The evolved management of neonates with major congenital heart disease

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Progressive pulmonary hypertension in cyanotic congenital heart disease with severe pulmonary stenosis

We report the progressive development of pulmonary hypertension despite the presence of severe pulmonary stenosis in three patients with cyanotic congenital heart disease. The associated intracardiac lesions were complete transposition with a ventricular septal defect, double outlet right ventricle, and a heart with univentricular atrioventricular connection, respectively. Serial measurements on hemodynamics andhistological findings documented the progression of pulmonary hypertension and pulmonary vascular diseases. The underlying etiology remains speculative. In view of the possibility of development of pulmonary hypertension despite a 'protected' pulmonary vasculature, corrective surgery should be contemplated as soon as technically feasible. © World Publishers Incorporated.published_or_final_versio

E-cigarette use was associated with the intention to smoke in Chinese adolescents

Conference Theme: Tobacco and Non-Communicable DiseasesPoster Discussion 28. E-cigarettes: Evidence and Analysis: no. PD-923-20BACKGROUND: E-cigarette use arguably could reduce cigarette smoking and the intention to smoke, although such studies are few, especially in adolescents. We investigated the association between e-cigarette use and the intention to smoke in Chinese adolescent smokers and never-smokers. DESIGN/METHODS: A total of 45857 secondary 1-6 (US Grade 7-12) students (response rate 96%) from 75 randomly selected schools completed an anonymous questionnaire in 2012/13 in Hong Kong. Students were classified as never-smokers, experimenters (smoked just a few puffs), ex-smokers and current smokers (occasional or daily smoking). E-cigarette use in the past 30 days was …published_or_final_versio

Electronic cigarette use and its association with smoking in Hong Kong Chinese adolescents

BACKGROUND: Electronic cigarettes (e-cigarettes) are increasingly used in adolescents with unknown impacts on conventional cigarette smoking. We examined the associations of e-cigarette use with smoking intention, nicotine addiction and smoking cessation in Chinese adolescents. METHODS: A total of 45,128 students (age 14.6±1.9; boys 51.4%) from 75 randomly selected schools in Hong Kong reported e-cigarette use (in the past 30days), conventional cigarette use and socio-demographic characteristics in an anonymous questionnaire survey. Adjusted odds ratios (AORs) of intention to smoke, morning smoking urge, intention to quit and quit attempts; and beta-coefficient (β) of cigarette consumption per day were calculated in relation to e-cigarette use. RESULTS: E-cigarette use was associated with intention to smoke with an AOR (95% CI) of 1.74 (1.30-2.31) in all students, 2.18 (1.12-4.23) in never and 2.79 (2.05-3.79) in ever smokers (non-significant interaction by smoking status). The associations were also significant in experimental and former smokers but not in current smokers. In current smokers, e-cigarette use was significantly associated with heavier smoking (β 2.54, 95% CI 1.28-3.81) and morning smoking urge (AOR 2.54, 95% CI 1.50-3.11), and non-significantly associated with lower quit intention (0.76, 0.52-1.09) and attempts (0.80, 0.56-1.23). CONCLUSIONS: E-cigarette use was associated with smoking intention in never, experimental and former smokers in Hong Kong Chinese adolescents. In current smokers, e-cigarette use was associated with nicotine addiction but not quit intention and attempts. Prospective studies with detailed measurements on e-cigarette use are warranted for further studies. Copyright © 2015 Elsevier Ltd. All rights reserved.postprin

E-cigarette use was associated with respiratory symptoms among Chinese adolescents in Hong Kong

Conference Theme: Tobacco and Non-Communicable DiseasesOral Presentation - 05. Innovative Ways for Achieving Tobacco Free Generations: no. OP-229-20BACKGROUND: Adverse effects of e-cigarette use were not clear. Some studies have found harmful effects on respiratory function (respiratory flow resistance and impedance) in adult smokers. We assessed the association between cigarette use and respiratory symptoms in adolescents. DESIGN/METHODS: A school-based smoking survey was conducted on 45857 secondary 1-6 (US Grade 7-12) students (response rate 96%) from 75 randomly selected secondary schools in Hong Kong in 2012/13 …published_or_final_versio

