1
|
Kuo YC, Chuang CH, Kuo HC, Lin CT, Chao A, Huang HJ, Wang HM, Hsieh JCH, Chou HH. Circulating tumor cells help differentiate benign ovarian lesions from cancer before surgery: A literature review and proof of concept study using flow cytometry with fluorescence imaging. Oncol Lett 2024; 27:234. [PMID: 38596263 PMCID: PMC11003220 DOI: 10.3892/ol.2024.14367] [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: 10/26/2023] [Accepted: 02/19/2024] [Indexed: 04/11/2024] Open
Abstract
Current tools are insufficient for distinguishing patients with ovarian cancer from those with benign ovarian lesions before extensive surgery. The present study utilized a readily accessible platform employing a negative selection strategy, followed by flow cytometry, to enumerate circulating tumor cells (CTCs) in patients with ovarian cancer. These counts were compared with those from patients with benign ovarian lesions. CTC counts at baseline, before and after anticancer therapy, and across various clinical scenarios involving ovarian lesions were assessed. A negative-selection protocol we proposed was applied to patients with suspected ovarian cancer and prospectively utilized in those subsequently confirmed to have malignancy. The protocol was implemented before anticancer therapy and at months 3, 6, 9 and 12 post-treatment. A cut-off value for CTC number at 4.75 cells/ml was established to distinguish ovarian malignancy from benign lesions, with an area under the curve of 0.900 (P<0.001). In patients with ovarian cancer, multivariate Cox regression analysis revealed that baseline CTC counts and the decline in CTCs within the first three months post-therapy were significant predictors of prolonged progression-free survival. Additionally, baseline CTC counts independently prognosticated overall survival. CTC counts obtained with the proposed platform, used in the present study, suggest that pre-operative CTC testing may be able to differentiate between malignant and benign tumors. Moreover, CTC counts may indicate oncologic outcomes in patients with ovarian cancer who have undergone cancer therapies.
Collapse
Affiliation(s)
- Yung-Chia Kuo
- Division of Hematology-Oncology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan, R.O.C
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan, R.O.C
- Department and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
| | - Chi-Hsi Chuang
- Department of Pediatrics, New Taipei Municipal TuCheng Hospital, New Taipei City 236, Taiwan, R.O.C
| | - Hsuan-Chih Kuo
- Division of Hematology-Oncology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan, R.O.C
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan, R.O.C
- Department and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
| | - Cheng-Tao Lin
- Department and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan, R.O.C
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan, R.O.C
| | - Angel Chao
- Department and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan, R.O.C
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan, R.O.C
| | - Huei-Jean Huang
- Department and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan, R.O.C
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan, R.O.C
| | - Hung-Ming Wang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan, R.O.C
- Department and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
| | - Jason Chia-Hsun Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan, R.O.C
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan, R.O.C
- Department and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan, R.O.C
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan, R.O.C
- Department and School of Medicine, National Tsing Hua University, Hsinchu 300044, Taiwan, R.O.C
| |
Collapse
|
2
|
Patel DS, Roberts SCM, Leslie DL, Liu G, Weisman C, Horvath S, Chuang CH. POSTER ABSTRACTS. Contraception 2021. [DOI: 10.1016/j.contraception.2021.07.048] [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] [Indexed: 10/20/2022]
|
3
|
Li HY, Chang SL, Chuang CH, Lin MC, Lin YJ, Lo LW, Hu YF, Chung FP, Chang YT, Chung CM, Chen SA, Lee PC. A Novel and Simple Algorithm Using Surface Electrocardiogram That Localizes Accessory Conduction Pathway in Wolff-Parkinson-White Syndrome in Pediatric Patients. Acta Cardiol Sin 2019; 35:493-500. [PMID: 31571798 DOI: 10.6515/acs.201909_35(5).20190312a] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The location of the accessory pathway (AP) can be precisely identified on surface electrocardiography (ECG) in adults with Wolff-Parkinson-White (WPW) syndrome. However, current algorithms to locate the AP in pediatric patients with WPW syndrome are limited. Objective To propose an optimal algorithm that localizes the AP in pediatric patients with WPW syndrome. Methods From 1992 to 2016, 180 consecutive patients aged below 18 years with symptomatic WPW syndrome were included. After the exclusion of patients with non-descriptive electrocardiography (ECG), multiple APs, congenital heart diseases, non-inducible tachycardia, and those who received a second ablation, 104 patients were analyzed retrospectively. Surface ECG was obtained before ablation and evaluated by using previously documented algorithms, from which a new pediatric algorithm was developed. Results Previous algorithms were not highly accurate when used in pediatric patients with WPW syndrome. In the new algorithm, the R/S ratio of V1 and the polarity of the delta wave in lead I could distinguish right from the left side AP with 100% accuracy. The polarity of the delta wave of lead V1 could distinguish free wall AP from septal AP with an accuracy of 100% in left-side AP, compared to 88.6% in leads III and V1 for right-side AP. The overall accuracy was 92.3%. Conclusions This simple, novel algorithm could differentiate left from right AP and septal from free wall AP in pediatric patients with WPW syndrome.
Collapse
Affiliation(s)
- Hsing-Yuan Li
- Division of Cardiology, Department of Pediatrics, Taipei Veterans General Hospital.,Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Chi-Hsi Chuang
- Division of Cardiology, Department of Pediatrics, Taichung Veterans General Hospital
| | - Ming-Chih Lin
- Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei.,Division of Cardiology, Department of Pediatrics, Taichung Veterans General Hospital
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Yao-Ting Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Chieh-Mao Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Department of Pediatric Cardiology, Chinese Medical University Children's Hospital, Taichung, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Pi-Chang Lee
- Division of Cardiology, Department of Pediatrics, Taipei Veterans General Hospital.,Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei
| |
Collapse
|
4
|
Van Scoy LJ, Scott AM, Reading JM, Chuang CH, Chinchilli VM, Levi BH, Green MJ. From Theory to Practice: Measuring end-of-life communication quality using multiple goals theory. Patient Educ Couns 2017; 100:909-918. [PMID: 28011081 DOI: 10.1016/j.pec.2016.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 11/17/2016] [Accepted: 12/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To describe how multiple goals theory can be used as a reliable and valid measure (i.e., coding scheme) of the quality of conversations about end-of-life issues. METHODS We analyzed conversations from 17 conversations in which 68 participants (mean age=51years) played a game that prompted discussion in response to open-ended questions about end-of-life issues. Conversations (mean duration=91min) were audio-recorded and transcribed. Communication quality was assessed by three coders who assigned numeric scores rating how well individuals accomplished task, relational, and identity goals in the conversation. RESULTS The coding measure, which results in a quantifiable outcome, yielded strong reliability (intra-class correlation range=0.73-0.89 and Cronbach's alpha range=0.69-0.89 for each of the coded domains) and validity (using multilevel nonlinear modeling, we detected significant variability in scores between games for each of the coded domains, all p-values <0.02). CONCLUSIONS Our coding scheme provides a theory-based measure of end-of-life conversation quality that is superior to other methods of measuring communication quality. PRACTICE IMPLICATIONS Our description of the coding method enables researches to adapt and apply this measure to communication interventions in other clinical contexts.
Collapse
Affiliation(s)
- L J Van Scoy
- Department of Medicine and Humanities, Penn State Milton S. Hershey Medical Center, United States.
| | - A M Scott
- Department of Communication, University of Kentucky, United States
| | - J M Reading
- Department of Medicine, Penn State Milton S. Hershey Medical Center, United States
| | - C H Chuang
- Department of Medicine and Public Health Sciences, Penn State Milton S. Hershey Medical Center, United States
| | - V M Chinchilli
- Department of Public Health Sciences and Statistics, Penn State Milton S. Hershey Medical Center, United States
| | - B H Levi
- Department of Humanities and Pediatrics, Penn State Milton S. Hershey Medical Center, United States
| | - M J Green
- Department of Medicine and Humanities, Penn State Milton S. Hershey Medical Center, United States
| |
Collapse
|
5
|
Chen KR, Chu WH, Fang HC, Liu CP, Huang CH, Chui HC, Chuang CH, Lo YL, Lin CY, Hwung HH, Fuh AYG. Beyond-limit light focusing in the intermediate zone. Opt Lett 2011; 36:4497-4499. [PMID: 22139221 DOI: 10.1364/ol.36.004497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We experimentally verify that a new nanolens of a designed plasmonic aperture can focus visible light to a single line with its width smaller than the limit of half the wavelength in the intermediate zone. The experimental measurement indicates that while the near field plays a role to increase the spot size in the near zone, it is negligible at the beyond-limit focused region; i.e., the focused light is dominated by the radiative fields. The image taken by the optical microscope shows that the fields focused have propagated to the far zone. Besides being of academic interest, the nanolens capable in achieving a lower diffraction limit in the intermediate zone is important for application possibilities.
