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Toles M, Kistler C, Lin FC, Lynch M, Wessell K, Mitchell SL, Hanson LC. Palliative care for persons with late-stage Alzheimer's and related dementias and their caregivers: protocol for a randomized clinical trial. Trials 2023; 24:606. [PMID: 37743478 PMCID: PMC10518941 DOI: 10.1186/s13063-023-07614-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Limited access to specialized palliative care exposes persons with late-stage Alzheimer's disease and related dementias (ADRD) to burdensome treatment and unnecessary hospitalization and their caregivers to avoidable strain and financial burden. Addressing this unmet need, the purpose of this study was to conduct a randomized clinical trial (RCT) of the ADRD-Palliative Care (ADRD-PC) program. METHODS The study will use a multisite, RCT design and will be set in five geographically diverse US hospitals. Lead investigators and outcome assessors will be masked. The study will use 1:1 randomization of patient-caregiver dyads, and sites will enroll N = 424 dyads of hospitalized patients with late-stage ADRD with their family caregivers. Intervention dyads will receive the ADRD-PC program of (1) dementia-specific palliative care, (2) standardized caregiver education, and (3) transitional care. Control dyads will receive publicly available educational material on dementia caregiving. Outcomes will be measured at 30 days (interim) and 60 days post-discharge. The primary outcome will be 60-day hospital transfers, defined as visits to an emergency department or hospitalization ascertained from health record reviews and caregiver interviews (aim 1). Secondary patient-centered outcomes, ascertained from 30- and 60-day health record reviews and caregiver telephone interviews, will be symptom treatment, symptom control, use of community palliative care or hospice, and new nursing home transitions (aim 2). Secondary caregiver-centered outcomes will be communication about prognosis and goals of care, shared decision-making about hospitalization and other treatments, and caregiver distress (aim 3). Analyses will use intention-to-treat, and pre-specified exploratory analyses will examine the effects of sex as a biologic variable and the GDS stage. DISCUSSION The study results will determine the efficacy of an intervention that addresses the extraordinary public health impact of late-stage ADRD and suffering due to symptom distress, burdensome treatments, and caregiver strain. While many caregivers prioritize comfort in late-stage ADRD, shared decision-making is rare. Hospitalization creates an opportunity for dementia-specific palliative care, and the study findings will inform care redesign to advance comprehensive dementia-specific palliative care plus transitional care. TRIAL REGISTRATION ClinicalTrials.gov NCT04948866. Registered on July 2, 2021.
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Affiliation(s)
- M Toles
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - C Kistler
- Department of Family Medicine and Palliative Care Program, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - F C Lin
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Lynch
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K Wessell
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S L Mitchell
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - L C Hanson
- Division of Geriatrics and Palliative Care Program, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kappelman MD, Lewis JD, Zhang X, Lin FC, Weisbein L, Chen W, Burris J, Dorand JE, Parlett LE, Haynes K, Nair V, Kaul AF, Dobes A, Long MD. Comparing Patient-Reported Outcomes Among Anti-TNF-Experienced Patients with Crohn's Disease Initiating Vedolizumab Versus Ustekinumab. Dig Dis Sci 2023:10.1007/s10620-023-07942-0. [PMID: 37115362 DOI: 10.1007/s10620-023-07942-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/30/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Primary and secondary non-response to anti-tumor necrosis factor (TNF) therapy is common in patients with Crohn's disease (CD), yet limited research has compared the effectiveness of subsequent biological therapy. OBJECTIVE We sought to compare the effectiveness of vedolizumab and ustekinumab in anti-TNF-experienced patients with CD, focusing on patient-prioritized patient-reported outcomes (PROs). METHODS We conducted a prospective, internet-based cohort study nested within IBD Partners. We identified anti-TNF-experienced patients initiating with CD vedolizumab or ustekinumab and analyzed PROs reported approximately 6 months later (minimum 4 months, maximum 10 months). Co-primary outcomes were Patient-Reported Outcome Measurement Information System (PROMIS) domains of Fatigue and Pain Interference. Secondary outcomes included patient-reported short Crohn's disease activity index (sCDAI), treatment persistence, and corticosteroid use. Inverse probability of treatment weighting (IPTW) was used to control for a number of potential confounders and incorporated into linear and logistic regression models for continuous and categorical outcomes, respectively. RESULTS Overall, 141 vedolizumab and 219 ustekinumab initiators were included in our analysis. After adjustment, we found no differences between treatment groups in our primary outcomes of Pain Interference or Fatigue or the secondary outcome of sCDAI. However, vedolizumab was associated with lower treatment persistence (OR 0.4, 95% CI 0.2-0.6) and higher corticosteroid use at follow-up assessment (OR 1.7, 95% CI 1.1-2.6). DISCUSSION Among anti-TNF experienced patients with CD, Pain Interference or Fatigue was not significantly different 4-10 months after starting ustekinumab or vedolizumab. However, reduced steroid use and increased persistence suggest superiority of ustekinumab for non-PRO outcomes.
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Affiliation(s)
- Michael D Kappelman
- University of North Carolina at Chapel Hill, Bioinformatics Building, 130 Mason Farm Rd., Campus Box 7229, Chapel Hill, NC, 27599-7555, USA.
| | - J D Lewis
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - X Zhang
- University of North Carolina at Chapel Hill, Bioinformatics Building, 130 Mason Farm Rd., Campus Box 7229, Chapel Hill, NC, 27599-7555, USA
| | - F C Lin
- University of North Carolina at Chapel Hill, Bioinformatics Building, 130 Mason Farm Rd., Campus Box 7229, Chapel Hill, NC, 27599-7555, USA
| | - L Weisbein
- University of North Carolina at Chapel Hill, Bioinformatics Building, 130 Mason Farm Rd., Campus Box 7229, Chapel Hill, NC, 27599-7555, USA
| | - W Chen
- University of North Carolina at Chapel Hill, Bioinformatics Building, 130 Mason Farm Rd., Campus Box 7229, Chapel Hill, NC, 27599-7555, USA
| | - J Burris
- Yale School of Medicine, New Haven, CT, USA
| | - J E Dorand
- Crohn's & Colitis Foundation, New York, NY, USA
| | | | | | - V Nair
- Medical Outcomes Management and the Practice Research Network (PRACNET), Sharon, MA, USA
| | - A F Kaul
- Medical Outcomes Management and the Practice Research Network (PRACNET), Sharon, MA, USA
| | - A Dobes
- Crohn's & Colitis Foundation, New York, NY, USA
| | - M D Long
- University of North Carolina at Chapel Hill, Bioinformatics Building, 130 Mason Farm Rd., Campus Box 7229, Chapel Hill, NC, 27599-7555, USA
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Gupta S, Keen S, Thota S, Jiang H, Jones H, Laible S, Sauter C, Lin FC, Simpson Jr RJ. Mitral valve dysfunction among sudden death victims. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.115] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Mitral dysfunction is a commonly found valvular abnormality in the US. The association between mitral dysfunction with sudden death is both complex and controversial.
Purpose
To assess mitral dysfunction as a potential risk factor for sudden death using medical and autopsy records in a population-based registry of sudden deaths.
Methods
From 2013-2015, out-of-hospital deaths aged 18-64 reported by Emergency Medical Services in Wake County, North Carolina were screened to adjudicate 399 sudden death victims. Medical records were available in 270 victims, echocardiograms in 53, and autopsies in 64. Echocardiogram reports of none/trace/trivial mitral insufficiency were compared to patients with mild, moderate, or severe insufficiency. Autopsy reports for thickened mitral leaflets, calcification, and redundancy were reviewed. Additionally, available echocardiograms from a control group of 1101 patients were reviewed for mitral insufficiency. Demographics and clinical comorbidities were assessed from medical and death records. Mean, t-tests, and a bivariate logistic regression were estimated, as appropriate.
Results
Of the 53 victims with echocardiograms, mean age was 53 years, 36 (65.5%) were male, and 21 (39.6%) were African-American. Victims with available echocardiograms were more likely to have congestive heart failure (41.8%), coronary artery disease (50.9%), and diabetes (47.3%) compared to victims without echocardiograms. None/trivial/trace insufficiency was present in 27 victims (50.9%), mild insufficiency in 18 (34.0%), and moderate-severe insufficiency in 8 (15.1%). There was no association between severity of mitral insufficiency with demographic covariates or comorbid conditions. The presence of structural mitral valve abnormalities, including thickened leaflets, calcification, and redundancy of the mitral valve, were present in only 8 (12.5%) of 64 victims with autopsies. In a control group of 1101 date-matched patients from the same county, 57 (4.8%) patients had an echocardiogram available. 14 (24.6%) of these patients had mild-moderate mitral insufficiency.
Conclusion
Mitral insufficiency and structural abnormalities of the mitral valve are often identified in echocardiograms or autopsies of sudden death victims. Living controls had approximately half the prevalence of mitral insufficiency, suggesting that mitral dysfunction and its associated comorbidities are associated with sudden death.
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Affiliation(s)
- S Gupta
- The University of North Carolina at Chapel Hill., Chapel Hill, United States of America
| | - S Keen
- University of North Carolina, Department of Family Medicine, Chapel Hill, United States of America
| | - S Thota
- Appalachian Regional Healthcare, Hazard, United States of America
| | - H Jiang
- University of North Carolina, Department of Biostatistics, Chapel Hill, United States of America
| | - H Jones
- The University of North Carolina at Chapel Hill., Chapel Hill, United States of America
| | - S Laible
- The University of North Carolina at Chapel Hill., Chapel Hill, United States of America
| | - C Sauter
- The University of North Carolina at Chapel Hill., Chapel Hill, United States of America
| | - FC Lin
- University of North Carolina, Department of Biostatistics, Chapel Hill, United States of America
| | - RJ Simpson Jr
- University of North Carolina, Division of Cardiology, Chapel Hill, United States of America
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Lee MT, Lin FC, Chen ST, Hsu WT, Lin S, Chen TS, Lai F, Lee CC. Web-Based Dashboard for the Interactive Visualization and Analysis of National Risk-Standardized Mortality Rates of Sepsis in the US. J Med Syst 2020; 44:54. [PMID: 31927706 DOI: 10.1007/s10916-019-1509-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/20/2019] [Indexed: 12/29/2022]
Abstract
Sepsis mortality is heavily influenced by the quality of care in hospitals. Comparing risk-standardized mortality rate (RSMR) of sepsis patients in different states in the United States has potentially important clinical and policy implications. In the current study, we aimed to compare national sepsis RSMR using an interactive web-based dashboard. We analyzed sepsis mortality using the National Inpatient Sample Database of the US. The RSMR was calculated by the hierarchical logistic regression model. We wrote the interactive web-based dashboard using the Shiny framework, an R package that integrates R-based statistics computation and graphics generation. Visual summarizations (e.g., heat map, and time series chart), and interactive tools (e.g., year selection, automatic year play, map zoom, copy or print data, ranking data by name or value, and data search) were implemented to enhance user experience. The web-based dashboard (https://sepsismap.shinyapps.io/index2/) is cross-platform and publicly available to anyone with interest in sepsis outcomes, health inequality, and administration of state/federal healthcare. After extrapolation to the national level, approximately 35 million hospitalizations were analyzed for sepsis mortality each year. Eight years of sepsis mortality data were summarized into four easy to understand dimensions: Sepsis Identification Criteria; Sepsis Mortality Predictors; RSMR Map; RSMR Trend. Substantial variation in RSMR was observed for different states in the US. This web-based dashboard allows anyone to visualize the substantial variation in RSMR across the whole US. Our work has the potential to support healthcare transparency, information diffusion, health decision-making, and the formulation of new public policies.
