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Chen PY, Wei L, Su YK, Lin JH, Jang JW, Hou WH, Hsu LF, Chiu HY. Psychometric properties and factor structure of the traditional Chinese version of the Community Integration Questionnaire-Revised in traumatic brain injury survivors. Int J Rehabil Res 2024; 47:129-134. [PMID: 38587088 DOI: 10.1097/mrr.0000000000000624] [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] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
This study aimed to translate and validate the traditional Chinese version of the Community Integration Questionnaire-Revised (TC-CIQ-R) in patients with traumatic brain injury (TBI). We included participants aged ≥20 years and diagnosed as having TBI for ≥6 months from neurosurgical clinics. The 18-item TC-CIQ-R, Participation Measure - 3 Domains, 4 Dimensions (PM-3D4D), Extended Glasgow Outcome Scale (GOSE), and Taiwanese Quality of Life After Brain Injury (TQOLIBRI) were completed. The sample included 180 TBI survivors (54% male, mean age 47 years) of whom 87% sustained a mild TBI. Exploratory factor analysis extracted four factors - home integration, social integration, productivity, and electronic social networking - which explained 63.03% of the variation, after discarding the tenth item with a factor loading of 0.25. For criterion-related validity, the TC-CIQ-R was significantly correlated with the PM-3D4D; convergent validity was exhibited by demonstrating the associations between the TC-CIQ-R and TQOLIBRI. Known-group validity testing revealed significant differences in the subdomain and total scores of the TC-CIQ-R between participants with a mean GOSE score of ≤6 and >7 (all P < 0.001). The TC-CIQ-R exhibited acceptable Cronbach's α values (0.68-0.88). We suggest the 17-item TC-CIQ-R as a valid tool for rehabilitation professionals, useful for both clinical practice and research in assessing community integration levels following TBI.
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Affiliation(s)
- Pin-Yuan Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung
| | - Li Wei
- Taipei Neuroscience Institute
- Division of Neurosurgery, Department of Surgery, Wan Fang Hospital
- Graduate Institute of Injury Prevention and Control
| | - Yu-Kai Su
- Taipei Neuroscience Institute
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei
- Department of Neurosurgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City
| | - Jiann-Her Lin
- Taipei Neuroscience Institute
- Neuroscience Research Center, Taipei Medical University
- Department of Neurosurgery, Taipei Medical University Hospital
- Division of Neurosurgery, Department of Surgery, School of Medicine
| | - Jing-Wen Jang
- School of Nursing, College of Nursing, Taipei Medical University
| | - Wen-Hsuan Hou
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Li-Fang Hsu
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
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Ratanasereeprasert N, Hsu LF, Wang SK, Chen YJ, Chang JH, Yao CCJ. Molecular signaling and mechanisms of low-level laser-induced gene expression in cells involved in orthodontic tooth movement. J Formos Med Assoc 2024; 123:442-451. [PMID: 37805307 DOI: 10.1016/j.jfma.2023.09.011] [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] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/03/2023] [Accepted: 09/19/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND The study aimed to observe molecular signaling, including reactive oxygen species (ROS) and mitochondrial membrane potential (ΔΨm), to evaluate the alteration of gene expression by low-level laser therapy (LLLT) and the correlation between its mechanisms and the NF-kB pathway in cells involved in orthodontic tooth movement. METHODS Osteoblast-like cells (MG63), immortalized periodontal ligament cells (iPDL), and M1 macrophage-like cells were irradiated by 980-nm LLLT with energy densities of 1 and 10 J/cm2 ΔΨm and intracellular ROS were monitored using fluorescent probes. The changes of mRNA expression were assessed using reverse transcription polymerase chain reaction (RT-PCR). NF-kB inhibitor, ROS scavenger, and ΔΨm suppressor were used to analyze signals associated with the regulation of gene expression. Finally, Western blot analysis was performed to confirm NF-kB signaling after LLLT. RESULTS We found the increases of ΔΨm and ROS in all three cell types after LLLT, but no significant difference was observed between 1 and 10 J/cm2 LLLT. Regarding gene expression, some target genes were upregulated in MG63 6 h, 12 h, and 1 day after LLLT and in iPDL cells 12 h and 1 day after LLLT. However, no changes occurred in M1 cells. The inhibitor that significantly reduced most changes in gene expression was NF-kB inhibitor. Western blot analysis showed the increase in p-IkBα level after LLLT in iPDL and MG63, but not in M1. CONCLUSION The 980-nm LLLT increased ΔΨm and ROS production in all three cell types. However, changes in gene regulation were found only in MG63 and iPDL cells, which related to the NF-kB pathway.