Collapse
Affiliation(s)
- K R Chen
- Department of Physics, National Cheng Kung University, 1 University Road, Tainan 70101, Taiwan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Lo YL, Chuang CH. Analytical analysis of modulated signal in apertureless scanning near-field optical microscopy. Opt Express 2007; 15:15782-15796. [PMID: 19550863 DOI: 10.1364/oe.15.015782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Eliminating background-scattering effects from the detected signal is crucial in improving the performance of super-high-resolution apertureless scanning near-field optical microscopy (A-SNOM). Using a simple mathematical model of the A-SNOM detected signal, this study explores the respective effects of the phase modulation depth, the wavelength and angle of the incident light, and the amplitude of the tip vibration on the signal contrast and signal intensity. In general, the results show that the background-noise decays as the order of the Bessel function increases and that higher-order harmonic frequencies yield an improved signal contrast. Additionally, it is found that incident light with a longer wavelength improves the signal contrast for a constant order of modulation frequency. The signal contrast can also be improved by reducing the incident angle of the incident light. Finally, it is demonstrated that sample stage scanning yields an improved imaging result. However, tip scanning provides a reasonable low-cost and faster solution in the smaller scan area. The analytical results presented in this study enable a better understanding of the complex detected signal in A-SNOM and provide insights into methods of improving the signal contrast of the A-SNOM measurement.
Collapse
|
7
|
|
8
|
Chan DC, Chuang CH, Liu CT, Yu JC. Education and imaging. Hepatobiliary and pancreatic: torsion of the gallbladder. J Gastroenterol Hepatol 2007; 22:1552. [PMID: 17716359 DOI: 10.1111/j.1440-1746.2007.05133.x] [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: 12/09/2022]
Affiliation(s)
- D C Chan
- Department of Surgery, Division of General Surgery, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | | | | | | |
Collapse
|
9
|
|
10
|
Abstract
We present a digital programmable light spectrum synthesis system based on a digital micromirror device (DMD) from Texas Instruments. A DMD pattern-scanning calibration method is developed and applied to the synthesis of various infrared C-band (1530-1565 nm) spectral profiles, including a fast programmable tunable light source with a bandwidth of approximately 3.8 nm, a square profile, a sawtooth waveform, and a triangular spectrum profile. The experimental results show that the wavelength resolution of the DMD spectrum synthesis system is approximately 0.076 nm/pixel. The proposed spectrum synthesis system has a number of key advantages, including a rapid and stable performance and multichannel compatibility. The spectrum synthesis system is suitable for various applications, including pulse shaping for coherent control and harmonic generation, a tunable light source, an equalizer for erbium-doped fiber amplifiers, and a wavelength scanner.
Collapse
Affiliation(s)
- C H Chuang
- National Cheng Kung University, Tainan, Taiwan
| | | |
Collapse
|
11
|
Wu CC, Liao TN, Lu KC, Chen JS, Chu P, Lin SH, Chuang CH, Lin YF. Apoptotic markers on lymphocytes and monocytes are unchanged during single hemodialysis sessions using either regenerated cellulose or polysulfone membranes. Clin Nephrol 2005; 64:198-204. [PMID: 16175944 DOI: 10.5414/cnp64198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/18/2022] Open
Abstract
BACKGROUND There is an increased rate of apoptosis of peripheral blood mononuclear cells (PBMCs) in patients undergoing hemodialysis (HD), but little is known about how different dialysis membranes may contribute to the process. We, therefore, studied the influence of two different dialysis membranes on apoptotic markers during HD. METHODS 8 healthy controls and 8 patients on regular HD 3 times per week were enrolled in this cross-controlled study. Patients received HD using polysulfone and then regenerated cellulose dialysis membranes for one week each, sequentially. Serum was collected for C-reactive protein (CRP) detection; flow cytometry with dual antibody staining was used to measure the apoptotic markers Fas (CD95), FasL (CD 178) and TNF-R2 (CD120b) in T cells (CD3+), B cells (CD19+), and monocytes (CD14+) at 0, 15, 120 and 240 min after starting HD. We also measured total leukocyte numbers and differential white cell counts. RESULTS Hemodialysis patients revealed lymphocytopenia, monocytopenia, higher CRP levels and higher Fas and TNF-R2 expression on lymphocytes and monocytes at baseline when compared with normal controls. Leukocyte numbers, including neutrophils, lymphocytes and monocytes, dropped significantly after 15 min of dialysis. There were no significant differences in Fas levels during hemodialysis on T and B lymphocytes or on monocytes. T lymphocyte FasL (CD 178) levels remained unchanged throughout the process. There was a significantly lower overall level of CD120b at 15 min of HD, whereas this marker was higher on monocytes after dialysis. There were no significant differences in the levels of apoptotic markers between the two membranes. CONCLUSION Our results suggest that uremia itself contributes to PBMC apoptosis. The two different dialysis membranes used in this study did not influence apoptotic markers on PBMCs significantly, but increased TNF-R2 expression on monocytes during a single dialysis session.
Collapse
Affiliation(s)
- C C Wu
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Liebschutz JM, Geier JL, Horton NJ, Chuang CH, Samet JH. Physical and sexual violence and health care utilization in HIV-infected persons with alcohol problems. AIDS Care 2005; 17:566-78. [PMID: 16036243 PMCID: PMC4854520 DOI: 10.1080/09540120512331314358] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We examined interpersonal violence and its association with health care utilization and substance use severity among a cohort of 349 HIV-infected men and women with histories of alcohol problems assessed biannually up to 36 months. Data included demographics, lifetime interpersonal violence histories, age at first violence exposure, recent violence (prior six months), substance use severity and health care utilization (ambulatory visits, Emergency Department (ED) visits, hospitalizations) and adherence to HIV medication. Kaplan-Meier survival curves estimated the proportion of subjects experiencing recent violence. Generalized estimating equation regression models evaluated the relationship between recent violence, utilization and substance use severity over time, controlling for demographics, CD4 counts and depressive symptoms. Subject characteristics included: 79% male; mean age 41 years; 44% black, 33% white and 23% other. Eighty percent of subjects reported lifetime interpersonal violence: 40% physical violence alone, and 40% sexual violence with or without physical violence. First violence occurred prior to age 13 in 46%. Twenty-four (41%) of subjects reported recent violence by 24 and 36 months, respectively. In multivariate analyses, recent violence was associated with more ambulatory visits, ED visits and hospitalizations and worse substance use severity, but not medication adherence. Due to the high incidence and associated increased health care services utilization, violence prevention interventions should be considered for HIV-infected patients with a history of alcohol problems.
Collapse
Affiliation(s)
- J M Liebschutz
- Clinical Addictions Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine, Northampton, MA, USA.
| | | | | | | | | |
Collapse
|
13
|
Kuo CC, Lee CT, Chuang CH, Su Y, Chen JB. Recombinant human erythropoietin independence in chronic hemodialysis patients: clinical features, iron homeostasis and erythropoiesis. Clin Nephrol 2005; 63:92-7. [PMID: 15730050 DOI: 10.5414/cnp63092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 11/18/2022] Open
Abstract
AIMS Recombinant human erythropoietin (r-HuEPO) is widely used to correct renal anemia in uremic patients. Interestingly, some chronic hemodialysis (HD) patients can maintain high hemoglobin level without the need of r-HuEPO. The aim of this study is to investigate clinical features, iron metabolism and erythropoiesis of these r-HuEPO-independent HD patients. METHODS r-HuEPO independence was defined in dialysis patients as hemoglobin greater than 12 g/dl and no use of r-HuEPO for at least 6 months. An age- and sex-matched group was selected for comparison. Their underlying diseases, duration of hemodialysis therapy, efficacy of dialysis (Kt/V), normalized protein catabolic rate (nPCR) and body mass index (BMI) were recorded. Laboratory data including: hemoglobin, albumin, high sensitivity C-reactive protein, serum iron, total iron binding capacity, transferrin saturation, ferritin, intact parathyroid hormone, soluble transferrin receptor (sTfR), serum EPO, cortisol, testosterone, aluminum and leptin levels were measured. Renal sonography was also performed in each patient to evaluate renal cyst formation. RESULTS About 2.3% of all HD patients (21/888; M : F = 18 : 3) were r-HuEPO-independent. These patients had significantly longer HD duration and higher serum EPO and sTfR levels, and lower transferrin saturation rate than dependent groups. Correlation analysis revealed that hemoglobin level strongly correlated with HD duration, serum sTfR and EPO levels. Levels of sTfR were positively related with serum EPO levels and BMI. Multivariate regression analysis showed that level of sTfR was the only independent factor related to r-HuEPO independence. CONCLUSION R-HuEPO independence is rare among chronic hemodialysis patients. Factors contributing to this dependence are complex and multiple. Level of serum sTfR parallels erythropoiesis and is the most significant factor associated with r-HuEPO independence in chronic HD patients.