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Affiliation(s)
- Meng-Tse Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Fong-Ci Lin
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Szu-Ta Chen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Pediatrics, National Taiwan University Hospital Yun-Lin Branch, Yunlin County, Taiwan.,Department of Pediatrics, National Taiwan University and College of Medicine, Taipei, Taiwan.,Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wan-Ting Hsu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Samuel Lin
- Department of Data Sciences, University of California, Berkeley, CA, USA
| | - Tzer-Shyong Chen
- Department of Information Management, Tunghai University, Taichung, Taiwan
| | - Feipei Lai
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Computer Science & Information Engineering, National Taiwan University, Taipei, Taiwan.,Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chien-Chang Lee
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan. .,Health Economic Outcomes Research Group and Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist, Taipei, 100, Taiwan.
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5
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Lin FC, Huang ST, Shang RJ, Wang CC, Hsiao FY, Lin FJ, Lin MS, Hung KY, Wang J, Shen LJ, Lai F, Huang CF. A Web-Based Clinical System for Cohort Surveillance of Specific Clinical Effectiveness and Safety Outcomes: A Cohort Study of Non-Vitamin K Antagonist Oral Anticoagulants and Warfarin. JMIR Med Inform 2019; 7:e13329. [PMID: 31271151 PMCID: PMC6636345 DOI: 10.2196/13329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/11/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 12/14/2022] Open
Abstract
Background Conventional systems of drug surveillance lack a seamless workflow, which makes it crucial to have an active drug surveillance system that proactively assesses adverse drug events. Objective The aim of this study was to develop a seamless, Web-based workflow for comparing the safety and effectiveness of drugs in a database of electronic medical records. Methods We proposed a comprehensive integration process for cohort surveillance using the National Taiwan University Hospital Clinical Surveillance System (NCSS). We studied a practical application of the NCSS that evaluates the drug safety and effectiveness of novel oral anticoagulants (NOACs) and warfarin by cohort tree analysis in an efficient and interoperable platform. Results We demonstrated a practical example of investigating the differences in effectiveness and safety between NOACs and warfarin in patients with nonvalvular atrial fibrillation (AF) using the NCSS. We efficiently identified 2357 patients with nonvalvular AF with newly prescribed oral anticoagulants between 2010 and 2015 and further developed 1 main cohort and 2 subcohorts for separately measuring ischemic stroke as the clinical effectiveness outcome and intracranial hemorrhage (ICH) as the safety outcome. In the subcohort of ischemic stroke, NOAC users exhibited a significantly lower risk of ischemic stroke than warfarin users after adjusting for age, sex, comorbidity, and comedication in an intention-to-treat (ITT) analysis (P=.01) but did not exhibit a significantly distinct risk in an as-treated (AT) analysis (P=.12) after the 2-year follow-up. In the subcohort of ICH, NOAC users did not exhibit a different risk of ICH both in ITT (P=.68) and AT analyses (P=.15). Conclusions With a seamless and Web-based workflow, the NCSS can serve the critical role of forming associations between evidence and the real world at a medical center in Taiwan.
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Affiliation(s)
- Fong-Ci Lin
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Tsung Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Rung Ji Shang
- Information Technology Office, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Chuan Wang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mei-Shu Lin
- Department of Development and Planning, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Yu Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Hsinchu, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Li-Jiuan Shen
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Feipei Lai
- Department of Computer Science & Information Engineering, National Taiwan University, Taipei, Taiwan.,Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chih-Fen Huang
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
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Lin YZ, Huang YX, Ying MG, Kong XQ, Lin FC. [Relationship between c-kit mRNA expression and prognosis in patients with rectal carcinoma]. Zhonghua Zhong Liu Za Zhi 2018; 40:667-671. [PMID: 30293390 DOI: 10.3760/cma.j.issn.0253-3766.2018.09.005] [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: 11/05/2022]
Abstract
Objective: To investigate the correlation between c-kit mRNA expression and prognosis in patients with rectal carcinoma. Methods: The expression of c-kit mRNA in rectal carcinoma tissues(n=66) was detected by multiplex branched-DNA liquid chip method. According to the expression level, the patients were classified into the c-kit mRNA high expression group and the low group. We analyzed the relationship between the c-kit mRNA expression and the clinicopathological characteristics of patients, as well as the factors affecting patients'prognosis. Results: Of the 66 rectal carcinoma patients, 18(27.3%)cases were c-kit mRNA high expression. No significant correlation was found between the c-kit mRNA expression and gender, age, preoperative carcinoembryonic antigen, preoperative hemoglobin, distance to verge, lymph node metastasis, tumor thrombus, T stage, TNM stage and tumor differentiation (P>0.05). In follow-up, 34 patients died, 32 patients and 36 patients were recurrence or metastasis. The 1-, 3-, 5-year overall survival(OS) of c-kit mRNA high expression group were 100.0%, 77.8%, 77.8%, respectively, while those of the low one were 93.8%, 56.3%, 45.8%, respectively. The difference was statistically significant(P=0.025). Lymph node metastasis, T stage and TNM stage were also significant associated with OS(P<0.05). The 1-, 3-, 5-year disease free rate (DFS)of the c-kit mRNA high expression group were 100.0%, 77.8% and 77.8%, respectively, while those of the low one were 77.1%、43.8% and 41.7%, respectively, and the difference between the two groups was significant (P=0.044). As a reslut, c-kit mRNA expression (P=0.038) and TNM stage (P=0.039) were the independent prognostic factors affecting the OS in rectal cancer patients. Conclusions: Low expression of c-kit was associated with poor prognosis of rectal carcinoma. And the mechanism underlying this phenomenon deserves further exploration.
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Affiliation(s)
- Y Z Lin
- Department of Gastrointestinal Surgical Oncology, Fujian Medical University Cancer Hospital, Fuzhou 350014, China
| | - Y X Huang
- Department of Abdominal Radiation Oncology, Fujian Medical University Cancer Hospital, Fuzhou 350014, China
| | - M G Ying
- Department of Gastrointestinal Surgical Oncology, Fujian Medical University Cancer Hospital, Fuzhou 350014, China
| | - X Q Kong
- Department of Abdominal Radiation Oncology, Fujian Medical University Cancer Hospital, Fuzhou 350014, China
| | - F C Lin
- Department of Radiation Oncology, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou 363000, China
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7
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Lin FC, Wang CY, Shang RJ, Hsiao FY, Lin MS, Hung KY, Wang J, Lin ZF, Lai F, Shen LJ, Huang CF. Identifying Unmet Treatment Needs for Patients With Osteoporotic Fracture: Feasibility Study for an Electronic Clinical Surveillance System. J Med Internet Res 2018; 20:e142. [PMID: 29691201 PMCID: PMC5941097 DOI: 10.2196/jmir.9477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/23/2018] [Accepted: 01/26/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Traditional clinical surveillance relied on the results from clinical trials and observational studies of administrative databases. However, these studies not only required many valuable resources but also faced a very long time lag. OBJECTIVE This study aimed to illustrate a practical application of the National Taiwan University Hospital Clinical Surveillance System (NCSS) in the identification of patients with an osteoporotic fracture and to provide a high reusability infrastructure for longitudinal clinical data. METHODS The NCSS integrates electronic medical records in the National Taiwan University Hospital (NTUH) with a data warehouse and is equipped with a user-friendly interface. The NCSS was developed using professional insight from multidisciplinary experts, including clinical practitioners, epidemiologists, and biomedical engineers. The practical example identifying the unmet treatment needs for patients encountering major osteoporotic fractures described herein was mainly achieved by adopting the computerized workflow in the NCSS. RESULTS We developed the infrastructure of the NCSS, including an integrated data warehouse and an automatic surveillance workflow. By applying the NCSS, we efficiently identified 2193 patients who were newly diagnosed with a hip or vertebral fracture between 2010 and 2014 at NTUH. By adopting the filter function, we identified 1808 (1808/2193, 82.44%) patients who continued their follow-up at NTUH, and 464 (464/2193, 21.16%) patients who were prescribed anti-osteoporosis medications, within 3 and 12 months post the index date of their fracture, respectively. CONCLUSIONS The NCSS systems can integrate the workflow of cohort identification to accelerate the survey process of clinically relevant problems and provide decision support in the daily practice of clinical physicians, thereby making the benefit of evidence-based medicine a reality.
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Affiliation(s)
- Fong-Ci Lin
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Yu Wang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Rung Ji Shang
- Information Technology Office, National Taiwan University Hospital, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mei-Shu Lin
- Department of Development and Planning, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Yu Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Zhen-Fang Lin
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.,Department of Computer Science & Information Engineering, National Taiwan University, Taipei, Taiwan.,Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Li-Jiuan Shen
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Fen Huang
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
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8
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Mooberry MJ, Bradford R, Hobl EL, Lin FC, Jilma B, Key NS. Procoagulant microparticles promote coagulation in a factor XI-dependent manner in human endotoxemia. J Thromb Haemost 2016; 14:1031-42. [PMID: 26857798 PMCID: PMC4870121 DOI: 10.1111/jth.13285] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED Essentials The procoagulant effects of microparticles (MPs) on coagulation in endotoxemia are not known. MPs from endotoxemia volunteers were evaluated for procoagulant activity in a plasma milieu. MPs from endotoxemia volunteers shortened clotting times and enhanced thrombin generation. MP procoagulant effects were mediated in a factor XI-dependent manner. SUMMARY Background Human endotoxemia is characterized by acute inflammation and activation of coagulation, as well as increased numbers of circulating microparticles (MPs). Whether these MPs directly promote coagulation and through which pathway their actions are mediated, however, has not been fully explored. Objectives In this study, we aimed to further characterize endotoxin-induced MPs and their procoagulant properties using several approaches. Methods Enumeration and characterization of MPs were performed using a new-generation flow cytometer. Relative contributions of the extrinsic and intrinsic pathways in MP-mediated procoagulant activity were assessed using plasmas deficient in factor (F) VII or FXI or with blocking antibodies to tissue factor (TF) or FXIa. Results Total MPs and platelet MPs were significantly elevated in plasma at 6 h after infusion of endotoxin in healthy human subjects. MPs isolated from plasma following endotoxin infusion also demonstrated increased TF activity in a reconstituted buffer system. When added to recalcified platelet-poor plasma, these MPs also promoted coagulation, as judged by a decreased clotting time with shortening of the lag time and time to peak thrombin using calibrated automated thrombography (CAT). However, the use of FVII-deficient plasma or blocking antibody to TF did not inhibit these procoagulant effects. In contrast, plasma clotting time was prolonged in FXI-deficient plasma and a blocking antibody to FXIa inhibited all MP-mediated parameters in the CAT assay. Conclusions The initiation of coagulation by cellular TF in endotoxemia is in contrast to (and presumably complemented by) the intrinsic pathway-mediated procoagulant effects of circulating MPs.
