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Chen N, Wang JH, Chiu CJ. Satisfaction with Teleophthalmology Services: Insights from Remote Areas of Taiwan. Healthcare (Basel) 2024; 12:818. [PMID: 38667580 PMCID: PMC11050710 DOI: 10.3390/healthcare12080818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
During and after the COVID-19 pandemic, teleophthalmology provided access to eye care for rural populations. This study aimed to assess the efficacy of and satisfaction with an integrated real-time videoconferencing module. This project incorporated ophthalmic instruments and telecommunication devices and provided on-site consultations via videoconferencing. Both patients and healthcare providers completed satisfaction questionnaires. From May 2020 to May 2021, this project provided eye care services to 395 patients (aged 6-90 years). The most frequent eye condition was chronic conjunctivitis (n = 197), followed by senile cataract (n = 163), dry eye (n = 103), and refractive error (n = 95). Among them, 40 (10.1%) patients were referred to secondary or tertiary hospitals for further evaluation or treatment. In total, 181 recruited respondents provided good satisfaction scores in all dimensions, including quality of medical care (4.50 of 5.00), financial aspects of care (4.48), supportive attitude toward the project (4.47), quality of service (4.40), and quality of telecommunication (4.40). Women had a substantially more supportive attitude toward the project, and 25 healthcare providers provided low ratings in areas representing the quality of telecommunication (4.04) and user-friendliness of the instrument (4.00). This teleophthalmology system provided efficient and satisfactory eye care to participants in remote communities. However, better internet access and training in instrument use can reduce obstacles to the future implementation of the project.
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Affiliation(s)
- Nancy Chen
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan;
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan;
| | - Cheng-Jen Chiu
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan;
- Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien 970, Taiwan
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Lee SH, Tseng BY, Wang JH, Chiu CJ. Efficacy and Safety of Low-Dose Atropine on Myopia Prevention in Premyopic Children: Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1506. [PMID: 38592670 PMCID: PMC10932201 DOI: 10.3390/jcm13051506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Early-onset myopia increases the risk of irreversible high myopia. Methods: This study systematically evaluated the efficacy and safety of low-dose atropine for myopia control in children with premyopia through meta-analysis using random-effects models. Effect sizes were calculated using risk ratios (RRs) with 95% confidence intervals (CIs). Comprehensive searches of PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov were conducted until 20 December 2023, without language restrictions. Results: Four studies involving 644 children with premyopia aged 4-12 years were identified, with atropine concentrations ranging from 0.01% to 0.05%. The analysis focused on myopia incidence and atropine-related adverse events. Lower myopia incidence (RR, 0.62; 95% CI, 0.40-0.97 D/y; p = 0.03) and reduction in rapid myopia shift (≥0.5 D/1y) (RR, 0.50; 95% CI, 0.26-0.96 D/y; p < 0.01) were observed in the 12-24-month period. Spherical equivalent and axial length exhibited attenuated progression in the atropine group. No major adverse events were detected in either group, whereas the incidence of photophobia and allergic conjunctivitis did not vary in the 12-24-month period. Conclusions: Our meta-analysis supports atropine's efficacy and safety for delaying myopia incidence and controlling progression in children with premyopia. However, further investigation is warranted due to limited studies.
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Affiliation(s)
- Ssu-Hsien Lee
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (S.-H.L.); (B.-Y.T.)
| | - Bor-Yuan Tseng
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (S.-H.L.); (B.-Y.T.)
| | - Jen-Hung Wang
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien 970, Taiwan;
| | - Cheng-Jen Chiu
- Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien 970, Taiwan
- Department of Ophthalmology, Hualien Tzu Chi Hospital, the Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
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Lee SH, Tsai PC, Chiu YC, Wang JH, Chiu CJ. Myopia progression after cessation of atropine in children: a systematic review and meta-analysis. Front Pharmacol 2024; 15:1343698. [PMID: 38318144 PMCID: PMC10838978 DOI: 10.3389/fphar.2024.1343698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/11/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose: To comprehensively assess rebound effects by comparing myopia progression during atropine treatment and after discontinuation. Methods: A systematic search of PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov was conducted up to 20 September 2023, using the keywords "myopia," "rebound," and "discontinue." Language restrictions were not applied, and reference lists were scrutinized for relevant studies. Our study selection criteria focused on randomized control trials and interventional studies involving children with myopia, specifically those treated with atropine or combination therapies for a minimum of 6 months, followed by a cessation period of at least 1 month. The analysis centered on reporting annual rates of myopia progression, considering changes in spherical equivalent (SE) or axial length (AL). Data extraction was performed by three independent reviewers, and heterogeneity was assessed using I2 statistics. A random-effects model was applied, and effect sizes were determined through weighted mean differences with 95% confidence intervals Our primary outcome was the evaluation of rebound effects on spherical equivalent or axial length. Subgroup analyses were conducted based on cessation and treatment durations, dosage levels, age, and baseline SE to provide a nuanced understanding of the data. Results: The analysis included 13 studies involving 2060 children. Rebound effects on SE were significantly higher at 6 months (WMD, 0.926 D/y; 95%CI, 0.288-1.563 D/y; p = .004) compared to 12 months (WMD, 0.268 D/y; 95%CI, 0.077-0.460 D/y; p = .006) after discontinuation of atropine. AL showed similar trends, with higher rebound effects at 6 months (WMD, 0.328 mm/y; 95%CI, 0.165-0.492 mm/y; p < .001) compared to 12 months (WMD, 0.121 mm/y; 95%CI, 0.02-0.217 mm/y; p = .014). Sensitivity analyses confirmed consistent results. Shorter treatment durations, younger age, and higher baseline SE levels were associated with more pronounced rebound effects. Transitioning or stepwise cessation still caused rebound effects but combining optical therapy with atropine seemed to prevent the rebound effects. Conclusion: Our meta-analysis highlights the temporal and dose-dependent rebound effects after discontinuing atropine. Individuals with shorter treatment durations, younger age, and higher baseline SE tend to experience more significant rebound effects. Further research on the rebound effect is warranted. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=463093], identifier [registration number].
