Forty male ApoE−/− mice were randomized into Needling-Acupoint Group, Simvastatin Intragastric Administration Group, Needling Nonacupoint Group, and Model Group. Each was fed with high fat diet for 8 weeks since 16 weeks of age; after 8 weeks of intervention, mice were sacrificed and tested for various examinations. Result showed that the body weight, TC, and serum IL-17 in Needling-Acupoint Group decreased. Compared with Model Group, the immunohistochemical expressions of IL-17 in liver tissue were significantly decreased among the other three groups. In conclusion, acupuncture was able to lower the expression of IL-17 level both in serum and liver tissue in ApoE−/− mice, which is helpful to reduce the inflammation and defers the progress from fatty liver to cirrhosis.The aim of the present paper was to observe the effects of needling ST40 and PC6 on IL-17 of ApoE As people's living standards improved, the intake of protein, fat, and alcohol has largely increased, which might lead to metabolic disorders and hyperlipidemia and trigger fatty liver disease. It is estimated that there might be over 160 million adults suffering from dyslipidemia in China. However, long-term use of lipid lowering drugs may result in side effects such as hepatic and renal dysfunction, which endanger human health –4 indicaThe inflammatory cytokines inside and outside the liver play a critical role in chronic liver diseases, including fatty liver. The significant increase of IL-17  can be detected in hyperlipidemic fatty liver and also cirrhosis patients . IL-17 iIn this study, from inhibiting the activity of inflammatory cytokines, we analyzed the effects of acupuncture on IL-17 expression in fat excess liver and provided some basic evidences that the inflammatory damage of hyperlipidemic fatty liver could be restricted through acupuncture.Experimental Animal. Adult male ApoE-gene-knockout mice  were purchased from Vital River Laboratory Animal Technology Co. Ltd., batch number: SCXK (Beijing) 2011-0012.Needling Instrument and Reagent. HuanQiu acupuncture needle, 0.20 × 20 mm, batch number: LOT/BATCH, . Simvastatin, . Anti-IL-17 antibody .−/− mice were randomly and equally divided into four groups: Needling-Acupoint Group; Simvastatin Intragastric Administration Group; Needling Nonacupoint Group, and Model Group. They were kept in SPF class experimental animal room, with temperature 23 ± 2°C, relative humidity 60–65%, a 12-hour light-dark cycle (7:00 am–7:00 pm), and free access to water and food.After normal diet feeding for one week, the ApoEAfter grouping, mice were fed with a high-fat diet, containing 21% fat, and 0.15% cholesterol supplied by Department of Laboratory Animal Science at Peking University, China.Mice in Needling-Acupoint Group were received acupuncture at both sides of ST40 and PC6 with 20 mm needles in diameter. ST40 was performed by straightly inserting a stainless steel needle to a depth of 3 mm and PC6 was obliquely toward the elbow to a depth of 2 mm. The needles were rotated slowly at the speed of 60 rounds per minute to moderate reinforcing and reducing. The entire procedure was completed in 2 minutes without retaining needle, three times a week for 8 weeks. The Simvastatin Intragastric Administration Group received Simvastatin intragastric administration (25 mg/kg/d) for 8 weeks. Needling Nonacupoint Group received nonacupoint needlings (two points in 0.5 cm and 1 cm to the end of tail), each inserted obliquely 1 mm in depth. Mice in Model Group were tied up without acupuncture and bred normally as the other groups.Body weight: measuring body weight before and after the experiment.Serum indicators: TC was detected at the beginning and the end of the experiment and IL-17 was also tested by ELISA.Histopathological examination: some fresh liver tissue was made into frozen section and stained with Oil-Red-O staining as well as Haematoxylin and eosin staining to observe the degree of hepatic steatosis.Immunohistochemical method for the expression of IL-17 in liver tissue. Three portal areas were selected randomly in each staining section and their positive expressions in cytoplasm were assessed by IOD .P < 0.05 for statistical significance, and P < 0.01 for a significant difference.SPSS17.0 software was employed. Comparisons between groups were analyzed by One-Way ANOVA and LSD test. The Data of each group were expressed as mean ± SD, P > 0.05). After 8 weeks of intervention, compared with Model Group, the body weights of Needling-Acupoint Group and Simvastatin Intragastric Administration Group decreased (P < 0.05); The body weight in Needling Nonacupoint Group rose slightly (P > 0.05).In first week of the experiment, the body weight among 4 groups was not significantly different (P > 0.05). After 8 weeks intervention, compared with Model Group, TC of the Needling-acupoint Group and Simvastatin Intragastric Administration Group were lower, but only the Needling-acupoint Group was statistically significant (P < 0.05), and the Needling Nonacupoint Group decreased little. , while Needling Nonacupoint Group went down lightly, with no statistical significance , with no significant difference among the three.Immunohistochemical results showed that the Model Group had strong IL-17 positive cells and brown pigmentation particles, deep in color and large in size. The pigmentation particles in Needling-acupoint Group and Simvastatin Intragastric Administration Group were lighter and smaller compared with Model Group. Unlike Model Group, the particles in Needling Nonacupoint Group were light colored, yet darker than those in Needling-acupoint Group and Simvastatin Intragastric Administration Group . The pos−/− mice' ST40 and PC6 are worth summarizing. (1) The body weight decreased, (2) TC and serum IL-17 lowered, (3) pathological changes in hepatic tissues improved, and (4) immunohistochemical expression of IL-17 in liver significantly reduced.Four of the findings of acupuncture on ApoEThe term “Fatty Liver” does not exist in Traditional Chinese Medicine, but its syndrome relates to accumulation, distention of abdomen, jaundice, hypochondriac pain, turbid phlegm, and so on, involving phlegm, dampness, blood stasis, and mass. Although the disease locates in the liver, the spleen and kidney are also related, and its first pathogenesis is the deficiency of spleen and kidney. The disease is caused by overeating greasy and sweet food and drinking excessively or by invasion of damp-heat epidemically exogenous pathogen, mental disturbance, and long illness, which could lead to the liver failing to maintain the normal flow of Qi, the spleen failing to transport and convert, and phlegm stasis. Furthermore, the kidney deficiency develops, so do the phlegm and blood stasis, afterwards the disease is formed. The treatment mainly focuses on smoothing the liver to strengthen the spleen, reducing phlegm to eliminate dampness, and on eliminating blood stasis to activate blood circulation, concurrently reinforcing the liver and kidney , 11–13.Treating hyperlipidemic fatty liver with acupuncture, its mechanism operates in inhibiting activity of inflammatory factors besides improving insulin resistance, antioxidative stress , 15. In Liver, as an important organ for lipid metabolism, centers on fat intake, oxidation of fatty acid, and the synthesis and secretion of cholesterol, phospholipid, and lipoprotein. When the lipid metabolism disorders, a large amount of fat enters into hepatocytes, which increases fat synthesis. If this grows beyond the hepatocytes' capability in Oxidation and Synthesis of lipoprotein, the lipids have to accumulate in the liver cells, leading to denaturing and swelling of the liver cell, consequently the inflammation, necrosis, and fibrosis of fatty liver. Hyperlipidemia shoulders large part in the formation of fatty liver, which means that it presents the positive correlation to the morbidity of fatty liver. Inflammatory factors inside or outside the liver play crucial role in the incidence of fatty liver and they are part of the early manifestations of the metabolism disorder.+ T lymphocyte subsets (Th17). This kind of proinflammatory factors has strong induction on neutrophils and simultaneously promotes the expressions of various cytokines, such as the expression and release of IL-6, IL-18, and TNF-α, various inflammatory diseases in human body are also related to them [IL-17 could be interpreted as the inflammatory factors mainly produced by CD4 to them . Th17 an to them , 21.−/− mice were used as the model of hyperlipidemic fatty liver, and ST40 and PC6 were acupunctured. It showed that acupunctural intervention on ApoE−/− mice would decrease IL-17 expression in serum and liver tissue. Likewise, serum total cholesterol was decreased. This result echoes Li Li Zhu et al.'s [In this study, ApoEet al.'s  and Li Zet al.'s . With ne−/− mice is capable of lowering TC and might also be able to control the expression of IL-17. In spite of all the limitations of our conclusions, in order to obtain more reliable and objective data, further research is required in a number of directions. For instance, on the topic about the effect and mechanism of regulating lipid metabolism by acupuncture at single acupoint, how IL-17 varies in tissue or serum at different time or the IL-17 involved signaling pathways. Hopefully, future study can not only provide a better understanding of acupoint specificity, but also reflect the development of disease, through immune regulation to guide the treatment.Needling on ST40 and PC6 of ApoE


Endogenous replicative stress could be one trigger leading to tumor initiation: indeed, activation of the DNA damage response (DDR), considered the result of replicative stress, is observed in pre-cancerous cells; moreover, in hereditary breast cancers, almost all of the genes affected relate to the DDR. The most frequently mutated gene in hereditary breast cancers, BRCA1, is essential for homologous recombination (HR), a fundamental process for maintaining genome stability that permits the reactivation of blocked replication forks. Recent studies have established links between DDR and the oncogenic kinase AKT1, which is upregulated in about 50% of sporadic breast cancers. More specifically, the activation of AKT1 shows a deficient phenotype in BRCA1 and HR, revealing molecular similarities between hereditary and sporadic breast cancers. However, these results reveal a paradox regarding the physiological role of AKT1: in non-tumor cells, AKT1 promotes cellular proliferation, but consequently endangers genome integrity during replication if HR is inhibited. Since HR could itself lead to genetic instability, we propose that, under physiological conditions, moderate activation of AKT1 does not inhibit but prevents an excess of HR. The regulation of AKT1 would represent a fine transitory system for controlling HR and maintaining genomic integrity. The coordination of a complex network of metabolic pathways ensures continued maintenance, duplication, and transmission of the genome. These metabolic pathways control the DNA damage response pathway (DDR) and bring together replication, recombination, DNA repair, chromosome segregation, and cell cycle control. However, in some common tightly-regulated processes, such as meiosis and the generation of the immune repertory, this network must allow/favor genetic diversity. Therefore, very precise regulation is necessary to control the equilibrium between genetic stability and diversity, while avoiding genetic instability. A defect in any of the actors in these pathways could result in genetic instability and a predisposition to tumor formation.Certain types of cancers correspond to areas exposed to oncogenic agents (often genotoxic), such as UV radiation for skin cancer or tobacco for throat or lung cancer. However, we emphasize that many cancers develop without substantial exposure to exogenous carcinogens. Therefore, endogenous stresses must play crucial roles in the etiology of cancer. For example, mutating the BRCA1 or BRCA2 genes confers a hereditary predisposition to breast cancer in the absence of exposure to exogenous genotoxic agents.Among endogenous stresses, the spontaneous blocking of replication forks could constitute a risk for spontaneous tumor initiation. In fact, DNA replication forks are regularly blocked by a variety