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Affiliation(s)
- M J Mooberry
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - R Bradford
- McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA
| | - E L Hobl
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - F C Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - B Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - N S Key
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA
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Law JR, Yeşiltepe-Mutlu G, Helms S, Meyer E, Özsu E, Çizmecioğlu F, Lin FC, Hatun Ş, Calikoglu AS. Adolescents with Type 1 diabetes mellitus experience psychosensorial symptoms during hypoglycaemia. Diabet Med 2014; 31:1245-51. [PMID: 24965522 PMCID: PMC4167966 DOI: 10.1111/dme.12533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/17/2014] [Accepted: 06/23/2014] [Indexed: 11/30/2022]
Abstract
AIM To describe mood and psychosensorial symptoms of hypoglycaemia in adolescents with Type 1 diabetes mellitus in two countries with different cultures, Turkey and the USA. METHODS We developed a 68-item questionnaire assessing physical, behavioural, mood and psychosensorial symptom frequency and ratings ['good', 'bad', or 'both' (sometimes good, sometimes bad)]. Adolescents with Type 1 diabetes were recruited from paediatric diabetes clinics at the University of North Carolina at Chapel Hill in the USA and Kocaeli University in Turkey. The percentages of participants at each clinic who endorsed individual symptoms, symptom categories and symptom ratings were calculated and compared. RESULTS Cronbach's α values were > 0.7 for each real symptom category. No symptom items were excluded from the questionnaire analysis based on item-total correlation results which were all > 0.2. Data were collected from 132 participants (69 from University of North Carolina, 63 from Kocaeli University, 54% male). The mean (SD) age of the participants was 14.9 (1.9) years, HbA1c level was 8.7 (1.8) % and duration of Type 1 diabetes was 5.8 (3.7) years. On average, each physical symptom was experienced by 65.2% of participants, each behavioural symptom by 46.5%, each mood symptom by 42.8%, and each psychosensorial symptom by 48.9%. On average, each physical, behavioral, mood and psychosensorial symptom was rated as 'good' or 'both' by 23.0, 29.1, 36.9 and 37.2% of participants, respectively. There were no symptom differences between the groups in each country. CONCLUSIONS In addition to the classic physical symptoms experienced during hypoglycaemia, adolescents with Type 1 diabetes report psychosensorial, mood and behavioral symptoms, and some describe them as positive experiences. Symptom experiences were similar in these two countries with different cultures.
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Affiliation(s)
- J R Law
- Division of Paediatric Endocrinology, Department of Paediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Lin CJ, Hung JW, Cho CY, Tseng CY, Chen HY, Lin FC, Li CY. Poststroke constipation in the rehabilitation ward: incidence, clinical course and associated factors. Singapore Med J 2013; 54:624-9. [DOI: 10.11622/smedj.2013222] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
A digitonin-solubilized cellulose synthase was prepared from Acetobacter xylinum. When this enzyme was incubated under conditions known to lead to active synthesis of 1,4-beta-D-glucan polymer (cellulose), electron microscopy revealed that clusters of fibrils were assembled within minutes. Individual fibrils are 17 +/- 2 angstroms in diameter. Evidence that the fibrils were freshly synthesized and cellulosic in nature was their incorporation of the tritium from UDP-[(3)H]glucose (UDP, uridine 5'-diphosphate), their binding of gold-labeled cellobiohydrolase, and an electron diffraction pattern with 004, 200, and 012 reflections (characteristic of cellulose synthesized in vivo) but missing 110 and 110 reflections. The small size of the fibrils is atypical of native A. xylinum cellulose microfibrils. The fibrils synthesized in vitro resemble, in morphology and size, the fibrillar cellulose produced when A. xylinum is cultured in the presence of agents that interfere with the normal process of crystallization of the microfibrils. The solubilized enzyme unit may therefore be producing a basic fibrillar structure that, in vivo, interacts laterally with other fibrils to produce native cellulose microfibrils.
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Narayanan S, Lin FC, Walder HJ. Sampling considerations in trace element analysis. Acta Pharmacol Toxicol (Copenh) 2009; 59 Suppl 7:598-601. [PMID: 3776633 DOI: 10.1111/j.1600-0773.1986.tb02834.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Yu CS, Lin FC, Li KC, Jiang TZ, Zhu CZ, Qin W, Sun H, Chan P. Diffusion tensor imaging in the assessment of normal-appearing brain tissue damage in relapsing neuromyelitis optica. AJNR Am J Neuroradiol 2006; 27:1009-15. [PMID: 16687534 PMCID: PMC7975724] [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: 05/09/2023]
Abstract
BACKGROUND AND PURPOSE Normal-appearing brain tissue (NABT) damage was established in multiple sclerosis by histology, MR spectroscopy, magnetization transfer imaging and diffusion tensor imaging (DTI). However, whether this phenomenon can be detected in relapsing neuromyelitis optica (RNMO) remains unclear. The aim of this study was to use DTI to investigate the presence of NABT damage in RNMO patients and its possible mechanism. METHODS Conventional MR imaging and DTI scans were performed in 16 patients with RNMO without visible lesions on brain MR imaging and in 16 sex- and age-matched healthy control subjects. Histogram analysis of mean diffusivity (MD) and fractional anisotropy (FA) was performed in the entire brain tissue (BT), white matter (WM), and gray matter (GM). Region of interest (ROI) analysis of MD and FA was also performed in WM regions connected with the spinal white matter tracts or optic nerve (including medulla oblongata, cerebral peduncle, internal capsule, and optic radiation), in corpus callosum without direct connection with them, and in some GM regions. RESULTS From histogram analysis, we found the RNMO group had a higher average MD of the BT, WM, and GM, a lower average MD peak height and a higher average MD peak location of the GM, and a higher average FA peak height of the WM than did the control group. From ROI analysis, compared with control subjects, RNMO patients had a higher average MD and a lower average FA in ROIs of WM connected with the spinal white matter tracts or optic nerve and a normal average MD and FA in corpus callosum without direct connection with them. In addition, a high average MD was found in parietal GM in these patients. CONCLUSIONS Our findings confirm the presence of abnormal diffusion in brain tissue in patients with RNMO and suggest that secondary degeneration caused by lesions in the spinal cord and optic nerve might be an important mechanism for this abnormality.
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Affiliation(s)
- C S Yu
- Department of Radiology, Xuanwu Hospital, Capital University of Medical Sciences, Beijing, China
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Lin CR, Cheng JT, Lin FC, Chou AK, Lee TC, Chen JT, Yang LC. Effect of thiopental, propofol, and etomidate on vincristine toxicity in PC12 cells. Cell Biol Toxicol 2002; 18:63-70. [PMID: 11991087 DOI: 10.1023/a:1014423330210] [Citation(s) in RCA: 4] [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: 11/12/2022]
Abstract
Neurotoxicity is the dose-limiting side-effect of vincristine in cancer therapy. Using the nerve growth factor (NGF)-dependent neurite outgrowth and cell proliferation of the PC12 pheochromocytoma cell line as an in vitro assay, the protective effect of different intravenous anesthetics was assessed. Vincristine (1 nmol/L) significantly decreased the percentage of neurite-forming cells from 68% +/- 9% to 27% +/- 7% within a 3-day incubation period. The longer neurites (> 2 x cell body) in particular proved to be extremely sensitive to vincristine (from 17% +/- 4% to 0% of total neurite-expressing cells). Flow cytometry results revealed an S-phase percentage of 15.85% +/- 3.25% after NGF induction, with vincristine reducing this percentage to 0.68% +/- 0.38%. Reversal of the inhibitory effect of vincristine was noted in the cells treated with thiopental or propofol but not etomidate. Bicuculline partially antagonized the protective effect of thiopental and propofol in both studies. We conclude that thiopental and propofol, but not etomidate, have a protective effect in vincristine-induced neurotoxicity. The protective effect produced by thiopental and propofol is probably secondary to activation of GABAA receptors.
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Affiliation(s)
- C R Lin
- Anesthesiology Research Laboratory, Kaohsiung Chang Gung Memorial Hospital, Taiwan, Niao-Shung Hsiang
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15
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Lin FC, Chou CW, Chang SC. Usefulness of the suspended microbubble sign in differentiating empyemic and nonempyemic hydropneumothorax. J Ultrasound Med 2001; 20:1341-1345. [PMID: 11762545 DOI: 10.7863/jum.2001.20.12.1341] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The suspended microbubble sign is defined as the image seen on ultrasonography consisting of a pleural effusion strewn with numerous hyperechoic pinpoints and more or less linear shadows that move synchronously with respiration. In this study, we intended to evaluate the clinical usefulness of the suspended microbubble sign in differentiating empyemic and nonempyemic hydropneumothorax. METHODS This series consisted of 8 patients with empyemic hydropneumothorax and 23 patients with nonempyemic hydropneumothorax. The finding of the presence of the suspended microbubble signs on ultrasonography was recorded. To further elucidate the generation of the suspended microbubble sign, the interaction between air and pleural fluid of different types was investigated in vitro. RESULTS The suspended microbubble sign was shown on ultrasonography in all 8 patients with empyemic hydropneumothorax but was absent in the 23 patients with nonempyemic hydropneumothorax. These findings were supported by the observation that the pus seemed to mix with and trap the air more easily than did the nonpurulent pleural fluid, as shown in vitro. In this selected population, the sensitivity and specificity of the suspended microbubble sign in aiding a diagnosis of empyemic hydropneumothorax were both 100%. CONCLUSION The suspended microbubble sign shown on ultrasonography might be of considerable value in differentiating empyemic and nonempyemic hydropneumothorax.