E-cigarette use, nicotine addiction and intention to quit among adolescent smokers in Hong Kong

Conference Theme: Tobacco and Non-Communicable DiseasesPoster Discussion 28. E-cigarettes: Evidence and Analysis: no. PD-924-20BACKGROUND: Although some studies have shown beneficial effects of e-cigarettes on smoking cessation in adults, less is known about e-cigarette use and its association with nicotine addiction and intention to quit smoking in adolescents. DESIGN/METHODS: A school-based smoking survey was conducted on 45857 secondary 1-6 (US Grade 7-12) students (response rate 96%) from 75 randomly selected secondary schools in Hong Kong in 2013/13. A total of 1768 (3.9%) current smokers (occasional or daily) were included in the present analysis. E-cigarette use in the past 30 days, intention to quit smoking (cigarette), and quit attempts in the past 12 months were recorded. Smoking …published_or_final_versio

Electronic Cigarette Use and Respiratory Symptoms in Chinese Adolescents in Hong Kong

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Parental pro-smoking practices and smoking susceptibility among children in Hong Kong

Conference Theme: Tobacco and Non-Communicable DiseasesPoster Discussion 61. Assessing the Factors that Influence Tobacco Use: no. PD-1313-21BACKGROUND: Parental influence on children smoking is well known, but most studies focused on general parenting and less on smoking-specific parental practices. We investigated the association between some parental pro-smoking practices (PPP) and children smoking susceptibility. DESIGN/METHODS: Among 100 primary schools with students viewing an anti-smoking drama performance commissioned by the Hong Kong Council on Smoking and Health in 2012/13, 7 were randomly selected and 1255 primary 2-4 students (mean age 8.5±0.02, 42.8% boys) completed an anonymous self-administered questionnaire. Fifteen specific items of PPP in the past 30 days were …published_or_final_versio

Electronic cigarette use among adolescents: a cross-sectional study in Hong Kong

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Evolving management for critical pulmonary stenosis in neonates and young infants

Over the years, management of critical pulmonary stenosis in young infants has evolved from surgical reconstruction of the right ventricular outflow tract and closed pulmonary valvotomy to transcatheter balloon valvoplasty. Our study aimed at evaluating how the changing policy for management had affected the immediate and long term outcomes of babies with this cardiac lesion. Interventions were made in 34 infants at a median age of 8.5 days (2-90 days). Reconstruction of the right ventricular outflow tract reconstruction was performed in 10 patients, closed pulmonary valvotomy in 13, and balloon valvoplasty in 11. Initial procedure-related mortality was 50%, 15% and 0% respectively. Multivariate analysis revealed transannular patching of the right ventricular outflow tract, and male sex, to be significant factors for death. For the 27 survivors, the ratio of right ventricular to systemic systolic pressure decreased from 1.6 ± 0.3 to 0.3 ± 0.2 after reconstruction of the outflow tract, 1.8 ± 0.5 to 0.8 ± 0.4 after closed valvotomy, and 1.8 ± 0.6 to 0.9 ± 0.3 after balloon valvoplasty. The decrease was significantly greater after patch reconstruction (p=0.025) that required no further reinterventions. The overall rate of reintervention for the survivors was 37% (10/27). The freedom from reintervention after closed valvotomy was 82%, 64% and 51% at 1, 5 and 10 years respectively. The figure remained at 78% at both 1 and 5 years (p=0.66) after balloon valvoplasty. The higher reintervention rate for closed valvotomy corresponded to the significantly greater residual gradient across the pulmonary valve noted on follow-up (p=0.01). Reinterventions included balloon dilation (n=6), reconstruction of the outflow tract (n=4), and 1 each of ligation of an arterial duct and systemic-pulmonary arterial shunting. The risk factor for reintervention was a hypoplastic right ventricle. In conclusion, transcatheter balloon valvoplasty appears to be the optimum initial approach in view of its low mortality, efficacy at relieving the obstruction, and low rate of reintervention. © Greenwich Medical Media Ltd.published_or_final_versio