Collapse
Affiliation(s)
- C C Kuo
- Division of Nephrology, Department of Internal Medicine, Chang-Gung Memorial Hospital, Kaohsiung, Taiwan
| | | | | | | | | |
Collapse
|
14
|
Abstract
Primary care physicians of all specialties should be familiar with prescribing emergency contraception (EC). We conducted a mail survey of 282 randomly sampled physicians in general internal medicine (31%), family medicine (34%) and obstetrics-gynecology (35%). Experience with prescribing EC significantly differed by specialty (63% of general internists, 76% of family physicians, and 94% of obstetrician-gynecologists, p < 0.0001). Controlling for year of graduation, gender, religion and practice location, family physicians [adjusted odds ratio (OR): 2.5, 95% confidence interval (CI): 1.2-5.2] and obstetrician-gynecologists (adjusted OR: 11.2, 95% CI: 4.0-31.3) were still significantly more likely to have ever prescribed EC than general internists. Efforts to increase awareness and knowledge of EC should be aimed at general internists since they provide primary care for many reproductive age women.
Collapse
Affiliation(s)
- C H Chuang
- Section of General Internal Medicine, Boston University Medical Center, 720 Harrison Avenue, Suite 1108, Boston, MA 02118, USA.
| | | | | | | |
Collapse
|
15
|
Abstract
BACKGROUND AND STUDY AIMS The study tested whether pronase can improve endoscopic visibility and alter the accuracy of the CLO test for H. pylori detection. PATIENTS AND METHODS A total of 160 patients were randomly assigned to receive one of five premedications for endoscopy: group A: dimethylpolysiloxane (DMPS) alone; group B: DMPS plus water (up to 100 ml); group C: pronase only, with 100 ml water; group D: pronase and sodium bicarbonate plus water up to 100 ml; group E: pronase, sodium bicarbonate, and DMPS, plus water up to 100 ml. Endoscopists, who were unaware of the premedication method administered, assessed visibility scores (range 1 - 4) for the antrum, lower gastric body, upper gastric body, and fundus. The higher the score, the less clear the visibility. The sum of scores from the four locations was defined as the total visibility score. A CLO test was also done during the endoscopy. One week after their endoscopy, patients in groups C, D, and E were scheduled for a (13)C-urea breath test (UBT). RESULTS Group E patients had a significantly lower total visibility score than those in the other four groups ( P < 0.05). Groups C and D had higher total visibility scores than the other three groups ( P < 0.05). The scores did not significantly differ between groups A and B. Based on the UBT results, the sensitivity and specificity of the CLO test were 92.6 % and 96.2 %, respectively. CONCLUSIONS Premedication as in group E provided the clearest endoscopic visibility. Without the application of DMPS, pronase alone cannot improve endoscopic visibility. Pronase does not influence H. pylori identification using the CLO test.
Collapse
Affiliation(s)
- C H Kuo
- Dept. of Internal Medicine, St. Martin De Porres Hospital, Chia-Yi, Taiwan
| | | | | | | | | |
Collapse
|
16
|
Sheu BS, Yang HB, Wang YL, Chuang CH, Huang AH, Wu JJ. Pretreatment gastric histology is helpful to predict the symptomatic response after H. pylori eradication in patients with nonulcer dyspepsia. Dig Dis Sci 2001; 46:2700-7. [PMID: 11768263 DOI: 10.1023/a:1012727513166] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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: 12/09/2022]
Abstract
This study aimed to test whether pretreatment gastric pathology in H. pylori-infected nonulcer dyspepsia (HpNUD) patients is relevant to and predictive of the symptomatic response after H. pylori eradication. Anti-H. pylori triple therapy was administered to 250 HpNUD patients, enrolled as the therapy group. In addition, 60 patients were enrolled as the control group, in which omeprazole was an alternatives to the triple therapy. Pretreatment gastric histology was evaluated thoroughly by the updated Sydney system. A [13C] urea breath test was also performed to evaluate the H. pylori eradication two months and 12 months later. For each patient, the baseline, month 2, and month 12 symptom scores were assessed for the month 2 or month 12 residual symptom ratio (RSR-2m or RSR-12m), calculated from: 100% x month 2 or month 12 score/baseline score. Based on either RSR-2m or RSR-12m, patients were categorized as good response (RSR < 50%), moderate response (50-70%), and poor response (> 70%) subgroups in both therapy and control groups to define the short-term and long-term symptomatic responses. Patients with successful H. pylori eradication in the therapy group showed a higher incidence of good symptomatic response (RSR < 50%) than those from the control group (month 2: 30.3 vs 12%, P < 0.05; month 12: 34.7 vs 17.1%, P < 0.05). Univariate and multivariate analysis disclosed that patients with a higher acute inflammation score (AIS) and the lowest incidence of lymphoid follicles (LF) at pretreatment gastric histology are predisposed to having a good symptom response after H. pylori eradication (P < 0.05). For HpNUD patients who have an AIS of more than three and an absence of LF at gastric histology, more than 85% had good short-term (month 2) and long-term (month 12) symptomatic relief after H. pylori eradication. In conclusion, nearly 30% of HpNUD patients can obtain symptomatic relief following H. pylori eradication. The pretreatment gastric histology of HpNUD can be helpful to monitor the symptomatic response after H. pylori eradication.
Collapse
Affiliation(s)
- B S Sheu
- Department of Internal Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | | | | | | | | |
Collapse
|
17
|
Wang SL, Lin SY, Chen TF, Chuang CH. Solid-state trans-cis isomerization of captopril determined by thermal Fourier transform infrared (FT-IR) microspectroscopy. J Pharm Sci 2001; 90:1034-9. [PMID: 11536207 DOI: 10.1002/jps.1056] [Citation(s) in RCA: 20] [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] [Indexed: 11/11/2022]
Abstract
Thermal Fourier transform infrared (FT-IR) microspectroscopy was used to investigate the conformational isomerization of captopril in the solid state. The result indicates that the IR peak intensity of captopril for original bands decreased dramatically at 102 degrees C, but for new bands it increased with the rise of temperature. The frequency of C=O stretching mode for carboxylic acid and for amide was located at a higher wavenumber of 1747 cm(-1) and at a lower frequency of 1591 cm(-1) as compared with the general compound, suggesting the existence of trans isomer of captopril in the solid state by intramolecular hydrogen bonding. Beyond 102 degrees C, several new bands at 1720, 1645, and 1610 cm(-1) were observed with the rise of temperature, indicating the coexistence of a cis isomer. However, the cis isomer could transform gradually to the trans isomer after cooling. The thermodynamics of equilibrium mixture of cis/trans isomers were also studied. The trans isomer was more stable than the cis isomer, but the cis isomer was favored at the higher temperature.
Collapse
Affiliation(s)
- S L Wang
- Biopharmaceutics Laboratory, Department of Medical Research & Education, Veterans General Hospital-Taipei, Shih-Pai, Taipei, Taiwan, Republic of China
| | | | | | | |
Collapse
|
18
|
Lo YL, Chuang CH. Differential optical fiber refractometer based on a path-matching differential interferometer with temperature compensation. Appl Opt 2001; 40:3518-3524. [PMID: 18360378 DOI: 10.1364/ao.40.003518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We present a new approach for the development of a highly stable optical fiber refractometer based on a path-matching differential interferometer. Exploiting a single-channel phase tracker and new synthetic heterodyne demodulations, one can eliminate the thermal drift on a piezoelectric transducer stack as a phase modulator by subtraction. A transducer in a differential Fabry-Perot refractometer is designed to compensate for the thermal effects not only from thermal expansion but also from the thermo-optic effect. The experimental data show that the refractive-index change in the sensing system can be kept at a level of approximately 5 x 10(-4) without serious variations for a 1-h period of long-term monitoring associated with a temperature variation of from 25 to 50 degrees C. Accordingly, the proposed new system can be easily implemented and used as a long-term monitoring system for medical care applications such as monitoring patients during drug injection.
Collapse
|
19
|
Chuang CH, Sheu BS, Yang HB, Wu JJ, Lin XZ. Ranitidine bismuth citrate or omeprazole-based triple therapy for Helicobacter pylori eradication in Helicobacter pylori-infected non-ulcer dyspepsia. Dig Liver Dis 2001; 33:125-30. [PMID: 11346139 DOI: 10.1016/s1590-8658(01)80066-9] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM To test the eradication rate of Helicobacter pylori by ranitidine bismuth citrate-based triple therapy, and evaluate the symptomatic response of Helicobacter pylori eradication therapy for non-ulcer dyspepsia. METHODS A total of 59 consecutive Helicobacter pylori infected non-ulcer dyspepsia patients were randomly selected to receive either one of two triple therapy regimens, including metronidazole, amoxycillin plus ranitidine bismuth citrate (RAM group) or omeprazole (OAM group). To determine the success of eradication, patients underwent the 13C-urea breath test, 6 weeks and one year after treatment. The dyspeptic symptom scores were also assessed at the time of enrolment, 6 weeks and one year after treatment. RESULTS Per-protocol and intention-to-treat eradication rates were 77.7% and 70% in RAM group and 83.8% and 68.9% in OAM group (p = non significant). At both the 6th week and at the first year after treatment, the mean symptom scores were lower than pre-treatment scores in the study population, regardless of whether treatment was successful or not. However, patients, whether eradicated successfully or not-eradicated, presented similar 6-week and 1-year scores. CONCLUSIONS One-week RAM triple therapy, which is cheaper than the OAM regimen, is a relatively effective alternative regimen for Helicobacter pylori eradication in Taiwanese. Triple therapy for Helicobacter pylori eradication was not the whole management for the relief of dyspeptic symptoms of non-ulcer dyspepsia patients.