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Affiliation(s)
| | - Li-Fang Hsu
- Department of Dentistry, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Shih-Kai Wang
- Department of Dentistry, School of Dentistry, National Taiwan University, Department of Pediatric Dentistry, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Yi-Jane Chen
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Division of Orthodontics and Dentofacial Orthopedics, Dental Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Heng Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Division of Orthodontics and Dentofacial Orthopedics, Dental Department, National Taiwan University Hospital, Taipei, Taiwan.
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Hsu LF, Ratanasereeprasert N, Wang SK, Chen JT, Chen YJ, Yeh TH, Sung HH, Yao CCJ. Craniofacial and olfactory sensory changes after long-term unilateral nasal obstruction-an animal study using MMP-3-LUC transgenic rats. Sci Rep 2024; 14:2616. [PMID: 38297007 PMCID: PMC10830476 DOI: 10.1038/s41598-024-51544-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/06/2024] [Indexed: 02/02/2024] Open
Abstract
Nasal obstruction exerts considerable physiological effects on the respiratory system and craniofacial morphology during the developmental stage. This study used MMP-3-LUC transgenic rats for in vivo tracking of long-term expression in the rat nasal region after unilateral nasal obstruction. Skeletal changes of the craniofacial, nasal, and sinus regions were measured through micro-computed tomography examination and analysis with 3D image processing and calculation. Matrix metalloproteinase-3 and olfactory marker protein expression were also investigated through immunohistochemistry (IHC). Unilateral nasal obstruction significantly reduced the MMP-3 signal in the nasal region of MMP-3-LUC transgenic rats, which was mainly expressed in the respiratory epithelium. Long-term obstruction also caused morphological changes of the craniofacial hard tissue, such as nasal septal deviation, longer inter-jaw distance, and increased maxillary molar dental height. It also caused compensatory growth in olfactory nerve bundles and the olfactory epithelium, as confirmed by IHC. In our study, long-term unilateral nasal obstruction caused nasal septal deviation toward the unobstructed side, hyper divergent facial development including longer molar dental height, and reduced MMP-3 production. However, further investigation is necessary to explore the mechanism in depth.
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Affiliation(s)
- Li-Fang Hsu
- Department of Dentistry, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei, 10048, Taiwan
| | - Nutthakarn Ratanasereeprasert
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei, 10048, Taiwan
| | - Shih-Kai Wang
- Department of Dentistry, National Taiwan University School of Dentistry, Taipei, Taiwan
| | - Jung-Tsu Chen
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei, 10048, Taiwan
| | - Yi-Jane Chen
- Department of Dentistry, National Taiwan University School of Dentistry, Taipei, Taiwan
- Division of Orthodontics and Dentofacial Orthopedics, Dental Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Te-Huei Yeh
- Department of Otolaryngology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Hsuan Sung
- National Laboratory Animal Center, National Applied Research Laboratories, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei, 10048, Taiwan.
- Division of Orthodontics and Dentofacial Orthopedics, Dental Department, National Taiwan University Hospital, Taipei, Taiwan.