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Affiliation(s)
- Ssu-Hsien Lee
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | | | - Yu-Chieh Chiu
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Cheng-Jen Chiu
- Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan
- Department of Ophthalmology, Hualien Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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Chiu YC, Tsai PC, Lee SH, Wang JH, Chiu CJ. Systematic Review of Myopia Progression after Cessation of Optical Interventions for Myopia Control. J Clin Med 2023; 13:53. [PMID: 38202060 PMCID: PMC10779574 DOI: 10.3390/jcm13010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Despite high discontinuation rates for myopia optical interventions, limited attention has been given to the potential rebound effects post-discontinuation. This systematic review aims to assess the extent of the rebound effects following the cessation of common clinical optical myopia-control interventions in children. A comprehensive search of PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov was conducted from inception to October 2023. The rebound effects, defined as changes in the axial length or spherical equivalent during and after treatment cessation, were categorized into four levels. These studies encompassed 703 participants and spanned from 2019 to 2023, with durations of treatment and cessation ranging from 6 months to 3.5 years and from 2 weeks to 5 years, respectively. This review, encompassing 14 studies, revealed a predominant strong rebound effect in orthokeratology (8 studies), a weak rebound effect in multifocal soft contact lenses (4 studies), and a variable rebound effect in peripheral-plus spectacle lenses (2 studies). Notably, with the increasing cessation duration, the rebound effects diminished, potentially linked to the reversal of choroidal thickening and the disappearance of peripheral myopic defocus. In conclusion, a temporal trend of rebound effects exists in all three myopia optical interventions, possibly contributing to their myopia control mechanisms.
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Affiliation(s)
- Yu-Chieh Chiu
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (Y.-C.C.); (P.-C.T.); (S.-H.L.)
| | - Ping-Chiao Tsai
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (Y.-C.C.); (P.-C.T.); (S.-H.L.)
| | - Ssu-Hsien Lee
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (Y.-C.C.); (P.-C.T.); (S.-H.L.)
| | - Jen-Hung Wang
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien 970, Taiwan;
| | - Cheng-Jen Chiu
- Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien 970, Taiwan
- Department of Ophthalmology, Hualien Tzu Chi Hospital, the Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
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Wu SY, Wang JH, Chiu CJ. Assessment of Satisfaction, Compliance and Side Effects among Long-Term Orthokeratology Wearers. J Clin Med 2022; 11:4126. [PMID: 35887890 PMCID: PMC9321806 DOI: 10.3390/jcm11144126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: This study aims to assess the satisfaction, compliance, and side effects among the long-term orthokeratology (Ortho-K) users in a tertiary hospital in Taiwan and analyze the side effects and related risk factors. Methods: Children and their guardians were assessed using a structured and validated questionnaire inquiring about background information, wear and care behaviors, daily activities, satisfaction, and related concerns. Clinical information, including refractive data and side effects, was obtained through patient medical files. Results: Three hundred and five school-aged patients were enrolled, and the average age was 13.13 ± 3.39 years, with an average wearing period of 17.1 ± 8.1 months. Over 83% of the subjects had clear daytime vision all day, around 88% felt satisfied or very satisfied with the results, and 98% exhibited a willingness to continue wearing the Ortho-K lenses. Most guardians (83%) were pleased with the controlling effect of myopic progression. Initial spherical equivalent and regular cleaning of the lens protein significantly correlated with clear day vision. Wearing >6 days/week correlated with less risk of lens binding. Based on the questionnaire, the main reasons for using Ortho-K were effectiveness, safety, and practicality, while the major concerns were discomfort, harmful to the eyes, and no effect. Conclusion: With a comprehensive care program from practitioners and good compliance of users, Ortho-K could be the most effective and satisfactory option for myopic children in Taiwan.
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Affiliation(s)
- Shang-Yen Wu
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan;
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan;
| | - Cheng-Jen Chiu
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan;
- Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien 970, Taiwan
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Tsai HR, Wang JH, Huang HK, Chen TL, Chen PW, Chiu CJ. Efficacy of atropine, orthokeratology, and combined atropine with orthokeratology for childhood myopia: A systematic review and network meta-analysis. J Formos Med Assoc 2022; 121:2490-2500. [DOI: 10.1016/j.jfma.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 11/26/2022] Open
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Tsai HR, Wang JH, Chiu CJ. Effect of orthokeratology on anisometropia control: A meta-analysis. J Formos Med Assoc 2021; 120:2120-2127. [PMID: 34119394 DOI: 10.1016/j.jfma.2021.05.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/08/2021] [Accepted: 05/21/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The effectiveness of orthokeratology in retarding anisometropic progression has been investigated in several small-sample studies. This quantitative analysis aimed to elucidate the efficacy of orthokeratology for anisometropia control. METHODS We searched PubMed, Embase, and Cochrane databases for relevant studies through September 2020. Axial length (AL) data at baseline and final follow-up were extracted, and AL elongation and difference were calculated. Methodological quality was evaluated using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool. Meta-analyses were performed using a fixed-effect model based on the heterogeneity. RESULTS A total of 10 cohort studies (nine retrospective studies; one prospective study) were included. The pooled results for the unilateral myopia group showed that the mean AL elongation difference between myopic and emmetropic eyes was -0.27 mm (95% CI, -0.31 to -0.22; p < 0.01) at the one-year follow-up (four studies) and -0.17 mm (95% CI, -0.33 to -0.02; p = 0.03) at the two-year follow-up (two studies). In the bilateral anisomyopic group, mean AL elongation difference between high and low myopic eyes was -0.06 mm (95% CI, -0.09 to -0.04; p < 0.01) at the one-year follow-up (seven studies) and -0.13 mm (95% CI, -0.21 to -0.06; p < 0.01) at the two-year followup (three studies). CONCLUSION This study demonstrated that orthokeratology can effectively retard myopic progression and reduce anisomyopic values. However, additional wellstructured randomized controlled trials or prospective studies with longer follow-up periods are warranted to address this topic in more detail.