Collapse
Affiliation(s)
- C H Chuang
- Department of Internal Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | | | | | | |
Collapse
|
20
|
Chuang CH, Hsu SC, Hsu CL, Hsu TC, Syu WJ. Construction of a tagging system for subcellular localization of proteins encoded by open reading frames. J Biomed Sci 2001; 8:170-5. [PMID: 11287747 DOI: 10.1007/bf02256409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 10/25/2022] Open
Abstract
We have previously characterized a monoclonal antibody (SC1D7) that is directed to maltose-binding protein (MBP) of Escherichia coli and other closely related enteric bacteria. SC1D7 does not cross-react with proteins in eucaryotes and appears to be a highly specific tool in immunochemical analyses. To better map the epitope, we took advantage of an available plasmid, pMAL-c2, that encodes the E. coli MBP-coding sequence and constructed plasmids to express MBP fragments. A construct containing the N-terminal portion of MBP does not react with SC1D7, whereas a second construct expressing glutathione S-transferase fused with the C-terminal half of MBP does react with SC1D7. To precisely define the epitope, random peptides displayed on M13 were used to react with SC1D7. Sequences of reactive peptides were aligned, and a consensus sequence of XDXRIPX was deduced. This sequence matches MBP with an amino acid stretch of KDPRIAA. To consolidate the mapping result, a sequence encoding this epitope was inserted into an expression vector and the resulting recombinant protein did react with SC1D7. Thereafter, this epitope was incorporated into a eucaryotic expression plasmid containing a previously defined hepatitis delta virus epitope for protein tagging. This two-epitope-tagging vector is useful in various molecular analyses. We demonstrate its usage for localization of a bacterial virulence factor in host cells. This vector should be applicable for high-throughput characterization of new open reading frames found in genome sequencing.
Collapse
Affiliation(s)
- C H Chuang
- Institute of Microbiology and Immunology, National Yang Ming University, Shih-Pai, Taipei 112, Taiwan, ROC
| | | | | | | | | |
Collapse
|
21
|
Wu G, Svenson RH, Littmann L, Chuang CH, Thompson M, Nanney GA, Splinter R, Tatsis GP, Dezern KR. Laser photoablation of experimental post-infarction ventricular tachycardia guided by three dimensional activation mapping. Lasers Surg Med 2000; 20:119-30. [PMID: 9047165 DOI: 10.1002/(sici)1096-9101(1997)20:2<119::aid-lsm2>3.0.co;2-t] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study was to evaluate the efficacy of epicardially delivered laser energy to ablate induced ventricular tachycardia in a post-infarction canine model. STUDY DESIGN/MATERIALS AND METHODS In 13 canines, the left anterior wall myocardial infarction was created. Five days later, 240 plunged electrodes were inserted into the heart. Three-dimensional ventricular activation sequences were analyzed on line by a computerized mapping system. RESULTS Sixteen sustained monomorphic ventricular tachycardias were reproducibly induced in 10 canines. Epicardially contacted Nd:YAG laser irradiated the areas of the final pathway in macro-reentrant activation and the impulse origin in focal excitation. Linear photocoagulation lesions (11-16 x 50-72 mm) were created. Seven macro-reentrant circuits and six of nine focal origins were eliminated (success rate 81%). Pathology showed that laser photocoagulation involved all surviving subepicardial and intramural fibers. CONCLUSION Epicardially delivered laser energy in conjunction with electrical activation mapping has a high probability of ablating post-infarction ventricular tachycardia.
Collapse
Affiliation(s)
- G Wu
- Laser and Applied Technologies Laboratory, Carolinas Medical Center, Charlotte, North Carolina 28232, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Sheu BS, Lee SC, Lin PW, Wang ST, Chang YC, Yang HB, Chuang CH, Lin XZ. Carbon urea breath test is not as accurate as endoscopy to detect Helicobacter pylori after gastrectomy. Gastrointest Endosc 2000; 51:670-5. [PMID: 10840298 DOI: 10.1067/mge.2000.105719] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [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: 12/30/2022]
Abstract
BACKGROUND This study was conducted to determine (1) whether Helicobacter pylori infection decreases in conjunction with time elapsed after gastrectomy and (2) the diagnostic efficacy of (13)C urea breath test (UBT) for H pylori in patients after gastrectomy. METHODS From January 1997 to June 1998, 86 patients who had undergone gastrectomy and 180 patients with dyspepsia without gastrectomy were enrolled. A UBT for the analysis of excess (13)CO(2)/(12)CO(2) ratio (ECR) was obtained for each patient. Each patient also underwent endoscopy to obtain gastric biopsies for histology and H pylori culture. The presence of H pylori by either histology or culture served as the standard to test the efficacy of UBT. The 86 patients with a prior gastrectomy were categorized into 3 subgroups (I, less than 1 year; II, 1 to 3 years; III, greater than 3 years), according to the interval between surgery and UBT. The initial H pylori status of these 86 patients was determined by histologic evaluation of the resected stomach. RESULTS At trial initiation, the postgastrectomy group had a lower H pylori infection rate (52.3%) as compared with the dyspeptic control group (80%). The initial H pylori status among subgroups I, II, and III was similar. There was a trend for the presence of H pylori in the stomach to decrease with increasing time elapsed after surgery (I to III: 68.8%, 48.3%, 36%, respectively; p < 0.05). The maximum UBT sensitivity and specificity achieved were 82.2% and 87.8% in the gastrectomy group and 97.2% and 96.3% in the dyspeptic group, with cutoff points of 2.5 and 4.0, respectively. CONCLUSION The prevalence of H pylori diminishes with time elapsed after gastrectomy. UBT for detection of H pylori is more effective in patients without prior gastrectomy than in patients who have undergone gastrectomy and is less effective than endoscopy for patients who have had a gastrectomy.
Collapse
Affiliation(s)
- B S Sheu
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Lin XZ, Chen CY, Chuang CH, Chen CS, Chang GL. An economically constructed feeding tube for pull-type percutaneous endoscopic gastrostomy. Endoscopy 2000; 32:S25. [PMID: 10817192] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- X Z Lin
- Department of Internal Medicine, Medical College, National Cheng Kung University Hospital, Tainan, Taiwan.
| | | | | | | | | |
Collapse
|
24
|
Hou MF, Huang CJ, Huang YS, Hsieh JS, Chan HM, Wang JY, Chuang CH, Chen FM, Huang TJ. Mondor's disease in the breast. Kaohsiung J Med Sci 1999; 15:632-9. [PMID: 10630059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Mondor's disease, superficial thrombophebitis of the breast, is an uncommon self-limiting condition. Surgical procedures and trauma were the common known causes. The objective of this study was to evaluate the incidence of Mondor's disease in different breast operations in lower risk of breast cancer area over a 6-year period and to identify its causes, clinical features, related surgical factors and associated breast cancer. Eighty-four cases of Mondor's disease were obtained from 9657 new patients in the breast clinic of Kaohsiung Medical University Hospital between January 1991 and December 1996. The incidence per year was close (0.84%-0.96%) although the number has been increasing each year. In 23 cases, no definite cause was diagnosed, whereas in 61 cases, the disorder was secondary because the pathogenesis could be discerned. The identified causes included forty-three cases caused by breast surgery, two cases associated with breast cancer and sixteen cases with other benign causes. Although the incidence did not differ significantly between breast surgery (0.95%) and non-surgical causes (0.79%), the highest incidence, 1.52%, occurred when excision through circumareolar incision and tunnel procedure for cosmesis (25 cases in 1634 excisions) were used, and the lowest 0.69% when excisions through direct incision (14 cases in 2004 excisions) were performed. (P < 0.05) The other incidence rates were 1.56% in breast conserving surgery which is higher than 0.37% following mastectomy. The incidence of the disease was higher (4.28%) when the distance of the breast lesion was more than 3 cm from the areolar edge, compared to 1.20% for the 2 cm group and 0.32% for the 1 cm group (P < 0.05) in tunnel procedures. The incidence of Mondor's disease during breast surgery was not significantly different in different breast quardrants. Although Mondor's disease is a benign, self-limiting condition, a high incidence developed in the excision biopsy through circumareolar incision with tunnel procedure when the distance from the breast lesion to the areolar edge was more than 3 cm. To prevent this complication, the tunnel procedure in breast biopsy should be avoided. The incidence of Mondor's disease associated with breast cancer was low (2.4%) in the lower-incidence breast cancer area from this series, but awareness of the condition is recommended.
