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Buckels EJ, Hsu HL, Buchanan CM, Matthews BG, Lee KL. Genetic ablation of the preptin-coding portion of Igf2 impairs pancreatic function in female mice. Am J Physiol Endocrinol Metab 2022; 323:E467-E479. [PMID: 36459047 DOI: 10.1152/ajpendo.00401.2021] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Preptin is a 34-amino acid peptide derived from the E-peptide of pro-insulin-like growth factor 2 and is co-secreted with insulin from β-cells. Little is understood about the effects of endogenous preptin on whole body glucose metabolism. We developed a novel mouse model in which the preptin portion of Igf2 was genetically ablated in all tissues, hereafter referred to as preptin knockout (KO), and tested the hypothesis that the removal of preptin will lead to a decreased insulin response to a metabolic challenge. Preptin KO and wild-type (WT) mice underwent weekly fasting blood glucose measurements, intraperitoneal insulin tolerance tests (ITT) at 9, 29, and 44 wk of age, and an oral glucose tolerance test (GTT) at 45 wk of age. Preptin KO mice of both sexes had similar Igf2 exon 2-3 mRNA expression in the liver and kidney compared with WT mice, but Igf2 exon 3-4 (preptin) expression was not detectable. Western blot analysis of neonatal serum indicated that processing of pro-IGF2 translated from the KO allele may be altered. Preptin KO mice had similar body weight, body composition, β-cell area, and fasted glucose concentrations compared with WT mice in both sexes up to 47 wk of age. Female KO mice had a diminished ability to mount an insulin response following glucose stimulation in vivo. This effect was absent in male KO mice. Although preptin is not essential for glucose homeostasis, when combined with previous in vitro and ex vivo findings, these data show that preptin positively impacts β-cell function.NEW & NOTEWORTHY This is the first study to describe a model in which the preptin-coding portion of the Igf2 gene has been genetically ablated in mice. The mice do not show reduced size at birth associated with Igf2 knockout suggesting that IGF2 functionality is maintained, yet we demonstrate a change in the processing of mature Igf2. Female knockout mice have diminished glucose-stimulated insulin secretion, whereas the insulin response in males is not different to wild type.
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Affiliation(s)
- E J Buckels
- Department of Molecular Medicine and Pathology, University of Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, New Zealand
| | - H-L Hsu
- Department of Molecular Medicine and Pathology, University of Auckland, New Zealand
| | - C M Buchanan
- Department of Molecular Medicine and Pathology, University of Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, New Zealand
| | - B G Matthews
- Department of Molecular Medicine and Pathology, University of Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, New Zealand
| | - K L Lee
- Department of Molecular Medicine and Pathology, University of Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, New Zealand
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2
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Chew N, Zhang A, Kong G, Lee KL, Ng CH, Chong B, Ngiam N, Loh PH, Kuntjoro I, Wong R, Kong W, Yeo TC, Poh KK. Prognostically distinct phenotypes of metabolic health beyond obesity in aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1608] [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] Open
Abstract
Abstract
Background
Whilst current evidence are in favour of metabolic health and non-obesity in the reduction of incident cardiovascular disease, little is known regarding the prognosis across the metabolic phenotypes once cardiovascular disease occurs. This study examined the prognosis of patients with significant aortic stenosis (AS) based on the presence of metabolic health and obesity.
Methods
This retrospective cohort on consecutive patients presenting with moderate-to-severe AS to a tertiary hospital between 2010 and 2015. Patients were allocated into 4 groups based on obesity and metabolic health: metabolically healthy obese (MHO), metabolically healthy non-obese (MHNO), metabolically unhealthy obese (MUO) and metabolically unhealthy non-obese (MUNO). Metabolic health was defined in accordance to Program Adult Treatment Panel III criteria. The primary outcome was all-cause mortality. Cox regression examined independent associations between mortality and metabolic phenotypes, adjusting for aortic valve area, ejection fraction, age, sex, chronic kidney disease and AVR as a time-dependent covariate.
Results
Of 727 patients, the majority (51.6%) were MUNO, followed by MUO (32.7%), MHNO (11.4%), and MHO (4.3%). MHNO had the highest mortality (43.0%), followed by the MUNO (37.5%), MUO (30.0%) and MHO (6.9%) groups (p=0.001). Compared to MHNO, MHO (HR 0.159, 95% CI 0.038–0.668, p=0.012) and MUO (HR 0.614, 95% CI 0.403–0.937, p=0.024) were independently associated with lower all-cause mortality rates, after adjusting for confounders. In obese patients, metabolic health had favourable survival compared to metabolically unhealthy (p=0.015), but this protective impact of metabolic health was not observed in overweight or normal weight individuals. Obesity had favourable survival compared to overweight and normal weight, in both metabolically health (p=0.002) and unhealthy (p=0.007) patients,
Conclusion
MHO patients with AS have the most favourable prognosis whilst the seemingly healthy MHNO group had the worst survival. There should be a paradigm shift towards prioritising metabolic health rather than weight reduction in patients with significant AS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Chew
- National University Heart Centre , Singapore , Singapore
| | - A Zhang
- National University Health System , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - K L Lee
- National University of Singapore , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - B Chong
- National University of Singapore , Singapore , Singapore
| | - N Ngiam
- National University Health System , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| | - I Kuntjoro
- National University Heart Centre , Singapore , Singapore
| | - R Wong
- National University Heart Centre , Singapore , Singapore
| | - W Kong
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
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3
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Kwok KM, Lee KL, Lam SY, Liong T, Wong HM, Lam PY, Chow EY, Law KI. Rotational thromboelastometry as a powerful tool to detect hyperfibrinolysis in a bleeding patient: a case report. Hong Kong Med J 2021; 27:370-372. [PMID: 34706990 DOI: 10.12809/hkmj208971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- K M Kwok
- Intensive Care Department, United Christian Hospital, Hong Kong
| | - K L Lee
- Intensive Care Department, United Christian Hospital, Hong Kong
| | - S Y Lam
- Intensive Care Department, United Christian Hospital, Hong Kong
| | - T Liong
- Intensive Care Department, United Christian Hospital, Hong Kong
| | - H M Wong
- Intensive Care Department, United Christian Hospital, Hong Kong
| | - P Y Lam
- Intensive Care Department, United Christian Hospital, Hong Kong
| | - E Y Chow
- Pathology Department, United Christian Hospital, Hong Kong
| | - K I Law
- Intensive Care Department, United Christian Hospital, Hong Kong
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4
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Cheung C, Ng CY, Lee KL, Wu KX, Chioh FWJ, Tan K, Siau A, Muthiah MD, Chen QF, Tan NS, Ng HH, Dan YY. Endothelial-T cell crosstalk contributes to vascular injury in fatty liver disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3435] [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: 11/14/2022] Open
Abstract
Abstract
Cardiovascular complications are often the fundamental causes of death in non-alcoholic fatty liver disease (NAFLD) patients. While there are known systemic mediators in NAFLD that may induce vascular inflammation, the mechanism of endothelial dysfunction remain understudied. In this work, we harnessed the replicative potential of blood outgrowth endothelial cells (BOECs) to develop personalized cell lines from NAFLD patients and healthy controls. Our transcriptomic analysis showed that the top interactome network enriched in NAFLD BOECs comprised of several C-C and C-X-C chemokine ligands involved in immune cell chemotaxis. We previously reported T cell infiltration in mouse model of non-alcoholic steatohepatitis, and here, we confirmed enhanced endothelial chemokine signatures in arterial histological sections. To elucidate endothelial-immune crosstalk, we performed single-cell analysis on human peripheral blood mononuclear cells and found T cell intensification in NAFLD patients compared to healthy controls. Our immunoprofiling by flow cytometry further revealed that NAFLD patients possessed higher levels CD8+ memory cells. Functionally, T cells, instead of monocytes, adhered more pronouncedly to NAFLD BOECs. In evaluating the CXCL12-CXCR4 axis in chemotaxis, CXCR4 antagonist (AMD3100) substantially modulated the migration of patient-derived CD8+ T cells towards NAFLD BOECs, which was not observed in healthy endothelial-T cell chemotaxis coculture. Finally, we validated NAFLD-associated endothelial dysfunction by enumerating two folds more circulating endothelial cells, a biomarker of vascular injury, in the blood samples of NAFLD patients than healthy controls. Our work provides insights for translation to restore blood vessel health and potentially mitigate adverse vascular events in NAFLD.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Industrial Alignment Fund Pre-Positioning grant from the Agency for Science, Technology and Research, Singapore Endothelial-T cell crosstalk in NAFLD
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Affiliation(s)
- C Cheung
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - C Y Ng
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - K L Lee
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - K X Wu
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - F W J Chioh
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - K Tan
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - A Siau
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - M D Muthiah
- National University Health System, Singapore, Singapore
| | - Q F Chen
- Agency for Science, Technology and Research, Singapore, Singapore
| | - N S Tan
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - H H Ng
- Agency for Science, Technology and Research, Singapore, Singapore
| | - Y Y Dan
- National University Health System, Singapore, Singapore
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5
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Joynt GM, Leung AKH, Ho CM, So D, Shum HP, Chow FL, Yeung AWT, Lee KL, Tang GKY, Yan WW. Admission triage tool for adult intensive care unit admission in Hong Kong during the COVID-19 outbreak. Hong Kong Med J 2021; 28:64-72. [PMID: 33518531 DOI: 10.12809/hkmj209033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Intensive care is expensive, and the numbers of intensive care unit (ICU) beds and trained specialist medical staff able to provide services in Hong Kong are limited. The most recent increase in coronavirus disease 2019 (COVID-19) infections over July to August 2020 resulted in more than 100 new cases per day for a prolonged period. The increased numbers of critically ill patients requiring ICU admission posed a capacity challenge to ICUs across the territory, and it may be reasonably anticipated that should a substantially larger outbreak occur, ICU services will be overwhelmed. Therefore, a transparent and fair prioritisation process for decisions regarding patient ICU admission is urgently required. This triage tool is built on the foundation of the existing guidelines and framework for admission, discharge, and triage that inform routine clinical practice in Hospital Authority ICUs, with the aim of achieving the greatest benefit for the greatest number of patients from the available ICU resources. This COVID-19 Crisis Triage Tool is expected to provide structured guidance to frontline doctors on how to make triage decisions should ICU resources become overwhelmed by patients requiring ICU care, particularly during the current COVID-19 pandemic. The triage tool takes the form of a detailed decision aid algorithm based on a combination of established prognostic scores, and it should increase objectivity and transparency in triage decision making and enhance decision-making consistency between doctors within and across ICUs in Hong Kong. However, it remains an aid rather than a complete substitute for the carefully considered judgement of an experienced intensive care clinician.