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Affiliation(s)
- F C Lin
- Department, Veterans General Hospital-Taipei, and School of Medicine, National Yang-Ming University, Taiwan, Republic of China
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Lin FC, Chang SC. Plate atelectasis: an implication of foreign body aspiration into the lower airways in two adults. Zhonghua Yi Xue Za Zhi (Taipei) 2001; 64:597-602. [PMID: 11791948] [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: 02/23/2023]
Abstract
Pneumonic patches and atelectatic or bronchiectatic changes in the tributary lung distal to the bronchial foreign body are common radiographic abnormal findings in adults with foreign body aspiration into the lower airways. Nevertheless, plate (plate-like or discoid) atelectasis, a form of peripheral atelectasis, has not been reported to associate with this condition. In this report, we describe two men with the foreign body impacted in the right intermediate bronchus. In both cases, plate atelectasis was found in the base of the right lung and disappeared after successful removal of the foreign body via fiberoptic bronchoscopy. These two cases illustrate that plate atelectasis may be an implication of foreign body aspiration into the lower airways.
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Affiliation(s)
- F C Lin
- Chest Department, Taipei Veterans General Hospital, Taiwan, ROC
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Abstract
For two communities, species overlap has been defined by Smith, Solow, and Preston (1996, Biometrics 52, 1472-1477) as the probability that a randomly selected species is present in both communities given that it is present in at least one community. Species overlap can thus be used to describe the similarity of two communities. In contrast with the parametric estimator of Smith et al., we propose a nonparametric maximum likelihood estimator (NPMLE). We prove that the NPMLE is consistent and asymptotically normally distributed and show that computation of the NPMLE and its standard error is straightforward. We also compare the NPMLE and the estimator of Smith et al. for a variety of situations.
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Affiliation(s)
- J C Yue
- Department of Statistics, National Chengchi University, Taipei, Taiwan, Republic of China.
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Hsieh IC, Chien CC, Chang HJ, Chern MS, Hung KC, Lin FC, Wu D. Acute and long-term outcomes of stenting in coronary vessel > 3.0 mm, 3.0-2.5 mm, and < 2.5 mm. Catheter Cardiovasc Interv 2001; 53:314-22. [PMID: 11458407 DOI: 10.1002/ccd.1174] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [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: 11/08/2022]
Abstract
We compared the acute and long-term outcomes of stentings in coronary vessels > 3.0 mm, 3.0-2.5 mm, and < 2.5 mm. A total of 1,152 patients underwent coronary stenting was divided into three groups based on the reference vessel size. Group A consisted of 598 patients (667 lesions) with a reference vessel diameter > 3.0 mm, group B 485 patients (544 lesions) with a reference vessel diameter of 3.0-2.5 mm, and group C 114 patients (119 lesions) with a reference vessel diameter < 2.5 mm. The procedural success, stent thrombosis, and in-hospital cardiac event rate were similar in the three groups. At 6-month angiographic follow-up, the lesion restenotic rate was significantly higher in the small-vessel group (14%, 22%, and 26% in groups A, B, and C, respectively; P = 0.011). These differences appeared to result from a lesser acute gain and a lesser net gain in small-vessel group; the late luminal loss was similar in the three groups. During a follow-up duration of 28 +/- 3 months, group C patients had a significantly lower rate of event-free survival than the group A and B patients (71% vs. 85% and 82%; P = 0.002). Stepwise regression analysis demonstrated that complex lesion (P = 0.032) and long lesion (P = 0.046) are independent predictors of restenosis in very-small-vessel (< 2.5 mm) stenting. In conclusion, the acute results of stenting in small coronary arteries appear safe and feasible with a high procedural success rate and a low incidence of stent thrombosis. Stenting in patients with a small coronary artery appears to have a similar in-hospital cardiac event rate, but a higher angiographic restenosis rate and a lower event-free survival rate, compared to stenting in patients with a larger coronary artery. The predictors of restenosis in very-small-vessel stenting are complex lesions and long lesions. Cathet Cardiovasc Intervent 2001;53:314-322.
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Affiliation(s)
- I C Hsieh
- Second Section of Cardiology, Chang Gung University College of Medicine and Hospital, 199 Tung-Hwa North Road, Tao-Yuan, Taipei, Taiwan
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Chou CW, Lin FC, Tung SM, Liou RD, Chang SC. Diagnosis of pulmonary alveolar proteinosis: usefulness of papanicolaou-stained smears of bronchoalveolar lavage fluid. Arch Intern Med 2001; 161:562-6. [PMID: 11252115 DOI: 10.1001/archinte.161.4.562] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The globules (stained green, orange, or orange in the center coated with a green rim) seen in Papanicolaou-stained smears of bronchoalveolar lavage fluid are suggested to be characteristic of pulmonary alveolar proteinosis (PAP). OBJECTIVE To evaluate the usefulness of Papanicolaou-stained smears of bronchoalveolar lavage fluid in aiding a diagnosis of PAP. METHODS Papanicolaou-stained smears of bronchoalveolar lavage fluid obtained from 7 patients (5 idiopathic, 2 secondary) with PAP were evaluated. To serve as controls, the smears of 11 normal subjects and 128 patients with other pulmonary disorders were also examined. The findings on the presence and number of globules were recorded. To differentiate PAP from other pulmonary disorders, the highest globule value obtained from the control group was chosen as the cutoff point. RESULTS The characteristic globules were not found in normal subjects and only found in 6 of 128 patients with other pulmonary disorders. Their clinical diagnoses were Sjögren syndrome in 2 cases; polymyositis, idiopathic pulmonary fibrosis, asbestosis, and hypersensitivity pneumonitis in 1 case each. The numbers of globules in these 6 patients were 1, 3, 17, 7, 3, and 2. In contrast, more than 100 globules were found in all patients with PAP. The number of globules was highly sensitive and specific in aiding a diagnosis of PAP when the cutoff value was set at 18. CONCLUSION The globules seen in Papanicolaou-stained smears of bronchoalveolar lavage fluid may be valuable in aiding a diagnosis of PAP, especially when the number of globules is more than 18.
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Affiliation(s)
- C W Chou
- Chest Department, Veterans General Hospital-Taipei, 201 Section 2, Shih-Pai Road, Shih-Pai, Taipei, Taiwan 112, Republic of China
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Hsieh IC, Chang HJ, Chern MS, Hung KC, Lin FC, Wu D. Benefits of late coronary artery stenting in patients with acute myocardial infarction with and without thrombolytic therapy. Chang Gung Med J 2000; 23:738-46. [PMID: 11416894] [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: 02/20/2023]
Abstract
BACKGROUND There are no added benefits when balloon angioplasty is conducted in conjunction with thrombolytic therapy in patients with acute myocardial infarction. The purpose of this study was to determine whether or not thrombolysis has an impact on the outcome of late coronary artery stenting following acute myocardial infarction. METHODS The outcome of late coronary artery stenting in the infarct-related artery following acute infarction was compared in patients with (68 patients, group A) and without (118 patients, group B) prior thrombolytic therapy. RESULTS The baseline characteristics were similar in the 2 groups except that total occlusion of the infarct-related artery was more common in group B. The angiographic characteristics of the target lesion were similar in the 2 groups; the procedural success rate was 98% in both groups. There was no subacute thrombosis or other complications in either group. The 6-month follow-up coronary angiography and the restenosis rate was 18% in both groups; the reocclusion rate was 2% in group A and 4% in group B. The increment of the left ventricular ejection fraction was similar in both groups (6% versus 7%). During a follow-up duration of 18 +/- 3 months, the mortality rate was 3% versus 2%, reinfarction 0% versus 1%, recurrent angina 6% versus 4%, and target lesion revascularization by angioplasty 13% versus 13% in group A and B patients, respectively. CONCLUSION The outcome of late coronary artery stenting following acute myocardial infarction in patients with and without prior thrombolytic therapy was comparable. Significant improvement of left ventricular function was noted in both groups.
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Affiliation(s)
- I C Hsieh
- Second Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan, R.O.C
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Chen BH, Liu HW, Huang SL, Lin FC, Dai MG, Chen YL, Hsieh SL, Huang TJ. Comparison of appendectomy medical expense and clinical outcome between fee for service and prospective payment system. Kaohsiung J Med Sci 2000; 16:293-8. [PMID: 11584430] [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: 02/21/2023] Open
Abstract
Since the introduction of national health insurance on March 1st 1995 in Taiwan, another 9 items (including appendectomy) were introduced into the Taiwan/prospective payment system (T/PPS). The modified T/PPS was based on those complicated appendectomy cases with secondary diagnosis or second operation where a total fee over 37,500 New Taiwan (NT) dollars was paid by National Health Insurance Bureau (NHIB) according to the real cost. The T/PPS was implemented in October 1997 due to the continuously increasing financial burden of medical expenses on the NHIB. The purpose of this study is (1) to compare the length of stay (LOS) and total medical expense of appendectomy of fee for service (FFS) and T/PPS and (2) to compare the clinical outcome of wound healing after discharge of the two systems by telephone interview. Our study investigated 100 consecutive appendectomy cases under FFS payment system and 99 consecutive appendectomy cases under T/PPS. We retrospectively analyzed LOS, operation time, and hospital cost of different items through chart review and computer data. Our results revealed that the LOS and operation time of T/PPS were significantly shorter than those of FFS (both p < 0.01). The total hospital cost, fee for room service, treatment, pharmacy, examination and anesthesia in T/PPS were also significantly less than those in FFS (all p < 0.01, except for anesthesia p < 0.05). There existed positive correlation between total hospital cost and LOS, operation time, fee for room service, treatment, pharmacy, examination and anesthesia both for T/PPS and FFS. To evaluate the clinical outcome of appendectomy between T/PPS and FFS, we interviewed 73 T/PPS cases and 73 FFS cases by telephone and chart review. Our results revealed that there were no significant differences in frequencies of having painful incision, clear incision wound on the day of discharge, and removal of stitches at hospital (p all > 0.05). We concluded that compared to FFS, T/PPS can decrease LOS and total hospital cost of appendectomy, and T/PPS's clinical outcome of appendectomy in T/PPS showed no significant difference from that in FFS.
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Affiliation(s)
- B H Chen
- Department of Clinical Laboratory, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Kaohsiung, Taiwan
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Abstract
Tissue plasminogen activator (t-PA) was administered to three patients with newly developed intracardiac thrombi. Cases 1 and 2 developed right heart thrombi after radiofrequency ablation for atrioventricular nodal reentrant tachycardia and case 3 had tachycardia-related cardiomyopathy and a left ventricular thrombus. In all three patients, the intracardiac thrombi were successfully eliminated following t-PA therapy without major bleeding complications. These observations suggest that t-PA is effective in lysing new thrombus complicating radiofrequency ablation or heart failure and may be the therapy of choice in these conditions. Cathet. Cardiovasc. Intervent. 49:91-96, 2000.