of endogenous stresses that can result from bulging regions in the DNA, regions of hybrid DNA/RNA, and from endogenous metabolism of the cell . FurtherOne example illustrating this point of view is Bloom syndrome, which results in an increased predisposition to spontaneous tumor formation in all tissues, even those that are not directly exposed. Bloom syndrome is caused by inactivation of the BLM protein, a RecQ member of the helicase family, which plays an important role in resolving HR intermediates and controlling blocked replication forks -9. FurthAbout one century ago, Theodor Boveri proposed that tumors arose from clonal development of a single aneuploid cell. He also proposed that this aneuploidy arose from unequal chomosome segregation, due to the presence of supernumerary centrosomes ,18. MoreFinally, it is important to emphasize that the communication between replication and recombination could represent an effective target for anti-cancer therapeutics. In fact, PARP inhibitors generate replicative stress, leading to the formation of DSBs; tumors deficient in HR, such as those with defects in BRCA1 or BRCA2, would therefore be highly sensitive to these inhibitors ,34.At present, the majority of mutations that confer a predisposition to familial breast cancer affect genes implicated in DDR, specifically at the interface of replication and recombination. The most frequently mutated gene, BRCA1, plays an important role in HR ,35. Thisin vitro [The extremely diverse characteristics of tumors grouped in a common category  represent an important obstacle to understanding the underlying molecular mechanisms in an unifying view. However, it is noteworthy that, in a number of studies, the oncogenic kinase AKT1 has been shown to be upregulated in 40-60% of sporadic breast cancers and 40% of sporadic ovarian cancers -40. Furtin vitro . Therefoin vitro . PTEN isin vitro ,44, and in vitro ; ii) mutin vitro ; iii) thin vitro -50; iv) in vitro ,50 and din vitro , which lin vitro ,53.Rencently, several studies have been demonstrating a relationship between AKT1 and DDR. For instance, AKT1 destabilizes p53 via the phosphorylation of Mdm2 ; AKT1 cobrca1−/− cells, without the need for mutating the BRCA1 gene. Moreover, it seems, that a lack of BRCA1 is linked to a constitutive activation of the AKT1 signaling pathway. Because BRCA1 is the most frequently mutated gene in hereditary breast cancers, the relationship between AKT1 and BRCA1 could constitute the missing molecular link between sporadic and familial breast cancers.More directly related to the questions discussed here, the overexpression of AKT1 has been shown to promote the sequestration of BRCA1 and RAD51 to the cytoplasm ,60. ThisConversely, BRCA1 negatively regulates AKT1 by inducing its degradation . In addiEpidemiological studies have concluded that hormone substitution leads to an increased risk for breast cancer -65. BecaThe negative impact of AKT1 on HR and on BRCA1 localization, resulting in a BRCA1-deficient phenotype (without requiring mutation in the BRCA1 gene) suggests that tumors with hyperactivated AKT1 might be sensitive to PARP inhibitors. In agreement with this model, PTEN deficient tumors are hypersensitive to PARP inhibitors . TherefoCip1, and iii) inactivation of p21 and p27 via direct phosphorylation by AKT1 [The inhibition of HR by AKT1 is mechanistically consistent with its role in breast cancer, i.e., under pathological conditions. However, under physiological conditions, this reveals a paradox, notably in response to growth factors, because AKT1 plays a role in cellular proliferation . A numb by AKT1 . BecauseWe must point out that the level and duration of AKT1 activation are very different between physiological and pathological conditions. The activation of AKT1 is moderate and mostly transient under physiological conditions, but is stronger and constant  under pathological conditions, thus accounting for the pathological phenotype. For example, the activation of AKT1 by a growth factor (heregulin β1) or by hormones (IGF-1 and estrogen)  promotes the nuclear localization of BRCA1 ,70. MoreIf HR is an essential process for maintaining genome integrity, it is also a double-edged sword, because it can also generate genetic instability:A - On one hand, defects in HR lead to genetic instability and increased mutagenesis.On the other hand, the genome contains many repetitive sequences, and HR between these sequences can lead to chromosomal rearrangements and therefore genetic instability Figure . Severe B - Unresolved HR intermediates are toxic and can generate genetic instability .vs. the HR intermediates, following the resection step. Moreover, helicases have been shown participate to the maintenance of genome stability by disrupting abortive HR intermediate [Therefore, maintaining genome stability benefits from the avoidance of excess HR initiation. This point is especially crucial during the S phase, because HR occurs preferentially during the S phase ,77. In armediate . HoweverThe previous explanations suggest that in non-stressed cells, the transient and moderate activation of AKT1 avoids excess HR, which could be harmful to genome stability, without completely repressing it. The activation of AKT1 by extracellular factors , which depends on the combination and concentration of these extracellular factors, and of the cellular receptors of these factors, should therefore allow for a subtle and transitory regulation of HR. Under physiological conditions, AKT1 would play a role as a rheostat to precisely regulate HR. For example, in human fibroblasts, the growth factor FGF (fibroblast growth factor) activates AKT1 and represses excess HR without inhibition of HR; in fact, the level of HR never decreases by more than 50% of the level in non-stimulated cells . In contThe characterization of the molecular mechanisms that allow AKT1 to modulate HR, and more generally DNA repair, represents an important focus of future research. Uncovering these processes will allow better understanding of the mechanisms that maintain genetic stability and result in spontaneous tumor development and to optimize cancer therapy.


FGFR2) gene in one Chinese family with Crouzon syndrome and to characterize the related clinical features.The purposed of this study was to investigate the fibroblast growth factor receptor 2 (FGFR2 were amplified by polymerase chain reaction (PCR) and directly sequenced. We performed ophthalmic examinations, including best-corrected visual acuity, slit-lamp examination, fundus examination, Pentacam, Goldmann perimetry, and computed tomography (CT) of the skull.One family underwent complete ophthalmic examinations, and two patients were diagnosed with Crouzon syndrome. Genomic DNA was extracted from leukocytes of peripheral blood collected from the family and 100 unrelated control subjects from the same population. Exons 8 and 10 of FGFR2 missense mutation c.866A>C (Gln289Pro) in exon 8 was identified in the affected individuals, but not in any of the unaffected family members and the normal controls.The two patients were affected with shallow orbits and ocular proptosis, accompanied by midface hypoplasia, craniosynostosis, and clinically normal hands and feet. A heterozygous FGFR2 mutations and polymorphisms have been reported in various ethnic groups, especially in the area of osteology, we report, for the first time, the identification of one new FGFR2 mutation in Chinese patients with Crouzon syndrome.Although  Crouzon syndrome (CS), the most common craniosynostosis syndrome, is an autosomal-dominant inherited disorder, characterized by craniosynostosis, shallow orbits, ocular proptosis, midface hypoplasia, and a curved, beaklike nose -4.Although this disorder is caused by the premature fusion of cranial sutures, leading to the clinical condition of craniosynostosis, which falls under the category of osteology, many patients would choose ophthalmology, due to the ocular proptosis and exposure keratitis. Until now, it was known that craniosynostosis is related to the fibroblast growth factor receptors (FGFRs).Fibroblast growth factors (FGFs) and their receptors (FGFRs) constitute an elaborate signaling system that is involved in the developmental processes of most mammalian tissues. FGFRs are transmembrane proteins consisting of an extracellular ligand-binding domain and composed of three immunoglobulin (Ig)-like domains, a transmembrane domain, and an intracellular domain, which carries tyrosine kinase activity. Ligand-binding specificity of FGFRs depends on the third extracellular Ig-like domain, which is subject to alternative splicing, which generates a variety of receptor isoforms. Three different splice variants, IgIIIa, IgIIIb, and IgIIIc, have been identified ,6.FGFR2 gene located on chromosome 10q26. Over 50 different mutations have been described in Crouzon syndrome [It is known that Crouzon syndrome is usually caused by mutations in the syndrome -12, withsyndrome .This study reported the mutational analysis of one Chinese family with Crouzon syndrome at the gene level, along with related clinical features, and identified one heterozygous mutation.Two patients in one Chinese family  were diaThe affected family was identified at the Zhongshan Ophthalmic Center. One hundred subjects without diagnostic features of Crouzon syndrome, from the same population, were recruited to serve as normal controls. After informed consent was obtained from all participating individuals, following the principles of the Declaration of Helsinki, venous blood samples were collected for genomic DNA extraction from peripheral blood leucocytes, using standard protocols.FGFR2 gene were amplified by polymerase chain reaction (PCR) with primers [NC_000010).Exons 8 and 10 of the  primers  .The superimposed mutant PCR products were subcloned into pGEM-T vector  and sequenced to identify the mutation. Briefly, PCR products were purified by gel extraction, using gel extraction kits  according to the manufacturer's instructions. The purified PCR fragments were ligated into the pGEM-T easy vector , and the resulting plasmids were transfected, by heat shock, into DH5a-competent The Chinese family studied in this report was from the southern area of China. Two individuals, in two successive generations, were found to have the same congenital disease . These pThe visual acuity, of the II-3 patient  as measured by LogMAR, was 0.10 (OD) and 0.10 (OS). The axial lengths of II-3 were 21.99 mm (OD) and 22.13 mm (OS). No abnormalities were detected in the lenses, retinas, choroids, or optic nerves. The eye prominence of II-3 was 19 mm (OD) and 20 mm (OS). The anterior segment photograph is shown in The visual acuity of the III-1 patient  was 0.0 (OD) and 0.0 (OS). Axial lengths were 22.32 mm (OD) and 22.25 mm (OS). No abnormalities were detected in the lenses, retinas, choroids, or optic nerves. The anterior segment photograph is shown in Computed tomography (CT) of the skull of III-1  was perfA heterozygous missense mutation c.866A>C (Gln289Pro) in exon 8  was idenFGFR2 gene that is associated with Crouzon Syndrome: c.866A>C. This mutation, rather than a rare polymorphism in the normal population, is the causative mutation in the family.In this study, we found one mutation in exon 8 of the FGFR2 in Chinese patients; however, it occurred at a hotspot for mutations, which have been found in other ethnic groups [The c.866A>C mutation (Gln289Pro) was identified for the ﬁrst time in c groups .Previously described mutations causing craniosynostosis are widely distributed across the FGFR2 protein, yet the majority localize in some amino acids that form the S-S bond in the IgIIIa/IIIc domain . Severe Kress et al.  found thFGFR mutations included downslanting palpebral fissures, shallow orbits and proptosis, hypertelorism, and strabismus. Okajima et al. [FGFR2 mutation had ocular anterior chamber dysgenesis, including Peters anomaly, optic nerve hypoplasia, scleralization of the cornea, and corectopia in craniosynostosis syndromes. Fortunately, the patients in our study did not have serious ocular disorders.The ocular manifestations in the conditions caused by a et al.  reportedFGFR mutations had congenital cataracts, as in our study.Actually, Chow et al.  and RobiFGFR2 in a Chinese family with Crouzon syndrome. This finding expands the mutation spectrum of FGFR2 and is useful and valuable for genetic counseling and prenatal diagnosis in families with Crouzon syndrome without serious ocular disorders.In summary, this study identified one novel mutation of