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Affiliation(s)
- Hou-Ren Tsai
- Department of Medical Administration Office, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan.
| | - Jen-Hung Wang
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
| | - Cheng-Jen Chiu
- Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan; Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan.
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Tsai WS, Wang JH, Chiu CJ. A comparative study of orthokeratology and low-dose atropine for the treatment of anisomyopia in children. Sci Rep 2020; 10:14176. [PMID: 32843658 PMCID: PMC7447800 DOI: 10.1038/s41598-020-71142-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 08/05/2020] [Indexed: 11/28/2022] Open
Abstract
Myopic anisometropia (anisomyopia) is a specific type of refractive error that may cause fusion impairment, asthenopia, and aniseikonia. It is sometimes severe enough to reduce the quality of life. Several studies have investigated the treatment effects of orthokeratology (Ortho-K) and topical atropine on anisomyopia control. However, no study has compared these two interventions simultaneously until now. The cohort of this retrospective study included 124 children with anisomyopia who were treated with binocular Ortho-K lenses, 0.01% atropine, or 0.05% atropine. After a 2-year follow-up, the inter-eye difference in axial length (AL) significantly decreased in the Ortho-K group (P = 0.015) and remained stable in the two atropine groups. When comparing the myopia control effect, the use of Ortho-K lenses resulted in an obviously smaller change in AL than the use of 0.01% and 0.05% atropine (P < 0.01). Ortho-K treatment may reduce the degree of anisomyopia and stabilise the progression of myopia. Hence, Ortho-K might be a better choice for anisomyopic children.
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Affiliation(s)
- Wei-Shan Tsai
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung-Yang Road, Hualien, 97002, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Cheng-Jen Chiu
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung-Yang Road, Hualien, 97002, Taiwan. .,Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan.
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Kuo YC, Wang JH, Chiu CJ. Comparison of open-field autorefraction, closed-field autorefraction, and retinoscopy for refractive measurements of children and adolescents in Taiwan. J Formos Med Assoc 2020; 119:1251-1258. [PMID: 32354691 DOI: 10.1016/j.jfma.2020.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/31/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate the accuracy and effectiveness of noncycloplegic and cycloplegic autorefraction using two types of autorefractors (ARs) compared with retinoscopy in children and adolescents. METHODS This cross-sectional study included 308 students (6-17 years old) from eastern Taiwan. Noncycloplegic and cycloplegic refractive measurements were obtained using open-field AR (Shin-Nippon NVision-K 5001), closed-field AR (Topcon KR-800), and cycloplegic retinoscopy. Three optical components emerged from the measurements: spherical equivalent (M) and two Jackson cross-cylinder values (J0 and J45). Agreement between both ARs and retinoscopy was evaluated using intraclass correlation coefficient. Measurement discrepancies from retinoscopy among different ARs and cycloplegic status were compared using repeated measures ANOVA and receiver operating characteristic curve analysis. RESULTS Compared with retinoscopy, measurements obtained before and after cycloplegia with both ARs showed excellent reliability for evaluating M and J0 and fair to good results for J45. More myopic results were obtained using KR-800 before cycloplegia; more hyperopic results were obtained using KR-800 and NVision-K 5001 after cycloplegia(all p < 0.05). J45 data obtained using NVision-K 5001 were closest to those obtained by retinoscopy; J0 data obtained using both ARs were comparable with retinoscopy after cycloplegia. NVision-K 5001 outperformed KR-800 in refractive measurements, particularly in hyperopia diagnosis among younger children. CONCLUSIONS Both autorefractors showed great agreement with retinoscopy. Results obtained using NVision-K 5001 without cycloplegia were most similar to those by retinoscopy, especially for oblique astigmatism and hyperopia detection in younger children. For large vision screening in elementary school, Shin-Nippon NVision-K 5001 might be a more suitable autorefractor.