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Affiliation(s)
- G M Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
| | - A K H Leung
- Department of Intensive Care, Queen Elizabeth Hospital, Hong Kong
| | - C M Ho
- Department of Intensive Care, Tuen Mun Hospital, Hong Kong
| | - D So
- Department of Intensive Care, Princess Margaret Hospital, Hong Kong
| | - H P Shum
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - F L Chow
- Department of Intensive Care, Caritas Medical Centre, Hong Kong
| | - A W T Yeung
- Department of Medicine and Geriatrics, Ruttonjee & Tang Shiu Kin Hospitals, Hong Kong
| | - K L Lee
- Department of Intensive Care, United Christian Hospital, Hong Kong
| | - G K Y Tang
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong
| | - W W Yan
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong
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6
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Xhani K, Neri E, Galantucci L, Scazza F, Burchianti A, Lee KL, Barenghi CF, Trombettoni A, Inguscio M, Zaccanti M, Roati G, Proukakis NP. Critical Transport and Vortex Dynamics in a Thin Atomic Josephson Junction. Phys Rev Lett 2020; 124:045301. [PMID: 32058733 DOI: 10.1103/physrevlett.124.045301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Indexed: 06/10/2023]
Abstract
We study the onset of dissipation in an atomic Josephson junction between Fermi superfluids in the molecular Bose-Einstein condensation limit of strong attraction. Our simulations identify the critical population imbalance and the maximum Josephson current delimiting dissipationless and dissipative transport, in quantitative agreement with recent experiments. We unambiguously link dissipation to vortex ring nucleation and dynamics, demonstrating that quantum phase slips are responsible for the observed resistive current. Our work directly connects microscopic features with macroscopic dissipative transport, providing a comprehensive description of vortex ring dynamics in three-dimensional inhomogeneous constricted superfluids at zero and finite temperatures.
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Affiliation(s)
- K Xhani
- Joint Quantum Centre (JQC) Durham-Newcastle, School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne NE1 7RU, United Kingdom
- European Laboratory for Non-Linear Spectroscopy (LENS), Università di Firenze, 50019 Sesto Fiorentino, Italy
| | - E Neri
- Dipartimento di Fisica e Astronomia, Università di Firenze, 50019 Sesto Fiorentino, Italy
| | - L Galantucci
- Joint Quantum Centre (JQC) Durham-Newcastle, School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne NE1 7RU, United Kingdom
| | - F Scazza
- European Laboratory for Non-Linear Spectroscopy (LENS), Università di Firenze, 50019 Sesto Fiorentino, Italy
- Istituto Nazionale di Ottica del Consiglio Nazionale delle Ricerche (CNR-INO), 50019 Sesto Fiorentino, Italy
| | - A Burchianti
- European Laboratory for Non-Linear Spectroscopy (LENS), Università di Firenze, 50019 Sesto Fiorentino, Italy
- Istituto Nazionale di Ottica del Consiglio Nazionale delle Ricerche (CNR-INO), 50019 Sesto Fiorentino, Italy
| | - K-L Lee
- Joint Quantum Centre (JQC) Durham-Newcastle, School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne NE1 7RU, United Kingdom
| | - C F Barenghi
- Joint Quantum Centre (JQC) Durham-Newcastle, School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne NE1 7RU, United Kingdom
| | - A Trombettoni
- CNR-IOM DEMOCRITOS Simulation Center and SISSA, Via Bonomea 265, I-34136 Trieste, Italy
| | - M Inguscio
- European Laboratory for Non-Linear Spectroscopy (LENS), Università di Firenze, 50019 Sesto Fiorentino, Italy
- Istituto Nazionale di Ottica del Consiglio Nazionale delle Ricerche (CNR-INO), 50019 Sesto Fiorentino, Italy
- Department of Engineering, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - M Zaccanti
- European Laboratory for Non-Linear Spectroscopy (LENS), Università di Firenze, 50019 Sesto Fiorentino, Italy
- Dipartimento di Fisica e Astronomia, Università di Firenze, 50019 Sesto Fiorentino, Italy
- Istituto Nazionale di Ottica del Consiglio Nazionale delle Ricerche (CNR-INO), 50019 Sesto Fiorentino, Italy
| | - G Roati
- European Laboratory for Non-Linear Spectroscopy (LENS), Università di Firenze, 50019 Sesto Fiorentino, Italy
- Istituto Nazionale di Ottica del Consiglio Nazionale delle Ricerche (CNR-INO), 50019 Sesto Fiorentino, Italy
| | - N P Proukakis
- Joint Quantum Centre (JQC) Durham-Newcastle, School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne NE1 7RU, United Kingdom
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Poole J, Russo AM, Cha YM, Monahan KH, Al-Khalidi HR, Silverstein AP, Bahnson TD, Mark DB, Lee KL, Packer DL. P2832Outcomes of catheter ablation for atrial fibrillation based on sex: data from the cabana trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1142] [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: 11/12/2022] Open
Abstract
Abstract
Background
Sex-specific outcomes may differ amongst patients receiving catheter ablation for atrial fibrillation (AF).
Purpose
Assess sex-specific outcomes in the patients randomized to catheter ablation or drug therapy in CABANA.
Methods
CABANA randomized 2204 pts with AF to catheter ablation or drug therapy (rate/rhythm-control). The outcomes of combined death, disabling stroke, severe bleeding, or cardiac arrest (intention to treat-ITT) or all-cause death were not different. But, ablation significantly improved combined death or CV hospitalization. This analysis compares clinical characteristics by sex and determines sex-specific hazard ratios based on a comparison of ablation vs drug therapy.
Results
Females were 37.3% of ablation and 37.0% of drug therapy patients. Females were older, more often white race, had less CAD, or sleep apnea, but had higher NYHA Class, higher CHA2DS2VASc, and more often had paroxysmal (v. persistent) AF, and prior AF hospitalization. (Table) HTN, CVA and diabetes were the same (Table).
For the CABANA primary endpoint, an ITT comparison of ablation vs. drug therapy, showed a female hazard ratio (HR) of 1.14 (95% confidence interval (CI) 0.70–1.86), and a male HR of 0.74, (95% CI 0.52–1.06). For all-cause mortality, the female HR was 0.75 (95% CI 0.41–1.40) and male HR was 0.91 (95% CI 0.59–1.40) and for all-cause mortality or CV hospitalization, the female HR was 0.90 (95% CI 0.75–1.09) and male HR was 0.79 (95% CI 0.69–0.92). All interaction p values were non-significant.
Recurrent AF (post 90-day blanking) was significantly reduced for both females and males: female HR 0.64 (95% CI 0.51–0.82), male HR 0.46 95% CI 0.39–0.56), p=0.035
Clinical Characteristics and Outcomes Baseline Characteristics Female (N=818) Male (N=1385) p-value Age: Median (Q1, Q3) 69 (65, 74) 66 (60, 71) <0.001 White 766 (93.9%) 1259 (91.0%) 0.015 CAD 92 (11.2%) 332 (24.0%) <0.001 NYHA ≥II 345 (42.4%) 433 (31.5%) <0.001 Sleep apnea 136 (16.6%) 372 (26.9%) <0.001 CHA2DS2-VASc: Median (Q1, Q3) 3 (3, 4) 2 (1, 3) <0.001 Paroxysmal AF 406 (49.6%) 540 (39.0%) <0.001 Persistent AF 412 (50.4%) 845 (61.0%) AF Hospitalization 353 (43.2%) 521 (37.7%) 0.011
Conclusion
Significant sex-specific outcomes differences were not observed. Sex should not be used as a determining factor in selecting patients for AF therapy.
Acknowledgement/Funding
NIH, St Jude Medical Foundation and Corporation, Biosense Webster Inc., Medtronic Corporation, and Boston Scientific Corporation
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Affiliation(s)
- J Poole
- University of Washington, Seattle, United States of America
| | - A M Russo
- Cooper University Hospital, Camden, United States of America
| | - Y M Cha
- Mayo Clinic, Rochester, United States of America
| | - K H Monahan
- Mayo Clinic, Rochester, United States of America
| | - H R Al-Khalidi
- Duke Clinical Research Institute, Durham, United States of America
| | - A P Silverstein
- Duke Clinical Research Institute, Durham, United States of America
| | - T D Bahnson
- Duke University Medical Center, Durham, United States of America
| | - D B Mark
- Duke University Medical Center, Durham, United States of America
| | - K L Lee
- Duke Clinical Research Institute, Durham, United States of America
| | - D L Packer
- Mayo Clinic, Rochester, United States of America
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Poon WL, Lee KL, Chan K. P4427Cardiovascular outcomes among runners of a marathon race - a 17 years' experience. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0829] [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] Open
Abstract
Abstract
Introduction
Over the past 17 years (2002–2018), 898,831 people participated in the Hong Kong Standard Chartered Marathon (HKSCM).
Purpose
We aim to study the incidence of marathon-related sudden cardiac arrest (SCA) and non-fatal myocardial injury (NFMI).
Methods
All the HKSCM related admissions between 2002 and 2017 were retrieved from the accident and emergency department admission records. We reviewed the data of HKSCM runners admitted for SCA and NFMI.
Results
Fourteen and thirty-nine runners were admitted for SCA (Mean age 38±13 years-old, 12 men) and NFMI (Mean age 42±12 years-old; 34 men) respectively.
Among the SCA runners, the arrest rhythms could not be retrieved in 3 cases. In the remaining 11 SCA runners, the arrest rhythms were ventricular fibrillation (VF) (N=6), pulseless-electrical activity (PEA) (N=3), and asystole (N=2). Nine of the 14 SCA runners were successfully resuscitated. Only 2 out of the 14 SCA runners had significant atherosclerotic coronary artery disease (CAD) requiring coronary angioplasty. Among the SCA runners, the etiologies of cardiac arrest were myocardial infarction (MI) (N=2), ischemic cardiomyopathy with VF (N=1), idiopathic VF (N=3), malignant coronary anomaly (N=1), and idiopathic (N=5). Percutaneous coronary intervention (PCI) was performed in 2 SCA runner with MI. Implantable cardioverter-defibrillators were implanted in 1 resuscitated runner with VF. Postmortem examination of the 3 deceased runners showed significant CAD in two and was unrevealing in one.