Postoperative pain control  has a very important effect on recovery time, hospitalization duration, hemodynamic disorders, bleeding, nausea, vomiting and medical costs.The aim of this study was to investigate and compare the effects of intravenous and rectal acetaminophen on controlling post-adenotonsillectomy pain in children, and duration of their analgesic effects.In this randomized double-blinded clinical trial, 96 children aged 4 - 10 years old with ASA physical status I or II who were candidates for adenotonsillectomy surgery in Amir-al-Momenin Hospital, Rasht, Iran were entered into the study and randomly divided into two equal groups. Anesthesia in both groups was induced injecting fentanyl-thiopental and at racurium; afterwards is of lurane was used to maintain anesthesia. After anesthesia induction, one group received intravenous and the other one, rectal acetaminophen, and were later compared based on CHIPPS criteria.Data analysis indicated a significant relationship between reduction of postoperative pain and the use of intravenous or rectal acetaminophen (P = 0.0001); in group receiving IV acetaminophen, only 10.4% of patients had no pain whereas in group receiving rectal acetaminophen, this number reached 43.8%. Also, on 4 and 6 hour time intervals, pain in rectal acetaminophen receiving group was less than that in IV acetaminophen receiving group (P < 0.05). Demand for additional analgesic medication in rectal acetaminophen receiving group was less than that in IV group (P = 0.0001).Post-operative pain in rectal acetaminophen group was less than that in intravenous acetaminophen group, and rectal acetaminophen group demanded their first additional analgesic medication later. Tonsillectomy with or without adenoidectomy is the most prevalent surgical procedure in children , indicatThis surgery is accompanied by complications like nausea and vomiting, bleeding, and postoperative pain. Pain, if not controlled, is one of the most prevalent complications of tonsillectomy, which especially in children, may result in longer period of recovery and later discharge, eating disorder, and dehydration leading to longer hospitalization duration and continuation of IV fluid intake -6.On the other hand, most patients undergoing this surgery are children, who have lower pain tolerance thresholds and experience earlier restlessness having negative psychological effects on them and their parents . In manySteroids such as dexamethasone are prescribed to control nausea and post-tonsillectomy pain, but complications such as increased blood pressure as well as digestive and hormonal disorders might progress .In some studies, the efficacy of lidocaine, morphine, and ketamine spray were compared , 9. EffiAcetaminophen is a non-opioid analgesic used to reduce mild to moderate musculoskeletal, osteoarticular, menstrual and post minor-surgery pains and head, and toothache. Its analgesic and antipyretic effects are similar to those of aspirin. However, unlike aspirin, it has no anti-inflammatory effects and does not show many side effects of NASIDs like gastrointestinal disorders, anticoagulant effects, and kidney activity .Oral acetaminophen exhibit sun predictable plasma concentration; also, in patients with inability to swallow for example after tonsillectomy or inpatients suffering from nausea, and vomiting, it is of limited use.Rectal form of acetaminophen may not be easily accepted and not induce sufficient therapeutic plasma levels. Intravenous acetaminophen makes minor changes in plasma concentration and induces predictable plasma level; thus, it is more easily accepted by patients, has no special complications during injection, and facilitates the intended treatment .On the other hand, acetaminophen seems to be low risk drug with no prevalent side effects. Of course, consuming high and long-term doses may lead to toxicity and liver damage. Its maximum permissible dose is 4 g, administered as 325-500 mg per 4-6 h in adults and 120-240 mg per 4-6 h in children. Acetaminophen suppository is presented with doses of 125 and 325 mg, and its intravenous form is available in 1 g vials with volume of 6.7 mL .Acetaminophen suppository has long been used for post-tonsillectomy pain reduction and development of its intravenous form in recent years has expanded its analgesic and antipyretic consumption. Given acetaminophen suppository's wide use for post-tonsillectomy pain reduction and considering the few studies addressing the IV form effects, this study was developed to compare the two.Searching the previous articles, we did not find any trial working on administration of rectal or intravenous acetaminophen to relieve post-adenotonsillectomy pain, therefore considering the multiple negative effects of post-operative pain, we decided to compare the duration of their analgesic effects following adenotonsillectomy in Amir-Al-Momenin Academic Hospital, Rasht, Iran.After writing the proposal, receiving justification register number from Vice-Chancellor of research department of Guilan University of Medical Science, and registering the study in Iranian Randomized Clinical Trial Site (IRCT) under No: 201107301138N8, we started this double–blinded clinical trial . This study was conducted on 96 children aged 4-10 years old with ASA physical status I or II, who were all candidates of elective adenotonsillectomy or adenoidectomy (inclusion criteria) from 1390 to 1391. Exclusion criteria included emergency surgery, identified allergy to studied drugs, history of known and active renal, liver, respiratory or cardiovascular diseases, seizure, neurological or neuromuscular disorders, history of chronic pain, or constant the use of analgesic drugs.After explanation of study issues and fulfilling the informed consent, patients were divided into two groups randomly. The simple randomization was done through selection of either A (for IV acetaminophen) or B  card by each patient.The study was organized in a double-blinded design (i.e. neither the patient nor the assessor knew about the administered medication); however, only the prescribing person was aware of the prescribed drug in order to take required measures in case of unfavorable medication complications.After intravenous access line establishment; all the children received normal saline 0.9%, 5-10 cc/kg. All the subjects were monitored using electrocardiography, pulse oximetry, capnography, non-invasive blood pressure measurement, and precordial stethoscope during the surgery.2, and the patients' ventilation was monitored . Surgery was performed by a unique surgical team of Otolaryngologist residents.All the children received 0.01 mg/kg atropine, 2 μg/kg fentanyl, and 0.1 mg/kg dexamethasone as antiemetic. Anesthesia was induced by 3-5 mg/kg sodium thiopental and 0.5 mg/kg at racurium. After endotracheal intubation, anesthesia was maintained by 0.5-0.6% isoflurane, 50% oxygen and 50% NOAfter anesthesia induction, groups A and B received intravenous acetaminophen 10 mg/kg  and rectal acetaminophen 15 mg/kg , respectively. At the end of surgery and after extubation, the patients were transferred to recovery room in tonsil position and put under ECG/POM/NIBP monitoring while receiving 4 - 5 lit/min oxygen via a facial mask.Postoperative pain was assessed based on CHIPPS criteria   and rest (In case the patients were suffering from the pain in spite of full dose acetaminophen administration (CHIPPS > 4), pethidine (0.5 mg/kg) was injected intravenously.Finally, collected data were analyzed by statistical software (SPSS ver.16). Chi square and T-test were used for data analysis. P-value was less than 0.05, was considered assignificant. The study was conducted on 96 children aged 4-10 years old who were candidates for adenotonsillectomy surgery from 1390 to 1391 in the Amir-Al- Momenin Academic Hospital. The patients were randomly divided into two groups receiving IV and rectal acetaminophen, and were supervised in recovery room until 24 hours in ward in terms of pain frequency, time of receiving the first additional analgesic medication, and pain score.Patient characteristics were described in After reviewing the data, no statistically significant relationship was observed between situation of children upon arrival at the recovery and using various forms of acetaminophen  as analgesic drugs (P = 0.207) . Comparing trend of changes in patients' pain score based on CHIPPS criteria, a statistically significant relationship was found between mean pain scores at different time intervals  . HoweverMoreover, using the Chi-square test, a significant relationship was determined between pain  after the end of anesthesia  and using various acetaminophen forms  (P = 0.0001); accordingly, in IV acetaminophen receiving group, only 10.4% of people were pain free, but in rectal acetaminophen receiving group, this amount reached to 43.8%. Consequently, the use of additional painkillers was higher in IV acetaminophen group; resulting in a statistically significant relationship (P = 0.0001).Statistical investigations and t-test, revealed that there was no significant relationship between mean pain score of children in the first hour after receiving acetaminophen by the following the operation in both IV and rectal groups showing pain score of higher than 4 (P = 0.452); however, rectal acetaminophen receiving group were administered additional doses of analgesic later than IV group (mean time of 4.96 versus 3.81 h). In terms of age, weight, and gender, there were no statistically significant relationships for the first hour analgesic consumption . This research studied and compared the duration of analgesic effects of two forms of rectal and IV acetaminophen following adenotonsillectomy. The findings showed no significant difference between children conditions in two groups when entering the recovery. Furthermore, a significant relationship was observed between pain in patients of both groups on 4th and 6th hours after surgery indicating that pain was considerably less in rectal than that in intravenous acetaminophen group. Additionally, the need for analgesic medication  in IV acetaminophen group was significantly higher.In a study on 50 children, aged between 2-5 years old undergoing adenotonsillectomy, Capici et al. found that receiving the first dose of additional analgesic was later in intravenous group, which was different from the findings of the present work. Also, Capici et al. noticed that few people from both groups received more additional analgesic medication in the first postoperative 6 hours compared to 6 to 10 hours after the operation; while such significant difference was not observed in the present study  104 pediatric patients were scheduled for tonsillectomy, advised acetaminophen plus honey or acetaminophen plus placebo. They observed that post-operative honey administration reduced post-operative pain in patients , and found that the need for analgesic medication in the saline group (71%) was higher than that in intravenous acetaminophen group (0%); accordingly, during 24 hour of patients' follow-up, the need for additional analgesics in the placebo group was 2.2 dose compared to 0.5 in IV acetaminophen group .To sum up considering the results of the present study, the difference between duration of analgesia caused by intravenous and rectal forms of acetaminophen in controlling postoperative pain could be probably due to the time difference between the peak plasma concentrations of these two drugs. Slower absorption of rectal acetaminophen (that lasts about 35-45 min), despite of the first hepatic passage, causes this form of drug to reach its peak plasma concentration after about 2-3 h . In contAltogether, according to the results obtained from this study, rate of post-adenotonsillectomy pain in 4th and 6th hours after the surgery in rectal acetaminophen group was less than that in the IV group, and the time for consumption the first additional painkiller in rectal group was delayed. Also, the need for postoperative additional analgesic medication in the rectal acetaminophen group was evidently less than that in IV acetaminophen group.