Collapse
Affiliation(s)
- M F Hou
- Department of Surgery, Kaohsiung Medical University, Taiwan, Republic of China
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Hou MF, Tsai LY, Tsai SM, Huang CJ, Huang YS, Hsieh JS, Chan HM, Wang JY, Chuang CH, Chen FM, Huang TJ. Biochemical markers for assessment of bone metastases in patients with breast cancer. Kaohsiung J Med Sci 1999; 15:452-60. [PMID: 10518361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Breast cancer commonly metastasizes to bones, producing both osteolytic and osteoblastic deposits. Different markers for quantitative determination of bone turnover have been developed to evaluate bone metastases of breast cancer. The urinary deoxypyridinoline (Dpd), a crosslink product of collagen molecules found in bone and excreted in urine during bone degradation, and bone specific alkaline phosphatase (B-ALP), an isoenzyme localized in the membrane of osteoblasts and released in circulation during bone formation, were recently described as a group of markers of bone turnover in metastatic cancer. The urinary Dpd/creatinine (Cre) ratios and the serum B-ALP activity were determined in the samples from 148 patients who suffered from breast cancer (BC patients) with or without bone metastases, and 42 healthy women. For comparison, other biochemical markers, e.g. carcinoembryonic antigen (CEA), CA15-3, tissue polypeptide antigen (TPA), tissue polypeptide specific antigen (TPSA), and total alkaline phosphatase (T-ALP) in these samples were also evaluated. The results showed that there was a significant difference in urinary Dpd/Cre ratio between the control group and the patients with breast cancer (BC group) (mean +/- S.D., 5.69 +/- 1.26 vs. 8.19 +/- 3.95 nM/mM, P < 0.05). However, there was no significant difference between their B-ALP activities in the two groups. In addition, the BC patients with bone metastases showed elevated urinary Dpd/Cre ratios and B-ALP activities and ratios of (Dpd/Cre)/B-ALP in compare with BC patients without bone metastases (P < 0.05). Meanwhile, the urinary Dpd/Cre ratios (10.50 +/- 5.04 nmol/mmol) in the advanced stage of BC patients were higher than those in an early stage (7.45 +/- 3.23 nmol/mmol) (P < 0.05), but their serum B-ALP activities increased only in stage IV (P < 0.05). The urinary Dpd/Cre ratios also increased progressively according to the degree of bone metastases (P < 0.05), but their serum B-ALP activities only increased in severe bone metastases (P < 0.05). The results showed that the increase of a bone osteolytic activity took place earlier than that of a bone osteoblastic activity in the metastatic BC patients. In compare with other conventional markers, the best diagnostic efficiency of biochemical markers, analyzed by step wise discriminate analysis, was provided by CEA followed by Dpd/Cre ratio, CA15-3, TPA, TPSA, B-ALP and T-ALP. We conclude that showed the urinary Dpd/Cre ratio was a useful tumor marker to evaluate breast cancer with bone metastases.
Collapse
Affiliation(s)
- M F Hou
- Department of Surgery, Kaohsiung Medical University, Taiwan, Republic of China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Splinter R, Svenson RH, Littmann L, Brucker GG, Chuang CH, Tuntelder JR, Dezern KR, Thompson M, Nanney GA, Tatsis GP. Myocardial temperatures during in vivo endocardial Nd:YAG laser irradiation. J Clin Laser Med Surg 1995; 13:61-8. [PMID: 10172366 DOI: 10.1089/clm.1995.13.61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To determine safety and efficacy of neodymium:YAG laser irradiation of the endocardium, temperatures at both the epicardium and the endocardium were recorded for thermal damage evaluation. A total of 48 coagulation lesions were created at power settings of 20 and 30 W in 20 open chest dogs by transcatheter endocardial laser irradiation. Tissue temperatures were monitored by epicardial thermography (Tepi), and by endocardial thermocouples at the catheter tip (Tprox) and 4 mm below the endocardial surface (Tdist). In group I the optical fiber extended 1 mm from the catheter and irradiation times ranged from 3 to 60 sec. Tepi reached > or = 57 degrees after a weighted average of 5 sec of laser irradiation (n = 44). In group II the fiber was retracted 1 mm from the catheter tip, and irradiation times were 100 to 150 sec. Tepi reached > or = 57 degrees C after a weighted average of 30 sec (n = 4). Blood vessels were recognized as heat sinks until coagulation occurred. Lesion volume showed a proportional increase with total delivered energy. From the observed timeframes in epicardial temperature rise it is suggested that total direct light absorption at the epicardium was the main contribution to Tepi, and the Nd:YAG laser can efficiently create transmural lesions. The epicardial temperatures remained below 80 degrees C in combination with the constant movement of the epicardial wall suggested safety from thermal damage to the ambient organs.
Collapse
Affiliation(s)
- R Splinter
- Carolinas Medical Center, Charlotte, North Carolina 28203, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Wu G, Littmann L, Svenson RH, Nanney GA, Tatsis GP, Tuntelder JR, Chuang CH, Thompson M, Dezern KR. Computerized three-dimensional activation mapping study of spontaneous ventricular arrhythmias during acute myocardial ischemia in dogs. Evidence against macroreentrant mechanism. J Electrocardiol 1995; 28:115-30. [PMID: 7616143 DOI: 10.1016/s0022-0736(05)80282-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 01/26/2023]
Abstract
This study was undertaken to investigate the activation patterns of spontaneous ventricular arrhythmias during acute myocardial ischemia in dogs. In 14 open-chest dogs, the left anterior descending coronary artery was occluded for 2 hours. Three-dimensional activation maps were derived from 240 bipolar sites by insertion of 60 plunge needle electrodes into both ventricles and the septum. Global ventricular activation sequences were displayed in five planes in 10 dogs, whereas the high density regional activation maps of the anterior wall were displayed in four layers in 4 dogs. Three-dimensional activation maps of 95 sinus beats, 82 premature ventricular complexes (PVCs), and 210 beats of ventricular tachycardia (VT) were analyzed. Sinus beats had a uniform activation pattern with total ventricular activation times measuring 42 +/- 4 ms and 67 +/- 8 ms during baseline and ischemia, respectively (P < .05). The PVCs and VTs originated from the subendocardial and intramural layers, and activation patterns invariably suggested focal excitation. Macroeentry was not operative because (1) the breakthrough sites were always remote from the latest activation areas; (2) there was no electrical activity bridging the gap between the termination of a beat and initiation of the subsequent beat; and (3) impulse conduction was not sufficiently delayed to reexcite the area of impulse origin even though functional conduction block was frequently present. In high-density regional activation maps, fragmented activity spanning the diastolic interval was never found. In conclusion, spontaneously occurring PVCs and VTs during acute myocardial ischemia in dogs display focal excitation with no evidence of macroreentry.
Collapse
Affiliation(s)
- G Wu
- Laser and Applied Technologies Laboratory, Carolinas Heart Institute, Carolinas Medical Center, Charlotte, NC 28232, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Hehrlein C, Thompson M, Chuang CH, Splinter R, Tuntelder JR, Littmann L, Svenson RH. Selective coagulation necrosis of canine adventitia and media induces extracellular matrix accumulation without neointima formation. Atherosclerosis 1995; 113:109-15. [PMID: 7755645 DOI: 10.1016/0021-9150(94)05435-l] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [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: 01/27/2023]
Abstract
Endothelial cell injury, the disruption of the internal elastic membrane and medial damage represent important stimuli for the development of a neointima. It is unclear whether selective adventitial and medial injury also induce neointima formation. Incremental argon laser energies (11.4-180 J/cm2) were applied to the external surface of dog femoral arteries to evaluate the vascular repair of acute adventitial or medial necrosis without injury of the intima. The animals were sacrificed either one hour after the initial procedure or after an 8 week follow up period for histologic examination. Acute, and mild to moderate necrosis of the arterial wall was found above 50 J/cm2. Ablation of the internal elastic membrane or mural thrombi was not detected. Eight weeks after photocoagulation with laser energies above 50 J/cm2, a significant increase in mean wall thickness of the media was observed. The medial thickening was characterised by an accumulation of extracellular matrix and a loss of smooth muscle cells. Necrosis of adventitia and media resulted in arterial wall thickening without neointima formation. It is concluded that, in dogs, an acute, selective injury of adventitia and media stimulates the production of extracellular matrix and not the proliferation of cells. Smooth muscle cell migration and subsequently neointima formation are induced by viable smooth muscle cells when blood-borne stimuli are available.
Collapse
Affiliation(s)
- C Hehrlein
- Department of Cardiology, University of Heidelberg, Germany
| | | | | | | | | | | | | |
Collapse
|
29
|
Splinter R, Semenov SY, Nanney GA, Littmann L, Tuntelder JR, Svenson RH, Chuang CH, Tatsis GP. Myocardial temperature distribution under cw Nd:YAG laser irradiation in in vitro and in vivo situations: theory and experiment. Appl Opt 1995; 34:391-399. [PMID: 20963128 DOI: 10.1364/ao.34.000391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Tissue samples ranging from 2 to 16 mm in thickness were irradiated at 1064 nm with energies ranging from 40 to 2400 J. Coagulation lesions of in vitro and in vivo experiments were subjected to temperature profiling and submitted for histology. Irreversible damage was calculated with the damage integral formalism, following the bioheat equation solved with Monte Carlo computer light-distribution simulations. Numerical temperature rise and coagulation depth compared well with the in vitro results. The in vivo data required a change in the optical properties based on integrating sphere measurements for high irradiance to make the experimental and numerical data converge. The computer model has successfully solved several light-tissue interaction situations in which scattering dominates over absorption.