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Affiliation(s)
- Yi-Chun Kuo
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Cheng-Jen Chiu
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
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Lee YC, Wang JH, Chiu CJ. Effect of Orthokeratology on myopia progression: twelve-year results of a retrospective cohort study. BMC Ophthalmol 2017; 17:243. [PMID: 29216865 PMCID: PMC5721542 DOI: 10.1186/s12886-017-0639-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/29/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Several studies reported the efficacy of orthokeratology for myopia control. Somehow, there is limited publication with follow-up longer than 3 years. This study aims to research whether overnight orthokeratology influences the progression rate of the manifest refractive error of myopic children in a longer follow-up period (up to 12 years). And if changes in progression rate are found, to investigate the relationship between refractive changes and different baseline factors, including refraction error, wearing age and lens replacement frequency. In addition, this study collects long-term safety profile of overnight orthokeratology. METHODS This is a retrospective study of sixty-six school-age children who received overnight orthokeratology correction between January 1998 and December 2013. Thirty-six subjects whose baseline age and refractive error matched with those in the orthokeratology group were selected to form control group. These subjects were followed up at least for 12 months. Manifest refractions, cycloplegic refractions, uncorrected and best-corrected visual acuities, power vector of astigmatism, corneal curvature, and lens replacement frequency were obtained for analysis. RESULTS Data of 203 eyes were derived from 66 orthokeratology subjects (31 males and 35 females) and 36 control subjects (22 males and 14 females) enrolled in this study. Their wearing ages ranged from 7 years to 16 years (mean ± SE, 11.72 ± 0.18 years). The follow-up time ranged from 1 year to 13 years (mean ± SE, 6.32 ± 0.15 years). At baseline, their myopia ranged from -0.5 D to -8.0 D (mean ± SE, -3.70 ± 0.12 D), and astigmatism ranged from 0 D to -3.0 D (mean ± SE, -0.55 ± 0.05 D). Comparing with control group, orthokeratology group had a significantly (p < 0.001) lower trend of refractive error change during the follow-up periods. According to the analysis results of GEE model, greater power of astigmatism was found to be associated with increased change of refractive error during follow-up years. CONCLUSIONS Overnight orthokeratology was effective in slowing myopia progression over a twelve-year follow-up period and demonstrated a clinically acceptable safety profile. Initial higher astigmatism power was found to be associated with increased change of refractive error during follow-up years.
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Affiliation(s)
- Yueh-Chang Lee
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, No. 707, Sec. 3, Zhongyang Rd, Hualien City, 97002, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Cheng-Jen Chiu
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, No. 707, Sec. 3, Zhongyang Rd, Hualien City, 97002, Taiwan. .,Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan.
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Abstract
This case report describes a female toddler with manifestations of ocular leech infestation. A 2-year-old girl was brought to our outpatient clinic with a complaint of irritable crying after being taken to a stream in Hualien 1 day previous, where she played in the water. The parents noticed that she rubbed her right eye a lot. Upon examination, the girl had good fix and follow in either eye. Slit-lamp examination showed conjunctival injection with a moving dark black–brown foreign body partly attached in the lower conjunctiva. After applying topical anesthetics, the leech, measuring 1 cm in length, was extracted under a microscope. The patient began using topical antibiotic and corticosteroid agents. By 1 week after extraction, the patient had no obvious symptoms or signs, except for a limited subconjunctival hemorrhage, and no corneal/scleral involvement was observed.
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Affiliation(s)
- Yueh-Chang Lee
- Department of Ophthalmology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan, ROC
| | - Cheng-Jen Chiu
- Department of Ophthalmology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan, ROC
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Abstract
AIMS To explore older patients' perceived impact of chronic co-morbid conditions on Type 2 diabetes self-management. METHODS We used purposive sampling to select 32 mentally alert community-dwelling adults, aged 60 years or older, diagnosed with Type 2 diabetes and at least one other chronic health condition to participate in focus groups. We summarized the discussions following each focus group and identified codes to describe the overarching themes. RESULTS We conducted eight 90-min focus groups, each consisting of two to six patients. Three themes emerged. (i) Diabetes complications as a motivator: managing co-morbid conditions made health an important focal point in the lives of older patients. Most patients acknowledged the positive effect complications had on their diabetes self-management by motivating them to pay greater attention to their diabetes to diminish the progression of these complications. (ii) Prioritizing health conditions: patients reported prioritizing health conditions and selectively attending to the management of those conditions based on perceived severity or importance. Further, many patients perceived some conditions as more serious than others and admitted to prioritizing another health condition over their diabetes. (iii) Emotional impact of co-morbidity management: patients described feeling frustrated, confused, and overwhelmed in response to conflicting treatment recommendations, particularly for diet, physical activity and medication regimens. CONCLUSIONS Complications and co-morbidities may have differential impacts on the diabetes self-management of older patients. Addressing the perceived impact of co-morbidity on diabetes self-management may improve patients' outcomes; however, the most effective method of utilizing this information in clinical practice needs to be examined.
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Affiliation(s)
- E A Beverly
- The Pennsylvania State University, University Park, PA, USA.
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Liao CW, Lee YL, Sukati H, D'lamini P, Huang YC, Chiu CJ, Liu YH, Chou CM, Chiu WT, Du WY, Hung CC, Chan HC, Chu B, Cheng HC, Su J, Tu CC, Cheng CY, Fan CK. Seroprevalence of Toxoplasma gondii infection among children in Swaziland, southern Africa. Ann Trop Med Parasitol 2010; 103:731-6. [PMID: 20030998 DOI: 10.1179/000349809x12554106963474] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- C W Liao
- Department of Parasitology, Taipei Medical University College of Medicine, Taiwan
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Yeh LK, Chiu CJ, Fong CF, Wang IJ, Chen WL, Hsiao CK, Huang SCM, Shih YF, Hu FR, Lin LLK. The Genetic Effect on Refractive Error and Anterior Corneal Aberration: Twin Eye Study. J Refract Surg 2007; 23:257-65. [PMID: 17385291 DOI: 10.3928/1081-597x-20070301-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the role of heredity in determining refractive variables, anterior corneal curvature, and anterior corneal aberrations. METHODS Thirty-three monozygotic and 10 dizygotic twin pairs were enrolled in this study. Corneal curvature, corneal astigmatism, and corneal topography were obtained from computerized videokeratoscope. The CTView program was used to compute anterior corneal aberrations from corneal height data of the videokeratoscope. Correlation analysis was performed to investigate the symmetry of the refractive error, corneal curvature, corneal astigmatism, and anterior corneal aberrations between right and left eyes of each twin pair. Heritability (h2) of these parameters was also calculated. RESULTS Positive correlations were noted between right and left eyes for spherical power, total astigmatism, mean corneal curvature, and corneal astigmatism. In monozygotic twins, vertical coma, secondary vertical coma, spherical aberration, and secondary spherical aberration were moderately correlated. In dizygotic twins, vertical coma, secondary horizontal coma, and spherical aberration were moderately correlated. In unrelated controls, secondary vertical coma, secondary horizontal coma, and secondary spherical aberration were moderately correlated. Root-mean-square (RMS) of higher order aberrations (3rd to 6th orders), RMS of spherical aberration, and RMS of coma were moderately correlated between right and left eyes in all three groups. Heritability of spherical aberration, RMS of spherical aberration, and corneal astigmatism (h2 = 0.56, 0.44, and 0.46) were greater than those of refractive power, corneal curvature, and other higher order aberrations. CONCLUSIONS These results suggest that corneal astigmatism and spherical aberration possess a greater genetic predisposition than those of other refractive errors and higher order aberrations.