China has numerous native domestic goat breeds, however, extensive studies are focused on the genetic diversity within the fewer breeds and limited regions, the population demograogic history and origin of Chinese goats are still unclear. The roles of geographical structure have not been analyzed in Chinese goat domestic process. In this study, the genetic relationships of Chinese indigenous goat populations were evaluated using 30 microsatellite markers.S of 0.644) and high population diversity at the species level  were estimated. Significant moderate population differentiation was detected . Significant excess homozygosity (FIS of 0.105) and recent population bottlenecks were detected in thirty-six populations. Neighbour-joining tree, principal components analysis and Bayesian clusters all revealed that Chinese goat populations could be subdivided into at least four genetic clusters: Southwest China, South China, Northwest China and East China. It was observed that the genetic diversity of Northern China goats was highest among these clusters. The results here suggested that the goat populations in Southwest China might be the earliest domestic goats in China.Forty Chinese indigenous populations containing 2078 goats were sampled from different geographic regions of China. Moderate genetic diversity at the population level  into two clusters: the Southwest and Northwest. It also indicated that the current genetic structure was caused by the geographical origin mainly, in close accordance with the human’s migration history throughout China. This study provides a fundamental genetic profile for the conservation of these populations and better to understand the domestication process and origin of Chinese goats. In China, there are about 58 native domestic goat breeds, distributed in different environmental areas including the north pastoral region, the Qinghai-Tibet plateau region, the mixed pastoral-agricultural region, and the north and south agricultural region . During this decade, these domestic breeds represent important genetic resources and have been aroused us more great attention, therefore, conservation of the domestic animal diversity is essential to meet the future needs. Considering the special economic and ecological characteristics, China recently has become concerned about these indigenous animal populations and initiated the conservation programs, such as setting the conservation area, conservation farm and the genebank of genetic resource for special breeds.The archaeological and genetic evidence suggests that goat (Capra hircus) was probably first domesticated in the Fertile Crescent region of the Near East ≈10,000 years ago The study of genetic diversity within and across breeds provides insight into population structure and relationships, and is essential for the conservation of these indigenous breeds In the Western region of China, the Hengduan Mountains, as a natural geographical barrier, block the Qinghai-Tibet Plateau and the Yunnan-Guizhou Plateau, and have the most complex river systems and a profoundly complex and dynamic geological history Since China is a vast subcontinent with the complex geographical situation, Chinese goat breeds exhibit enormous variations in fecundity; production of meat, milk, and fiber; draughtability; disease resistance; and heat tolerance. In addition, many previous studies of Chinese goats were conducted in the limited number of samples within fewer breeds and regions In total, 2078 animals representing 40 goat breeds were studied /Food and Agriculture Organization of the United Nations (FAO) working group: CSRD247, ETH10, MAF209, OARAE54, SRCRSP15, SRCRSP3, SRCRSP5, TGLA53, DRBP1, ILSTS087, INRABERN172, MAF065, MCM527, OARFCB20, SPS113, SRCRSP8, ILSTS029, INRA023, INRA063, INRABERN185, P19(DYA), SRCRSP23, SRCRSP9, TCRVB6, BM6444, ILSTS011, ILSTS005, SRCRSP7, OARFCB48, MAF70.The 30 microsatellite markers were amplified in multiplex polymerase chain reactions (PCRs) using fluorescence-labelled primers. PCR products had been run on PAGE-SDS gel to check the real size, and separated using an ABI-PRISM 3100-Avant Genetic Analyzer  according to manufacturer recommendations. Allele sizes relative to an internal size standard (GS400HD) were determined using GENEMAPPER 3.5 .O), expected (HE) heterozygosities average genetic diversity (HS) both within populations and among populations and total gene diversity (HT) were obtained from the FSTAT 2.9.3 software For each microsatellite locus, the mean number of alleles, observed heterozygosities , two-phase model of mutation (TPM) and the stepwise mutation model (SMM), and the allele frequency distribution mode shift analysis were performed using BOTTLENECK version 1.2.02 To estimate whether of the reduction in the effective population size, the Wilcoxon’s signed-rank tests (one-tailed) with the null hypothesis, HAccording to the geographic origin of these populations, a hierarchical analysis of variance was performed to partition the total genetic variance into components due to within-individuals, among-populations and among individuals within populations’ differences. Variance components were used to compute the fixation indexes and their significance was tested using a non-parametric permutation approach To illustrate the genetic divergence among the breeds, the Reynolds distances were estimated by the PHYLIP package to reconstruct the neighbor-joining consensus tree, with the bootstrapping of 1,000 replicates, and the dendrogram was depicted using the software package TreeView version 1.4.0 To study population genetic structure and to detect the most likely number of clusters (K) in the data set, the STRUCTURE 2.3 software was performed S) among the locus was 0.644 and ranging from 0.237 to 0.820. Additionally, the average overall genetic diversity (HT) estimate among the populations was 0.737, ranging from 0.274 to 0.907. As shown in E per population ranged from 0.5070 in DYS to 0.7378 in FNB. HO ranged from 0.4336 in DYS to 0.6730 in HNN. It is observed that the FNB population was the highest one in MNA, AR and HE among all the 40 populations, showing the higher genetic variation. In contrast, the DYS population showed the lower genetic variation than other populations. Additionally, it is obtained that HO was lower than HE in all the populations analyzes in this study. As shown in IS over all the loci was found to be significant in thirty-eight populations except CDM and LLH, whereas the FIS within populations was significant for twenty loci , TCRVB6, BM6444, ILSTS011, SRCRSP7)  . These rAccording to Wilcoxon’s signed-rank test performed using BOTTLENECK, thirty-six populations  showed a significant deviation (excess heterozygosity) from the mutation-drift equilibrium under the SMM , whereas under the IAM and TPM, all the 40 goat populations showed a significant deviation from the mutation-drift equilibrium, suggesting that decreased in the population size had occurred due to a bottleneck effect . The modST value of 0.129 detected, ranging from 0.066 (INRABERN172) to 0.273 (INRA023). The measure of the relative genetic differentiation for the pairwise FST values between populations was found to be significant , FIT = 0.223 (−0.028–0.601) and FST = 0.132 (0.072–0.293). Breeds estimated of FIS were computed using FSTAT  and ranged from 0.018 to 0.21  was not straightforward because log-likelihood values for the data conditional on K, and lnP(x|K), increased progressively as K increased, as shown in K = 2 to 40, the largest change in the log of the likelihood function (△K) was when K = 4. The △K value obtained was 19.90 at K = 3, 120.50 at K = 4, 0.78 at K = 5, 2.59 at K = 6, and 0.52 at K = 7. Changing the assumptions of an “equal alpha for each population” and “correlated allele frequencies” could not change the final result. The proportion of individuals in each population assigned into four clusters (or gene pools) is shown in K = 2 indicated that there was a clear transition from the West China populations (green) to the East China populations (red). At K = 3, the West China populations had been divided into two clusters, the Southwest China populations (green) and the Northwest China populations (blue). At K = 4, the △K value reached a maximum, and the Southwest China populations subsequently had been divided into the Southwest China populations (green) and South China populations (yellow). It was suggested that gene pool 1(Southwest China) included nine populations: LLS, MGS, YLS, ZTS, JCS, GSS, FQH, GZS and LNS, and that this pool was most abundant in the Yunnan-Guizhou Plateau, except LNS in the Liaoning Province. Similar results were also found in the NJ-tree and PCA analysis. The gene pool 2 (South China) surrounded the Yunnan-Guizhou Plateau and reached the southernmost of China along the Pearl River, and that this pool included six populations: CDM, GLM, LLY, LZS, HND and DAS. Gene pool 3(Northwest China) was predominant on the northern of Qingling Mountains –Huaihe River Line which represented the geographical boundaries of North and South in China, especially Eastern China, and encompassed fourteen populations: MGR, CDS, XJS, XZS, HXR, ZWS, SNB, BJS, FNB, HNN, HWS, JNQ, YMH and LBB. Gene pool 4 (East China) was predominant on Yangtze River hills and encompassed twelve populations: LLH, THS, CJB, CDB, GFS, GXS, MTS, YCB, XDH, FQS and DYS. However, the populations: YMH and LBB, which located at the Shandong Province, showed a mixture of the four ancestral genetic resources  and high population diversity (HT = 0.737) at the species level. Our results showed that the genetic variation estimated by MNA and AR in Chinese indigenous populations was lower than that of European breeds which was 5.2–9.1 MNAs, with an average of 7.1 and 6.1–7.9 AR values, but was higher than that of EastAsian indigenous populations which was 2.5–7.6, with an average of 5.8 and 2.3–6.89 AR values In the current study, we attempted to estimate the genetic diversity and differentiation of the 40 China indigenous goat populations using 30 microsatellite markers. It was detected that the moderate genetic diversity at the population level , similar to the EastAsian indigenous populations with the mean value of 0.13, but higher than that of the European breeds, which had a mean value of 0.07 ST values than the mean, suggesting that these goat populations showed higher genetic differentiation than other populations. The regions of these Eastern populations were located farthest from the goat domestication center of West Asia.Significant population differentiation was indicated by the high FIn the present study, Bottlenecks occurred in thirty-six populations, except CDS, XJS, BJS and YMH, which were located in North of Qinling-Huaihe Line. Our results indicated that population bottleneck had happened over the entire distribution of Chinese goats. It is the first report to analysis the bottleneck in Chinese indigenous goats using 30 microsatellite markers. The results of Bottleneck analysis of Chinese goats would help us to understand the developing progress of these populations, and provide new sights to establish the conservation programs to maintain the high genetic diversity of these indigenous goat populations.IS value over all the loci  in the Yunnan province.In addition, as a geographical boundary in China, the Qinling Mountains-Huaihe