Among the 39 NFMI runners, coronary angiograms (CAG) or CT coronary angiogram were performed in 14 cases (36%), which showed minor CAD or unremarkable findings in 7 runners, and significant CAD in 7 runners. PCI and coronary artery bypass were performed in 5 and 2 NFMI runners respectively. Only 8 out of 39 NFMI runners reported chest pain. Significant ischemic ECG changes were detected in 9 out of 39 NFMI runners. Invasive CAGs were not performed in the remaining NFMI runners due to low pre-test likelihood of CAD and normal non-invasive test results.
Conclusions
The incidence of SCA and mortality among HKSCM runners was 1.56 per 100,000 and 0.56 per 100,000 respectively. The incidence of NFMI was 4.3 per 100,000. Coronary artery disease, coronary anomaly and idiopathic VF were the commonest etiologies of SCA.
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Affiliation(s)
- W L Poon
- Ruttonjee Hospital, Hong Kong, Hong Kong
| | - K L Lee
- Ruttonjee Hospital, Hong Kong, Hong Kong
| | - K Chan
- The University of Hong Kong - Shenzhen Hospital, Medicine, Shenzhen, China
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9
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Monahan KH, Bunch TJ, Poole JE, Bahnson TD, Al-Khalidi HR, Silverstein AP, Mark DB, Lee KL, Packer DL. 484Impact of AF type on the outcome of atrial fibrillation ablation: insights from the CABANA trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0134] [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] Open
Abstract
Abstract
Background
Prior studies suggest that catheter ablation (ABL) for atrial fibrillation (AF) is a treatment option for patients (pts) with paroxysmal AF (PAF). Pts with persistent (Per) or long-standing persistent (LSP) were routinely excluded from most ABL based clinical trials. The effectiveness of ABL compared to drug therapy (MED) in relation to underlying AF type has not been evaluated in a large randomized clinical trial.
Objective
To assess the impact of AF type on clinical outcomes of ABL vs. MED in pts with AF.
Methods
The CABANA trial randomized 2204 pts with AF at 126 sites worldwide to ABL vs. MED with rate or rhythm control drugs. The primary endpoint was a composite of death, disabling stroke, severe bleeding, or cardiac arrest. Key secondary endpoints included mortality and recurrence of AF. Outcomes of ABL vs. MED were compared within subgroups defined by AF type using Intention-to-Treat (ITT) analyses.
Results
Of the 2204 pts, 946 had PAF, 1042 had Per and 215 presented with LSP. There were baseline differences among AF types in age, gender, HTN, LVH, CHF and NYHA Class. For the primary endpoint, there were no significant differences between ABL and MED in pts with PAF (hazard ratio (HR) 0.82; 95% confidence interval (CI) 0.51, 1.31), Per (HR 0.87; 95% CI 0.59, 1.28), or LSP (HR 1.01, 95% CI 0.39, 2.61). Likewise, there were no significant treatment differences in mortality; PAF (HR 0.84; 95% CI 0.46, 1.52), Per (HR 0.90; 95% CI 0.56, 1.46) and LSP (HR 0.67, 95% CI 0.23, 1.94). Post-blanking AF (time to first recurrence) was significantly reduced by ABL compared to MED across all AF types (PAF by 51%), (Per by 47%) and (LSP by 36%).
Clinical Characteristics and Outcomes Clinical Outcomes Comparing ABL vs. MED (HR and 95% CI) Interaction p-value Primary Endpoint 0.82 (0.51, 1.31) 0.87 (0.59, 1.28) 1.01 (0.39, 2.61) 0.925 Mortality 0.84 (0.46, 1.52) 0.90 (0.56, 1.46) 0.67 (0.23, 1.94) 0.881 Recurrent AF 0.49 (0.38, 0.62) 0.53 (0.43, 0.65) 0.64 (0.41, 1.01) 0.564
Conclusion
Pts with LSP have a lower proportion of women, and a higher proportion with manifestations of heart failure despite lower CHA2DS2VASc scores. By ITT analysis, there is no significant effect of ABL compared to MED in the primary endpoint or mortality in any AF group. However, ABL is more effective than MED for reducing recurrences of AF regardless of AF type, but with a greater effect in PAF vs Per vs LSP.
Acknowledgement/Funding
NIH, St Jude Medical Foundation and Corporation, Biosense Webster Inc., Medtronic Corporation, and Boston Scientific Corporation
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Affiliation(s)
- K H Monahan
- Mayo Clinic, Rochester, United States of America
| | - T J Bunch
- Intermountain Medical Center, Salt Lake City, United States of America
| | - J E Poole
- University of Washington, Seattle, United States of America
| | - T D Bahnson
- Duke University Medical Center, Durham, United States of America
| | - H R Al-Khalidi
- Duke Clinical Research Institute, Durham, United States of America
| | - A P Silverstein
- Duke Clinical Research Institute, Durham, United States of America
| | - D B Mark
- Duke University Medical Center, Durham, United States of America
| | - K L Lee
- Duke Clinical Research Institute, Durham, United States of America
| | - D L Packer
- Mayo Clinic, Rochester, United States of America
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10
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Leung SC, Yung CY, Chan K, Lee KL, Lau YK. P992Efficacy of subclinical atrial fibrillation screening by AliveCor in patients with CHA2DS2-VASc score ≥2. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S C Leung
- Ruttonjee and Tang Shiu Kin Hospitals, Medicine, Hong Kong, China People's Republic of
| | - C Y Yung
- Ruttonjee and Tang Shiu Kin Hospitals, Medicine, Hong Kong, China People's Republic of
| | - K Chan
- Ruttonjee and Tang Shiu Kin Hospitals, Medicine, Hong Kong, China People's Republic of
| | - K L Lee
- Ruttonjee and Tang Shiu Kin Hospitals, Medicine, Hong Kong, China People's Republic of
| | - Y K Lau
- Ruttonjee and Tang Shiu Kin Hospitals, Medicine, Hong Kong, China People's Republic of
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11
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Kwok KM, Lee KL, Poon YS, Lam SY, Liong T, Wong HM, Chiu NK, Law KI. Portomesenteric vein thrombosis following laparoscopic sleeve gastrectomy in a Chinese patient. Hong Kong Med J 2017; 23:651-2. [PMID: 29226834 DOI: 10.12809/hkmj166321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- K M Kwok
- Department of Intensive Care, United Christian Hospital, Kwun Tong, Hong Kong
| | - K L Lee
- Department of Intensive Care, United Christian Hospital, Kwun Tong, Hong Kong
| | - Y S Poon
- Department of Intensive Care, United Christian Hospital, Kwun Tong, Hong Kong
| | - S Y Lam
- Department of Intensive Care, United Christian Hospital, Kwun Tong, Hong Kong
| | - T Liong
- Department of Intensive Care, United Christian Hospital, Kwun Tong, Hong Kong
| | - H M Wong
- Department of Intensive Care, United Christian Hospital, Kwun Tong, Hong Kong
| | - N K Chiu
- Department of Surgery, United Christian Hospital, Kwun Tong, Hong Kong
| | - K I Law
- Department of Intensive Care, United Christian Hospital, Kwun Tong, Hong Kong
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12
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Lee KL, Ng HW, Tse ML, Lau FL. Daytime versus Night Time Intentional Drug Overdose: The Outcome is Different. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791001700406] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction In drug overdose, it is generally perceived that the dosage can predict the clinical outcome. Are the dosages of intentional drug overdosing the same between day and night? If so, are these overdoses followed by similar clinical outcomes? Answers to these two questions might affect resource allocation and clinical judgment. The present study was performed to establish whether daytime patients and night time patients report similar drug doses, and see which group of patients would have a higher incidence of severe outcomes. Method A retrospective observational study on intentional drug overdose was performed. The reported numbers of total tablets ingested and the incidences of major outcomes, in terms of death and intensive care unit admissions, were compared between daytime and night time. Results A total of 400 patients were included. The reported number of ingested tablets in daytime had no statistical difference with that at night time. The numbers of severe outcomes had no differences between the patients presenting to the emergency department at daytime or night time. Yet overdosing at night time was more likely associated with severe outcomes. Conclusions We advise a higher index of suspicion at the emergency department on the reliability of the dosages reported by patients who overdose during night time. The larger number of severe outcomes may also be related to more toxic drug exposures in the night time. More resources in the community could be allocated to self-harm prevention at night time.
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Affiliation(s)
| | - HW Ng
- Hong Kong Poison Information Centre, K3A, United Christian Hospital, Accident & Emergency Department, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
| | - ML Tse
- Hong Kong Poison Information Centre, K3A, United Christian Hospital, Accident & Emergency Department, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
| | - FL Lau
- Hong Kong Poison Information Centre, K3A, United Christian Hospital, Accident & Emergency Department, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
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Lee KL, Chan YH, Lee TC, Goggins WB, Chan EYY. The development of the Hong Kong Heat Index for enhancing the heat stress information service of the Hong Kong Observatory. Int J Biometeorol 2016; 60:1029-39. [PMID: 26546311 DOI: 10.1007/s00484-015-1094-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 05/26/2023]
Abstract
This paper presents a study to develop a heat index, for use in hot and humid sub-tropical climate in Hong Kong. The study made use of hospitalization data and heat stress measurement data in Hong Kong from 2007 to 2011. The heat index, which is called Hong Kong Heat Index (HKHI), is calculated from the natural wet bulb temperature, the globe temperature, and the dry bulb temperature together with a set of coefficients applicable to the high humidity condition in the summer of Hong Kong. Analysis of the response of hospitalization rate to variation in HKHI and two other heat indices, namely Wet Bulb Globe Temperature (WBGT) and Net Effective Temperature (NET), revealed that HKHI performed generally better than WBGT and NET in reflecting the heat stress impact on excess hospitalization ratio in Hong Kong. Based on the study results, two reference criteria of HKHI were identified to establish a two-tier approach for the enhancement of the heat stress information service in Hong Kong.