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Affiliation(s)
- Lung-Kun Yeh
- Department of Ophthalmology, Chang-Gung University College of Medicine
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15
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Liou SW, Chiu CJ, Wang IJ. Effect of intracameral injection of lidocaine and carbachol on the rabbit corneal endothelium. J Cataract Refract Surg 2004; 30:1351-5. [PMID: 15177616 DOI: 10.1016/j.jcrs.2003.10.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2003] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the effect of intracameral injection of preservative-free lidocaine 1% and carbachol 0.01% on corneal endothelial cells of rabbits. SETTING Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan. METHODS Forty eyes of 20 New Zealand White rabbits were divided into 2 equal groups. In the first group, 1 eye was injected with 0.02 mL of preservative-free lidocaine 1% and the fellow eye was injected with 0.02 mL of normal saline as a control. In the second group, 1 eye was injected with 0.02 mL of carbachol 0.01% and the fellow eye was injected with 0.02 mL of normal saline. Specular microscopy was used to evaluate corneal endothelial cell loss and corneal thickness 1 week and 1 month postinjection. For morphologic studies, corneal buttons were excised and stained with alizarin red with trypan blue. Scanning electron microscopy (SEM) examination was performed. RESULTS Specular microscopy revealed no significant endothelial cell loss and normal endothelial thickness with the intracameral injection of preservative-free lidocaine 1% and carbachol 0.01% compared with the control eye. Alizarin red with trypan blue stain and SEM examinations revealed smooth, distinct, and intact intercellular borders and normal viability of corneal endothelial cells in both groups. CONCLUSIONS Intracameral injections of preservative-free lidocaine 1% and carbachol 0.01% do not produce morphologic and functional changes in the corneal endothelial cells of rabbits.
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Affiliation(s)
- Shiow-Wen Liou
- Department of Ophthalmology, Municipal Jen-Ai Hospital-Taipei, Taipei, Taiwan.
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16
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Abstract
Epinephrine is frequently used in the phacoemulsification to dilate pupils. To determine the effects of different concentration of epinephrine on the corneal endothelial cells, twenty-eight rabbit eyes were equally divided into four groups. Solutions, which contained normal saline, 1:1000 epinephrine, 1:5000 epinephrine and 1:10000 epinephrine respectively, were injected into the anterior chambers of the eyes of four groups of rabbits. In vivo morphological changes of corneal endothelium and changes of thickness were checked with specular microscopy. In vitro morphological evaluation of corneal endothelium was observed in excised corneal buttons stained with alizarin red with trypan blue, and with scanning electron microscopy. Our results showed that there was no significant difference in cell density and corneal thickness among the four groups. Alizarin red with trypan blue stain and SEM exam revealed smooth and distinct cell borders of endothelial cells in each group. Intracameral injection of epinephrine does not produce toxic effect on corneal endothelial cells in rabbits.
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Affiliation(s)
- Shiow-Wen Liou
- Department of Ophthalmology, Taipei Women's and Children's Hospital, Taipei, Taiwan.
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Chiu CJ, Chiang CP, Chang ML, Chen HM, Hahn LJ, Hsieh LL, Kuo YS, Chen CJ. Association between genetic polymorphism of tumor necrosis factor-alpha and risk of oral submucous fibrosis, a pre-cancerous condition of oral cancer. J Dent Res 2001; 80:2055-9. [PMID: 11808761 DOI: 10.1177/00220345010800120601] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Many cytokines have been thought to play important roles in the pathogenesis of oral submucous fibrosis (OSF), an areca nut chewing-specific pre-cancerous condition characterized by the deposition of collagen in oral submucosa. Tumor necrosis factor-alpha (TNF-alpha), situated in the class III region of human leukocyte antigen (HLA), is a mediator with multiple functions, including the regulation of inflammatory reaction and transcriptions of collagen and collagenase. In total, 809 male subjects were recruited for assessment of the association of OSF with a bi-allelic promoter-region (-308) polymorphism on the TNFA gene. The high production allele, TNF2, was significantly lower among OSF subjects (n = 166) than in areca-chewing controls (n = 284). This association was independent of oral cancer status. The multivariate-adjusted odds ratio for the TNFA 11 genotype was 2.6 (95% confidence interval = 1.4-4.9; p = 0.004). The finding may imply a multifunctional etiological factor of TNF-alpha in OSF pathogenesis.