River Line which divides the regions of China into the South and the North, and generates the difference between the South and the North: the climate, agricultural forms, geographical features as well as the human’s habits. In the present study, our results clearly demonstrated that the Qinling Mountains-Huaihe River Line also had separated the West goat populations into two clusters: the Southwest cluster and the Northwest cluster. Although with some admixture to the Northwest China population, our results indicated that the LNS located in the north of China had been clustered into the Southwest China populations, inconsistent to other results Previous genetic studies and archaeological data had revealed goats were probably first domesticated in the Fertile Crescent region of Near East around 10,000 years ago In our study, we estimated that the goat populations in Southwest China might be the earliest domestic goats in China, even in Asia. The reasons contributed to the result are as following. Firstly, the results of genetic structure analysis by STRUCTURE demonstrated that, the Northwest China populations combining with the Southwest populations had been clustered into the West populations, when K was 2. However, the East China populations had been clustered into a single clade. Similar result was also observed in the NJ-tree. In other words, if the goat populations in Southwest China were not the earliest domestic goats, the Northwest China populations would be an independent cluster, while the Southwest China and East China populations would be another cluster, however, it is inconsistent with the present results. The observation that the genetic diversity of Northwest China populations was higher than the Southwest and the East China populations provided additional evidence to support this hypothesis.Secondly, the domestication process of livestock is closely associated to the human activities Thirdly, the Southwest China has the most complex river systems and a profoundly complex and dynamic geological history, and it also is rich of biodiversity Certainly, the results of microsatellite markers don’t have the convincing evidence to support the hypothesis completely, due to the low density of microsatellite markers in the DNA nuclear. Therefore, it is necessary to explore the origin of Chinese goats through a detailed study of goats in Asia using the archeological records, ancient DNA, wild goat samples from more locations, and more accurate molecular methods, such as the genome-wide SNP array and mitochondrial DNA.In this study, we had analyzed the diversity of forty Chinese domestic goat breeds which were come from all the regions of China, from Qinghai-Tibet plateau region to the north and south agricultural region, and these breeds also had special purpose, such as meat, cashmere, fur and so on. The results here provide valuable information to help understanding the genetic structure of these important indigenous goats for future genetic improvement and setting the conservation program in China. The information of this study also would help to formulate the species-specific breeding programs to maintain the genetic characteristics and to reduce unnecessary inbreeding or gene flow among populations. The present work presents the first substantial analysis of the diversity of Chinese domestic goat microsatellite markers and provides information about the genetic structure of goat breeds within this important region, and thus insights into their genetic history. With the introduction of foreign species, these indigenous goat populations have been threatened, some of which have nearly disappeared or admixed with the exotic species. Assessment of the genetic status of Chinese indigenous goat population is essential for the establishment of the conservation programs.Table S1The information of the 40 Chinese indigenous goat populations. The information included the name, number and phenotypic characteristic of these goat populations, even the geographical location in China.(DOC)Click here for additional data file.Table S2Bottleneck analysis of the 40 Chinese indigenous goat populations.(DOC)Click here for additional data file.Table S3ST values  and DA genetic distance  between 40 goat populations.Pairwise F(DOC)Click here for additional data file.


To the Editor: Delhi, in the northern part of India, has had outbreaks of dengue caused by various dengue virus types in 1967, 1970, 1982, 1988, and 1996  of 42 samples processed for virus isolation . Of the All previous outbreaks in Delhi have occurred during the monsoon (rainy) season between August and November and subsided with the onset of winter. We recently reported the results of serologic testing during the 2003 outbreak, which also occurred from September to November, with a peak in mid-October 2003 (Dengue virus types 1, 2, and 3 have all been isolated during previous dengue outbreaks in Delhi, but a particular type has always predominated. During the 1996 outbreak of DHF/DSS, we had 26 isolates of dengue virus type 2, but only 1 isolate was identified as dengue type 1 (


To evaluate the association between physical activity changes in those aged 11 to 15 years and lung function at age 15 years.The original cohort comprised 5,249 hospital-born children during the calendar year of 1993 in Pelotas, Brazil. In 2004–2005 and 2008–2009, all cohort members were sought for follow-up visits. Self-reported physical activity was measured at ages 11 and 15 years. At the 2008–2009 visit, when participants were 15 years old, spirometry was performed. Linear regression was used, and all analyses were stratified by sex.β = 3.573 ) and forced expiratory volume in the 6 seconds  than those who were inactive in the two periods. Also in girls, those who became active at 15 years of age had higher peak expiratory flow than those who were inactive at 11 and 15 years of age. In boys, only those who became inactive in leisure time had worse peak expiratory flow  than boys who were inactive at ages 11 and 15 years.Of the 5,249 original members of the cohort, 4,325 were located at 15 years of age, and spirometry was performed on 4,010 members. Forced expiratory volume in 1 second was not associated with physical activity. In girls, those who were active in leisure time in both periods have better percent-predicted forced vital capacity (Self-reported leisure-time physical activity was associated with better effort-dependent lung function parameters, particularly among girls. Adolescent girls were more likely to have better parameters of lung function at 15 years of age if they were active at age 11 and 15 years, particularly in comparison with those who were inactive in the two periods. Girls who became active at 15 years of age had also higher parameters of lung function such as PEF than those inactive at 11 and 15 years of age.Global public health priorities have been shifting in recent decades. Contributing factors include the aging of the population, rapid urbanization, industrialization, and globalization, among others. The combination of these factors has led to an increase in unhealthy lifestyles In a literature review, Lucas and Platts-Mills 1] and forced vital capacity [FVC]) among 8-year-old children who used to swim at the ages of 4 and 7 years.Part of the inconsistency observed in the literature is owing to the plethora of cross-sectional studies Both physical activity and lung function have been shown to track from adolescence to adulthood Hospital-born children in the city of Pelotas, Brazil, in the calendar year of 1993  are part of a birth cohort study. Of 5,265 mothers who gave birth that year, 5,249 agreed to take part. In 2004–2005 and 2008–2009, all cohort members were sought for follow-up visits, and questionnaires were administered by trained interviewers at the participant's household. At the 2008–2009 visit, when participants were, on average, 15 years old, maximally forced expiratory volume maneuvers were performed. Methodological details about the spirometric tests are available elsewhere 1 and FVC to 150 mL (91.2% pre-bronchodilator [BD] and 90.0% post-BD). Outcome variables included FVC and FEV1, both expressed as percentage of predicted value 6) and the peak expiratory flow (PEF).In summary, adolescents performed the tests while they were seated, with a nose-clip and a disposable 500-mL spacer. A battery-operated portable spirometer was used . Standard exclusion criteria were used, including thoracic, eye, or abdominal surgery within the previous 3 months; heart conditions; or hospital admissions in the previous 3 months. We also excluded pregnant girls and those who reported being in treatment for tuberculosis. Based on all these criteria, 64 adolescents were not eligible for spirometry. The mean of seven maneuvers was performed by the adolescents; 12% of them were asked to perform more tests (up to 15) to produce three acceptable curves Physical activity was assessed through self-report, both at 11 and 15 years of age. The questionnaire covered practice of leisure-time physical activity, including sports practice inside and outside school, and commuting physical activity. According to current global physical activity guidelines, a cutoff point of 300 min/wk was used to classify adolescents as physically active or not p values showing interaction between sex and physical activity at predicting lung function, all analyses were stratified by sex. Data were analyzed using Stata 11.0 .Confounding variables included family income, maternal schooling, birth weight, maternal smoking during pregnancy, maternal height, adolescent height, wheezing in past year, allergy status, body mass index, and asthma medication past 2 weeks. Because the association between adolescent height and lung function is known to be nonlinear, we used both quadratic and logarithm transformation in the models. Results were similar, and therefore only the latter are presented. Following statistically significant All phases of the 1993 Pelotas (Brazil) Birth Cohort Study obtained approval from certified institutional review boards. Parents or guardians provided written informed consent in all follow-up visits, and adolescents provided verbal consent.Of the 5,249 original members of the cohort, 4,325 were located at 15 years of age, corresponding to a total follow-up rate of 85.7%, taking into account those known to have died in the period. Of the 4,325 adolescents located, we obtained valid spirometric data for 4,010 (51% girls).1 was .53 L higher in boys than girls. Mean pre-BD FVC was .71 L higher among boys than girls. In terms of percentage of predicted values, the mean FEV1 was 95.6 among boys and 107.9 among girls, whereas mean FVC was 103.2 among boys and 108.4 among girls. FEV6 and PEF were also higher among boys than girls.Among boys, 20% were inactive in both follow-up visits, whereas the equivalent proportion among girls was 46%. On the other hand, 38% of the boys and only 15% of the girls were active in both follow-up waves. In terms of leisure-time physical activity only, 30% of the boys and 61% of the girls were inactive at both time points. Also, 26% of the boys and only 7% of the girls were active in both visits. Mean pre-BD FEV6 values as compared with those who were inactive at 11 and 15 years. FEV1 was reduced among girls who were inactive and became active, as well for those who were active and became inactive from 11 to 15 years. Girls who were categorized as active in terms of leisure-time physical activity, at both ages, had an increase in FEV1, but it was not statistically significant. These findings were nearly the same in the unadjusted and adjusted analysis , and therefore a better clinical measure that indicates obstruction The fact that physical activity in our cohort was related to PEF, FEVLeisure-time physical activity was generally more strongly associated with lung function parameters as compared with total physical activity. This is also expected. We have previously found that commuting physical activity in this cohort is highly associated with socioeconomic status Comparing our data with previous studies is challenging for several reasons. First, the prospective design used is rare. Second, measures of physical activity used in the literature are highly inconsistent 1 or FVC 1 and FVC in girls but not in boys A longitudinal study from The Netherlands with individuals aged 13–27 years found that physical activity was inversely related to PEF but directly related to FVC A possible relationship between physical activity and lung function might be explained by environmental, behavioral, and genetic factors In summary, we found that physical activity in adolescence is related to improved lung function, particularly among girls. Both physical activity and lung function are related to noncommunicable diseases, which represent the largest share of the burden of disease in the world