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Affiliation(s)
- K H Yeh
- Second Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
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Hsieh IC, Chern MS, Chang HJ, Hung KC, Lin FC, Wu D. Clinical and angiographic outcomes are similar with half, single, or multiple contiguous Palmaz-Schatz stent implantations for a single coronary stenosis. Am J Cardiol 1999; 84:970-5. [PMID: 10569648 DOI: 10.1016/s0002-9149(99)00482-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We compared the immediate and 6-month clinical and angiographic outcomes in patients undergoing a half, a single, or multiple contiguous stent implantations for a single coronary stenosis. Four hundred forty-three consecutive patients, who underwent elective Palmaz-Schatz stent implantations for 542 stenoses between November 1995 and July 1998, were analyzed. Sixty-three patients with 78 stenoses received a half stent (group A), 346 patients with 395 stenoses received a single stent (group B), and 68 patients with 69 stenoses received multiple overlapping stents (group C) for a single coronary stenosis. Seventy-eight half stents were implanted in 78 stenoses in group A, 395 stents in 395 stenoses in group B, and 141 stents in 69 stenoses in group C. The baseline characteristics were similar in the 3 groups. There were no deaths, no subacute thrombosis, and no vascular complications. Forty-nine patients with 57 stenoses in group A, 280 patients with 326 stenoses in group B, and 59 patients with 60 stenosis in group C underwent 6-month follow-up coronary angiography; the restenotic rate per patient was 10% in group A, 20% in group B, and 24% in group C (NS); the restenotic rate per stenosis was 9% in group A, 18% in group B, and 23% in group C (NS). Follow-up of 18 +/- 3 months revealed no differences in mortality, reinfarction, recurrent angina, target narrowing angioplasty, and elective coronary artery bypass surgery among the 3 groups. The overall cardiac event-free survival was 90%, 82%, and 83% in groups A, B, and C, respectively (p = 0.275). Thus, the procedural success rate, the in-hospital morbidity, and the long-term outcome are similar with coronary stenting using a half, a single, or multiple overlapping Palmaz-Schatz stents for a single stenosis.
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Affiliation(s)
- I C Hsieh
- Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
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Hung KC, Lin FC, Chern MS, Chang HJ, Hsieh IC, Wu D. Mechanisms and clinical significance of transient atrioventricular block during dobutamine stress echocardiography. J Am Coll Cardiol 1999; 34:998-1004. [PMID: 10520781 DOI: 10.1016/s0735-1097(99)00306-x] [Citation(s) in RCA: 19] [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: 11/16/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the possible mechanism and the clinical significance of transient atrioventricular block (AVB) during dobutamine stress echocardiography (DSE). BACKGROUND Transient AVB occurs rarely during DSE; however, the mechanisms responsible for blocks are unclear. METHODS A retrospective analysis of clinical, echocardiographic, catheterization, revascularization and head-up tilting test data was conducted in patients who developed transient AVB during DSE. RESULTS A total of 302 patients with known or suspected coronary artery disease (CAD) underwent DSE before coronary angiography between November 1997 and August 1998. Transient AVB developed in 12 patients during the test. Mobitz I block was noted in six patients and Mobitz II block in the other six patients. Nine of these 12 patients were subsequently shown to have CAD and three had no significant coronary artery stenosis. Mobitz II block was observed only in patients with CAD, while Mobitz I block occurred in three patients with and three patients without CAD (p < 0.05). Eight of the nine patients with CAD underwent a successful coronary angioplasty with or without stenting and a repeat DSE revealed no recurrence of heart block except in one patient. Head-up tilting test in the 12 patients revealed a positive response in three of the nine patients with and all three patients without CAD. A negative head-up tilting test was likely to be observed in patients with, as compared with those without, CAD in this study population (p < 0.05). CONCLUSIONS Transient AVB is not an infrequent manifestation during DSE. Both myocardial ischemia and neurally mediated vagal reflex may be responsible for this phenomenon. The development of Mobitz II block during DSE is indicative of the presence of CAD. A successful revascularization in patients with CAD who develop transient AVB may abolish this phenomenon.
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Affiliation(s)
- K C Hung
- Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
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Ho AC, Tan PP, Yang MW, Yang CH, Chu JJ, Lin PJ, Chang CH, Lin FC. The use of multiplane transesophageal echocardiography to evaluate residual patent ductus arteriosus during video-assisted thoracoscopy in adults. Surg Endosc 1999; 13:975-9. [PMID: 10526030 DOI: 10.1007/s004649901150] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [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: 11/29/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) has emerged as an innovative and popular procedure for interruption of patent ductus arteriosus (PDA), while intraoperative transesophageal echocardiography (TEE) has proven to be an effective monitor in the evaluation of residual patency. Previous reports on the adequacy of surgical interruption of PDA under VATS and TEE are available for pediatric patients, but only limited information is available for adults with PDA. MATEIALS AND METHODS: Between August 1995 and October 1997, we monitored 35 adult patients undergoing PDA interruption via VATS with Hewlett-Packard color Doppler multiplane TEE throughout the procedure. The average PDA diameter was 10.2 +/- 1.8 mm. All the PDA were completely ligated. RESULTS Thirty-two patients showed no ductal flow after double ligation. In the other three patients, residual flow was detected intraoperatively after double ligation, but it was quickly abolished by the third ligation. One patient showed faint ductal flow by transthoracic echocardiography at postoperative follow-up, but no reintervention was needed. CONCLUSIONS Our study showed that, with the refinement of adult PDA interruption via VATS, intraoperative multiplane TEE provides higher resolution for direct evaluation of the entire course of PDA ligation without interrupting the surgical procedure and minimizes the incidence of complications.
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Affiliation(s)
- A C Ho
- Department of Anesthesia, Chang Gung Memorial Hospital, 5, Fu-shin Street, Kwei-shan, Taoyuan 333, Taipei, Taiwan, Republic of China
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Yang PY, Chern MS, Lin FC. Aberrant infrarenal inferior vena cava as a hindrance to percutaneous transvenous mitral valvuloplasty in a patient with mitral stenosis: case report. Changgeng Yi Xue Za Zhi 1999; 22:530-5. [PMID: 10584431] [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: 02/14/2023]
Abstract
Cardiac catheterization and percutaneous transvenous mitral commissurotomy using the Inoue technique were attempted in a 44-year-old woman with mitral stenosis. The pulmonary arterial wedge pressure was 25 mmHg, mean transmitral diastolic pressure gradient 20.3 mmHg, cardiac index 1.80 L/min/m2, and mitral valve area 0.70 cm2. After the diagnostic catheterization, the guide wire for the transseptal procedure was checked in the middle of the inferior vena cava (IVC). A 7-French end-holed Bermann catheter was then used to detect the course of the IVC. It was found that the IVC coursed along the left border of the 4th and 5th lumbar vertebrae, to the left of the abdominal aorta. At the upper border of the third lumbar vertebra, the IVC returned to the right side of the vertebra. In consideration of the inability to pass the Brockenbrough needle through the detoured infrarenal IVC and the risk of rupturing the vessel, the transseptal procedure and attempted percutaneous transvenous mitral commissurotomy were aborted. Therefore, the patient underwent open mitral commissurotomy instead.
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Affiliation(s)
- P Y Yang
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C
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Abstract
Percutaneous transvenous mitral commissurotomy using the Inoue technique was performed in a 59-year-old female with mitral stenosis and a severely calcified mitral leaflets. Although not entrapped in the subvalvular apparatus, the balloon catheter was deviated away from the mitral orifice-apex axis of the left ventricle during the inflation of the proximal balloon, which plucked and severed the chordae tendineae of the posterior mitral leaflet and resulted in severe mitral regurgitation.
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Affiliation(s)
- M S Chern
- Department of Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
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Hung MJ, Lin FC, Cherng WJ, Wang CH, Hung KC, Hsieh IC, Wen MS, Wu D. Comparison of antihypertensive efficacy and tolerability of losartan and extended-release felodipine in patients with mild to moderate hypertension. J Formos Med Assoc 1999; 98:403-9. [PMID: 10443063] [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: 02/13/2023] Open
Abstract
Appropriate control of blood pressure has been shown to reduce morbidity and mortality in patients with hypertension. Losartan potassium, a selective antagonist of the angiotensin II type 1 (AT1) receptor, has been shown to lower blood pressure in patients with hypertension. The purpose of this study was to compare the efficacy and tolerability of losartan and extended-release (ER) felodipine in Taiwanese patients with mild to moderate hypertension. Patients with mild to moderate hypertension (sitting diastolic blood pressure, 95-115 mm Hg) were enrolled in this prospective, randomized, parallel study. Sitting blood pressure, heart rate, adverse reactions, and serum biochemistry values were assessed during 2 weeks of placebo and 12 weeks of active treatment. Each patient received 50 mg of losartan or 5 mg of felodipine ER once daily, and the dosage was adjusted to double the initial level at week 6 if necessary. Of the 44 patients randomly allocated to receive losartan (n = 23) or felodipine (n = 21) therapy, 37 completed the study; three patients in the losartan group and four in the felodipine group withdrew because of adverse experiences, or were lost to follow-up. The mean reductions in sitting diastolic blood pressure at 6 and 12 weeks were significant with both losartan (-8.6 and -11.38 mm Hg, respectively) and felodipine (-9.2 and -10.69 mm Hg, respectively), and did not differ significantly between the two groups. Both losartan and ER felodipine were well tolerated by patients. However, the ER felodipine group had a significantly higher rate of drug-related flushing than the losartan group (24% vs 0%, p = 0.022). The results indicate that once-daily administration of losartan is as effective and well tolerated as once-daily ER felodipine in blood pressure reduction.
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Affiliation(s)
- M J Hung
- Department of Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
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Huang HL, Lin FC, Hung KC, Wang PN, WU D. Hemolytic anemia in native valve infective endocarditis: a case report and literature review. Jpn Circ J 1999; 63:400-3. [PMID: 10943622 DOI: 10.1253/jcj.63.400] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hemolytic anemia is a rare manifestation of infective endocarditis. A 19-year-old man with a small ventricular septal defect developed right-sided infective endocarditis with huge vegetations involving the tricuspid valve, the ventricular septal defect, and the pulmonary valve. Intravascular hemolysis was suggested by the presence of numerous fragmented erythrocytes, giant platelets and polychromasia of the red blood cells. The direct Coombs test was positive, and there were spherocytes and splenomegaly, findings that suggested an immune-mediated mechanism also played a role in the hemolysis. The hematological picture persisted despite antibiotic therapy and recovered only after surgical removal of the vegetations, tricuspid and pulmonary valvectomy, and patch closure of the ventricular septal defect.