Collapse
|
30
|
Splinter R, Tuntelder JR, Chuang CH, Thompson M, Littmann L, Svenson RH, Dezern KR, Tatsis GP. Ultrasonic characterization of myocardial photocoagulation lesion size in vivo during Nd:YAG laser irradiation. J Clin Ultrasound 1994; 22:221-229. [PMID: 8006180 DOI: 10.1002/jcu.1870220403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Endocardial coagulation lesions were created using transcatheter continuous-wave Nd:YAG laser irradiation. Ultrasound monitoring of thermal lesion dimensions was performed using 7.5-MHz and 10-MHz transducers directly from the epicardial surface in short-axis configuration (group A) or through the chest wall (group B). A total of 33 lesions were created in 10 dogs at energy levels ranging from 300 J to 1000 J. Mean histological lesion width (HW) compared with ultrasonically determined mean width (UW) showed that the differences (mean +/- standard deviation) in group A (UW - HW) was = 1.14 +/- 0.8 mm, which was not statistically significantly different from zero. In group B, (UW - HW) = 2.04 mm +/- 0.7 mm (p < .05), which was statistically significantly different from zero. Mean histological depth (HD) differentially related to ultrasound mean depth (UD) for group A and B combined showed (UD - HD) = -0.19 mm +/- 0.46 mm, not statistically significantly different from zero. The frequency distribution for width in group A showed magnitude of UW-HW > 3 mm in 32% of cases. In group B magnitude of UW-HW > 3 mm in 15%, whereas ultrasound width was larger than histology in 75% of the cases. For depth, magnitude of UD-HD > 3 mm in 15% of cases. With further refinement of the technique, ultrasonic tissue characterization may become a useful adjunct to monitoring lesion dimensions during transcatheter laser photocoagulation.
Collapse
Affiliation(s)
- R Splinter
- Laser and Applied Technologies Laboratory, Carolinas Medical Center, Charlotte, North Carolina 28203
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Littmann L, Svenson RH, Chuang CH, Kempler P, Splinter R, Tuntelder JR, Tatsis GP. Catheterization technique for laser photoablation of atrioventricular conduction from the aortic root in dogs. Pacing Clin Electrophysiol 1993; 16:401-6. [PMID: 7681190 DOI: 10.1111/j.1540-8159.1993.tb01601.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [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: 01/26/2023]
Abstract
A simple catheterization technique for producing suppression or block of atrioventricular (AV) conduction in dogs by neodymium:YAG (Nd:YAG) laser photocoagulation from the aortic root is described. In 14 canines, electrode catheters were percutaneously advanced to the high right atrium, to the His bundle area at the tricuspid valve (right His [RH]), and the noncoronary cusp of the aortic valve (left His [LH]). A 400 microns optical fiber was fed into the lumen of the LH catheter. Continuous wave Nd:YAG lasing at lambda = 1,064 nm at 15-20 watts was performed at the site of the largest recorded LH deflection, opposite to the RH catheter, until complete AV block (CAVB, group I, eight dogs) or persistent A-H prolongation (AHPr, group II, four dogs) occurred; in two animals, laser photoablation was unsuccessful. CAVB and AHPr were achieved in < 140 seconds of lasing. Mean lasing time was 51 +/- 41 seconds, total energy delivered, 776 +/- 601 J. There were no complications. Dogs were followed for up to 120 days. In group I, 6/6 dogs followed for at least 1 week continued to have CAVB (three AV nodal, five infra-His). In group II, 1/4 dog progressed to infra-His CAVB; 3/4 had depressed AV nodal function. AV block was not reversed by isoproterenol. Aortic root angiograms revealed intact valve function in all. Histology showed various degrees of damage and repair of AV junctional tissue. There were no valvular perforations. Transcatheter Nd:YAG laser photocoagulation of the AV junction from the aortic root is a fast, simple, and safe method for creating AV conduction block in dogs.
Collapse
Affiliation(s)
- L Littmann
- Laser and Applied Technologies Laboratory, Carolinas Heart Institute, Charlotte, North Carolina 28232
| | | | | | | | | | | | | |
Collapse
|
32
|
Littmann L, Svenson RH, Bharati S, Lev M, Chuang CH, Kempler P, Splinter R, Tuntelder JR, Tatsis GP. Selective elimination of retrograde conduction by intraoperative neodymium: YAG laser photocoagulation in dogs. J Am Coll Cardiol 1993; 21:523-30. [PMID: 8426020 DOI: 10.1016/0735-1097(93)90698-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [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: 01/30/2023]
Abstract
OBJECTIVES The purpose of this study was to test the feasibility of selective elimination of ventriculoatrial (VA) conduction by limited laser photocoagulation of the atrioventricular (AV) node, and to analyze the histologic substrate of unidirectional retrograde block. BACKGROUND Atrioventricular node reentry requires intact retrograde conduction. METHODS Neodymium:yttrium-aluminum-garnet laser photocoagulation was performed during cardiopulmonary bypass through a right atriotomy in 15 dogs that had intact retrograde conduction before operation. Short laser pulses were delivered to an area between the coronary sinus orifice and the proximal His bundle. The end point of lasing was second-degree AV node block at a paced atrial cycle length of 250 ms. RESULTS Complete retrograde block developed immediately in 11 of the 15 dogs (group I), while AV conduction persisted in all 11. In 4 of the 15 dogs (group II), both AV and VA conduction remained intact. During a 3-month follow-up period, retrograde conduction remained absent in all group I dogs. Retrograde block was not reversed by isoproterenol. Anterograde AV node characteristics (Wenckebach cycle length, functional refractory period, ventricular rate during atrial fibrillation) were unchanged in five dogs and modified in six. Complete AV block did not develop. In four control dogs (group III, sham operation), anterograde and retrograde AV node characteristics were unchanged. The anterograde Wenckebach cycle lengths in groups I, II and III at 3 months measured 192 +/- 15 ms, 195 +/- 6 ms and 170 +/- 22 ms, respectively, whereas the retrograde Wenckebach cycle lengths in groups II and III measured 345 +/- 62 ms and 278 +/- 25 ms, respectively. Histologic study at 3 months in cases with unidirectional VA block showed the compact part of the AV node intact with destruction of the atrial approaches and the superficial layers of the proximal end of the node on the right side. CONCLUSIONS 1) With limited laser photocoagulation of the proximal AV node area, VA conduction can be eliminated and anterograde AV node transmission maintained. 2) Destruction of the atrial approaches on the right side with preservation of the compact part of the AV node may result in unidirectional retrograde block.
Collapse
Affiliation(s)
- L Littmann
- Laser and Applied Technologies Laboratory, Carolinas Heart Institute, Charlotte, N.C. 28232
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Littmann L, Svenson RH, Chuang CH, Splinter R, Kempler P, Norton HJ, Tuntelder JR, Thompson M, Tatsis GP. Neodymium:YAG contact laser photocoagulation of the in vivo canine epicardium: dosimetry, effects of various lasing modes, and histology. Lasers Surg Med 1993; 13:158-67. [PMID: 7681924 DOI: 10.1002/lsm.1900130203] [Citation(s) in RCA: 13] [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: 01/26/2023]
Abstract
UNLABELLED Neodymium:YAG laser photocoagulation (LPC) is an investigational technique for the treatment of drug-resistant postinfarction ventricular tachycardia that requires cardiopulmonary bypass and open heart surgery. The purpose of this experimental study was to evaluate the feasibility of contact epicardial LPC to reach subepicardial, deep myocardial, and subendocardial regions without ventriculotomy and to analyze the dose-response relationships of this new technology. In 24 open-chest, closed heart dogs, a total of 219 epicardial laser lesions were generated under sterile conditions. Laser source was a continuous wave 1064 nm Nd:YAG; the delivery system consisted of a 400 mu bare quartz fiber fed into an 8F electrode catheter in direct contact with the epicardial surface. Laser variables were power at 10-15-20 W; lasing time, 6-12-18-24 s; lasing mode, continuous and pulse-pause; fiber mode, optical fiber tip inside and extending out from the electrode catheter. Hearts were harvested at 1 week. Histologic measurements included lesion surface diameter, internal diameter, and depth. RESULTS Significant linear correlation was found between the total delivered energy and all measured lesion parameters. Transmural lesions were found at energy levels of 270-480 J. Maximum depth measured up to 1.68 cm; at high energies, it was limited by myocardial thickness only. At constant energy levels, power and lasing time did not independently affect lesion dimensions; lasing mode and fiber mode had statistically significant but minor effects. Laser lesions were homogeneous and sharply demarcated without epicardial crater or endocardial thrombus formation. Endocardial surface cooling by circulating blood and the presence of epicardial vessels resulted in modifications in lesion morphology. In 29 out of 74 grossly transmural lesions, there was a 0.082 +/- 0.127 cm thin surviving subendocardium. Forty-five coagulation lesions were truly transmural with no surviving myocardial strands. In conclusion, contact epicardial LPC can result in deep, transmural myocardial coagulation lesions. Lesion dimensions can be adequately controlled by total delivered energy. Closed heart epicardial Nd:YAG laser photocoagulation could become a new, less invasive surgical technique for the treatment of drug-resistant ventricular tachycardia.