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Affiliation(s)
- K L Lee
- Hong Kong Observatory, 134A Nathan Road, Tsim Sha Tsui, Kowloon, Hong Kong, China
| | - Y H Chan
- Hong Kong Observatory, 134A Nathan Road, Tsim Sha Tsui, Kowloon, Hong Kong, China.
| | - T C Lee
- Hong Kong Observatory, 134A Nathan Road, Tsim Sha Tsui, Kowloon, Hong Kong, China
| | - William B Goggins
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - Emily Y Y Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
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14
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Ghanem N, Jin JI, Kim SS, Choi BH, Lee KL, Ha AN, Song SH, Kong IK. The Anti-Müllerian Hormone Profile is Linked with theIn VitroEmbryo Production Capacity and Embryo Viability after Transfer but Cannot Predict Pregnancy Outcome. Reprod Domest Anim 2016; 51:301-10. [DOI: 10.1111/rda.12681] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 02/04/2016] [Indexed: 11/30/2022]
Affiliation(s)
- N Ghanem
- Department of Animal Science; Division of Applied Life Science (BK21 Plus); Gyeongsang National University; Jinju Korea
- Department of Animal Production; Faculty of Agriculture Cairo University; Giza Egypt
| | - JI Jin
- Department of Animal Science; Division of Applied Life Science (BK21 Plus); Gyeongsang National University; Jinju Korea
| | - SS Kim
- Department of Animal Science; Division of Applied Life Science (BK21 Plus); Gyeongsang National University; Jinju Korea
| | - BH Choi
- Department of Animal Science; Division of Applied Life Science (BK21 Plus); Gyeongsang National University; Jinju Korea
| | - KL Lee
- Department of Animal Science; Division of Applied Life Science (BK21 Plus); Gyeongsang National University; Jinju Korea
| | - AN Ha
- Department of Animal Science; Division of Applied Life Science (BK21 Plus); Gyeongsang National University; Jinju Korea
| | - SH Song
- Department of Animal Science; Division of Applied Life Science (BK21 Plus); Gyeongsang National University; Jinju Korea
| | - IK Kong
- Department of Animal Science; Division of Applied Life Science (BK21 Plus); Gyeongsang National University; Jinju Korea
- Institute of Agriculture and Life Science; Gyeongsang National University; Jinju Korea
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15
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Leung AKH, Ng GWY, Sin KC, Au SY, Lai KY, Lee KL, Law KI. Acquired factor V inhibitor in a patient receiving venous-venous extracorporeal membrane oxygenation for Legionella pneumonia. Hong Kong Med J 2016; 21:175-8. [PMID: 25904567 DOI: 10.12809/hkmj134141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report a rare complication of factor V deficiency in a patient having Legionella pneumonia. This patient also had other complications like severe acute respiratory distress syndrome, acute kidney injury, and septic shock that required venous-venous extracorporeal membrane oxygenation support. This is the first reported case of acquired factor V deficiency in a patient receiving extracorporeal membrane oxygenation for Legionella pneumonia. With the combined use of intravenous immunoglobulin, rituximab and plasma exchange, we achieved rapid clearance of the factor V inhibitor within 1 week so as to allow safe decannulation of extracorporeal membrane oxygenation.
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Affiliation(s)
- Anne K H Leung
- Intensive Care Unit, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - George W Y Ng
- Intensive Care Unit, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - K C Sin
- Intensive Care Unit, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - S Y Au
- Intensive Care Unit, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - K Y Lai
- Intensive Care Unit, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - K L Lee
- Intensive Care Unit, United Christian Hospital, Kwun Tong, Hong Kong
| | - K I Law
- Intensive Care Unit, United Christian Hospital, Kwun Tong, Hong Kong
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16
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Liong T, Lee KL, Poon YS, Lam SY, Kwok KM, Ng WF, Lam TL, Law KI. Extrapulmonary involvement associated with Mycoplasma pneumoniae infection. Hong Kong Med J 2015; 21:569-72. [DOI: 10.12809/hkmj144403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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17
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Ng I, Segal R, Lee KL, Ilyas S, Story D. A prospective audit of difficult airway equipment at University of Melbourne-affiliated hospitals. Anaesth Intensive Care 2015; 43:528. [PMID: 26099768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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18
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Ha AN, Fakruzzaman M, Lee KL, Bang JI, Deb GK, Wang Z, Kong IK. Effects of co-culture of cumulus oocyte complexes with denuded oocytes during in vitro maturation on the developmental competence of cloned bovine embryos. Reprod Domest Anim 2015; 50:292-298. [PMID: 25605137 DOI: 10.1111/rda.12487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 12/26/2014] [Indexed: 11/26/2022]
Abstract
This study evaluated the effects of co-culture of immature cumulus oocyte complexes (COCs) with denuded immature oocytes (DO) during in vitro maturation on the developmental competence and quality of cloned bovine embryos. We demonstrated that developmental competence, judged by the blastocyst formation rate, was significantly higher in the co-cultured somatic cell nuclear transfer (SCNT+DO, 37.1 ± 1.1%) group than that in the non-co-cultured somatic cell nuclear transfer (SCNT-DO, 25.1 ± 0.9%) group and was very similar to that in the control IVF (IVF, 38.8 ± 2.8%) group. Moreover, the total cell number per blastocyst in the SCNT+DO group (101.7 ± 6.2) was higher than that in the SCNT-DO group (81.7 ± 4.3), while still less than that in the IVF group (133.3 ± 6.0). Furthermore, our data showed that mRNA levels of the methylation-related genes DNMT1 and DNMT3a in the SCNT+DO group were similar to that in the IVF group, while they were significantly higher in the SCNT-DO group. Similarly, while the mRNA levels of the deacetylation-related genes HDAC2 and HDAC3 were significantly higher in the SCNT-DO group, they were comparable between the IVF and SCNT+DO groups. However, the mRNA levels of HDAC1 and DNMT3B were significantly higher in the SCNT+DO group than in the other groups. In conclusion, the present study demonstrated that co-culture of COCs with DO improves the in vitro developmental competence and quality of cloned embryos, as evidenced by increased total cell number.
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Affiliation(s)
- A-N Ha
- Department of Animal Science, Division of Applied Life Science (BK21 Plus), Gyeongsang National University, Jinju, Korea
| | - M Fakruzzaman
- Department of Animal Science, Division of Applied Life Science (BK21 Plus), Gyeongsang National University, Jinju, Korea
| | - K-L Lee
- Department of Animal Science, Division of Applied Life Science (BK21 Plus), Gyeongsang National University, Jinju, Korea
| | - J-I Bang
- Department of Animal Science, Division of Applied Life Science (BK21 Plus), Gyeongsang National University, Jinju, Korea
| | - G-K Deb
- Biotechnology Division, Bangladesh Livestock Research Institute, Savar, Dhaka, Bangladesh
| | - Z Wang
- Department of Animal, Dairy, and Veterinary Sciences, Utah State University, Logan, UT, USA
| | - I-K Kong
- Department of Animal Science, Division of Applied Life Science (BK21 Plus), Gyeongsang National University, Jinju, Korea.,Institute of Agriculture and Life Science, Gyeongsang National University, Jinju, Korea
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Kim SS, Bang JI, Fakruzzaman M, Lee KL, Ko DH, Ghanem N, Wang Z, Kong IK. Effects of Flunixin Meglumine and Prostaglandin F2αTreatments on the Development and Quality of Bovine EmbryosIn Vitro. Reprod Domest Anim 2014; 49:957-63. [DOI: 10.1111/rda.12413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/29/2014] [Indexed: 11/29/2022]
Affiliation(s)
- S-S Kim
- Division of Applied Life Science (BK21 Plus); Department of Animal Science; Gyeongsang National University; Jinju Korea
| | - J-I Bang
- Division of Applied Life Science (BK21 Plus); Department of Animal Science; Gyeongsang National University; Jinju Korea
- Institute of Agriculture and Life Science; Gyeongsang National University; Jinju Korea
| | - M Fakruzzaman
- Division of Applied Life Science (BK21 Plus); Department of Animal Science; Gyeongsang National University; Jinju Korea
| | - K-L Lee
- Division of Applied Life Science (BK21 Plus); Department of Animal Science; Gyeongsang National University; Jinju Korea
| | - D-H Ko
- Department of Animal Science and Biotechnology; Sangji Youngseo College; Wonju Korea
| | - N Ghanem
- Division of Applied Life Science (BK21 Plus); Department of Animal Science; Gyeongsang National University; Jinju Korea
- Department of Animal Production; Faculty of Agriculture Cairo University; Giza Egypt
| | - Z Wang
- Department of Animal, Dairy, and Veterinary Sciences; Utah State University; Logan UT USA
| | - I-K Kong
- Division of Applied Life Science (BK21 Plus); Department of Animal Science; Gyeongsang National University; Jinju Korea
- Institute of Agriculture and Life Science; Gyeongsang National University; Jinju Korea
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20
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Pan NY, Law CY, Tsang WK, Lee KL, Wong KC, Tam KF. Giant Cell Tumour of the Axial Skeleton: Report of Four Cases. Hong Kong J Radiol 2014. [DOI: 10.12809/hkjr1411064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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21
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Abstract
Acute appendicitis complicating Amyand's hernia is an extremely rare condition, in which the appendix herniates into the inguinal sac and, subsequently, gets inflamed. The condition is difficult to diagnose clinically. Imaging is valuable for its diagnosis and detection of the associated complications. In this article, we will discuss the imaging features of acute appendicitis complicating Amyand's hernia and the results of a literature review on the condition.
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Affiliation(s)
- W K Tsang
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - K L Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Shatin, Hong Kong
| | - K F Tam
- Department of Radiology, North District Hospital, Sheung Shui, Hong Kong
| | - S F Lee
- Department of Radiology, North District Hospital, Sheung Shui, Hong Kong
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22
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Lui PY, Lee KL, Tam KY, Chan CC. Imaging in Salmonella spp. Infection. Hong Kong J Radiol 2014. [DOI: 10.12809/hkjr1413205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Karpiuk T, Cherroret N, Lee KL, Grémaud B, Müller CA, Miniatura C. Coherent forward scattering peak induced by Anderson localization. Phys Rev Lett 2012; 109:190601. [PMID: 23215369 DOI: 10.1103/physrevlett.109.190601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Indexed: 06/01/2023]
Abstract
Numerical simulations show that, at the onset of Anderson localization, the momentum distribution of a coherent wave packet launched inside a random potential exhibits, in the forward direction, a novel interference peak that complements the coherent backscattering peak. An explanation of this phenomenon in terms of maximally crossed diagrams predicts that the signal emerges around the localization time and grows on the scale of the Heisenberg time associated with the localization volume. Together, coherent back and forward scattering provide evidence for the occurrence of Anderson localization.