Knowledge on the epidemiology of non-hip fractures in Spain is limited and somewhat outdated. Using computerized primary care records from the SIDIAP database, we derived age and sex-specific fracture incidence rates for the region of Catalonia during the year 2009.The SIDIAP database contains quality-checked clinical information from computerized medical records of a representative sample of >5,800,000 patients . We conducted a retrospective cohort study including all patients aged ≥50 years, and followed them from January 1 to December 31, 2009. Major osteoporotic fractures registered in SIDIAP were ascertained using ICD-10 codes and validated by comparing data to hospital admission and patient-reported fractures records. Incidence rates and 95% confidence intervals were calculated.In total, 2,011,430 subjects were studied (54.6% women). Overall fracture rates were 10.91/1,000 person-years (py) [95%CI 10.89–10.92]: 15.18/1,000 py [15.15–15.21] in women and 5.78/1,000 py [5.76–5.79] in men. The most common fracture among women was wrist/forearm , while among men it was clinical spine . All fracture rates increased with age, but varying patterns were observed: while most of the fractures  increased continuously with age, wrist and multiple rib fractures peaked at age 75–80 and then reached a plateau.Our study provides local estimates of age, sex and site-specific fracture burden in primary health care, which will be helpful for health-care planning and delivery. A proportion of fractures are not reported in primary care records, leading to underestimation of fracture incidence rates in these data. Osteoporosis is a common public health problem, due to its association with fragility fractures. In the year 2000, approximately 9 million fractures occurred in the world, of which 1.6 million were hip, 1.7 were wrist/forearm and 1.4 million were clinical spine fractures .The epidemiology of osteoporotic fractures in Spain is only partially known: several authors have studied and reported the age, sex and geographical distribution of hip fracture -6 and itWe therefore estimated age and sex-specific fracture incidence rates as registered in primary care electronic medical records (SIDIAP database) for the population of Catalonia aged 50 years or older during the year 2009. Secondly, we assessed the completeness of the fracture coding in this database, when compared to hospital data (for hip fractures) and to patient reports .General practitioners (GPs) play an essential role in the public health care system of Spain, as they are responsible for primary health care, long-term prescriptions and specialist and hospital referrals. The Spanish public health care system covers more than 98% of the population. The data in this study was obtained from the SIDIAP Database, comprised of electronic medical records of a representative sample of patients attended by GPs in Catalonia (North-East Spain), covering a population of more than 5.8 million patients  from 274 primary care practices with 3,414 participating GPs. The SIDIAP data comprises the clinical and referral events registered by primary care health professionals (GPs and nurses) and administrative staff in electronic medical records, comprehensive demographic information, prescription and corresponding pharmacy invoicing data, specialist referrals, primary care laboratory test results, and hospital admissions and their major outcomes. Health professionals gather this information using ICD-10 codes, and structured forms designed for the collection of variables relevant for primary care clinical management, such as country of origin, sex, age, height, weight, body mass index, tobacco and alcohol use, blood pressure measurements, blood and urine test results. Only GPs who meet quality control standards can participate in the SIDIAP database . EncodinAll patients aged ≥50 years registered in the database in 2009 were eligible for the current study.Fractures registered in 2009 in the SIDIAP database were identified using medical codes for a list of skeletal sites of fracture . The 95% confidence intervals were estimated using the delta method, as proposed by Kirkwood et al. .For the validation of fracture codes in the SIDIAP database, crosstabs were used, with rows indicating SIDIAP fracture (yes/no) and columns indicating either ARTPER fracture (yes/no) or CMBD fracture (yes/no). Specificity, sensitivity and predictive values were estimated for each of the fracture sites studied.All these analyses were carried out using Microsoft Excel 2008 for Mac, SPSS for Mac version 18.0 and R for Mac version 2.9.1.SIDIAP provided purely observational data for this study. It obtained approval from the SIDIAP Scientific Committee, responsible for reviewing protocols for scientific quality. The ARTPER cohort study was approved by the local Ethics Committee (IDIAP Jordi Gol i Gurina). Informed consent was obtained from all the participants, and the recommendations of the World Medical Association Declaration of Helsinki were followed throughout the study.The SIDIAP database included information on 5,805,093 people in the year 2009, of whom 2,011,430 were 50 years or older, and therefore eligible for this study. Of these, 1,098,386 (54.6%) were women, and the mean (standard deviation) age of the study population was 66.9 (12.1) years. Study participants were then followed up for a median of 0.997 years (interquartile range 0.996 to 0.999), with only 0.13% lost to follow-up , consistent with some degree of under-reporting of fracture events in primary care. Conversely, the data in SIDIAP are highly specific , and thus highly reliable for a confirmable fracture. All these values are, as expected, higher for hip than for wrist or clinical spine fracture.Although Spain has been identified by Kanis et al.  as a couCauses of under-coding of fractures in primary care medical records can vary, but may include non-reporting of high-energy trauma fractures  and use of private health care services.The main limitations of our data are the lack of individual validation for each fracture identified, as well as on the methods used for fracture diagnoses and on the nature of the impact that caused these fractures (high impact trauma versus fragility fractures). However, hip fractures were validated using hospital admission data and a sample of other fractures  were confirmed by patient-reported data within a prospective cohort study including almost 3,500 patients. On the other hand, this is the first population-based study to describe the burden of osteoporotic fractures in the Primary Health Care system of Catalonia. In addition, the diversity of skeletal sites validated in this study is much greater than in any previous study in Spain.We have demonstrated that the overall burden of osteoporotic fractures in the Catalan Primary Health Care setting is remarkable, with an incidence of almost 11/1,000 pyar. In a representative primary care practice, where each GP has on average 1,500 patients and about 40% of them are aged 50 years or older, each physician would be seeing 6 to 7 new osteoporotic fractures per year. In general terms, because older patients and women are at a higher risk of suffering fragility fractures, practices covering aged populations could potentially be seeing a much higher number of fractures.We have also shown that medical records from the SIDIAP database are a valuable source of data for the investigation of the epidemiology of osteoporotic fractures, with some under-reporting  but high specificity and predictive values when compared to hospital and cohort data.Prox Hum: Proximal humerus.All the authors report no conflicts of interest regarding this piece of work.APG, CCA, XN, ADP and DPA contributed to study design; APG, CCA, FFA, MA, JMBD, DML and DPA carried out the acquisition of data; APG, CCA and DPA drafted the manuscript; all the authors had access to the data and critically reviewed the manuscript before submission. All authors read and approved the final manuscript.This study has received partial funding from the Ministerio de Sanidad, Política Social e Igualdad (Government of Spain), through the Ayudas a la Investigación Independiente 2010 scheme: the CUTE-REINA-BIS Study; reference EC10-080.“4a Convocatòria d’una estada a una Unitat de Recerca de l’IMIM o de l’ASPB”). The Internal Medicine Department and the URFOA IMIM receive support from the RETICEF .Daniel Prieto-Alhambra receives support from the IDIAP Jordi Gol and Institut Catala de la Salut (The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/13/79/prepubICD-10 Codes used to identify fractures in the SIDIAP database.Click here for file