Collapse
Affiliation(s)
- L Littmann
- Laser and Applied Technologies Laboratory, Carolinas Heart Institute, Charlotte, North Carolina 28232
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Hehrlein C, Svenson RH, McKusik AP, Chuang CH, Tuntelder JR, Tatsis GP, Littmann L, Thompson M. Thermal laser arterial injury and prostacyclin administration in dogs: thrombotic and hyperplastic consequences. J Cardiovasc Surg (Torino) 1992; 33:366-71. [PMID: 1601923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Angioplasty is considered as an alternative to surgical reconstruction of arteriosclerotic vessels especially since lasers and atherectomy devices have become clinically available. However, the resulting arterial injury may lead to acute thrombotic occlusion and chronic restenosis because of hyperplastic vascular repair. The purpose of this experimental study was to evaluate the consequences of thermal laser arterial injury on platelet deposition and myointimal hyperplasia in dog femoral arteries. An intraarterial, short-term prostacyclin (PGI2) infusion was given to evaluate the antithrombotic and antiproliferative effects of this drug. Severe arterial necrosis, partly carbonized and vacuolized, extending to the adventitia was induced by a transluminal heated laser probe motion. The platelet deposition after one hour was 33.62 +/- 6.56 (x 10(6)/cm2.) (mean +/- SEM) without prostacyclin, after 40 ng/kg/min prostacyclin (PGI2) 24.70 +/- 5.45 and after 400 ng/kg/min 9.3 +/- 2.26 (p less than 0.005 no PGI2 vs 400 ng/kg/min PGI2). Myointimal hyperplasia was present eight weeks after thermal laser vascular injury independent of the initially administered prostacyclin. In conclusion, acutely thrombotic and chronically hyperplastic femoral arteries were found following transluminal thermal arterial injury in dogs. Prostacyclin administration could be clinically beneficial in reducing acute vascular thrombosis following thermal angioplasty. Short-term use of this substance, however, may not prevent a hyperplastic response to angioplasty.
Collapse
Affiliation(s)
- C Hehrlein
- Lasers and Applied Technologies Laboratory, Heineman Medical Research Center, Charlotte, NC
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Fan PC, Chung WC, Kuo CL, Lin CY, Hsu HM, Chuang CH, Chow CY. Evaluation of efficacy of four pediculicides against head louse (Pediculus capitis) infestation. Gaoxiong Yi Xue Ke Xue Za Zhi 1992; 8:255-65. [PMID: 1377757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To evaluate the efficacy and to determine the minimum effective dosage of four pediculicides against head louse infestation, as well as to select a safe, effective, practical, and cheap agent, 1,657 infested school children in 25 primary schools in Szu-Hu, Kou-Hu, and Ku-Keng Districts of Yunlin County were treated and 1,611 of them were examined. The overall cure rate was 73% and the rate for boys (84%) was higher than that for girls (71%). The cure rate of Nix (permethrin 1%) cream rinse was 81%. The cure rate for single dosages of 1, 2, 3 and 4 cases/tube (56 gm/tube) was 87%, 83%, 81% and 71%, respectively. The cure rate of Para aerosol (bioallethrine 0.66%) was 78%. The cure rate for single dosages of 30 and 40 cases/tube (90 gm/tube) was 87% and 70%, respectively. The cure rate of Prioderm (malathion 1%) cream shampoo was 64%. The cure rate for single dosages of 10, 15 and 20 cases/tube (40 gm/tube) was 74%, 71% and 52%, respectively. The cure rate of Delice (1% gamma benzene hexachloride) was 71%. The cure rate for single dosages of 5 and 10 ml/case was 64% and 76%, respectively. Of the 226 infested girls, 181 (80%) were found to be infested with 1-10 head lice, 33 (15%) with 11-50 lice, 7(3%) with 51-100 lice and 5 (2%) with over 100 lice. Of the 2,160 head lice collected, 1,788 (83%) were nymphs, 284 (13%) females, and 88 (4%) males. The mean number of head lice in each infested girl was 10 (range 1-137). The low cure rates obtained in the present study may be due to the fact that many school girl & have long hair. In comparison, Nix had the highest cure rate (81%) but the highest price (NT$ 120/case). The cure rate and price of Para aerosol (78%, NT$ 7.2/case) and Delice (71%, NT$ 16.7/case) came next. Prioderm (64%, NT$ 10.0/case) had the lowest rate and a slight offensive smell. Preliminary trials show that based on the cost-effectiveness, Para aerosol is best in head louse infestation control.
Collapse
Affiliation(s)
- P C Fan
- Department of Parasitology, National Yangming Medical College, Taipei, Taiwan, Republic of China
| | | | | | | | | | | | | |
Collapse
|
36
|
Hehrlein C, Chuang CH, Tuntelder JR, Tatsis GP, Littmann L, Svenson RH. Effects of vascular runoff on myointimal hyperplasia after mechanical balloon or thermal laser arterial injury in dogs. Circulation 1991; 84:884-90. [PMID: 1860229 DOI: 10.1161/01.cir.84.2.884] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [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: 12/29/2022]
Abstract
BACKGROUND Clinical evidence suggests that poor vascular runoff reduces the long-term success rate of femoral angioplasty procedures. The purpose of this experimental study was to examine myointimal hyperplasia of dog femoral arteries after balloon denudation, thermal laser arterial injury, or sham operation in normal and reduced vascular runoff conditions. METHODS AND RESULTS Before mechanical balloon injury or transluminal heated laser probe motion, the peripheral vascular runoff of dogs was reduced by ligating the femoral artery below its three distal side branches, decreasing the femoral flow rate from 114 +/- 9 to 52 +/- 5 ml/min (mean +/- SEM). Endothelial denudation with a predominantly intact elastic internal membrane and circumferential structural changes in the media were noted by light microscopy 1 hour after balloon injury. Focal completely necrotic lesions of intima and media were found 1 hour after thermal laser arterial injury. After 8 weeks, the maximal thickness of neointima plus media of the site of previous intervention was greater after balloon injury (0.45 +/- 0.03 mm) and thermal laser injury (0.54 +/- 0.03 mm) than after sham operation (0.40 +/- 0.01 mm; p less than 0.001) in normal runoff dogs. Reduced vascular runoff augmented myointimal hyperplasia both in the balloon-injured and thermally damaged arteries; the wall thickness increased from 0.45 +/- 0.03 to 0.93 +/- 0.10 mm and from 0.54 +/- 0.03 to 0.65 +/- 0.05 mm, respectively (p less than 0.001). The neointimal and medial wall area of the balloon-injured arteries contributed 48% to the area encompassed by the external elastic membrane compared with an 81% portion when vascular runoff was reduced (p less than 0.01). A 47% neointimal and medial wall area was found in thermally injured arteries with normal runoff compared with 63% after runoff reduction (p less than 0.05). CONCLUSION This study suggests that hemodynamic factors associated with poor vascular runoff play an important role in extending myointimal hyperplasia independent of method and severity of the arterial injury during angioplasty.
Collapse
Affiliation(s)
- C Hehrlein
- Laser and Applied Technologies Laboratory, Heineman Medical Research Center, Charlotte, N.C
| | | | | | | | | | | |
Collapse
|
37
|
Chuang CH. Current status of malaria in Taiwan from 1966 to 1990. Gaoxiong Yi Xue Ke Xue Za Zhi 1991; 7:233-42. [PMID: 2056557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Malaria was highly or moderately endemic in about 200 townships among the 360 municipalities in Taiwan before the World War II. During and after the War, annual incidence of malaria was estimated as 1.2 million cases out of 6 million population at that period. In 1952, malaria mortality was reported as 27.5 per 100,000 persons. Malaria Eradication Program in Taiwan was successfully carried out during 1947-1965 through a combined effort made by the Government, WHO, UNICEF and USAID, and by the participation of the community. Since 1966, avoidance of malaria transmission in population centers has been well maintained through the network of malaria surveillance system, both parasitological and entomological, at the ports (sea and air) of entry and by the 383 public health services all over the island. Through this surveillance network, a total of 936 malaria cases and distribution of the vector mosquito Anopheles minimus have been well documented during 1966- June 1990. Of the 936 malaria cases detected, 819 cases were classified as imported from outside the country, 14 cases as relapsing, 17 cases as induced infection through blood transfusion, and 86 cases as the secondary infection originating from the imported cases. These 86 cases were exclusively P. vivax infections which were found concealed in the mountainous area of the northern most of Taiwan during 1968-1973. This small transmission focus was swiftly eliminated without further dissemination to the other parts of the island. Of the 819 imported cases; 250 cases were P. falciparum infection, 516 cases were P. vivax, 19 cases were P. malariae, 18 cases were P. ovale and 16 cases were mixed infection of P. falciparum with other parasite species. among the imported malaria cases with P. falciparum (in total 266), six were reported fatal cases before proper diagnose and treatment. Of the 14 relapsing cases; 13 cases were P. malariae infection, and the remaining one case was P. vivax malaria. All the 17 induced malaria cases were caused by the blood transfusion, exclusively with P. malariae infection. It was quite difficult to prove the positive parasitemia directly under microscopy from the blood donors due to very low parasite density of their blood.