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Ratanasereeprasert N, Hsu LF, Wang SK, Jane Yao CC. Orthodontically induced changes to the genetic profile in periodontal ligament tissue and cytokine release in gingival crevicular fluid - A pilot investigation. J Dent Sci 2024; 19:387-396. [PMID: 38303827 PMCID: PMC10829649 DOI: 10.1016/j.jds.2023.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 07/31/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose It has been known that genetic factors influence orthodontic tooth movement, however, scientific research on humans is lacking. Therefore, this study aimed to investigate dynamic changes to the genetic profile in human periodontal ligament (PDL) tissue and cytokine release in gingival crevicular fluid (GCF) during the first 28 days of orthodontic treatment. Materials and methods Fifteen teeth from three patients were recruited. Full-mouth fixed appliances with extraction of four premolars and one maxillary third molar was planned for orthodontic treatment. GCF collection and tooth extraction were performed following force application for 0, 1, 3, 7, and 28 days. GCF was analyzed using multiplex immunoassay for 27 cytokines. PDL tissue was collected after extraction and submitted for RNA exome-sequencing using Illumina sequencing platform. Further analysis of differentially expressed genes (DEGs), gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways, and heatmaps were conducted. Results GCF cytokine levels varied among three patients; some patients exhibited a peak cytokine level on Day 0 whereas others did so on Days 1-3. In RNA exome sequencing data, GO and KEGG analyses showed that genes associated with sensory receptors were upregulated on Day 1, genes involved in bone remodeling were upregulated on Days 3 and 28, and genes related to osteoclast differentiation were upregulated on Day 7. Conclusion RNA sequencing data demonstrate that the specific types of genes are expressed at different time points, whereas the data on cytokine changes show a large variation in concentration levels and dynamic change patterns among the patients.
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Affiliation(s)
| | - Li-Fang Hsu
- Department of Dentistry, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Shih-Kai Wang
- Department of Dentistry, School of Dentistry, National Taiwan University, Department of Pediatric Dentistry, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Division of Orthodontics and Dentofacial Orthopedics, Dental Department, National Taiwan University Hospital, Taipei, Taiwan
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Hsu LF, Moon W, Chen SC, Chang KWC. Digital workflow for mini-implant-assisted rapid palatal expander fabrication-a case report. BMC Oral Health 2023; 23:887. [PMID: 37985987 PMCID: PMC10659097 DOI: 10.1186/s12903-023-03589-5] [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] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Non-surgical mini-implant assisted rapid palatal expansion, or midfacial skeletal expansion, is a paradigm-shifting concept that in recent years has expanded the envelope of orthopedic movement in the transverse direction for adult patients. Although adding mini-screws to a rapid palatal expander is not complicated, accurate and successful expansion strongly depends on the device's position and its relation to the resisting structures of the maxillofacial complex. CASE PRESENTATION This article presents a digital workflow to locate the optimal position of the Midfacial Skeletal Expander (MSE) device in a CBCT-combined intraoral scan file and describes how to transfer the MSE position intra-orally with properly sized bands during the device fabrication. The complete digital workflow of MSE fabrication and its application for a Class III orthognathic surgical case is presented in detail. CONCLUSIONS This report describes a completely digital process that can accurately position the MSE device according to the orientation and morphology of maxillary basal bone, which is crucial in adult cases demand maxillary expansion.
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Affiliation(s)
- Li-Fang Hsu
- Department of Dentistry, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Won Moon
- The Forsyth Institute, Cambridge, MA, USA
- Ajou University School of Medicine, Suwon-si, Korea
| | - Shih-Chin Chen
- Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Los Angeles, CA, USA
| | - Kelvin Wen-Chung Chang
- Breeze Dental Center, No. 588, Xianzheng 2Nd Rd., Zhubei City, Hsinchu County, Taiwan (R.O.C.).
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Chen YJ, Yao CC, Chang ZC, Lai HH, Hsu LF, Hsu TH, Kok SH. Occlusal function and electromyographic activity of masticatory muscles in skeletal Class III patients with different patterns of mandibular asymmetry. J Oral Rehabil 2023; 50:276-285. [PMID: 36597189 DOI: 10.1111/joor.13412] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 12/17/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although jaw asymmetry is commonly seen in skeletal Class III patients, its correlation with occlusal function and masticatory muscle activity has not been fully elucidated. OBJECTIVES The purpose of this study was to investigate the occlusal function and masticatory muscle activity in skeletal Class III patients with various patterns of mandibular asymmetry. METHODS Forty-two patients and 10 normal participants were examined. The patients were categorised into three groups. Groups 1 and 2 exhibited menton and ramus deviation to the same side. Menton deviation was larger than ramus deviation in Group 1, whereas Group 2 showed the inverse relation. Group 3 patients showed menton and ramus deviation in opposite directions. Occlusal contact area (OCA), relative bite force (RBF), and temporalis anterior (TA) and masseter muscle (MM) activity at maximum clenching were measured using T-Scan Novus system and Bio-EMG-III. Statistical analysis was performed using the t-test, one-way analysis of variance with Bonferroni correction and Spearman correlation (α = .05). RESULTS Compared with normal participants, the patients had smaller OCA and greater asymmetry in the distribution of masticatory muscle activity. Greater ramus deviation was associated with smaller OCA in Group 1 but with larger OCA in Group 3. In Group 1, greater menton deviation was related to stronger TA activity on the non-deviation side. In Group 2, greater ramus deviation was related to stronger MM activity on the deviation side. CONCLUSION Deviation of the menton and ramus was individually related to OCA and masticatory muscle activity, and this relationship varied according to the pattern of mandibular asymmetry.