In a classical study, Durkheim noted a direct relation between suicide rates and wealth in the XIX century France. Since that time, several studies have verified this relationship. It is known that suicide rates are associated with income, although the direction of this association varies worldwide. Brazil presents a heterogeneous distribution of income and suicide across its territory; however, evaluation for an association between these variables has shown mixed results. We aimed to evaluate the relationship between suicide rates and income in Brazil, State of São Paulo (SP), and City of SP, considering geographical area and temporal trends.Data were extracted from the National and State official statistics departments. Three socioeconomic areas were considered according to income, from the wealthiest (area 1) to the poorest (area 3). We also considered three regions: country-wide (27 Brazilian States and 558 Brazilian micro-regions), state-wide (645 counties of SP State), and city-wide (96 districts of SP city). Relative risks (RR) were calculated among areas 1, 2, and 3 for all regions, in a cross-sectional approach. Then, we used Joinpoint analysis to explore the temporal trends of suicide rates and SaTScan to investigate geographical clusters of high/low suicide rates across the territory.Suicide rates in Brazil, the State of SP, and the city of SP were 6.2, 6.6, and 5.4 per 100,000, respectively. Taking suicide rates of the poorest area (3) as reference, the RR for the wealthiest area was 1.64, 0.88, and 1.65 for Brazil, State of SP, and city of SP, respectively . Spatial cluster of high suicide rates were identified at Brazilian southern (RR = 2.37), state of SP western (RR = 1.32), and city of SP central (RR = 1.65) regions. A direct association between income and suicide were found for Brazil (OR = 2.59) and the city of SP (OR = 1.07), and an inverse association for the state of SP (OR = 0.49).Temporospatial analyses revealed higher suicide rates in wealthier areas in Brazil and the city of SP and in poorer areas in the State of SP. We further discuss the role of socioeconomic characteristics for explaining these discrepancies and the importance of our findings in public health policies. Similar studies in other Brazilian States and developing countries are warranted. Suicide rates vary widely between and within countries, since it is a complex phenomenon, related to several singularities. Some general demographic risk factors are known as sex (men), age-strata  and ethnicity (European). Other factors contribute to suicide and include: genetic loading, personality characteristics , psychiatric and physical disorders , life events , social isolation, availability of means, substance abuse, economic condition ,2.The highest suicide rates are in Eastern Europe (former USSR countries) and the lowest rates, in some Latin American countries ,3. DispaThe first population-based suicide studies date from the early nineteenth century Europe, highlighted through the work of Jean-Pierre Falret, Esquirol disciple ,8. LaterIn this context, several methodological aspects hinder analysis of this phenomenon. For instance, different study designs have been used to evaluate suicide rates in relation to socioeconomic factors, although most have been ecological. There are also multiple indexes that can be used to evaluate socioeconomic characteristics , average income, etc.). Also, most studies were performed in developed countries. Partially because of these questions, results have been heterogeneous.A systematic review of ecological studies in North America, Europe, Australia, and New Zealand, dating from 1897 to 2004, reported an inverse relation between socioeconomic characteristics and suicide . Other rLongitudinal studies also present interesting findings. One study using data from 1960 to 1999 included data from 21 countries grouped into three categories according to GDP per capita; results showed notably that countries with higher income presented higher suicide rates than poorer countries . Other lTherefore, the relationship between income and suicide varies, although it seems that it is mediated by socioeconomic development and income level. In this context, Brazil covers a wide area with almost 200 million inhabitants with very distinct cultural and socioeconomic characteristics, as shown by indexes such as the Gini coefficient and the HDI. In addition, although the overall suicide rate in Brazil is low, in Brazilian urban centers the rates vary from 5 to 15 per 100,000 -33. Few Considering that (I) suicide and income are related, (II) Brazil presents important socioeconomic disadvantage, and (III) suicide rates in Brazil vary among location, the purpose of our study was to evaluate the relationship between suicide and income in Brazil and its regions. We also verified whether such relationship is related to socioeconomic characteristics.We designed an epidemiological study considering suicide mortality data in three different regions Figure : (1) a nTo explore our hypothesis that suicide, income, and socioeconomic disadvantage are related, we chose regions with distinct socioeconomic patterns. Regions were characterized by the Gini index, the HDI, and the GDP per capita. The Gini coefficient is a measure of income inequality, ranging from 0  to 1 . The HDI is based on life expectancy, education, and GDP per capita, also ranging from 0 (minimum development) to 1 (maximum development). Remarkably, these regions present distinct indexes of Gini, HDI, and GDP per capita . Population projections was based on SEADE Foundation . AverageFor each region, income was categorized in tertiles according to its distribution in three areas, from the wealthiest (area 1) to the poorest (area 3) .We performed the following analyses:Descriptive analysis, cross-sectional approach (1996–2008), in which we described age-adjusted suicide rates per gender and income area in the three regions: Brazil, State of São Paulo, and city of São Paulo; relative risks (RRs) and 95% Confidence Interval (CI) were estimated using the poorest area as the reference.a)Temporal analysis, in which we used Joinpoint Regression Program 3.4.3 nstitute ) to idenSpatial analysis, which employs a series of geographical information system (GIS) techniques and statistical methods. ArcGis was used to explore spatial patterns of suicide rates and average monthly income. SaTScan [c) SaTScan  was applTable From 1996–2008, there were 98,904 suicides  in Brazil, 21,066 suicides  in the State of São Paulo, and 5,589 suicides  in the city of SP. The State of São Paulo presented the highest male/female ratio (4.4) and the city of São Paulo showed the lowest (3.7). Suicide rates in Brazil, the State of São Paulo, and the city of São Paulo were 6.2, 6.6, and 5.4 per 100,000 inhabitants, respectively (Table Taking the poorest area area 3) as reference, the RR of suicide in more wealthy regions (areas 1 and 2) was significantly higher in Brazil and the city of São Paulo , with a RR of 2.37, and another cluster of low rates  with a RR = 0.60. The former cluster is located in the South region, encompassing 73 micro-regions; the latter cluster includes 98 micro-regions and comprises the east border, including the states of Rio de Janeiro, Espírito Santo, Minas Gerais and Bahia States . A suicide protection cluster located in Campinas and north of São Paulo mid-regions was also identified Figure D. Here aSuicide rate in the city of SP was 5.4 per 100,000. The city has a high per capita income and high suicide rates in the central, south central and west areas  reported an inverse association between income and suicide; most (88%) were also performed in developed countries . Recent The same was noted in longitudinal approach studies -49 and udisqualifying and integrated poverty. The latter, which best suits Brazil and the city of São Paulo (higher Gini coefficient), is observed in societies in which poverty is compensated by a solidarity response within family, neighborhood, and region. Integrated poverty was, in fact, the social reality that Durkheim referred when he claimed that “poverty protects” [Some studies found a direct relation between suicide and income ,26. The rotects” . On the rotects” .The present study has some limitations. Different procedures and cultural and social practices and values probably have various effects on death records and lead to misclassification of suicide ,2. AnothIn conclusion, we performed a descriptive, temporal, and spatial analysis regarding income level and suicide in different regions of Brazil. Results showed that the direction of association varied, albeit resembling similar patterns observed worldwide, with a direct and inverse association in less and more unequal areas, respectively. Taken together, these findings suggest that income and suicide in Brazil are related, although socioeconomic regional characteristics might act as a moderator variable. Future studies comparing suicide rates in other Brazilian States and developing countries should take into account these results by performing separate analyses by region. Also, these results highlight that the association between suicide and income in Brazil varies importantly according to the considered region. The result of the present study is not conclusive. It helps to understand the phenomenon of suicide, generates new hypotheses for other study designs and can be useful for prevention strategies.The authors declare that they have no competing interests.DHB undertook data extraction and analysis and wrote the first draft. ARB wrote the revised version. IMB and PAL formulated research questions and contributed to writing the drafts. All the authors contributed to the preparation of the final manuscript and approved the submission.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/12/127/prepub


Objectives. To compare the failure ratio and inhospital complications across three age groups of patients and to investigate the effects of balloon sizing on the success and the device diameter. Methods. This retrospective review was of 665 patients who had been listed for transcatheter-based closure of ASD between 1999 and 2010. The patients were divided into three age groups: children , adults , and older adults . Procedural outcomes and early complications were reviewed. Use of balloon sizing was explored for its benefits. Results. Overall, failure of closure was 6.6% (n = 44). Use of balloon sizing tended to lead to a smaller device/defect ratio that was comparable to procedures without balloon sizing, though it did not predict the success rate . Seven patients reported device embolization (1%). No mortalities were noted. In-hospital complications were 3.4%, with common complications, being vascular complications (1.4%) and cardiac arrhythmia (1.1%). No differences in failure rate or events were found among the three groups. Conclusion. Transcather closure of ASD is feasible and safe, regardless of the patient's age. A low rate of early complications was noted. Balloon sizing does not aggravate an oversizing of the device, but does not predict success. Atrial septal defect (ASD) is a common congenital heart malformation comprising 5.9–10% of all congenital heart diseases (CHD) , 3. The ™, was introduced in Thailand in 1999. Early outcomes for 26 Thai patients were initially reported by Durongpisitkul et al. in 2000 [Transcatheter closure of ASD, using the Amplatzer septal occluder in 2000 . Subsequ in 2000 . In 2008 in 2000 . The num in 2000 –17.The purposes of the study were to (1) compare the failure rates and in-hospital complications among three age groups: children and adolescents (<18 years), adults (18–50 years), and older adults (>50 years) and (2) investigate the effects of balloon sizing on the success rate and the device diameter.This retrospective, descriptive study was approved by the Siriraj Institutional Review Board and Ethics Committee. A total of 665 patients, who had been listed for catheter-based closure of ASD at Siriraj Hospital between February 1, 1999 and February 28, 2010 were identified from the Siriraj Hospital Interventional Cardiovascular Database. All patients who had been diagnosed with isolated secundum ASD and an adequate rim >5 mm, and who were suitable for transcatheter closure by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE), were eligible for the study.n = 183), young to middle-aged adults , and older adults , at the time of device closure. A review of the demographic data included age at first presentation, age on the