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Feng HW, Zhao YT, Lin J, Weng CL. T-wave alternans: an ominous pattern for malignant arrhythmias. QJM 2023; 116:781-783. [PMID: 37202351 DOI: 10.1093/qjmed/hcad097] [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] [Received: 05/15/2023] [Indexed: 05/20/2023] Open
Affiliation(s)
- Hang-Wei Feng
- Department of Intensive Care Unit, The Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, No. 516, Jinrong South, Fuzhou, Fujian Province, China
| | - Yun-Tao Zhao
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
| | - Jian Lin
- Department of Intensive Care Unit, The Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, No. 516, Jinrong South, Fuzhou, Fujian Province, China
| | - Cui-Lian Weng
- Department of Intensive Care Unit, The Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, No. 516, Jinrong South, Fuzhou, Fujian Province, China
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Wang XC, Gao SJ, Zhuo SL, Weng CL, Feng HW, Lin J, Lin XS, Huang L. Predictive factors for cerebrocardiac syndrome in patients with severe traumatic brain injury: a retrospective cohort study. Front Neurol 2023; 14:1192756. [PMID: 37538256 PMCID: PMC10394875 DOI: 10.3389/fneur.2023.1192756] [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: 03/23/2023] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Background and objective Cerebrocardiac syndrome (CCS) is a severe complication of severe traumatic brain injury (sTBI) that carries high mortality and disability rates. Early identification of CCS poses a significant clinical challenge. The main objective of this study was to investigate potential risk factors associated with the development of secondary CCS in patients with sTBI. It was hypothesized that elevated right heart Tei index (TI), lower Glasgow Coma Scale (GCS) scores, and elevated cardiac troponin-I (cTnI) levels would independently contribute to the occurrence of CCS in sTBI patients. Methods A retrospective cohort study was conducted to identify risk factors for CCS secondary to sTBI. One hundred and fifty-five patients were enrolled with sTBI admitted to the hospital between January 2016 and December 2020 and divided them into a CCS group (n = 75) and a non-CCS group (n = 80) based on the presence of CCS. This study involved the analysis and comparison of clinical data from two patient groups, encompassing demographic characteristics, peripheral oxygen saturation (SPO2), neuron-specific enolase (NSE), cardiac troponin-I (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), optic nerve sheath diameter (ONSD), cardiac ultrasound, acute physiology and chronic health evaluation (APACHE II) scores, and GCS scores and so on. Multivariate logistic regression was employed to identify independent risk factors for CCS, and receiver operating characteristic (ROC) curves were used to assess their predictive value for CCS secondary to sTBI. Results The study revealed that 48.4% of sTBI patients developed secondary CCS. In the multivariate analysis model 1 that does not include NT-proBNP and cTnI, ONSD (OR = 2.582, 95% CI: 1.054-6.327, P = 0.038), right heart Tei index (OR = 2.81, 95% CI: 1.288-6.129, P = 0.009), and GCS (OR = 0.212, 95% CI: 0.086-0.521, P = 0.001) were independent risk factors for secondary CCS in sTBI patients. In multivariate analysis model 2 that includes NT-proBNP and cTnI, cTnI (OR = 27.711, 95%CI: 3.086-248.795, P = 0.003), right heart Tei index (OR = 2.736, 95% CI: 1.056-7.091, P = 0.038), and GCS (OR = 0.147, 95% CI: 0.045-0.481, P = 0.002) were independent risk factors for secondary CCS in sTBI patients. The area under the ROC curve for ONSD, Tei index, GCS, and cTnI were 0.596, 0.613, 0.635, and 0.881, respectively. ONSD exhibited a positive predictive value (PPV) of 0.704 and a negative predictive value (NPV) of 0.634. The Tei index demonstrated a PPV of 0.624 and an NPV of 0.726, while GCS had a PPV of 0.644 and an NPV of 0.815. On the other hand, cTnI exhibited a significantly higher PPV of 0.936 and an NPV of 0.817. These findings indicate that the Tei index, GCS score, and cTnI possess certain predictive value for secondary CCS in patients with sTBI. Conclusions The study provides valuable insights into the identification of independent risk factors for CCS secondary to sTBI. The findings highlight the significance of right heart Tei index, GCS score, and cTnI as potential predictive factors for CCS in sTBI patients. Further larger-scale studies are warranted to corroborate these findings and to provide robust evidence for the development of early intervention strategies aimed at reducing the incidence of CCS in this patient population.