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Affiliation(s)
- C J Chiu
- Graduate Institute of Epidemiology, College of Public Health, National Taiwan University,Taipei
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Andrews JM, Doran SM, Di Matteo AC, Leong L, Macintosh C, Chiu CJ, Read NW, Fraser RJ. Effect of a lacto-ovo vegetarian diet on fasting small intestinal motility. Scand J Gastroenterol 2001; 36:1037-43. [PMID: 11589375 DOI: 10.1080/003655201750422620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Changes in diet can alter gastric and small intestinal (SI) motility. The effects of a vegetarian diet on fasting SI motility are unknown. METHODS Manometric studies were performed in 9 lacto-ovo vegetarians (7 women) and 9 omnivores (7 women) of similar age and body mass index. On each study day, manometry was used to assess SI motility for 5 h, or 3 complete cycles of the interdigestive motor complex (IDMC). Lacto-ovo vegetarians were studied once: omnivores were studied twice, on their usual diet, and after consuming a 14-day lacto-ovo vegetarian diet. Diet diaries were kept for 5 days prior to each manometric study. Data were analysed for dietary composition and for cycle length and duration of each phase (I, II and III) of the IDMC. RESULTS Dietary intake did not differ between chronic vegetarians and chronic omnivores apart from a trend to higher fibre intake (29 +/- 3 versus 20 +/- 3 g/day; P = 0.058). Omnivores eating a vegetarian diet showed a trend to decreased alcohol consumption (P = 0.068), but did not increase their fibre intake (20 +/- 3 versus 21 +/- 3 g/day). Neither cycle length nor duration of each IDMC phase differed between chronic vegetarians and chronic omnivores. After 14 days of a vegetarian diet, omnivores had a reduction in cycle length (128 +/- 19 versus 86 +/- 12 min; P = 0.02), with a non-significant reduction of Phase II (99 +/- 20 versus 50 +/- 8 min: P = 0.066). CONCLUSIONS A chronic vegetarian diet has no major effect on fasting SI motility; but acute dietary change may alter the cycle length and component phases of the IDMC.
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Affiliation(s)
- J M Andrews
- University Dept. of Medicine, Royal Adelaide Hospital, SA, Australia.
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Abstract
PURPOSE to measure the contrast sensitivity function of varying degrees of myopia with two types of optical correction (spectacle lens and contact lens). METHODS One hundred and five myopic eyes and twenty-eight emmetropic eyes were collected. The myopic group included 105 eyes corrected with spectacle lenses and 71 eyes of them corrected with contact lenses, too; all had corrected vision acuity of 20/20 or better. The myopic eyes were divided into four groups: group 1 (-1D to -3D), low myopia; group 2 (-3.25D to -6D), medium myopia; group 3 (-6.25D to -12D), high myopia; and group 4 (> -12D), severe myopia. Spatial contrast sensitivity was measured using the OPTEC 2000 Contrast Sensitivity System. RESULTS In groups 1 and 2, no statistically significant difference was found between myopes and emmetropes. In group 3, statistically significant loss of contrast sensitivity at higher spatial frequencies was found for myopic subjects corrected with spectacle lens, but not for myopes corrected with contact lens. In group 4, myopic subjects corrected with spectacle lenses showed significantly reduced contrast sensitivity function at all spatial frequencies; subjects corrected with contact lenses showed statistical sensitivity losses at 6, 12, 18 cycle/degree spatial frequencies. CONCLUSIONS 1. We may suppose that low and medium myopes (groups 1 and 2), who showed normal contrast sensitivity functions, had no retinal dysfunction. 2. For high myopes, contact lens correction could reduce optical defocus and improve contrast sensitivity function in high spatial frequencies. 3. As retinal function disturbances occurred in severe myopes, the diminished contrast sensitivity was not fully compensated by contact lens correction. 4. Loss of contrast sensitivity might be interpreted as evidence for early retinal function disruption before retinal pathological events occur in severe myopes.
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Affiliation(s)
- S W Liou
- Department of Ophthalmology, Taipei Municipal Jen-Ai Hospital, Taipei, Taiwan, R.O.C
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20
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Abstract
The sequence of RNA genome segment S4 of the avian reovirus (ARV) strain S1133 was determined. S4 RNA is 1185 base pairs long and contains one open reading frame encoding a protein of 367 amino acid residues (40.6 kDa), the similar size as the known S4 gene product (sigma NS), with a net charge of -1 at neutral pH. The S4 RNA sequence possesses a pentanucleotide sequence UCAUC at the 3'-terminus of its plus strand like in ARV S1 and S3 segments and ten segments of mammalian reovirus (MRV). The predicted amino acid sequence comparison revealed that the homology is 44.02%, 45.71%, and 42.33% for ARV sigma NS and three serotypes of MRV sigma NS, respectively. The relatively high content of alpha-helix structure in the C-terminal portion of ARV sigma NS suggests that this protein may functionally relate to MRV sigma NS. Northern blot hybridization showed that a 32P-labeled cDNA insert S4-49 from ARV S4 RNA cross-hybridized with the corresponding RNA segments of all seven strains of ARV tested.