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Affiliation(s)
- Yi-Jane Chen
- School of Dentistry, National Taiwan University, Taipei City, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chung-Chen Yao
- School of Dentistry, National Taiwan University, Taipei City, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Zwei-Chieng Chang
- School of Dentistry, National Taiwan University, Taipei City, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Hsiang-Hua Lai
- School of Dentistry, National Taiwan University, Taipei City, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Li-Fang Hsu
- School of Dentistry, National Taiwan University, Taipei City, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Tzu-Hang Hsu
- School of Dentistry, National Taiwan University, Taipei City, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Sang-Heng Kok
- School of Dentistry, National Taiwan University, Taipei City, Taiwan.,Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei City, Taiwan
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Hsieh HY, Yao CC, Hsu LF, Tsai LH, Jeng JH, Young TH, Chen YJ. Biological properties of human periodontal ligament cell spheroids cultivated on chitosan and polyvinyl alcohol membranes. J Formos Med Assoc 2022; 121:2191-2202. [DOI: 10.1016/j.jfma.2022.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 01/02/2023] Open
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Hsu LF, Chang BE, Tseng KJ, Liao CC, Tsai SC, Hsiao HY, Lin SC, Liao PW, Chen YJ, Jane Yao CC. Orthodontic force regulates metalloproteinase-3 promoter in osteoblasts and transgenic mouse models. J Dent Sci 2022; 17:331-337. [PMID: 35028055 PMCID: PMC8740386 DOI: 10.1016/j.jds.2021.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 11/20/2021] [Indexed: 11/25/2022] Open
Abstract
Background/purpose Previously we demonstrated up-regulation of matrix metalloproteinase-3 (MMP-3) in human osteoblasts under compression and in bony specimens of experimental orthodontic tooth movement (OTM). Here, we studied the temporal characteristics of compression stimulation in human and mouse osteoblast cell lines, and generated a transgenic mouse model for assessing the MMP-3 expression during OTM. Materials and methods We investigated MMP-3 expressions in human and murine osteoblasts through RT-PCR and luciferase assay, after compressive force loading. Inhibitors were added to identify the possible mechanisms for signal transduction. A human MMP-3 promoter was isolated, cloned and transfected to generate a transgenic mouse with a green fluorescent protein reporter. OTM was then initiated to observe the location and time course of transcriptional regulation of MMP-3 signals. Results We found changes in the transcription of MMP-3 in response to mechanical force applied to both human and mouse osteoblast cell lines, suggesting that the response is positive across species. Cloned human MMP-3 promoter may cause the response of luciferase to 1% compression. Moreover, p38 inhibitor exerted a down-regulatory effect on MMP-3 promoter expression, although the inhibitory effect didn't reach a significant level. In the transgenic mouse OTM model, we again found increased expression of MMP-3 in response to mechanical force loading around the periodontal ligament. Conclusion Mechanical force can stimulate MMP-3 expression, possibly through the p38 MAPK pathway, with its strongest signal occurring at 24 h. The mechanical responsiveness in MMP-3 promoter regions can be observed in both humans and rodents in vitro and in vivo.