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Affiliation(s)
- T Karpiuk
- Centre for Quantum Technologies, National University of Singapore, 3 Science Drive 2, Singapore 117543, Singapore
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Dey SR, Deb GK, Ha AN, Lee JI, Bang JI, Lee KL, Kong IK. Coculturing denuded oocytes during the in vitro maturation of bovine cumulus oocyte complexes exerts a synergistic effect on embryo development. Theriogenology 2011; 77:1064-77. [PMID: 22153275 DOI: 10.1016/j.theriogenology.2011.10.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 10/03/2011] [Accepted: 10/08/2011] [Indexed: 11/25/2022]
Abstract
The present study examined the effect of coculturing cumulus oocyte complexes (COCs) and denuded oocytes (DOs) during in vitro maturation (IVM) on nuclear and cytoplasmic maturation, zona pellucida (ZP) hardening, the pattern of fertilization and glutathione peroxidase 1 (GPX1) gene expression in the oocyte. Furthermore, the rate of embryonic development and the quality of blastocysts were examined for both COCs and DOs. Three IVM conditions were studied: 1) the coculture of 12 COCs and 60 DOs, 2) COC control with 12 COCs, and 3) DO control with 60 DOs. The IVM was performed in a 120-μl droplet of TCM199-based IVM medium. Following IVM, in vitro fertilization (IVF) and in vitro culture (IVC) were conducted separately for the COCs and DOs (DO coculture) from the IVM coculture group. Coculturing COCs and DOs increased the percentage of oocytes reaching the blastocyst stage and the total number of cells per blastocyst in both the COC coculture (44.4 ± 8.6 vs 26.7 ± 9.7%, P < 0.01, and 137.9 ± 24.9 vs 121.7 ± 21.1, P < 0.05) and the DO coculture (20.5 ± 5.0 vs 11.1 ± 2.5%, P < 0.01, and 121.9 ± 27.5 vs 112.3 ± 33.2, P < 0.05) compared to their respective control groups. The synergistic effects of coculturing were detected as increased nuclear and cytoplasmic maturation, the prevention of ZP hardening, increased monospermic fertilization and increased expression of GPX1 in the oocytes in response to endogenous oocyte-secreted factors. In conclusion, coculturing COCs and DOs may be an effective culture system for both intact COCs and immature DOs.
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Affiliation(s)
- S R Dey
- Division of Applied Life Science (BK21 Program), Graduate School of Gyeongsang, National University, Republic of Korea
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Ng TL, Leong IS, Tang WL, Chan KF, Luk YW, Lao WC, Leung CM, Liu SY, Kho CS, Lee KL, Chan KK, Li MKW. Immunoglobulin G4-related sclerosing disease: experience with this novel entity in a local hospital. Hong Kong Med J 2011; 17:280-285. [PMID: 21813895] [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: 05/31/2023] Open
Abstract
OBJECTIVE To review the site of involvement, clinical presentation, and treatment outcome of patients having immunoglobulin G4-related sclerosing disease in a local regional hospital. DESIGN Retrospective case series. SETTING Pamela Youde Nethersole Eastern Hospital, Hong Kong. PATIENTS All patients with a diagnosis of immunoglobulin G4-related sclerosing disease in the hospital diagnosed in the period from April 2008 to March 2010. RESULTS A total of 12 patients with involvement of various organs were identified. There was a male predominance (male-to-female ratio=5:1). The mean age at diagnosis was 65 years. The salivary glands, biliary tract, pancreas, and cervical lymph nodes were the commonest involved sites. The immunoglobulin G4 level was elevated in 83% of the patients. Patients usually appeared to respond well to steroid treatment. CONCLUSION Immunoglobulin G4-related sclerosing disease is a systemic disease and can involve various systems.
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Affiliation(s)
- T L Ng
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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Chan KKC, Lee KL, Lam PKN, Law KI, Joynt GM, Yan WW. Hong Kong's experience on the use of extracorporeal membrane oxygenation for the treatment of influenza A (H1N1). Hong Kong Med J 2010; 16:447-454. [PMID: 21135421] [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: 05/30/2023] Open
Abstract
OBJECTIVE To report Hong Kong's experience on the use of extracorporeal membrane oxygenation for the treatment of acute respiratory distress syndrome caused by influenza A (H1N1). DESIGN Multi-centred, retrospective observational study. SETTING Intensive care units in Hong Kong. PATIENTS Recipients of extracorporeal membrane oxygenation for confirmed influenza A (H1N1) infection from 1 May 2009 to 28 February 2010. MAIN OUTCOME MEASURE Hospital mortality. RESULTS During the study period, 120 patients were mechanically ventilated in intensive care units, among whom seven received veno-venous extracorporeal membrane oxygenation. The median (interquartile range) age of the latter patients was 42 (39-50) years, four had various chronic illnesses and one had a body mass index of greater than 30 kg/m². The median (interquartile range) time from symptom onset to hospital admission was 5 (4-7) days. Corresponding values for the duration of extracorporeal membrane oxygenation, mechanical ventilation, intensive care unit stay, and hospital stay were 6 (6-10), 19 (11-25), 19 (18-30), and 31 (25-55) days, respectively. One patient died (hospital mortality, 14%) and six made full recoveries. All seven patients received oseltamivir; in addition three received intravenous zanamivir, four received convalescent plasma, and one received hyperimmune immunoglobulin. Nosocomial infection was the commonest complication. There was no life- or limb-threatening complication directly attributable to extracorporeal membrane oxygenation. CONCLUSION In response to the pandemic of influenza A (H1N1), some intensive care units in Hong Kong were able to offer extracorporeal membrane oxygenation to selected cases. In this small series, patient outcomes were similar to those reported in other observational studies, indicating that intensive care units in Hong Kong are capable of successfully introducing this technology. However, the cost-effectiveness and optimal delivery of this strategy remain uncertain.
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Affiliation(s)
- K K C Chan
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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Najiah M, Lee KL, Noorasikin H, Nadirah M, Lee SW. Phenotypic and genotypic characteristics of Mycobacterium isolates from fighting fish Betta spp. in Malaysia. Res Vet Sci 2010; 91:342-5. [PMID: 20971487 DOI: 10.1016/j.rvsc.2010.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 08/25/2010] [Accepted: 09/20/2010] [Indexed: 10/18/2022]
Abstract
Mycobacteriosis due to mycobacteria is one of the most common bacterial diseases in ornamental fish. We describe here the phenotypic and genotypic characteristics of Mycobacterium isolates from fighting fish Betta spp. using ATCC Mycobacterium marinum, Mycobacterium fortuitum and Mycobacterium chelonae as references. A total of four isolates (M1, M2, M3, M4) were obtained from four out of 106 fish samples using selective agar, and identified to Mycobacterium genus using acid-fast staining and 16s rRNA gene-based genus specific polymerase chain reaction. DNA sequencing and NCBI-BLAST analysis further identified isolate M1 as M. marinum and isolates M2, M3, M4 as M. fortuitum. Morphological, physiological and biochemical tests were carried out for phenotypic characterizations. Universal M13 and wild-type phage M13 RAPD dendogram was generated to illustrate the genetic relationship of the isolates and reference strains.
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Affiliation(s)
- M Najiah
- Department of Fisheries Science and Aquaculture, Faculty of Agrotechnology and Food Science, Universiti Malaysia Terengganu (UMT), Mengabang Telipot, 21030 Terengganu, Malaysia.
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28
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Abstract
Acute hepatitis A (AHA) is one of the most common infectious diseases; it is usually a self-limiting disease affecting the liver. Although extrahepatic manifestations are not common, some cases have been reported associated with acute renal failure. We reviewed the clinical features of patients with AHA complicated by acute renal failure (ARF group) and compared them with patients with noncomplicated AHA (non-ARF group). The medical records of 208 consecutive patients with AHA who were diagnosed between January 2003 and October 2008 were reviewed. We identified 15 patients (7.2%) with ARF associated with AHA. There were no differences between the ARF and non-ARF group with regard to gender and age. The peak value of alanine aminotransferase (ALT) (median: 6060 IU/L vs 1792 IU/L, P < 0.001), prothrombin time (PT) (International normalized ratio, median 1.72 vs 1.10, P < 0.001), and total bilirubin level (median: 9.6 mg/dL vs 6.3 mg/dL, P = 0.04) were significantly higher in the ARF than in the non-ARF group. Twelve patients (80%) recovered completely with haemodialysis (seven patients, 46.7%) or only conservative management (five patients, 33.3%), while one patient underwent liver transplantation because of fulminant hepatic failure, and two patients died because of fulminant hepatic failure. There were no deaths among patients with noncomplicated AHA in the non-ARF group. Five patients underwent kidney biopsy; two patients were diagnosed with acute tubular necrosis, two patients with acute interstitial nephritis with IgA nephropathy and one patient with acute tubulointerstitial nephritis. All patients in the ARF group had microscopic haematuria and proteinuria (100%vs 31.1%, P < 0.001). Urine sodium levels were more than 10 mEq/L in 10 patients. The findings of high urinary sodium concentrations, microscopic haematuria and proteinuria did not support the diagnosis of hepatorenal syndrome (HRS). Patients with AHA with ARF had higher ALT levels, more prolonged PTs, and higher total bilirubin levels. The prognosis for these patients was poorer than for those without ARF. However, the patients with ARF and nonfulminant AHA had recovered with proper treatment and should not be confused with patients that have HRS.