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Affiliation(s)
- H L Huang
- Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
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Chern MS, Lin FC, Wu D. Comparison of clinical efficacy and adverse effects between extended-release felodipine and slow-release diltiazem in patients with isolated systolic hypertension. Changgeng Yi Xue Za Zhi 1999; 22:44-51. [PMID: 10418209] [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: 02/13/2023]
Abstract
BACKGROUND Isolated systolic hypertension (ISH) is a risk factor for cardiovascular disease. Extended-release felodipine (felodipine ER) has been shown to be effective in the treatment of ISH in Caucasians. However, its pharmacological properties are different from another calcium blocker, diltiazem. Also, the effectiveness, tolerability, and adverse reactions of these two antihypertensive agents for ISH have not been thoroughly assessed in Chinese. METHODS Sitting blood pressures (BP), heart rate, body weight, adverse reactions, and serum biochemistry were assessed in 70 patients with isolated systolic hypertension (34 treated with felodipine ER and 36 slow-release diltiazem [diltiazem SR] for 10 weeks). Each patient was given 5 mg of felodipine ER or 90 mg of diltiazem SR once daily and was doubled to twice daily if necessary. RESULTS Five patients on felodipine ER and four on diltiazem SR withdrew because of intolerable side effects. By ten weeks, 67.6% of the patients responded to a daily dose of 5-10 mg of felodipine ER and 58.3% to a daily dose of 90-180 mg of diltiazem SR. At the end of treatment, felodipine ER lowered the mean BP from 187/83 mmHg at baseline to 149/74 mmHg, whereas diltiazem SR decreased the BP from 185/84 mmHg to 158/78 mmHg (not significant between the two groups). The heart rate did not change significantly in either group. Overall, these two groups of patients had the same rate of adverse reactions (50.0% vs. 50.0%) with similar profiles of the adverse effects. CONCLUSION Equivalent doses of felodipine ER and diltiazem SR are effective first-line monotherapeutic agents for the treatment of ISH.
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Affiliation(s)
- M S Chern
- Department of Internal Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taouan
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Abstract
OBJECTIVES The main objective of this study was to characterize the phenomenon of variation in the P-QRS relation during atrioventricular node reentry tachycardia. BACKGROUND Variation of P-QRS relation during tachycardia has been observed occasionally in atrioventricular node reentry tachycardia. However, the incidence, the characteristics and the mechanisms of this phenomenon have not been investigated previously. METHODS Retrospective analysis was performed in 311 consecutive patients with slow-fast form and 108 patients with atypical or multiple form of atrioventricular node reentry tachycardia to examine whether variation of P-QRS relation with changes in AH, HA and AH/HA (A = atria; H = His bundle) ratio occurred during tachycardia. RESULTS A total of 28 patients, 8 with slow-fast and 20 with atypical or multiple tachycardias, were found to manifest this phenomenon. There were 6 males and 22 females, with an average age of 38+/-16 years. In 10 patients, this phenomenon occurred transiently following electrical induction of the tachycardia. In 15 patients, changes in AH, HA and AH/HA ratio were associated with the occurrence of Wenckebach or 2:1 block proximal to the His bundle (H) recording site without interruption of the tachycardia. In nine patients, three with nonsustained tachycardia and six after administration of adenosine triphosphate, this phenomenon was observed at the termination of the tachycardia. This phenomenon was usually accompanied by a mild lengthening of the tachycardia cycle length. CONCLUSIONS Variation of P-QRS relation with or without block may occur during atrioventricular node reentry tachycardia, especially in atypical or multiple-form tachycardias. It was postulated that decremental conduction in the distal common pathway, which exists between the distal link of the reentry circuit and the H, is primarily responsible for this phenomenon.
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Affiliation(s)
- Y Taniguchi
- Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
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Abstract
BACKGROUND The safety and efficacy of late coronary artery stenting of the infarct-related artery after acute infarction has not been evaluated previously. METHODS AND RESULTS Coronary artery stenting was performed in 117 consecutive patients with acute infarction who were receiving ticlopidine/aspirin regimen without coumarin. There were 97 men and 18 women, aged 58+/-11 (mean +/- SD) years. A total of 136 Palmaz-Schatz stents were successfully implanted in 130 lesions 15+/-8 days after acute myocardial infarction (median 9 days) in 115 of 117 (98%) patients. The minimal luminal diameter (MLD) increased from 0.66+/-0.46 to 3.14+/-0.53 mm (P< .001), with an acute gain of 2.49+/-0.61 mm. One patient had acute thrombosis requiring further stenting and another patient received emergency bypass surgery. There was no subacute thrombosis or other complications. During a follow-up duration of 14+/-3 months, 2 patients had angina pectoris develop and 1 died suddenly. Sixty-two patients underwent a follow-up coronary angiography 195+/-36 days after stenting. Restenosis was noted in 8 patients (13%); the MLD was 2.19+/-0.73 mm, the late loss was 0.96+/-0.65 mm (P< .001), the loss index was 0.39+/-0.28, and the net gain was 1.56+/-0.79 mm (P< .001). The angiographic left ventricular ejection fraction increased from 47%+/-12% to 55%+/-12% (P< .001). CONCLUSIONS Late coronary stenting of the infarct-related artery in patients with acute myocardial infarction is a safe and effective late reperfusion therapy and may be beneficial to the patients.
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Affiliation(s)
- I C Hsieh
- Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan, Republic of China
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Chang CH, Lin PJ, Chu JJ, Liu HP, Tsai FC, Chung YY, Kung CC, Lin FC, Chiang CW, Su WJ, Yang MW, Tan PP. Surgical closure of atrial septal defect. Minimally invasive cardiac surgery or median sternotomy? Surg Endosc 1998; 12:820-4. [PMID: 9601998 DOI: 10.1007/s004649900721] [Citation(s) in RCA: 21] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Closure of ostium secundum atrial septal defect (ASD) vis median sternotomy (MS) is a simple procedure for most cardiac surgeons. Minimally invasive cardiac surgery (MICS) has recently been applied in the management of intracardiac lesions. METHODS We report our experience in surgical closure of isolated ASD via MICS in 60 patients and via MS in 58 patients. There was no difference between these two groups in gender, age, body weight, ratio of systemic to pulmonary blood flow, and pulmonary arterial pressure. RESULTS The duration of cardiopulmonary bypass was significantly longer in the MICS group than in the MS group [27 to 126 min (42 +/- 12) and 14 to 158 min (27 +/- 11), respectively; (p < 0.001]. However, the length of incision, incidence of temporary pacemaker wire insertion rate, duration of endotracheal intubation, timing of oral intake, postoperative day drainage amount, incidence of parenteral analgesic injection, postoperative length of stay, and return to normal activity interval were significant shorter and lower in patients of the MICS group than in those of the MS group. All the patients recovered rapidly from the surgery. Follow-up was complete in all patients, with no late complications and no residual shunt. CONCLUSION Our results suggest that MICS is a good option for surgical closure of ASD.
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Affiliation(s)
- C H Chang
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
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Hsu SY, Lin FC, Chang HJ, Yeh SJ, Wu D. Multiplane transesophageal echocardiography in diagnosis of anomalous origin of the left coronary artery from the pulmonary artery: a case report. J Am Soc Echocardiogr 1998; 11:668-72. [PMID: 9657407 DOI: 10.1016/s0894-7317(98)70044-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Anomalous origin of the left coronary artery from the pulmonary artery in adults is difficult to identify reliably by transthoracic echocardiography (TTE). We describe a 32-year-old woman with this coronary anomaly mimicking a coronary artery fistula on conventional TTE study. This anomaly was suggested by multiplane transesophageal echocardiography (TEE) and subsequently confirmed by coronary angiography. Multiplane TEE thus may serve as a first-line diagnostic tool for detecting anomalous origin of coronary arteries.
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Affiliation(s)
- S Y Hsu
- Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
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Chu JJ, Chang CH, Lin PJ, Liu HP, Tsai FC, Wu D, Chiang CW, Lin FC, Su WJ, Tan PP. Video-assisted cardiac surgery: preliminary results in Chang Gung Memorial Hospital. Chin Med J (Engl) 1998; 111:422-7. [PMID: 10374351] [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: 02/12/2023] Open
Abstract
OBJECTIVE To summarize the experience of utilization of video-assisted endoscopy in 91 patients operated on at Chang Gung Memorial Hospital, Taipei, China. METHODS From October 1995, through August 1996, 91 patients (44 male and 47 female) received video-assisted cardiac surgery (VACS). Their ages ranged from 1 year to 79.5 years (25.7 +/- 21.7). Indications for surgery were atrial septal defect (59 patients), ventricular septal defect (15), coronary artery disease (4), severe mitral regurgitation (4), severe tricuspid regurgitation (3), thrombosis of mitral mechanical prosthesis (3), left atrial tumor (2), and left ventricular thrombus with dilated cardiomyopathy (1). The VACS was performed through right or left anterior minithoracotomy and guided by video-assisted endoscopic techniques by means of projected images on the video monitor under extracorporeal circulation. The aorta was not cross-clamped and the myocardium was protected by continuous coronary perfusion with hypothermic fibrillatory arrest (rectal temperature 22.6 +/- 4.0 degrees C). Conventional instruments were used. RESULTS All lesions were corrected successfully. The bypass time was 27 to 335 minutes (72.8 +/- 52.7). The operative time was 1.3 to 8.5 hours (3.0 +/- 1.7). There were no operative deaths and 3 late deaths. Follow-up was complete in all survivors (6 to 16 months, mean 8.7). Most of them were found to be in NYHA functional I or II. CONCLUSION Our preliminary experiences demonstrate that VACS is simple and effective in surgical correction of selected cardiac lesions. Short-term results show good outcomes.
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Affiliation(s)
- J J Chu
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, China
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Abstract
Clinical and electrophysiologic parameters were analyzed to define the factors potentially related to tachycardia recurrences in 79 patients undergoing successful radiofrequency ablation of idiopathic right or left ventricular tachycardia. It was found that the endocardial activation time at the successful ablation site was the only independent predictor of tachycardia recurrences.