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Affiliation(s)
- Xin-Cai Wang
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Shang-Jun Gao
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Department of Orthopedics, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
| | - Shi-Long Zhuo
- Department of School of Electronic, Electrical Engineering and Physics, Fujian University of Technology, Fuzhou, China
| | - Cui-Lian Weng
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Hang-Wei Feng
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Jian Lin
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Xing-Sheng Lin
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Long Huang
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
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Lin XS, Li Y, Huang L, Weng CL. Idiopathic paroxysmal atrioventricular block. Intensive Care Med 2021; 47:1156-1157. [PMID: 34050390 DOI: 10.1007/s00134-021-06442-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Xing-Sheng Lin
- Department of Intensive Care Unit, The Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, No.516, Jinrong South Road, Fuzhou, Fujian, China
| | - Yong Li
- Department of Digestive Endocrinology, Linxi County People's Hospital, 39 Yulan Road Linxi County, Xingtai, Hebei, China
| | - Long Huang
- Department of Intensive Care Unit, The Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, No.516, Jinrong South Road, Fuzhou, Fujian, China
| | - Cui-Lian Weng
- Department of Intensive Care Unit, The Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, No.516, Jinrong South Road, Fuzhou, Fujian, China.
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Gu WJ, Weng CL, Zhao YT, Liu QH, Yin RX. Psoriasis and risk of cardiovascular disease: a meta-analysis of cohort studies. Int J Cardiol 2013; 168:4992-6. [PMID: 23931969 DOI: 10.1016/j.ijcard.2013.07.127] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 07/13/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Wan-Jie Gu
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People's Republic of China; Department of Anesthesiology, the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
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Abstract
BACKGROUND Noninvasive ventilation (NIV) is commonly used to treat patients with acute cardiogenic pulmonary edema (ACPE), but the findings of a recent large clinical trial suggest that NIV may be less effective for ACPE than previously thought. PURPOSE To provide an estimate of the effect of NIV on clinical outcomes in patients with ACPE that incorporates recent trial evidence and explore ways to interpret that evidence in the context of preceding evidence that favors NIV. DATA SOURCES PubMed and EMBASE from 1966 to December 2009, Cochrane Central Register of Controlled Trials and conference proceedings through December 2009, and reference lists, without language restriction. STUDY SELECTION Randomized trials that compared continuous positive airway pressure and bilevel ventilation with standard therapy or each other. DATA EXTRACTION Two independent reviewers extracted data. Outcomes examined were mortality, intubation rate, and incidence of new myocardial infarction (MI). DATA SYNTHESIS Compared with standard therapy, continuous positive airway pressure reduced mortality (relative risk [RR], 0.64 [95% CI, 0.44 to 0.92]) and need for intubation (RR, 0.44 [CI, 0.32 to 0.60]) but not incidence of new MI (RR, 1.07 [CI, 0.84 to 1.37]). The effect was more prominent in trials in which myocardial ischemia or infarction caused ACPE in higher proportions of patients (RR, 0.92 [CI, 0.76 to 1.10] when 10% of patients had ischemia or MI vs. 0.43 [CI, 0.17 to 1.07] when 50% had ischemia or MI). Bilevel ventilation reduced the need for intubation (RR, 0.54 [CI, 0.33 to 0.86]) but did not reduce mortality or new MI. No differences were detected between continuous positive airway pressure and bilevel ventilation on any clinical outcomes for which they were directly compared. LIMITATIONS The quality of the evidence base was limited. Definitions, cause, and severity of ACPE differed among the trials, as did patient characteristics and clinical settings. CONCLUSION Although a recent large trial contradicts results from previous studies, the evidence in aggregate still supports the use of NIV for patients with ACPE. Continuous positive airway pressure reduces mortality more in patients with ACPE secondary to acute myocardial ischemia or infarction. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Cui-Lian Weng
- Peking University People's Hospital, Peking University, China