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Affiliation(s)
- Y J Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul Municipal Boramae Hospital, Seoul, Korea
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Chun J, Kim W, Kim BG, Lee KL, Suh KS, Yi NJ, Park KU, Kim YJ, Yoon JH, Lee HS. High viremia, prolonged Lamivudine therapy and recurrent hepatocellular carcinoma predict posttransplant hepatitis B recurrence. Am J Transplant 2010; 10:1649-59. [PMID: 20642687 DOI: 10.1111/j.1600-6143.2010.03162.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Hepatitis B virus (HBV) recurrence following orthotopic liver transplantation (OLT) is generally preventable by prophylaxis with hepatitis B immunoglobulin (HBIG) and lamivudine (LAM). However, HBV recurrence sometimes develops despite prophylaxis. This study assessed posttransplant outcomes and identified predictors of HBV recurrence. We analyzed the outcomes of 209 consecutive patients positive for hepatitis B surface antigen who underwent OLT, who received either combination prophylaxis with HBIG and LAM (89.0%) or HBIG monoprophylaxis (11.0%). The median follow-up was 36.8 months (range, 1.0-84.4). Posttransplant HBV recurrence occurred in 22 patients (10.5%), including 13 patients with drug-resistant mutations. HBV recurrence was observed in six patients after hepatocellular carcinoma (HCC) recurrence. Independent predictors of HBV recurrence were recurrent HCC (p < 0.001), LAM therapy >1.5 years (p = 0.001) and high HBV DNA titers (> or =10(5) copies/mL) at OLT (p = 0.036). In conclusion, high viremia at OLT and prolonged exposure to LAM should be further stressed as main predictors of HBV recurrence.
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Affiliation(s)
- J Chun
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Korea
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30
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Liong T, Lee KL, Poon YS, Lam SY, Chan CP, Yue CS, Chu CM, Yuen KY, Law KI. The first novel influenza A (H1N1) fatality despite antiviral treatment and extracorporeal membrane oxygenation in Hong Kong. Hong Kong Med J 2009; 15:381-384. [PMID: 19801697] [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: 05/28/2023] Open
Abstract
We report the first fatality caused by novel influenza A (H1N1) infection despite having the diagnosis confirmed and being given antiviral treatment after hospitalisation. This patient was also the first with influenza A (H1N1) to be supported with extracorporeal membrane oxygenation in Hong Kong. Although extracorporeal membrane oxygenation is an effective means of supporting patients with refractory hypoxaemia on high mechanical ventilatory support, it is labour-intensive and technically demanding. We also discuss the challenges faced when managing this case.
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Affiliation(s)
- T Liong
- Intensive Care Unit, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
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31
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Lee KL, Graham CA, Lam JMY, Yeung JHH, Ahuja AT, Rainer TH. Impact on trauma patient management of installing a computed tomography scanner in the emergency department. Injury 2009; 40:873-5. [PMID: 19394016 DOI: 10.1016/j.injury.2008.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [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] [Received: 06/25/2008] [Revised: 11/12/2008] [Accepted: 12/01/2008] [Indexed: 02/02/2023]
Abstract
BACKGROUND Computed tomography (CT) plays a central diagnostic role for trauma patients. A 16-slice multi-detector CT scanner was installed in the emergency department (ED) of Prince of Wales Hospital in December 2004. The aims of this study were to evaluate the impact of the CT scanner within the ED on trauma management and to compare the utilisation patterns of trauma CT before and after the introduction of EDCT. METHODS Analysis of prospectively collected trauma registry data. All consecutive trauma cases admitted through the ED that underwent CT between June 2004 and June 2005 (6 months before and after EDCT installation) were included. A positive CT was defined as the identification (by a specialist radiologist) of a significant finding which was consistent with injury. RESULTS There were 226 and 202 trauma patients in the 6 months before and after EDCT installation, respectively. 111 (49.1%) patients underwent CT scanning before EDCT compared with 110 (54.5%) afterwards. 72 (65%) patients had CT scans performed before admission to definitive care compared with 99 (90%) after EDCT installed (p<0.0001, chi(2) test). Mean time from arrival to first CT was shorter after EDCT (102 min vs. 197 min, p=0.011). Mean trauma room length of stay increased after EDCT was implemented (106 min vs. 80 min; p<0.001). Median time to urgent operation (<6h) was less with EDCT (134 min before vs. 112 min after). No changes in median time to neurosurgical operation (138 min before vs. 148 min after); mean length of stay (12.8 days before vs. 12.5 days after); or mortality (8 patients before vs. 7 patients after). There were 203 scans (1.8/patient) done before EDCT compared with 226 scans (2.5/patient) after. There was no difference in the number of scans done by body region or the proportion of positive scans (32% before vs. 30% after). Logistic regression confirmed that after adjusting for injury severity and admission physiology, time to first CT was shorter (p=0.0307) but ED length of stay was increased (p<0.0001). CONCLUSION After the installation of EDCT, more trauma patients had CT scanning before definitive care, and scans were done sooner, with no significant increase in the number of unnecessary scans.
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Affiliation(s)
- K L Lee
- Accident & Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
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Abstract
BACKGROUND Amiodarone hydrochloride has been in use for two decades for the control of ventricular and supraventricular arrhythmias. Established and emerging evidence indicates that amiodarone has an antiarrhythmic efficacy superior to that of most other drugs. HYPOTHESIS The study was undertaken to evaluate the efficacy and acceptability of low-dose amiodarone therapy in the long-term management of supraventricular and ventricular tachyarrhythmias. METHODS A total of 124 patients with symptomatic drug-refractory or life-threatening arrhythmias managed with low-dose oral amiodarone therapy over a 10-year period was analyzed retrospectively. Of these, 45 patients (36%) had ventricular arrhythmias, 52 (42%) had atrial arrhythmias, and 27 (22%) had atrioventricular reentry tachycardia. Loading doses of amiodarone 600 mg daily for 1 week were administered for supraventricular arrhythmias and 600-1200 mg daily for 2 weeks for ventricular arrhythmias. Maintenance daily doses were 194 +/- 48 and 206 +/- 55 mg, respectively. Mean treatment duration was 32 +/- 28 months, with 326.3 patient years of therapy. RESULTS Of 39 patients with sustained ventricular tachyarrhythmias, the actuarial incidence of satisfactory arrhythmia control (absence of sudden cardiac death or nonfatal arrhythmia recurrence) was 78% at 1 year and 71% at 2 years. Satisfactory control of supraventricular arrhythmias (mean ventricular rate < 100/min with significant symptomatic improvement for sustained atrial arrhythmias and < 1 attack per year for paroxysmal atrial or atrioventricular arrhythmias) was achieved in 73, 65, and 62% of patients at 1, 2, and 3 years, respectively. The cumulative incidence of amiodarone-related adverse effects was 5.8 per 100 patient years, with drug withdrawal required in 12 patients (9.7%). Fifteen patients had thyroid dysfunction, 2 had hepatic toxicity, and 1 developed nonfatal pulmonary fibrosis. Overall, the incidence of successful use of amiodarone (satisfactory arrhythmia control and freedom from side effects) was 67, 59, and 53% at 1, 2, and 3 years, respectively. CONCLUSIONS The results of this study suggest that the efficacy of low-dose amiodarone therapy in the management of serious ventricular and supraventricular arrhythmias would be similar to those achieved with higher doses, but with a much more acceptable side effect profile.
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Affiliation(s)
- K L Lee
- Department of Medicine, Queen Mary Hospital, Hong Kong
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McVie-Wylie AJ, Lee KL, Qiu H, Jin X, Do H, Gotschall R, Thurberg BL, Rogers C, Raben N, O'Callaghan M, Canfield W, Andrews L, McPherson JM, Mattaliano RJ. Biochemical and pharmacological characterization of different recombinant acid alpha-glucosidase preparations evaluated for the treatment of Pompe disease. Mol Genet Metab 2008; 94:448-455. [PMID: 18538603 PMCID: PMC2774491 DOI: 10.1016/j.ymgme.2008.04.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 04/10/2008] [Accepted: 04/10/2008] [Indexed: 12/19/2022]
Abstract
Pompe disease results in the accumulation of lysosomal glycogen in multiple tissues due to a deficiency of acid alpha-glucosidase (GAA). Enzyme replacement therapy for Pompe disease was recently approved in Europe, the U.S., Canada, and Japan using a recombinant human GAA (Myozyme, alglucosidase alfa) produced in CHO cells (CHO-GAA). During the development of alglucosidase alfa, we examined the in vitro and in vivo properties of CHO cell-derived rhGAA, an rhGAA purified from the milk of transgenic rabbits, as well as an experimental version of rhGAA containing additional mannose-6-phosphate intended to facilitate muscle targeting. Biochemical analyses identified differences in rhGAA N-termini, glycosylation types and binding properties to several carbohydrate receptors. In a mouse model of Pompe disease, glycogen was more efficiently removed from the heart than from skeletal muscle for all enzymes, and overall, the CHO cell-derived rhGAA reduced glycogen to a greater extent than that observed with the other enzymes. The results of these preclinical studies, combined with biochemical characterization data for the three molecules described within, led to the selection of the CHO-GAA for clinical development and registration as the first approved therapy for Pompe disease.
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Affiliation(s)
- A J McVie-Wylie
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - K L Lee
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - H Qiu
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - X Jin
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - H Do
- Glycobiology Research Institute, Genzyme Corporation, Oklahoma City, OK 73104, USA
| | - R Gotschall
- Glycobiology Research Institute, Genzyme Corporation, Oklahoma City, OK 73104, USA
| | - B L Thurberg
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - C Rogers
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - N Raben
- Arthritis and Rheumatism Branch, NIAMS, National Institutes of Health, Bethesda, MD 20892, USA
| | - M O'Callaghan
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - W Canfield
- Glycobiology Research Institute, Genzyme Corporation, Oklahoma City, OK 73104, USA
| | - L Andrews
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - J M McPherson
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - R J Mattaliano
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
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Chien FC, Lin CY, Yih JN, Lee KL, Chang CW, Wei PK, Sun CC, Chen SJ. Coupled waveguide–surface plasmon resonance biosensor with subwavelength grating. Biosens Bioelectron 2007; 22:2737-42. [PMID: 17178218 DOI: 10.1016/j.bios.2006.11.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 11/13/2006] [Accepted: 11/15/2006] [Indexed: 11/28/2022]
Abstract
This study develops a coupled waveguide-surface plasmon resonance (CWSPR) biosensor with a subwavelength grating structure for the real-time analysis of biomolecular interactions. In the proposed optical metrology system, normally incident white light is coupled into the waveguide layer through the subwavelength grating structure thereby enhancing the wave vector which excites the surface plasmons on the metal sensing surface. The proposed CWSPR biosensor not only retains the same sensing sensitivity as that of a conventional surface plasmon resonance device, but also yields a sharper dip in the reflectivity spectrum and therefore provides an improved measurement precision. Moreover, the metrology setup overcomes the limitations of the conventional Kretschmann attenuated total reflection approach and is less sensitive to slight variations in the angle of the incident light. The experimental results confirm that the current CWSPR biosensor provides a straightforward yet powerful technique for real-time biomolecular interaction analysis.