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Affiliation(s)
- M S Wen
- Department of Medicine, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China
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Lin PJ, Chang CH, Chu JJ, Liu HP, Tsai FC, Lin FC, Chiang CW, Tan PP. Minimal access surgical techniques in coronary artery bypass grafting for triple-vessel disease. Ann Thorac Surg 1998; 65:407-12. [PMID: 9485237 DOI: 10.1016/s0003-4975(97)01153-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Minimal access surgical techniques in coronary artery bypass grafting have been used mainly in the management of single-vessel disease. METHODS Fifteen patients, 11 men and 4 women with a mean age of 64.1 years (range, 35.7 to 78.0 years), underwent operation for triple-vessel disease using minimal access techniques. The procedures were performed through a limited left parasternal thoracotomy using femorofemoral extracorporeal circulation. The myocardium was protected by the antegrade infusion of cold blood cardioplegic solution while the aorta was cross-clamped. RESULTS Under direct vision, the left saphenous vein grafts were connected sequentially to the diagonal branch, obtuse marginal branch, and posterior descending branch, and the left internal thoracic artery graft was anastomosed to the left anterior descending artery in each patient. The mean aortic cross-clamp time was 86 +/- 17 minutes (range, 67 to 125 minutes). The mean duration of extracorporeal circulation was 112 +/- 22 minutes (range, 82 to 162 minutes). The postoperative course was uneventful in all patients. Follow-up was complete in all patients at a mean of 7.4 months (range, 6.0 to 8.5 months), and there were no late deaths or angina. Coronary angiography in 8 patients showed patent grafts. CONCLUSIONS Our experience demonstrates that minimal access surgical techniques in coronary artery bypass grafting are technically feasible and may be an alternative approach in the surgical revascularization of triple-vessel disease.
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Affiliation(s)
- P J Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
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Abstract
In this study, asymmetric poly(4-methyl-1-pentene) (TPX) membranes, fabricated by the dry/wet inversion method, were applied to transdermal delivery of nitroglycerin (NTG), a drug for treating angina pectoris. The flux of NTG through the TPX membrane was measured in vitro by a Franz cell. The results indicate that the NTG flux through asymmetric TPX membranes is strongly dependent on the membrane structure, which can be varied by adding nonsolvents in the casting solution. By adding different kinds of nonsolvents and adjusting the added amounts, membranes with different NTG release rates can be fabricated. It was also found that, with suitable drug formula, the NTG dissolution rate of a prototype TPX patch is comparable to that of a commercial patch, Transderm-Nitro. In addition, the data of NTG flux through a composite of TPX membrane and pig skin are also presented.
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Affiliation(s)
- D M Wang
- Department of Chemical Engineering, Chung Yuan University, Chung Li, Taiwan, People's Republic of China
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Abstract
OBJECTIVES This study demonstrates that exercise-provocable tachycardia resembling right ventricular outflow tract tachycardia may originate from the anterobasal left ventricle. BACKGROUND Reentry is the operative mechanism of idiopathic left ventricular tachycardia, with a QRS complex of right bundle branch block and superior axis that is responsive to verapamil but not adenosine. Whether some mechanism other than reentry is operative in some idiopathic left ventricular tachycardias is unclear. METHODS In 4 of 53 consecutive patients with idiopathic left ventricular tachycardia, the tachycardia was sensitive to adenosine. These four patients were women 63, 61, 61 and 31 years old and were the subjects of the present study. RESULTS In all four patients, spontaneous tachycardia was related to exercise or emotional stress. The tachycardia displayed atypical left (one patient) or right (three patients) bundle branch block with an inferior axis and marked variation in cycle length. An intravenous bolus of adenosine triphosphate (10 to 20 mg) terminated tachycardia in all four patients. Tachycardia was terminated or prevented in three patients given intravenous or oral verapamil. Atrial or ventricular incremental or extrastimulus testing induced tachycardia in all four patients (three with, one without isoproterenol infusion). Electrically induced tachycardia also demonstrated marked variation in cycle length, which ranged from 230 to 390 ms. Entrainment was not demonstrable with overdrive pacing from multiple sites. Endocardial mapping during tachycardia revealed that the earliest activations were registered 25, 40, 35 and 50 ms before onset of the QRS complex, respectively, from the anterior aspect of the left ventricle just below the mitral annulus, adjacent to the left ventricular outflow tract. High frequency Purkinje spikes were not recorded at this site. Radiofrequency current delivered to this site successfully ablated the tachycardia in three of the four patients. CONCLUSIONS Exercise-provocable, catecholamine-mediated, verapamil-responsive, adenosine-sensitive ventricular tachycardia may arise from the anterobasal left ventricle adjacent to the outflow tract.
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Affiliation(s)
- S J Yeh
- Department of Medicine, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China
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Gui LA, Xin CT, Xue CS, Lin FC, Yu W, Li NW, Yan Q, Shu C, Yajima M, Yamada N, Asano G. Regenerative changes in median nerve defects using various rabbit skeletal muscles. Nihon Hansenbyo Gakkai Zasshi 1997; 66:207-13. [PMID: 9513346 DOI: 10.5025/hansen.66.207] [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] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We examined the morphological changes of median nerve regeneration which situated to pass through degenerative latissimus dorsi and brachial triceps muscles in rabbits. Morphological observation was performed at 7, 14, 28, 45, 60 and 180 days after the creation of defect of the bilateral median nerves. Regenerative nerve fibers were observed in the residual tubes of left degenerative muscle bridges. In this respect the regenerative effect of the latissimus dorsi was better than that of the brachial triceps. These results suggest that regular and longer muscle fibers as those of latissimus dorsi may contribute to the effective regeneration of nerve.
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Affiliation(s)
- L A Gui
- Department of Histoembryology, Shenyang Medical College, China
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Abstract
OBJECTIVES This study sought to assess the possibility of ablating verapamil-responsive idiopathic left ventricular tachycardia at a site distant from the tachycardia exit and thus to define the tachycardia circuit. BACKGROUND The nature of the reentry circuit in idiopathic left ventricular tachycardia is unclear. If the circuit is of considerable size, then it should be possible to ablate the tachycardia at a site distant from the exit site. METHODS Electrophysiologic studies and radiofrequency ablation were performed in 27 consecutive patients with verapamil-responsive idiopathic left ventricular tachycardia. In all 27 patients, the tachycardia exit site was defined as the site where the earliest Purkinje potential was recorded > or = 25 ms before the onset of the QRS complex during the tachycardia and where the pace map QRS complex resembled that during the tachycardia. A potential ablation site other than the exit site was then sought around the midseptum, proximal to the exit site. At such sites the tachycardia could be terminated transiently by pressure applied to the catheter tip, without induction of ventricular ectopic beats. RESULTS The potential ablation site, other than the tachycardia exit site, was identified in seven male patients (mean [+/-SD] age 31 +/- 12 years, range 13 to 52). Application of the radiofrequency current at this site resulted in termination of the tachycardia within 1 to 5 s (mean 2.9 +/- 1.6), and successful ablation of the tachycardia was achieved in all seven patients (success rate 100%, 95% exact confidence interval 0.5898 to 1). The mean distance between the ablation site and the tachycardia exit site was 3.1 +/- 0.7 cm (range 2.0 to 4.0). A presystolic Purkinje spike was recorded 14 +/- 5 ms (range 8 to 20) before the onset of the QRS complex during the tachycardia. During the follow-up period of 24 +/- 11 months (range 12 to 39), there was no recurrence of tachycardia in these seven patients. CONCLUSIONS Successful ablation of idiopathic left ventricular tachycardia can be achieved at sites away from the tachycardia exit site in some patients. This finding suggests that the reentry circuit is likely to be of considerable size, encompassing the middle, inferior and lower aspects of the left interventricular septum.
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Affiliation(s)
- M S Wen
- Department of Medicine, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China
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Abstract
We retrospectively reviewed all of the patients who were treated for cardiac tamponade at Linkou Chang Gung Memorial Hospital between January 1991 and December 1995. There were a total of 112 patients (57 males, 55 females) with a mean age of 51 +/- 14 years (53 +/- 15, 49 +/- 13, respectively). Dyspnea was the most common complaint (85%). The mean blood pressure was 129 +/- 24/78 +/- 17 mmHg, and only 8% had a systolic blood pressure of less than 90 mmHg. Sinus tachycardia was the most frequent electrocardiographic finding (72%, 62/86). Diffuse low voltage was noted in 35% (30/86) of the patients and electrical alternans was seen in 17% (15/86). The mean volume of pericardial effusion was 610 +/- 263 ml. Sixty-five percent of the pericardial effusions were bloody, 31% were serosanguineous, 2% were purulent and 2% were chylous. Overall, 54.5% of the patients had malignant diseases. Of the 61 patients who died, 79% had malignancies. Thirty-five (57%) of these 48 patients had lung cancer. The mean survival time from emergent pericardiocentesis was 3.4 months. In conclusion, non-traumatic cardiac tamponade had a poor prognosis because most patients had malignant etiologies. There is still no definitive treatment for recurrent malignant pericardial effusion-induced cardiac tamponade. Percutaneous pericardiocentesis as clinically required may be the most appropriate treatment, since it is questionable whether such subjects should be subjected to the unnecessary pain and suffering associated with an operative procedure, considering their short mean survival time.
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Affiliation(s)
- M L Wang
- Department of Primary Care Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C
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Abstract
This report describes a patient who developed stenosis of coronary sinus and cardiac veins five years after application of electric shock currents to the posterior mitral annulus and posteroseptal region of the tricuspid annulus for ablation of a left posterior accessory pathway and a right posteroseptal accessory pathway. This is the first angiographic documentation of coronary sinus stenosis as a late complication of electric ablation of accessory pathway.
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Affiliation(s)
- S Y Wang
- Department of Medicine, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
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Chern MS, Lin FC, Wu D. Comparison of clinical efficacy and adverse effects between extended-release felodipine and atenolol in patients with mild and moderate essential hypertension. Changgeng Yi Xue Za Zhi 1997; 20:86-93. [PMID: 9260367] [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: 02/05/2023]
Abstract
BACKGROUND Essential hypertension is a risk factor for cardiovascular disease. Atenolol, a cardio-selective beta-blocker, has been shown to be a safe and effective antihypertensive agent. The extended-release form of felodipine (felodipine ER), a vascular-selective dihydropyridine calcium blocker, is extensively used in Caucasians. However, its effectiveness, tolerability and adverse side-effect have not been assessed in Chinese populations. METHODS Sitting blood pressure (BP), heart rate, body weight, adverse reaction and serum biochemistry were assessed in 70 patients with mild-moderate essential hypertension treated either with felodipine ER (37 patients), or atenolol (33 patients) for 10 weeks. Each patient was prescribed 5 mg of felodipine ER or 50 mg of atenolol once daily and this daily dosage was doubled to twice daily if necessary. RESULTS Six patients who received felodipine ER and 3 who received atenolol withdrew from the treatment because of intolerable side effects. Within ten weeks, 81.1% of the patients had responded to a total daily dosage of 5-10 mg of felodipine ER and 81.8% to a daily dose of 50-100 mg of atenolol. By the end of treatment, the mean BP in the felodipine ER group had decreased from 176/104 mmHg at baseline to 145/85 mmHg, while the BP in the atenolol group had dropped from 173/103 mmHg to 145/84 mmHg (NS between the two groups). Heart rate declined in the atenolol group but did not change in patients who received felodipine ER. Overall, patients in the felodipine ER group had a higher rate of adverse reaction (70.3% vs. 39.4%; p < 0.001), and 16.2% of the patients in the felodipine ER group experienced symptoms of hypotension. CONCLUSION Equivalent doses of felodipine ER and atenolol are effective first-line monotherapeutic agents for the treatment of mild-moderate essential hypertension.