Collapse
Affiliation(s)
- C H Chuang
- Bureau of Communicable Disease Control, Department of Health, Taipei, Republic of China
| |
Collapse
|
38
|
Splinter R, Svenson RH, Littmann L, Tuntelder JR, Chuang CH, Tatsis GP, Thompson M. Optical properties of normal, diseased, and laser photocoagulated myocardium at the Nd: YAG wavelength. Lasers Surg Med 1991; 11:117-24. [PMID: 2034009 DOI: 10.1002/lsm.1900110205] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.0] [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: 12/29/2022]
Abstract
Laser photocoagulation of the myocardium effectively destroys arrhythmogenic foci. The purpose of this study was 1) to compare the optical properties of canine myocardium before and after photocoagulation, 2) to compare the canine model with clinical cases by measuring the optical properties of human myocardium, and 3) to assess the optical properties of human myocardial scar and epicardial fat tissue. Measured optical properties were the absorption coefficient, mu a; scattering coefficient, mu s; and scattering anisotropy factor, g. Optical measurements were performed at 1064 nm wavelength on thin plane parallel tissue slices using the integrating sphere method with glass hemispheres on either side of the sample. The study showed 1) an increase of the scattering coefficient by 40% and a two- to threefold increase in reduced scattering coefficient as a result of photocoagulation; 2) that the mu a (0.035 +/- 0.024 mm-1) and mu s (17.9 +/- 3.8 mm-1) of human myocardium were not significantly different from mu a (0.043 +/- 0.021 mm-1) and mu s (17.3 +/- 2.2 mm-1) of canine myocardium, whereas the human g (0.964 +/- 0.005) was slightly different from the canine g (0.974 +/- 0.008); and 3) that the mu a (0.021 +/- 0.016 mm-1) of epicardial fat and mu s (13.8 +/- 1.1 mm-1) of myocardial scar were significantly lower than those of normal myocardium. A dynamic model of laser-tissue interaction incorporating these changes and inhomogeneities is necessary to better describe light distribution during laser photocoagulation.
Collapse
Affiliation(s)
- R Splinter
- Laser and Applied Technologies Laboratory, Carolinas Heart Institute and Heineman Medical Research Center, Charlotte, North Carolina 28232
| | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
Three kinds of Bupleuri Radix were found in Taiwan. To clarify their origins, histological studies were carried out to identify their internal and external structures. It was found that Bupleuri Radix or "Chai-hu" of Taiwan is derived from roots of the following species" 1, Bupleurum chinense which was imported from China, 2, Bupleurum falcatum var. komarowi a cultivated production of Japanese origin, and 3, Bupleurum kaoi which is indigenous to Taiwan. These Bupleuri Radix were easily assigned by anatomical characteristics and their qualitative analysis of active principle - saikosaponin were established by TLC.
Collapse
Affiliation(s)
- C C Lin
- School of Pharmacy, Department of Biology, Kaohsiung Medical College, Taiwan
| | | | | | | | | |
Collapse
|
40
|
Hsu HM, Wang YF, Lo SH, Sun HC, Yip KK, Chen JS, Chuang CH, Chen DS. Hepatitis D virus infection among intravenous drug abusers in Taiwan: analysis of risk factors and liver function tests. J Med Virol 1990; 31:76-81. [PMID: 2388047 DOI: 10.1002/jmv.1890310203] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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: 12/31/2022]
Abstract
To investigate the prevalence of hepatitis D virus (HDV) and hepatitis B virus (HBV) infection among intravenous drug abusers in Taiwan, a total of 761 male prisoners, including 680 intravenous drug abusers, were studied for serological markers of HBV and HDV. Questionnaires were distributed to evaluate the risk factors for HDV infection and also to estimate the strength of association among HDV infection and the risk factors. HBV infection was common, and the positive rates of HBV markers between intravenous drug abusers and non-drug abusers were not statistically different. However, the positive rate of the antibody to HDV was significantly higher among intravenous drug abusers than among non-drug abusers (21.3% vs. 8.6%). Of 131 chronic HBV carriers with intravenous drug abuse, 119 (91%) were anti-HD positive. Using multiple logistic regression models, we found that the most important risk factor for HDV infection was hepatitis B surface antigen (HBsAg) carriage, and intravenous drug addiction the next. A matched case-control study also was conducted to compare liver function tests among both anti-HD- and HBsAg-positive group anti-HD-negative, and HBs-AG-positive group as well as those with neither positive. Statistically significant difference in liver function tests was not found. It is concluded that the HBsAg carriers with intravenous drug abuse in Taiwan are commonly HDV infected with and that the infection does not seem to affect the liver as assessed by liver function tests.
Collapse
Affiliation(s)
- H M Hsu
- Bureau of Disease Control, Department of Health, Taipei, Taiwan, Republic of China
| | | | | | | | | | | | | | | |
Collapse
|
41
|
|
42
|
Hsu HM, Chen DS, Chuang CH, Lu JC, Jwo DM, Lee CC, Lu HC, Cheng SH, Wang YF, Wang CY. Efficacy of a mass hepatitis B vaccination program in Taiwan. Studies on 3464 infants of hepatitis B surface antigen-carrier mothers. JAMA 1988. [PMID: 2971827 DOI: 10.1001/jama.1988.03410150079034] [Citation(s) in RCA: 94] [Impact Index Per Article: 2.6] [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: 12/18/2022]
Abstract
To evaluate the efficacy of the mass hepatitis B vaccination program in Taiwan in interrupting perinatal hepatitis B virus transmission, 3464 randomly selected 18-month-old infant vaccinees born to hepatitis B surface antigen-carrier mothers were recruited from 9697 eligible infants during a six-month period of the program. They were divided into ten groups according to maternal infectivity and compliance with the vaccination schedule. Serum samples were tested for hepatitis B surface antigen, antibody to hepatitis B surface antigen, and antibody to hepatitis B core antigen. In 786 infants who had highly infectious mothers and who received hepatitis B immune globulin and vaccine on schedule, the protective efficacy was about 85%. The efficacy seemed to be slightly lower in those immunized off schedule. Overall, 11% of infants still carried hepatitis B surface antigen, and 81% of the infants had antibody to hepatitis B surface antigen that exceeded 10 mIU/mL in more than 90% of them. The geometric mean titers of antibody to hepatitis B surface antigen were more than 200 mIU/mL in every group of infants. We conclude that the mass vaccination program is efficacious in preventing perinatal hepatitis B virus transmission and the chronic carrier state; most infant vaccinees have adequate levels of protective antibody at 18 months of age. This program is extremely significant in the control of hepatitis B virus infection in Taiwan.
Collapse
Affiliation(s)
- H M Hsu
- Bureau of Disease Control, Department of Health, Taipei, Taiwan, Republic of China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
Sequential liver scintiphotography with Tc-99m pyrophosphate (PYP) was used to prospectively evaluate its uptake patterns in hepatoma. The scintiphotos and time-activity curves of 40 cases were analyzed. Two distinct patterns of tumor activity were noted: gradual but complete extraction and trapping of Tc-99m PYP in hepatoma in 38% of the patients (group 1), and absence of subsequent Tc-99m PYP uptake in hepatoma after initial blood pool activity in 62% of the patients (group 2). Since extraction and trapping of Tc-99m PYP occur approximately in two fifths of the patients with hepatoma, we conclude that Tc-99m PYP liver scintigraphy is not worthwhile supplementing the conventional radionuclide studies for diagnosing hepatoma, even in the selected patients in the countries where the prevalence of hepatoma is high.
Collapse
|
44
|
Abstract
We studied DNA (mtDNA) replication in adult female rat hearts undergoing hypertrophy secondary to constriction of the ascending aorta. MtDNA was measured in isolated mitochondria by a fluorometric method adapted for that purpose. The conditions for removal of contaminating nuclear DNA were developed, and the purity of the mtDNA was assessed from its molecular conformation (open and closed circles) and by renaturation-kinetic analysis. The mtDNA concentration in mitochondria, expressed as micrograms of DNA per milligram of mitochondrial protein, increased 2, 4, and 7 days postoperatively by 21, 73, and 98%, respectively. Similar results were obtained when mtDNA was expressed per nonomole of cytochrome a. The population of replicative intermediates of mtDNA was analyzed by electron microscopy. In normal hearts, we observed molecular forms characteristic of animal mtDNA, such as circular monomers and dimers, catenated molecules, D-loops, expanded D-loops, and gapped molecules. D-loop frequency, which was near 50% in the mtDNA of control hearts, was markedly reduced to 5-7% in hypertrophying hearts. This result indicates that the increase in replicative flux of mtDNA is associated with the removal of a block in the conversion of D-loops to other intermediates.
Collapse
|
45
|
Pao TT, Hsu KF, Liu KT, Chang LG, Chuang CH, Sung CY. Protective action of schizandrin B on hepatic injury in mice. Chin Med J (Engl) 1977; 3:173-9. [PMID: 410602] [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: 12/15/2022] Open
|