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Affiliation(s)
- F-C Chien
- Institute of Optical Sciences, National Central University, Chung-Li 320, Taiwan
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35
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Lau KCH, Yiu KKH, Lee KL, Ko RLY, Lam YM, Lam L, Lee SWL. A case of takotsubo cardiomyopathy: transient left ventricular apical ballooning. Hong Kong Med J 2006; 12:388-90. [PMID: 17028361] [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: 05/12/2023] Open
Abstract
A 78-year-old woman was admitted to hospital with central chest pain and the electrocardiographic and cardiac marker changes typical of acute anterior myocardial infarction. Coronary angiography revealed normal epicardial coronary arteries, and left ventriculography showed apical akinesis as well as basal hyperkinesis. This is a case of transient left ventricular apical ballooning or takotsubo cardiomyopathy, possibly attributable to catecholamine-mediated myocardial stunning.
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Affiliation(s)
- K C H Lau
- Department of Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong
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Abstract
The DCA (Drug Control Authority), Malaysia has implemented the phase three registration of traditional medicines on 1 January 1992. As such, a total of 100 products in various pharmaceutical dosage forms of a herbal preparation found in Malaysia, containing tongkat Ali hitam, either single or combined preparations, were analyzed for the presence of a heavy toxic metal, mercury, using atomic absorption spectrophotometer, after performing a simple random sampling to enable each sample an equal chance of being selected in an unbiased manner. Results showed that 26% of these products possessed 0.53-2.35 ppm of mercury, and therefore, do not comply with the quality requirement for traditional medicines in Malaysia. The quality requirement for traditional medicines in Malaysia is not exceeding 0.5 ppm for mercury. Out of these 26 products, four products have already registered with the DCA, Malaysia whilst the rest, however, have not registered with the DCA, Malaysia.
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Affiliation(s)
- H H Ang
- School of Pharmaceutical Sciences, University Science Malaysia, Minden, Penang 11800, Malaysia.
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Abstract
OBJECTIVE Patients with autoimmune diseases such as systemic lupus erythematosus (SLE) and Sjögren's syndrome (SS) are associated with an increased severity of lower urinary tract symptoms (LUTS). Recent surveys also reveal that rheumatoid arthritis (RA) is prevalent in patients with interstitial cystitis (IC). Therefore, we have investigated LUTS in patients with RA. METHODS A total of 198 female patients with RA, aged 40 years or older, from the rheumatology outpatient clinic completed this prospective study. The American Urological Association Symptom Index (AUASI) score was used to assess the severity of LUTS and the O'Leary-Sant Symptom Index (ICSI) was used to evaluate IC-like urinary symptoms in these patients, which were compared to those of 679 age-matched controls. The possible associations of clinical parameters with LUTS were also explored. RESULTS The Mean AUASI score and the percentage of individuals reporting severe LUTS (AUASI score > or = 20) or IC-like urinary symptoms (ICSI score > or = 12) showed no significant differences between the RA and control groups. However, in the RA group multivariate regression analyses identified patients with secondary SS (n = 21) to be associated with a significantly higher AUASI score (p = 0.007) and a higher percentage of severe LUTS (p = 0.02); these were also significantly higher than those of the control group (p = 0.02 and p = 0.01, respectively). CONCLUSION Patients with RA have similar urinary complaints when compared to controls. However, those with secondary SS have a greater severity of LUTS, a finding similar to that observed in patients with primary SS.
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Affiliation(s)
- K-L Lee
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
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Lee KL, Patel DV, McGhee CNJ. Macrophthalmos as a long-term outcome of severe open globe injury. Eye (Lond) 2005; 20:728-30. [PMID: 15951752 DOI: 10.1038/sj.eye.6701957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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39
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Lee KL, Dean S, Guest S. A comparison of outcomes after indocyanine green and trypan blue assisted internal limiting membrane peeling during macular hole surgery. Br J Ophthalmol 2005; 89:420-4. [PMID: 15774917 PMCID: PMC1772609 DOI: 10.1136/bjo.2004.049684] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [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: 11/04/2022]
Abstract
AIMS To compare the anatomical and visual outcomes of macular hole repair surgery using indocyanine green (ICG) or trypan blue (TB) staining of the internal limiting membrane (ILM). METHOD Retrospective analysis of 37 eyes from 37 consecutive patients with stage 2, 3, and 4 idiopathic macular holes who underwent macular hole repair by one surgeon using the same technique but utilising different dyes for ILM peeling. In 19 patients ICG was used while 18 patients had TB. The anatomical and visual results in these two groups were compared. RESULTS There were no significant differences in the demographic and macular hole characteristics of the ICG and TB groups. Macular hole closure was achieved in 91.9% of all patients of which the ICG group had an 89.5% hole closure rate and the TB group had a 94.4% hole closure rate. After excluding cases with failed hole closure and other vision affecting complications, there was no significant difference between the preoperative visual acuities in the TB and ICG groups but the postoperative visual acuities were better in the TB than the ICG group (p = 0.036). The TB group also had more Snellen lines of improvement than the ICG group (2.94 v 1.79 lines; p = 0.046). CONCLUSION TB appears to be less toxic than ICG when used in dye assisted peeling of ILM during macular hole repair as reflected by the better visual results in the TB group of patients.
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Affiliation(s)
- K L Lee
- Department of Ophthalmology, Waikato Hospital, Hamilton, New Zealand
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40
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Abstract
The DCA (Drug Control Authority), Malaysia implemented the phase 3 registration of traditional medicines on 1 January 1992 with special emphasis on the quality, efficacy and safety (including the presence of heavy metals) in all pharmaceutical dosage forms of traditional medicinal preparations. As such, a total of 100 traditional medicinal preparations, containing Smilax myosotiflora, in various pharmaceutical dosage forms, which were bought in the Malaysian market, were analysed for lead content using atomic absorption spectrophotometry. Results showed that 15% of the products analysed possessed 10.23-23.05 ppm of lead, and therefore, do not comply with the quality requirement for traditional medicines in Malaysia. The quality requirement for traditional medicines in Malaysia is that they should not exceed 10 ppm of lead. Out of these 15 products, five products exhibited 10.23-23.05 ppm of lead, in fact they have already been registered with the DCA Malaysia. However, the rest of the products, which possessed 12.24-20.72 ppm of lead, have still not been registered with the DCA Malaysia. Although this study successfully showed that only 85% of the products complied with the quality requirement for traditional medicines in Malaysia pertaining to lead, they cannot, however, be assumed to be safe from lead contamination because of batch-to-batch inconsistency.
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Affiliation(s)
- H H Ang
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang.
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41
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Abstract
SUMMARYDetailed investigations on the structural and mechanical properties of the forewing of the cicada were carried out. Measurement of the structures of the wings showed that the thickness of the membrane of each cell and the diameter of each vein were non-uniform in both the longitudinal and transverse directions, and their means were approximately 12.2 and 133.3 μm,respectively. However, the aspect ratios of the wings and the bodies were quite uniform and were approximately equal to 2.98 and 2.13, respectively. Based on the measured thickness, mass and area of the membranes of the cells,the mean density and the mean area density of the wing were approximately 2.3 g cm-3 and 2.8×10-3 g cm-2,respectively. In addition, the diameters of the veins of the wings, including the diameters of the holes in the vein of the leading edge, were examined. The mechanical properties of the wing were investigated separately by nanoindentation and tensile testing. The results indicated that the mean Young's modulus, hardness and yield stress of the membranes of the wings were approximately 3.7 GPa, 0.2 GPa and 29 MPa, respectively, and the mean Young's modulus and strength of the veins along the direction of the venation of wings were approximately 1.9 GPa and 52 MPa, respectively. Finally, the relevant results were briefly analyzed and discussed, providing a guideline to the biomimetic design of the aerofoil materials of micro air vehicles.
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Affiliation(s)
- F Song
- State Key Laboratory of Nonlinear Mechanics (LNM), Institute of Mechanics, Chinese Academy of Sciences, Beijing 100080, People's Republic of China
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Abstract
The effects of various fractions of Eurycoma longifolia Jack were studied on the orientation activities of the inbred, adult middle-aged Sprague-Dawley rats, 9 months old and retired breeders towards the receptive females (anogenital sniffing, licking, mounting), the environment (climbing, raring, exploration), themselves (nongenital grooming, genital grooming) and mobility (restricted, unrestricted) after treating these subjects twice daily for 10 days. Results showed that subjects treated with 800 mg/kg of E. longifolia Jack increased orientation activities towards the receptive females (anogenital sniffing, licking and mounting), increased genital grooming towards themselves and restricted movements to a particular area of the cage but decreased interest in the external environment (climbing, raring, exploration) as compared with the controls during the investigation period. In conclusion, this study gives further evidences that different fractions of E. longifolia Jack modified the orientation activities of the middle-aged male rats.
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Affiliation(s)
- H H Ang
- School of Pharmaceutical Sciences, University Science Malaysia, Minden, 11800, Penang, Malaysia.