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Zhuang XF, Zhao MM, Weng CL, Sun NL. Adipocytokines: a bridge connecting obesity and insulin resistance. Med Hypotheses 2009; 73:981-5. [PMID: 19692185 DOI: 10.1016/j.mehy.2009.05.036] [Citation(s) in RCA: 28] [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] [Received: 05/02/2009] [Revised: 05/02/2009] [Accepted: 05/12/2009] [Indexed: 11/16/2022]
Abstract
Overweight or obesity has become a critical health problem in the world. The association of obesity with type 2 diabetes mellitus (T2D) has been recognized for decades, and the major basis for this link is the ability of obesity to engender insulin resistance (IR). Adipose tissue is not only an energy depot but also an active endocrine organ. Furthermore, fat distribution in the body is important for the progress of IR. Many studies show that visceral fat is more important in relation to IR than subcutaneous fat. Circulating free fatty acids (FFAs) derived from adipocytes are elevated in many IR states and have been suggested to be a main underlying mechanism of IR in obesity-associated T2D. However, compelling evidence demonstrates that adipocytokines including several adipocyte-derived cytokines or hormones are also involved in obesity-induced IR. Therefore, we hypothesise that adipocytokines may be a bridge connecting obesity and IR, and abnormal fat depot distribution or visceral fat/subcutaneous fat ratio (V/S ratio) in obesity also could be a primer for IR. When visceral fat accumulates and V/S ratio deteriorates , just like a primer,in visceral obesity it should begin to display unhealthy effect begin to take place in the body. In addition to it, as one of physiological regulation mechanisms of the body, most of the adipocytokines from the visceral fat reduce the visceral fat volume or normalize the V/S ratio. Actually, on the contrary, with serum a change in the serum adipocytokine level and an imbalance of them in the body for a long term, it will become a pathological condition and various kinds of effects may contribute to the development of IR. If confirmed, this hypothesis may lead to the formulation of new pathogenesis and new therapeutic approaches to IR. For example, an effective slimming pill will be assessed in future on the basis of the decrease of V/S and serum adipocytokines level rather than of body weight.
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Affiliation(s)
- Xiao-Feng Zhuang
- Department of Cardiology, Peking University People's Hospital, Beijing, China
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Cheng HL, Tong YC, Tzai TS, Weng CL, Ho CL, Yang WH, Lin JS, Chow NH. Expression of nm23-H1 in transitional cell carcinoma of the upper urinary tract. Oncol Rep 2001. [DOI: 10.3892/or.8.1.193] [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: 11/06/2022] Open
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Cheng HL, Tong YC, Tzai TS, Weng CL, Ho CL, Yang WH, Lin JS, Chow NH. Expression of nm23-H1 in transitional cell carcinoma of the upper urinary tract. Oncol Rep 2001; 8:193-6. [PMID: 11115597] [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: 02/18/2023] Open
Abstract
Transitional cell carcinoma of the upper urinary tract is an uncommon neoplasm. Relatively little information is available regarding the clinical relevance of molecular markers. This study was performed to examine the importance of nm23-H1 gene expression (NM23-H1) in this type of tumors. Immunohistochemical expression of NM23-H1 was analyzed in 90 cases of upper urinary tract cancer, and was compared for its prognostic significance with conventional biological indicators. High expression of NM23-H1 was found in 7 cases (8%), intermediate expression in 32 cases (36%), and low expression in 51 cases (57%). Reduced NM23-H1 (defined as intermediate or low level of expression) was associated with a higher histological grading (p=0.002), invasive tumor growth (p=0. 002), or an increased proliferating cell nuclear antigen labeling index (p=0.004). NM23-H1 tended to inversely relate to later recurrence or long-term survival (p=0.06), but, only tumor staging was found to be significant in predicting clinical outcome (p=0.002). nm23-H1 appears to function as a tumor suppressor for upper urinary tract cancer, however, evaluation of NM23-H1 provides limited prognostic information.
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Affiliation(s)
- H L Cheng
- Department of Urology, Medical College, National Cheng Kung University, Tainan, Taiwan 704, R.O.C
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