The less distensible carotid wall in patients with KD compared with that in Cont without major alteration of the lipid profile is likely to be secondary to the changes in arterial walls after a diffuse vasculitis involving noncoronary arteries. These results indicate that the coronary arteries may be predisposed to accelerated atherosclerosis in patients with KD and CAL.
Statistical AnalysisAll numeric data are presented as the means ± SD. Because of differences in the variables and limited sample numbers, statistic analysis was performed using Wilcoxon nonparametric analysis or chi-square analysis when necessary. A p-value less than 0.05 was considered significant. Circ J 2007; 71: 1606 -1609 (Received May 8, 2007 revised manuscript received June 14, 2007; accepted June 22, 2007 Background This study was performed to investigate the frequency and importance of supraventricular arrhythmia and sinus node (SN) dysfunction in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT). Methods and ResultsEight patients with CPVT (mean age: 16.8±8.1 years) underwent an electrophysiological study. SN recovery time (1,389±394 ms) was slightly prolonged, and 4 of 8 patients had abnormal values. Atrial flutter (AF) was induced by low-rate atrial pacing in 2 patients and by isoproterenol infusion in 1 patient. Atrial fibrillation (Af) was induced by isoproterenol infusion in 2 patients. One patient presented with Af during the follow-up period, and 2 of 4 patients with AF/Af presented with increased SN recovery time.Conclusions Patients with CPVT frequently have associated with SN dysfunction, and inducible atrial tachyarrhythmias, which indicate that the pathogenesis of CPVT is limited not only to the ventricular myocardium, but also to broad regions of the heart, including the SN and atrial muscle. (Circ J 2007; 71: 1606 -1609)
The objective of this study was to test the hypothesis that accelerated endothelial dysfunction and the development of premature atherosclerosis are associated with age in subjects with coronary artery lesions after Kawasaki disease (KD). A case-control study was performed at a university hospital that included 35 post-KD subjects across a wide age range (range, 8-42 years) without traditional cardiovascular risk factors and 35 age- and sex-matched healthy control subjects (Cont). Flow-mediated dilatation (FMD) of the brachial artery-induced by reactive hyperemia, intima media thickness (IMT), and elastic modulus (Ep) of the common carotid artery were compared between KD and Cont subjects assessed against age. KD subjects had slightly higher levels of body mass index, lipid profile, and HbA1c than Cont subjects, but the differences were not significant. The mean IMT (p < 0.001), age-adjusted percentage normal IMT (%N IMT; p < 0.0001), and Ep (p < 0.001) were significantly higher in KD than Cont subjects, and the peak FMD% (p < 0.01) was significantly lower in KD than Cont subjects. There were significant correlations between FMD% and age (r = -0.51 p < 0.0001), IMT and age (r = 0.68, p < 0.001), and Ep and age (r = 0.58, p < 0.01) in KD but not Cont subjects. When the difference in FMD% between KD and matched Cont subjects (DeltaFMD%) was plotted against age, no significant relationship was found, although significant correlations between DeltaIMT and age (r = 0.52, p < 0.01) as well as between DeltaEp and age (r = 0.46, p < 0.05) were observed. When we defined values that were +2.0 SD over the mean control values (i.e., %N IMT >or= 120% and/or Ep >or= 50 kPa) as markers of subclinical atherosclerosis, 15 subjects met the criteria. Subjects over the age of 22 years were more likely to have (OR = 16.54, p = 0.0001) subclinical atherosclerosis in this cohort. Our results suggest that endothelial dysfunction and the development of premature atherosclerosis were accelerated in adult post-KD compared to Cont subjects.
The positive effects of wearing a mouthguard have been indicated in various epidemiological surveys and experiments, and their usage appears to be increasing in many sports. However, many preventable sports-related dental injuries still occur even with the use of a conventional mouthguard. We have developed a mouthguard (the Hard & Space mouthguard) with sufficient injury prevention ability (more than 95% shock absorption ability against impact with a steel ball carrying 15.2 kgm 2 /S 2 potential energy) and ease of clinical application. This mouthguard consists of an outer and an inner EVA layer and a middle layer of acrylic resin (hard insert), with a space to prevent contact between the inner surface of the mouthguard and the buccal surfaces of the maxillary front teeth or teeth already weakened through prior damage or treatment. The purpose of this article is to describe the method by which the Hard & Space mouthguard may easily be fabricated. We believe that this new type of mouthguard has the potential to reduce sports-related dental injuries. OutlineThe positive effects of wearing a mouthguard have been indicated in various epidemiological surveys and experiments (1-5), and their usage appears to be increasing in many sports. However, many preventable sports-related dental injuries still occur despite the use of a conventional mouthguard. For example, in a study of NCAA basketball teams, although athletes wearing custom-made mouthguards sustained significantly fewer oral injuries than those who did not, injuries did still occur (1.16injuries per 1,000 athletic exposures versus 3.00 injuries per 1,000 athletic exposures, respectively)(6).It is clear that when the impact force far exceeds the protective capability of the mouthguard, injury will occur. This is particularly true in cases where the wearer has restored(7-9) or endodontically treated(10) teeth as the strength and resiliency of a treated tooth never returns to normal levels. Furthermore, if a dental implant (11) is used, the periodontal tissues become susceptible to secondary injury due to a high elasticity modulus. However, the ordinal impact power in sports is estimated to be smaller than that found in traffic accidents(12). Therefore, most sports-related dental injuries not only in sound teeth, but also in treated teeth are assumed to be preventable by use of an appropriate mouthguard with high shock absorption ability.Many studies have investigated new methods for improving the shock absorption capabilities of mouthguards. These have included use of air cells(13), Sorbothane(14), a metal wire(15), a sponge(16), and a hard material (17)(18)(19). Most of these studies showed that these materials or fabrication methods were effective. However, the results of these studies have not been clinically applied.The ability of a mouthguard to protect against frequent injuries, often caused by a direct blow to the teeth, is believed to depend on 3 factors: 1) its ability to absorb and dissipate the force of impact throughout the mouthguard materi...
We conclude that dobutamine stress echocardiography is a safe and accurate diagnostic method for detection of coronary artery stenosis in Kawasaki disease. Moreover, this is a possible alternative method for patients unable to exercise adequately, even if they are small children.
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