day of procedure, body weight, height, ASD size by intraprocedural TEE, ASD device size, intraprocedural method to confirm the size of defects , balloon sizing), Qp : Qs, pulmonary artery pressure (measured by right heart catheterization), fluoroscopy time, and procedural time. Success of implantation was defined as the device being properly placed and deployed without malposition or embolization in the catheterization lab. Following the procedure, all major events were recorded to gather information about in-hospital complications. These included cardiac arrest, device embolization, cardiac tamponade, cardiac arrhythmia, hypotension, bleeding (requiring blood transfusion), vascular complications , stroke, and residual shunt by the day of discharge.The 665 consecutive patients were divided into three groups according to age: children and adolescents , electrocardiograms (ECG), and echocardiographies, before the procedure. Standard transthoracic echocardiographic studies were used to assess ASD morphology, right ventricular systolic pressure (RVSP), and cardiac function to determine the feasibility for transcatheter-based ASD closure. After being informed and giving their consent, patients were scheduled for transcatheter closure of ASD under general anesthesia. Right heart catheterization was performed for all cases to measure pulmonary pressure. Unfractionated heparin (50 unit/kg/dose) and antibiotics were administered intravenously via an arm approach to all patients after femoral access and prior to the procedure. The maximal dose of unfractionated heparin was 3000 unit. Right-heart catheterization was performed for all cases to measure pulmonary pressure. Standard technical delivery of the device over a guide wire through the defect was performed, as previously described , 18.The largest diameter and rim of the atrial septal defect were confirmed by intraprocedural TEE or ICE. In cases where the ASD size and rim were not well visualized in echocardiography, balloon sizing , as a stop flow technique, was used to measure the stretch diameter of the ASD. The ASD device was delivered by an appropriate delivery system and deployed after confirming a satisfactory device position by TEE or ICE and fluoroscopy. When the procedure took more than 60 minutes, the activated clotting time (ACT) was measured and kept to a level of 200–300 seconds. In cases where the ACT was less than 200 seconds, another injection of 25–50 unit/kg/dose of unfractionated heparin was allowed. Following the procedure, patients routinely received six-months of aspirin therapy. All had repeated physical examinations, ECG, and CXR, to determine echocardiographic parameters at 24 hours. A residual shunt was considered if the color Doppler echocardiography revealed left- to right-shunt across the interatrial septum. Patients, who attended the interventional clinic, were evaluated with physical examinations and echocardiographies at: one month, three months, six months, and one year after discharge, and at regular intervals thereafter, according to guidelines.The outcomes of interest for the study included failure rate of transcatheter closure of ASD for patients who were on the list, and in-hospital complications of patients who had achieved deployment of the ASD device.U test for variables with nonnormal distributions. Category variables were evaluated by the chi-square test and Fisher's exact test. A univariate analysis was performed for each variable with a P value < 0.05 considered to be statistically significant. Statistical analyses were performed with SPSS 10.0 for Windows .Patients were categorized into three age groups: children and adolescents (<18 years), young and middle-aged adults (18–50 years), and older adults (>50 years). Baseline characteristics of patients and potential confounders were summarized using descriptive statistics and shown in percentage, median, and range. Failure rates were calculated as the ratio among groups. Continuous variables were compared between groups by a One-Way ANOVA for normal distribution variables, and by the Kruskal-Wallis test and the Mann-Whitney n = 183) were under 18 years of age, 50.7%  (n = 337) were between 18 and 50 years of age, and 21.8%  (n = 145) were older than 50 years of age on the day of the operation. Pulmonary artery systolic pressures ranged from 19 to 100 mm Hg, with the lower values being found in pediatric patients. ASD diameter and ASD device ratio in this study was 1.17. The median Qp : Qs was 3.4. Adult patients with Qp : Qs less than 1.5 were indicated to have closure of ASD from suspicion of paradoxical emboli. The median hospital length of hospital stay (LOS) was 1.5 days; however, pediatric patients tended to have longer LOSs, compared to the adult groups. Demographics are shown in During the 11-year study period, a total of 665 patients were scheduled to undergo transcatheter closure of ASD at Siriraj Hospital. Of these, 512 were female and 153 were male (ratio of 77 : 23). The median age at the time of the procedure was 33.5 years (range = 1.2–80.6 years). Of the total number of patients, 27.5%  (n = 44)  . This inP  value = 0.08). The Amplatzer septal occluder™ was used mostly  in the institute. Two others commercial types of devices the Cocoon septal occluder and the Figulla septal occluder from Occlutech, were used in some selected patients (21 (3.3%) and 3 (0.4%), resp.). The mean device/diameter ratio for ASD for the 621 patients with successful device implantations was 1.25 ± 0.33 (median = 1.17). n = 467) underwent balloon sizing to measure the defect. Of this number, 34 (7.2%) experienced an unsuccessful placement of the device. Also, 10 (5%) of the 198 patients, who did not undergo balloon sizing, did not have their ASDs closed by the devices. No statistical difference was found in the success rates among those who underwent balloon sizing or imaging studies on their own . Basically, patients who underwent the balloon sizing had larger original defects than the patients who underwent imaging studies only. As a result, greater sizes of ASD devices were required in the prior group  had adverse events reported in a recovery ward . One pedIn the surveillance of cases, the failure ratio of ASD device implantation was 6.6% of the intentions to treat. No significant differences were found in the failure ratio among children, middle-aged adults, and older adult groups. The device/defect ratio was 1.25 ± 0.33. The predicted device size appears to be approximately equal to the original diameter of defect plus 4.2 mm. The balloon-sizing technique was used to augment the procedure in 70.1% of the patients, and the balloon-sizing method appears to have no affect on the success rate . Nevertheless, a bias seems to be present so that balloon sizing is performed generally in large complex or marginal septum atrial septal defects, to more precisely measure the diameter of stretching in the defect by the stop-flow technique. Accordingly, larger defects and larger devices tend to be associated with the use of balloon sizing. Also, the ratio between device and original defect size was found to have a converse relationship in the study. Smaller ratios are more often associated with patients who underwent balloon sizing. This suggests that, in this institute, balloon sizing does not lead to the oversizing of devices, which is in contrast to prior retrospective studies , 16. Thin = 69) and concluded that patients' weight, diameter of defect, device size, aortic rim, and device/defect ratio were considerably related to their composite success, whereas patient age and consultant experience were not important factors. Recently, in a large cohort study of 1,013 ASD patients, Butera and colleagues [The impact of age and the procedure's success rate has been mentioned in some prior studies, though no studies have provided data that compares three age groups. Rastogi and colleagues  determinlleagues  suggestelleagues  reportedThis surveillance found that procedure-related in-hospital complications occurred in 3.4% of cases. No cases of mortality or cardiac perforation were found. The most common events were vascular complications and cardiac arrhythmia, which occurred similarly across all age groups. Serious life-threatening events, such as cardiac tamponade, possibly due to guide-wire perforation, occurred in one older adult patient and was resolved after pericardiocentesis. A hemorrhagic stroke was reported in one patient who had been unaware that he had a coincidental cerebral aneurysm prior to a procedure. The use of unfractionated heparin, which is applied routinely, may have lead to the complication in this case. Regarding device embolization, seven cases were reported; six occurred immediately in the cardiac catheterization lab, and one was detected at six hours after the procedure. Surgical management of the complications was needed in four patients. Overall, in our institute, surgical rescue for serious complications of transcatheter closure of ASD occurred in 0.7% of the cases. Adverse events and complications were not found to differ across the three age groups. In terms of residual shunt, the percentage of residual defect was 5.3% in the 621 patients at 24 hour after the procedure. The ongoing, longitudinal preliminary findings for 353 patients show a reduction to 0.5% at 1 year after the procedure.Device embolization has long been reported as one of the serious intraprocedural and postprocedural concerns. Prior studies , 21, 22 In summary, the number of accumulative failures and in-hospital complications was found to be relatively small in this study, which reflects the safety of the procedures, even among pediatric or older adult patients. Balloon sizing, used for some patients (70%), does not increase the success or affect the device oversizing. The most common early complications are vascular complications and cardiac arrhythmia. Surgical rescue for serious device complications was reported for 0.7% of cases. These findings support the use of ASD device closure as a procedure with high efficacy and safety, regardless of the patients' age group.(1) In general, selection bias is inevitable in retrospective studies. Some informative clinical parameters, such as functional capacities, ECG, PR interval, QT dispersion, complete echocardiographic measurement of ventricular function and deformation, and morphological aspect of ASD, were not available. In this study, we gathered as many values as possible, often relying on the intention to treat.(2) Meaningful outcomes should be based on longitudinal followup, to consider both functional capacities and cardiac adaptation after treatment. In this study, the surveillance of in-hospital outcomes indicates that early complications and failure rates should be considered with caution. With aggregate databases over longer periods and with more inter-institutional cases, overall outcomes and the nation-wide improvements in quality of care for patients may be determined.The transcather closure of ASD procedure at Siriraj Hospital has high efficacy and safety, regardless of patient's age at the time of the procedure. From this study, the balloon sizing technique does not affect the success rate or cause oversizing of the device. A low rate of early complications was also noted. More long-term investigations may provide additional valuable information.