 (95% CI, 4.12-9.18) for students with a total cholesterol level > or =250 mg/dL and obesity, compared with students with a total cholesterol level <200 mg/dL and normal weight. CONCLUSION This study found a high prevalence of elevated blood pressure in children with abnormal urinalysis results, with a strong association with BMI and total cholesterol level.

Fabrication of large-area hydrophobic surfaces with femtosecond-laser-structured molds

Fast replication of large-area femtosecond-laser-induced surface micro/nanostructures on plastic parts by injection molding is demonstrated. An STAVAX steel mold insert is irradiated by femtosecond laser pulses with linear or circular polarization to form periodic-like nanostructures or nanostructure-covered conical microstructures. It was then used for the process of thermal injection molding. The process provides high-volume manufacturing means to generate hydrophobic enhanced plastic parts, which is expected to be widely used in consumables and chemical/biomedical device industries.

Population-based study of pediatric sudden death in Taiwan

OBJECTIVES We sought to estimate the incidence of pediatric sudden death (SD) in Taiwan. STUDY DESIGN Cases of SD were identified from National Health Insurance databases, 2000 to 2006. RESULTS In the Taiwan pediatric population (age, 0 to 18 years; 5.44 million), the neonatal, infant, postneonatal infant, and under-5 years mortality rates were 3, 6, 2.81, and 8.02 per 1000 live births, and the 1 to 18 years mortality rate was 33 per 100 000 person-years. There were 1528 SDs (59% boys). In the population 1 to 18 years, annual incidence of SD was 2.7 (95% confidence interval, 2.6 to 2.9), ranging from 0.7 (11 to 12 years) to 6.1 (1 to 2 years) per 100 000. Male predominance was noted (3.2 vs 2.2 per 100 000), particularly in groups ages 16, 17, and 18 years. The proportionate mortality ratio by SD ranged from 1.8% to 12.0% (8.9 +/- 2.2%), being lowest in the group ages 11 to 12 years. In infants, the incidence of SD was 0.36 per 1000 live births, and the proportionate mortality ratio by SD was 1.0% and 11.7% in the neonates and postneonatal infants. CONCLUSIONS The incidence of pediatric SD in Taiwan, an Asian country with a child health care index comparable with that in the United States, was within the range from Western reports and indicated male predominance and a nadir around 11 to 12 years.

Comparison of 3 risk estimation methods for predicting cardiac outcomes in pregnant women with congenital heart disease

BACKGROUND Three risk estimation methods for predicting the cardiac outcomes of pregnancy in women with heart disease have been proposed. This study was designed to compare their prediction performance in an Asian cohort with congenital heart disease (CHD). METHODS AND RESULTS This study enrolled pregnant women with CHD who delivered their babies after the 20th gestational week between 1985 and 2011. Of 268 pregnancies in 190 women with CHD, 18 (6.7%) had cardiac complications. The incidence of maternal cardiac events among women with a CARPREG index of 0, 1 or 2 was 3.4%, 27.3% and 100%. The incidence was 2.7%, 8.6%, 11.1%, 40% and 17.6% for those with a ZAHARA score 0-0.5, 0.51-1.5, 1.51-2.5, 2.51-3.5 and >3.5. Among patients with a modified World Health Organization (WHO) classification I, II, III and IV, the incidence of maternal cardiac events was 0%, 4.0%, 12.2% and 25.7%. The c-statistic was 0.732 (95% confidence interval (CI): 0.589, 0.876; P<0.001) for the CARPREG score, 0.737 (95% CI: 0.611, 0.864; P=0.001) for the ZAHARA score and 0.827 (95% CI: 0.745, 0.909; P<0.001) for the WHO classification. CONCLUSIONS All 3 risk estimation methods had good performance in predicting maternal cardiac outcomes; however, the modified WHO classification demonstrated superior discrimination and calibration.

Effect of temperature on the infrared and sum-frequency generation spectra of adsorbates

The dephasing and energy relaxation contributions to the line width in infrared (IR) and sum-frequency generation (SFG) spectra of adsorbates are derived from the generalized master equation approach. Expression for the line shift is also obtained. The anharmonic interaction between the adsorbate and the substrate is expanded in a polynomial in terms of the adsorbate and phonon coordinates, and the dephasing is shown to be mainly due to two-phonon processes, while two-phonon, three-phonon or four-phonon processes can contribute to energy relaxation, depending on the relative values of the adsorbate vibrational and the phonon frequencies. The temperature-dependence data of the IR absorption for C(111):H is found to be consistent with the theory, and the large line width for C(111):D can be accounted for by the efficient two-phonon energy relaxation process which is not available for C(111):H due to the higher adsorbate vibrational frequency for C(111):H.

Characterization of CH stretches on diamond C(111) single‐ and nanocrystal surfaces by infrared absorption spectroscopy

The stretching motions of CH on diamond C(111) single‐ and nanocrystal surfaces have been investigated using Fourier transform infrared spectroscopy. The observations at 800 K indicate a band center of 2835.7 cm−1 and a heterogeneous broadening of 3 cm−1 for the monohydride CH stretch on ideally hydrogen‐terminated C(111)‐1×1 surfaces at 0 K.