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Affiliation(s)
- E W H To
- Division of Head & Neck, Plastic and Reconstructive Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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Lee KL, Shin DH. [The medical system and its characteristics during the Koryo Dynasty period]. Uisahak 2001; 10:153-180. [PMID: 12190072] [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: 05/23/2023]
Abstract
This article explores the medical system of the Koryo Dynasty period and its social characteristics. First, the structure of medical system and roles of medical institutions during the Koryo Dynasty period will be summarized. Then, the characteristics of the medical system will be identified through exploring the principles of its formation in a view of social recognition of medical care and a view of public policy. During the Koryo Dynasty period, medical experts were trained in national education institutions from the early days of Dynasty. After trained, they were appointed to the posts at government service with their medical profession. In the meantime, they sought ways to ascend their social position. Physicians of Oriental medicine were appointed to the posts at each local government and troops to take charge of medical treatments of the common people. Also, the state tried to assume the reins of medical system by actively taking part in circulation (collection and distribution) of herb. Taeuigam and Sangyakguk represent central medical institutions of the Koryo, taking charge of medical service for the aristocracy and the bureaucracy. The Common people were treated at DongSeoDaeBiWOn, JeWuiBo, HyeMinGuk, and YakJum in SeoKyung. However, activities of these institutions became less active around the days of military officials regime, as officers became negligent and financial base went broken. The roles of medical institutions of the Koryo government were not restricted to the treatment of diseases. Policies for the common people were constituted by two main policies, the policy for encouraging agriculture and the policy for giving relief to people. Medical institutions, with other social systems, had a social responsibility to support the governing system of the Koryo and maintain the stability of the society. In this aspect, medical institutions such as DongSeoDaeBiWon and JeWuiBo, and relief institutions such as UiChang, were all related and connected organically, and they were results of, and bases of the relief policy. However, medical system for the common people was made up first for practical needs and then improved successively. Allocation of medical experts and execution of relief work were carried out by each local government, except the case of serious disaster, which central government took part in. As the Koryo Dynasty went into its latter period, temporary institutions and one - time benefits replaced permanent institutions. These four characteristics described above were systemic characteristics of medical system during the Koryo Dynasty period.
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Affiliation(s)
- K L Lee
- Don eun Medical Museum, Yonsei University College of Medicine
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Wang HJ, Lee KL, Park HW. [The Gurhigae Jejoongwon: its size and activities]. Uisahak 2001; 10:135-152. [PMID: 12190071] [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: 05/23/2023]
Abstract
This article explores the location, size of the site, and medical activities of the Gurhigae Jejoongwon. Relevant documents such as reminiscences, diplomatic notes, newspaper accounts, maps, and photographs were referred for this study. The Gurhigae Jejoongwon located on a hill that, at present, covers the area from Ulchi-ro to MyungDong Cathedral. Its main entrance was towards Ulchi-ro. Real estate including the buildings of the Gurhigae Jejoongwon was returned to the Chosun government in 1905, and the estimated size of its site varied from 1,810 pyung to 5,036 pyung. The site of the Gurhigae Jejoongwon was 2 - 5 times larger than the 862.16-pyung-site of the Jejoongwon in its Jaedong days. With such larger size, the Jejoongwon could take care of more patients. Dr. Avison started medical education again. The Gurhigae Jejoongwon took the central part in medical treatment activities for public in Seoul, as it carried out the prevention activities against Cholera in 1895. The Chosun government highly recognized its medical treatment activities for the common people.
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Affiliation(s)
- H J Wang
- Department of History, Yonsei University College of Art and Science
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Lee KL, Lau CP. Should all implantable cardioverter defibrillators for ventricular arrhythmias be dual-chamber devices? Curr Cardiol Rep 2001; 3:447-50. [PMID: 11602074 DOI: 10.1007/s11886-001-0065-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The advantages of a dual-chamber implantable cardioverter defibrillator (ICD) over a single-chamber ICD include physiologic pacing capability, atrial electrogram storage, enhanced arrhythmia discrimination algorithms, and a potential to treat atrial arrhythmia by pacing or defibrillation. Current evidence supports the supposition that dual-chamber ICDs are definitely indicated in patients who have a concomitant indication for physiologic pacing, such as bradycardia or bradycardia-dependent ventricular tachyarrhythmias. Refined dual-chamber arrhythmia discrimination algorithms and enhanced atrial therapies are probably required for patients with frequent supraventricular arrhythmias. Furthermore, in patients with systolic heart failure, low ejection fraction, and intraventricular conduction delay, triple-chamber ICDs with biventricular pacing may improve their functional status and prevent sudden arrhythmic death. Careful patient selection is required to optimize the cost-effectiveness of these sophisticated technologies.
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Affiliation(s)
- K L Lee
- University Department of Medicine, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, PR China
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Pires LA, Lehmann MH, Buxton AE, Hafley GE, Lee KL. Differences in inducibility and prognosis of in-hospital versus out-of-hospital identified nonsustained ventricular tachycardia in patients with coronary artery disease: clinical and trial design implications. J Am Coll Cardiol 2001; 38:1156-62. [PMID: 11583897 DOI: 10.1016/s0735-1097(01)01482-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The goal of this study was to describe the influence of the clinical setting (in-hospital vs. out-of-hospital) in which nonsustained ventricular tachycardia (NSVT) is discovered on the rate of inducibility of sustained ventricular tachycardia (VT), arrhythmic events and survival in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction. BACKGROUND In-hospital presentation of sustained VT is independently associated with lower long-term overall survival. The impact of the clinical setting in which NSVT is documented is unknown. METHODS In the Multicenter Unsustained Tachycardia Trial (MUSTT), designed to assess the benefit of randomized antiarrhythmic therapy guided by electrophysiologic testing in patients with asymptomatic NSVT, CAD and LV dysfunction, eligible patients were enrolled irrespective of the setting in which the index arrhythmia was discovered. In this retrospective analysis, we compared the rate of VT inducibility and outcome of MUSTT-enrolled patients with in-hospital versus out-of-hospital presentation of NSVT. RESULTS Monomorphic sustained VT was induced in 35% and 28% of the patients whose index NSVT occurred in-hospital and out-of-hospital, respectively (adjusted p = 0.006). Cardiac arrest or death due to arrhythmia at two- and five-year follow-ups were 14% and 28% for untreated patients with in-hospital-identified NSVT and 11% and 21% for the out-of-hospital group (adjusted p = 0.10). Overall mortality rates at two- and five-year follow-ups were 24% and 48% for inpatients and 18% and 38% for outpatients (adjusted p = 0.018). In patients randomized to antiarrhythmic therapy, there was no significant interaction between patient status (in-hospital vs. out-of-hospital) and treatment impact on the rates of total mortality (p = 0.98) and arrhythmic events (p = 0.08). CONCLUSIONS In patients with CAD and impaired LV function, asymptomatic NSVT identified in-hospital, compared with that identified out-of-hospital, is associated with a higher rate of induction of sustained VT and overall mortality. Therefore, in similar patients, the clinical setting in which NSVT is discovered should be taken into account when formulating patient risk, treatment and clinical trial design.
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Affiliation(s)
- L A Pires
- St. John Hospital and Medical Center and Wayne State University School of Medicine, Detroit, Michigan 48236, USA.
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DeLong ER, Nelson CL, Wong JB, Pryor DB, Peterson ED, Lee KL, Mark DB, Califf RM, Pauker SG. Using observational data to estimate prognosis: an example using a coronary artery disease registry. Stat Med 2001; 20:2505-32. [PMID: 11512139 DOI: 10.1002/sim.930] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With the proliferation of clinical data registries and the rising expense of clinical trials, observational data sources are increasingly providing evidence for clinical decision making. These data are viewed as complementary to randomized clinical trials (RCT). While not as rigorous a methodological design, observational studies yield important information about effectiveness of treatment, as compared with the efficacy results of RCTs. In addition, these studies often have the advantage of providing longer-term follow-up, beyond that of clinical trials. Hence, they are useful for assessing and comparing patients' long-term prognosis under different treatment strategies. For patients with coronary artery disease, many observational comparisons have focused on medical therapy versus interventional procedures. In addition to the well-studied problem of treatment selection bias (which is not the focus of the present study), three significant methodological problems must be addressed in the analysis of these data: (i) designation of the therapeutic arms in the presence of early deaths, withdrawals, and treatment cross-overs; (ii) identification of an equitable starting point for attributing survival time; (iii) site to site variability in short-term mortality. This paper discusses these issues and suggests strategies to deal with them. A proposed methodology is developed, applied and evaluated on a large observational database that has long-term follow-up on nearly 10 000 patients.
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Affiliation(s)
- E R DeLong
- Outcomes Research & Assessment Group, Duke Clinical Research Institute, Duke University, Department of Medicine, Biometry Division, Community and Family Medicine, 2400 Pratt Street, Durham, NC 27705, USA.
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Abstract
Anaemia caused by persistent parvovirus B19 infection can be remitted by intravenous immunoglobulin (IVIG) treatment. However, maintenance IVIG therapy is required in some AIDS patients as well as patients with combined immuno-deficiency because of relapse of anaemia. We used a simple semi-quantitative polymerase chain reaction (PCR) method to trace plasma B19 viral load after administration of IVIG. We noted that the rebound of B19 viral load occurred 6 weeks prior to detection of anaemia. This method may be helpful in determining the interval of maintenance IVIG therapy.
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Affiliation(s)
- C C Hung
- Department of Internal Medicine, Section of Infectious Disease, National Taiwan University Hospital, Taipei, Taiwan
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Abstract
The highly conserved, ubiquitous high mobility group protein HMGB1 (formerly named as HMG1) is an architectural transcription factor encoded by a single functional gene in human. HMGB1 is expressed in almost all cell or tissue types studied. In general, it is expressed at a basal level in most cells but at a slightly elevated level of 2--3-fold in actively proliferating tissues or estrogen stimulated breast cancer cells. To understand the regulatory mechanism controlling expression of the human HMGB1 gene, we cloned and analyzed the upstream region as well as the first intron of this gene. We found that transcription of the human HMGB1 gene in the breast cancer MCF-7 cells starts at one major site 57 nucleotides upstream from the first exon-intron boundary. Expression of the human HMGB1 gene is under the control of a very strong TATA-less promoter, which has an activity more than 18-fold that of the SV40 promoter. Immediately upstream, a silencer element is present. This silencer can repress the activity of the HMGB1 promoter down to just one-sixth. The first intron of the human HMGB1 gene contains enhancer elements, which can increase the human HMGB1 promoter activity by 2--3-fold. We postulate that the human HMGB1 gene is capable of being expressed at a very high level. The basal level of expression observed in most cells is probably a result of the strong promoter being held in check by the silencer. The 2--3-fold increase in HMGB1 expression observed in proliferating cells or breast cancer cells stimulated by estrogen may probably result from the action of the enhancer elements in intron 1.
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Affiliation(s)
- H K Lum
- Department of Applied Biology and Chemical Technology, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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