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Affiliation(s)
- M S Chern
- Department of Medicine, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, R.O.C
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Lin PJ, Chang CH, Chu JJ, Liu HP, Tsai FC, Lin FC, Chiang CW, Yang MW, Tan PP. Video-assisted coronary artery bypass grafting during hypothermic fibrillatory arrest. Ann Thorac Surg 1997; 63:1113-7. [PMID: 9124915 DOI: 10.1016/s0003-4975(97)00064-7] [Citation(s) in RCA: 11] [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: 02/04/2023]
Abstract
BACKGROUND Hypothermic fibrillatory arrest without aortic cross-clamping is a technique for quieting the heart during coronary artery bypass grafting. This report reviews the preliminary results with this technique in 4 patients having video-assisted coronary artery bypass grafting. METHODS Four male patients 28.5 to 64.5 years old (mean age, 45.4 years) underwent operation for unstable angina. With video-assisted techniques, coronary artery bypass grafting was performed through a left anterior minithoracotomy with femoral-femoral cardiopulmonary bypass without cross-clamping the aorta. The myocardium was protected by continuous coronary perfusion during hypothermic fibrillatory arrest. RESULTS A left internal thoracic artery graft was anastomosed to the left anterior descending coronary artery in each patient. The posterior descending branch of the right coronary artery was grafted with a pedicled right gastroepiploic artery in 1 patient. The duration of cardiopulmonary bypass was 72 to 127 minutes (mean duration, 92 +/- 21 minutes). The postoperative course of each patient was uneventful. Follow-up (range, 3.9 to 5.8 months; mean follow-up, 4.9 months) was complete for all patients. There were no late deaths. Coronary angiography showed patent grafts. All patients were in New York Heart Association functional class I or II (mean class, 1.25). CONCLUSIONS Hypothermic fibrillatory arrest is a simple and effective method of quieting the heart, thereby providing a motionless operative field for video-assisted coronary artery bypass grafting.
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Affiliation(s)
- P J Lin
- Divisions of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China
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Abstract
Composite membranes were prepared by casting a linear poly(2-hydroxyethyl methacrylate) (pHEMA) solution onto polyester non-woven supports, and then the supported pHEMA within the membranes was cross-linked by a diisocyanate cross-linking agent to form a network structure. The swelling and permeation properties of these membranes were evaluated, with a system of nitroglycerin and aqueous ethanol solution, for potential application in transdermal drug delivery. The degree of swelling of these membranes in water and aqueous ethanol decreases as the cross-linker content is increased and increases slightly with an increase in the original molecular weight of the linear pHEMA. The permeation rates of both nitroglycerin and ethanol increase as the cross-linker content is reduced, the polymer molecular weight increases, and the concentration of the casting solution or membrane thickness decreases. Depending on the preparation conditions, the membranes can be tailored to give a permeation flux ranging from 4 to 68 micrograms cm-2 h-1 for nitroglycerin.
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Affiliation(s)
- Y M Sun
- Department of Chemical Engineering, Yuan-Ze Institute of Technology, Chung-Li, Taiwan, Republic of China
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Chu JJ, Chang CH, Lin PJ, Liu HP, Tsai FC, Wu D, Chiang CW, Lin FC, Tan PP. Video-assisted thoracoscopic operation for interruption of patent ductus arteriosus in adults. Ann Thorac Surg 1997; 63:175-8; discussion 178-9. [PMID: 8993261 DOI: 10.1016/s0003-4975(96)01026-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [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: 02/03/2023]
Abstract
BACKGROUND Patent ductus arteriosus (PDA) is a frequent congenital heart disease encountered in premature neonates, infants, and children. Video-assisted endoscopic techniques have been used in PDA interruption since 1993. Almost all the experiences are in pediatric patients. Applications in adults with PDA have been limited. METHODS We report our experience of video-assisted thoracoscopic surgical ligation of PDA in adults. From August 1995 to January 1996, 60 patients with PDA were operated on with a video-assisted thoracoscopic technique. Twelve adults were identified with mean age of 30 years (range, 20 to 57 years). With the patient under general anesthesia and double-lumen endotracheal intubation, two 5-mm holes were made in the left lateral chest wall. Another 4-cm incision was made in the left third intercostal space for manipulation, dissection, and ligation. Conventional surgical instruments were used except an endoscopic grasper and an endoscopic tube that connected to a video camera. The surgical procedure was viewed on a video screen. Transesophageal echocardiography was used for monitoring during PDA ligation. RESULTS All patients had successful ligation of the PDA. There was no surgical mortality, but there was one morbidity; transient recurrent nerve injury, which recovered 3 months later. Ten patients were extubated in operative room and 2 patients were extubated 2 hours after the operation. Tube thoracostomy was performed in the first 2 cases; it was omitted thereafter. No patients needed narcotic to control chest pain. Postoperative follow-up by echocardiography showed faint ductal flow in 1 patient without any murmur. All patients were discharged within 3 days after the operation. CONCLUSIONS Our experience suggests that with refinement of instruments and surgical technique, video-assisted thoracoscopic surgical ligation can be safely applied not only in pediatric patients, but also in adults with PDA.
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Affiliation(s)
- J J Chu
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China
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Tsai FC, Lin PJ, Chang CH, Liu HP, Tan PP, Lin FC, Chiang CW. Video-assisted cardiac surgery. Preliminary experience in reoperative mitral valve surgery. Chest 1996; 110:1603-7. [PMID: 8989084 DOI: 10.1378/chest.110.6.1603] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [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] Open
Abstract
OBJECTIVES Video-assisted endoscopic techniques had been applied in the surgical correction of patent ductus arteriosus, vascular ring, or coronary artery disease. However, it has been used only recently in the correction of reoperative mitral valve lesions. DESIGN Video-assisted cardiac operations were performed on four patients who had received surgical interventions on their mitral valves and needed emergent reoperation. PATIENTS Four patients (3 men and 1 woman) received emergency surgery from September to December 1995 for thrombosis of mechanical mitral prosthesis (2 patients) and severe mitral regurgitation with previously failed mitral valve repair (2 patients). Six previous operations had been performed on these mitral valves. Patient ages ranged from 26.7 to 68.1 years (mean, 47.3 years). Preoperatively, acute pulmonary edema occurred in two patients, cerebral emboli occurred in one patient, and sepsis was found in one patient. Mechanical ventilatory support was used in two patients before operation. INTERVENTION The operations were performed through right anterior minithoracotomy, guided by video-assisted endoscopic techniques with femoro-femoral extracorporeal circulation. The operative procedures were thrombectomy of mitral prosthesis in two patients, mitral valve repair in one patient, and mitral valve replacement in one patient. RESULTS The duration of extracorporeal circulation was 166 to 320 min (222 +/- 67 min) and the operation time was 4.6 to 6.8 h (6.1 +/- 1.0 h). All patients recovered from the operations rapidly with uneventful postoperative courses except 1 patient who had sepsis preoperatively and died 2 months later. CONCLUSION Our experience demonstrates that video-assisted cardiac surgery is technically feasible and could be performed in reoperation of the mitral valve.
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Affiliation(s)
- F C Tsai
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China
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Abstract
This study examined the incidence and significance of catheter-induced atrioventricular nodal block (AVNB) during a radiofrequency ablation procedure that uses stiff large-tip steerable ablation catheters. AVNB was noted in 10 (1.6%) of 613 consecutive patients undergoing radiofrequency ablation therapy for atrioventricular nodal (AVN) reentrant tachycardia (592 patients) or atrioventricular reentry tachycardia incorporating a midseptal accessory pathway (21 patients). Of these 10 patients, 9 underwent AVN modification for AVN reentrant tachycardia and 1 for ablation of a midseptal accessory pathway. One patient had two episodes of AVNB during two sessions undertaken because of recurrence of tachycardia. No patient had a preexisting conduction defect before the study. In all 10 patients, AVNB was transient, and it lasted for a mean of 9.1 +/- 19 minutes. It occurred during positioning of the ablation catheter in the junctional area before (8 patients) or after (2 patients) the start of radiofrequency current applications. Complete AVNB was noted on six occasions, second-degree AVNB on four occasions, and first-degree AVNB on one occasion. All blocks were associated with narrow QRS ventricular beats and with a site of block proximal to the His bundle. The mean ventricular heart rate during AVNB was 60 +/- 23 beats/min. Two patients had transient asystole, with one having loss of consciousness. No patient required special treatment for heart block. One-to-one conduction resumed after repositioning of the catheters, and the subsequent ablation procedure was successfully completed in 8 of the 10 patients. During a follow-up of 20 +/- 12 months, none of the patients had severe dizziness or syncope, and none required implantation of a permanent pacemaker. In conclusion, transient AVNB due to mechanical injury occurs during positioning of a stiff large-tip steerable ablation catheter in the junctional area. Delivery of radiofrequency current to the site that provokes catheter-induced AVNB should be avoided.
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Affiliation(s)
- A King
- Second Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung Medical College, Taiwan, Republic of China
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Abstract
Among 652 patients with Wolff-Parkinson-White syndrome who underwent radiofrequency ablation in this laboratory, 139 (21%) were found to have a total of 146 posteroseptal accessory pathways. Ablation was conducted by the regular transvenous or transaortic approach; ablation from cardiac venous structures was used only if regular approaches were unsuccessful. Of the 146 posteroseptal accessory pathways, 94 were successfully ablated from the left posteroseptal region and 45 from the right posteroseptal region. In 3, successful ablation of the accessory pathway required delivery of the current to the proximal coronary sinus, and in 1 it required delivery of the current to both the atrial and ventricular aspects of the tricuspid valve at the right posteroseptum. Thus, the accessory pathway was successfully ablated in 143 (98%) of 146 instances or in 136 (98%) patients. In 3 patients, ablation was unsuccessful despite delivery of current to the left posteroseptum, the right posteroseptum, the proximal coronary sinus, and the middle cardiac vein. Seventy-seven (57%) patients with an initial success, including 9 patients with resumed preexcitation or recurrence of paipitations, underwent a follow-up electro-physiologic study 90 +/- 72 days after ablation. Of these 9 patients, the initial successful ablation site was the right posteroseptum in 7 and the left posteroseptum in 2. The accessory pathways were ablated successfully by subsequent trials in 8 patients, whereas in 1 the accessory pathway was severely damaged. Thus radiofrequency ablation of posteroseptal accessory pathways can be achieved by the regular transvenous or transaortic approach; delivery of current to the coronary sinus or middle cardiac vein is unnecessary in most patients.
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Affiliation(s)
- M S Wen
- Department of Medicine, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
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