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Affiliation(s)
- C J Chiu
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
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Chiu CJ. 1988: The muscle-powered dual-chamber counterpulsator: rheologically superior implantable cardiac assist device. Updated in 1995. Ann Thorac Surg 1995; 59:782-3. [PMID: 7887739 DOI: 10.1016/0003-4975(94)00961-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- C J Chiu
- Division of Cardiovascular and Thoracic Surgery, McGill University, Montreal, Quebec, Canada
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22
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Chiu CJ. Hematuria as a sign of aorto-caval fistula. Ann Surg 1981; 193:122-3. [PMID: 7458445 PMCID: PMC1345022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Modry DL, Chiu CJ, Hinchey EJ. The roles of ventilation and perfusion in lung metabolism. J Thorac Cardiovasc Surg 1977; 74:275-85. [PMID: 881881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The lung, like other viable organs, requires the adequate supply of oxygen and metabolic substrates for its functional and structural integrity. Therefore, we studied the metabolic and ultrastructural consequences in the canine lung following bronchial and/or pulmonary arterial occlusions. The results indicate that the lung can maintain its bioenergetic levels for 5 hours with either the ventilation or perfusion alone. Ultrastructural changes appear to precede metabolic alterations measured. When both the ventilation and perfusion were interrupted, rapid biochemical and structural deteriorations occurred, whereas the combinations of alveolar obliteration and hypoxemia, induced with low F102, produced intermediate damage. The implications of these findings on the pathogenesis and evolution of acute respiratory distress syndrome, on the lung preservation for transplantation, and on the rationale for membrane oxygenator support are discussed.
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Abstract
Several epithelium-lined organs are highly vulnerable in low flow states, and may lead to lesions such as hemorrhagic enteritis, stress ulcer, renal tubular necrosis, acalculous cholecystitis and "shock lung". A hypothesis is presented which postulated that the redistribution of the subepithelial microcirculatory blood flow and the subsequent damage to the epithelial barrier are the crucial processes in their pathogenesis. Presently available evidence in support of this thesis is summarized.
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Chiu CJ, Mulder DS. New surgical approach to diffuse coronary occlusion: selective arterialization of the coronary veins. Adv Exp Med Biol 1977; 82:340-1. [PMID: 920389 DOI: 10.1007/978-1-4613-4220-5_83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Livingstone AS, Chiu CJ, Mulder DS, Scott HJ. Spontaneous aortocaval fistula secondary to ruptured abdominal aortic aneurysm. Can J Surg 1977; 20:33-6. [PMID: 832201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Two patients with the rare condition of spontaneous aortocaval fistula secondary to ruptured abdominal aortic aneurysm were treated successfully by surgical closure of the fistula. In view of the existing controversies on certain aspects of the pathophysiology involved, canine experiments were performed to elucidate the pathogenesis of regional venous hypertension and hematuria observed in these patients. The experiments demonstrated that regional venous hypertension is a purely rheologic phenomenon and that hematuria originates from a congested lower urinary tract.
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Abstract
The reasons for the high failure rate of radial artery grafts for aortocoronary bypass (ACB) are appraised. Each of 11 dogs received four types of grafts: femoral arteries were grafted to carotid arteries, and jugular veins were grafted to femoral arteries bilaterally. One of each pair of grafts was wrapped in a plastic sheet in order to interfere with the regeneration of vasa vasorum. The grafts were examined 2 months later. The results suggest that although operative trauma and intraluminal pressure change play important roles, the thick-walled artery appears to depend more on vasa vasorum for its integrity than does the thin-walled vein. A free radical artery graft, with vasa vasorum disrupted at both ends, cannot regenerate readily from the adjacent tissue, as is the case at the ACB position, and is therefore more vulnerable to subintimal hyperplasia and occlusion than either the vein graft or the internal mammary artery graft; both of these grafts are thinner, and the internal mammary artery graft remains undisrupted at one end.
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Dutton JW, Gwise PJ, Chiu CJ, Mersereau WA, Hinchey EJ. A new method to study the healing dynamics of acute gastric erosions and its application on restrained rats. J Surg Res 1976; 20:499-504. [PMID: 945431 DOI: 10.1016/0022-4804(76)90128-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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MacRae ML, Chiu CJ, Hinchey EJ. Effects of exogenous cyclic adenosine monophosphate in hemorrhagic shock. Surgery 1975; 78:254-60. [PMID: 168656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hemorrhageic shock produces potentially damaging alterations in the metabolism of cyclic adenosine 3',5'-monophosphate (cAMP), which is an intracellular second messenger for many hormones. The hypothesis that the administration of exogenous cAMP might have salutary effects on cardiovascular hemodynamics in shock was tested in canine experimetns. Intravenous bolus injection of dibutyryl cAMP (2 mg. per kilogram) produced hyperglycemia, but no changes occurred in heart rate, arerial pressure cardiac output, or in the first derivative of left ventricualr pressure (dp/dt). The findings were similar in conscious and anesthetized (Nembutal) normotensive dogs, in dogs after 3 hours of shock (at blood pressure of 40 mm. Hg) and after the reinfusion of shed blood. The only hemodynamic change noted was a transient hypotensionupon injection of massive doses of dibutyryl-(db-) cAMP or cAMP (greater than 10 mg. per kilogram). The implication of these findings in light of earlier reported hemodynamic effects of cAMP is discussed.
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Chiu CJ, Mulder DS. Selective arterialization of coronary veins for diffuse coronary occlusion. An experimental evaluation. J Thorac Cardiovasc Surg 1975; 70:177-82. [PMID: 1080223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The selective arterialization of coronary veins as a surgical therapy for diffuse coronary arteriosclerosis was studied in canine and sheep experiments. The arterialized blood can be delivered promptly to the selected region of the myocardium and an adequate runoff exists for this mode of revascularization, so that myocardial edema and hemorrhage do not occur. The retrograde blood flow through an anastomosis between the internal mammary artery (IMA) and great cardiac vein (GCV) is excellent, with a predominantly diastolic flow pattern. Follow-up studies indicate significant but partial protection of the myocardium against diffuse LAD occlusion. The size of infarcts is decreased. However, the focal or small transmural infarcts observed are usually located near the apex of the heart. The studies with radioactive microspheres (15 plus or minus 5 mu diameter) revealed that the degree of capillary trapping of microspheres is very much less when the microspheres are injected retrograde into the vein than when injected into the artery. This may indicate that significant "shunt" blood flow exists when the coronary vein is arterialized. Thus this study demonstrates both the potential and the limitation of the selective arterialization of coronary veins in revascularizing patients suffering from diffuse coronary arteriosclerosis.
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Dutton JW, Chiu CJ, Hinchey EJ. The use of a cholestyramine glucose solution to prevent vasopressin-induced gastric erosions in pigs. J Surg Res 1975; 18:501-4. [PMID: 1127915 DOI: 10.1016/0022-4804(75)90125-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
Hormonal regulation is fundamental to homeostasis, and the response in tissues is mediated by adenosine 3':5' equals cyclic phosphate (cyclic AMP). Since circulating levels of catecholamines are elevated during hemorrhagic shock, experiments were carried out to study the effects of epinephrine and of shock on cyclic AMP levels of plasma and of the intestine, a particularly vulnerable organ in canine hemorrhagic shock. Epinephrine was given to normotensive dogs as a constant infusion (group 1) or as a single pulse (group 2). Sequential blood samples showed a marked increase in circulating cyclic AMP, especially in portal and hepatic venous blood. Little change was noted in the tissues. Hemorrhagic shock (group 3) induced a marked increase in plasma cyclic AMP, with a depletion of mucosal cyclic AMP and adenosine triphosphate (ATP). Pretreatment before shock with alpha-blockade (group 4) abolished the decrease in mucosal cyclic AMP and ATP, and reduced the increase in plasma cyclic AMP.
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Kwan A, Chiu CJ, Mersereau W, Hinchey EJ. The roles of intraluminal chyme and vasomotor response in the pathogenesis of non-occlusive intestinal infarcts. Ann Surg 1974; 179:877-82. [PMID: 4835506 PMCID: PMC1355918 DOI: 10.1097/00000658-197406000-00010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The purpose of this study is to clarify the role of intraluminal chyme and the splanchnic vasomotor reaction on the pathogenesis of non-occlusive intestinal infarcts. In 5 mongrel dogs, 3 types of intestinal loops were created. A cervical loop, which is a heterotopic autotransplant of a segment of intestine, contains no chyme and is disconnected from the splanchnic innervation. A Thiry-Vella loop simultaneously constructed in the abdomen is also devoid of intraluminal chyme, but is still innervated. The intestine-in-continuity possesses both splanchnic innervation and intraluminal chyme. Hemorrhagic shock was then induced and the morphological response of the three types of intestine examined. The results indicate that the cervical loop is least damaged, whereas both the Thiry-Vella loop and the intestine-incontinuity are both severely damaged. It is concluded that in the non-occlusive hemorrhagic infarction of the intestinal mucosa, the peculiar splanchnic vasomotor response plays the dominant role. The pathogenesis of non-occlusive intestinal infarcts and its clinical implications are discussed.
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Kass TG, Symes JF, Chiu CJ, Blundell PE. Effect of myocardial revascularization on ventricular fibrillation thresholds in dogs. Can J Surg 1974; 17:97-101. [PMID: 4817698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Chiu CJ, MacRae ML, Scott HJ. Role of "myocardial sinusoids" in the early run-off of myocardial arterial implants: a critical reappraisal. Can J Surg 1974; 17:70-3. [PMID: 4817694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Hueckel HJ, Chiu CJ, Hinchey EJ. The effect of intraluminally administered glucose in reducing fluid and electrolyte loss from the ischemic intestine. Surg Gynecol Obstet 1973; 136:780-4. [PMID: 4701911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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41
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Chiu CJ, Scott HJ. The nature of early runoff in myocardial arterial implants. A Morphologic and hemodynamic reappraisal. J Thorac Cardiovasc Surg 1973; 65:768-77. [PMID: 4696876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Chiu CJ, Mersereau WA, Scott HJ. Subendocardial hemorrhagic necrosis. The role of direct mechanical trauma on the endocardium. J Thorac Cardiovasc Surg 1972; 64:66-75. [PMID: 5053962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Chiu CJ, McArdle AH, Brown RA, Scott HJ, Gurd FN. Gastric mucosal changes following burns in rats. A morphological and metabolic approach to the stress ulcer problem. Arch Surg 1971; 103:147-52. [PMID: 5562802 DOI: 10.1001/archsurg.1971.01350080063009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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47
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Chiu CJ, Scott HJ. [Role of pulsatile blood flow in the superior mesenteric artery: physiologic bases of an amelioration of organ perfusion and cardiopulmonary derivation]. Union Med Can 1971; 100:485-90. [PMID: 5555107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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48
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Chiu CJ, Blundell PE, Scott HJ, Gurd FN. The intestinal lesions and circulating lysosomal enzymes in extracorporeal circulation. A clinical and experimental study. J Thorac Cardiovasc Surg 1971; 61:141-8. [PMID: 5540455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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49
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Chiu CJ, Scott HJ, Gurd FN. Intestinal mucosal lesion in low-flow states. II. The protective effect of intraluminal glucose as energy substrate. Arch Surg 1970; 101:484-8. [PMID: 5311679 DOI: 10.1001/archsurg.1970.01340280036010] [Citation(s) in RCA: 83] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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50
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Chiu CJ, McArdle AH, Brown R, Scott HJ, Gurd FN. Intestinal mucosal lesion in low-flow states. I. A morphological, hemodynamic, and metabolic reappraisal. Arch Surg 1970; 101:478-83. [PMID: 5457245 DOI: 10.1001/archsurg.1970.01340280030009] [Citation(s) in RCA: 1334] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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