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Affiliation(s)
- Li-Fang Hsu
- Department of Dentistry, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.,Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Bei-En Chang
- Graduate Institute of Oral Biology, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuo-Jung Tseng
- Graduate Institute of Oral Biology, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Ching Liao
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Shu-Chun Tsai
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Hsuan-Yi Hsiao
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Sheng-Chin Lin
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Pei-Wen Liao
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Yi-Jane Chen
- School of Dentistry, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Dental Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Dental Department, National Taiwan University Hospital, Taipei, Taiwan
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Yao CCJ, Chang ZC, Lai HH, Hsu LF, Hwang HM, Chen YJ. Architectural changes in alveolar bone for dental decompensation before surgery in Class III patients with differing facial divergence: a CBCT study. Sci Rep 2020; 10:14379. [PMID: 32873841 PMCID: PMC7463229 DOI: 10.1038/s41598-020-71126-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/10/2020] [Indexed: 11/09/2022] Open
Abstract
This study aimed to investigate alveolar bone change around mandibular anterior teeth during orthodontic decompensation in patients with skeletal Class III malocclusion and different vertical facial patterns. The records of 29 consecutive Class III patients selected from those pending two-jaw orthognathic surgery were divided into low (≤ 28°), average (30°-37°), and high (≥ 39°) mandibular plane angle (MPA) groups. The DICOM files of CBCT scans and STL files of digital dental models, taken before (T1) and after (T2) presurgical orthodontic treatment, were imported into Dolphin imaging software to reconstruct dentoskeletal images. T1 and T2 images were superimposed and analyzed for bone thickness and height at the level of root apex on each mid-sagittal slice of six mandibular anterior teeth. Differences between T1 and T2 were analyzed by non-parametric tests and mixed-effect model analysis. The results showed that the measurements of alveolar bone height generally decreased after treatment, regardless of MPA. The facial divergence, incisor irregularity, tooth site, treatment time, and change in proclination were identified as the significant factors affecting alveolar bone thickness and height during treatment. The presurgical orthodontic treatment to decompensate mandibular anterior teeth should be very careful in all MPA groups.
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Affiliation(s)
- Chung-Chen Jane Yao
- School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei City, 10048, Taiwan.,Divison of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Zwei-Chieng Chang
- School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei City, 10048, Taiwan.,Divison of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Hsiang-Hua Lai
- School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei City, 10048, Taiwan.,Divison of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Li-Fang Hsu
- School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei City, 10048, Taiwan.,Divison of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Hann-Min Hwang
- School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei City, 10048, Taiwan.,Divison of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Yi-Jane Chen
- School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei City, 10048, Taiwan. .,Divison of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei City, Taiwan.
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Hsu LF, Cheng YC, Peng HH, Yao CCJ. Simplified orthognathic surgical treatment using non-surgical asymmetric maxillary expansion: A case report. Int Orthod 2020; 18:839-849. [PMID: 32839141 DOI: 10.1016/j.ortho.2020.07.001] [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] [Received: 05/25/2020] [Revised: 06/30/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Transverse problems can be exacerbated by highly compensated occlusion in patients with skeletal asymmetry, which makes pre-surgical decompensation harder to achieve. OBJECTIVE This case report describes a case of combined orthognathic surgery with facial asymmetry. We used pre-orthodontic surgical simulation to visualize the goal for presurgical orthodontics, planning for a one-jaw surgical treatment option. METHODS The planned asymmetric expansion was performed using a maxillary skeletal expander (MSE II) with surgical corticopuncture over only the left side before MSE activation. Surgery was performed to achieve mandibular left outward yaw rotation to correct the patient's facial asymmetry after the planned amount of expansion was reached. RESULTS The results showed substantial improvement of facial aesthetics as well as skeletal symmetry. Cooperation and communication between surgeon and orthodontist ensured that the final results were satisfactory.
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Affiliation(s)
- Li-Fang Hsu
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan Department of Dentistry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yu-Cheng Cheng
- Department of Oral & Maxillofacial Surgery, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Hsin-Hui Peng
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan, Department of Dentistry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chung-Chen Jane Yao
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan. Division of Orthodontics and Dentofacial Orthopaedics, Department of Dentistry, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
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Hsu LF, Tsai MH, Shih AHY, Chen YC, Chang BE, Chen YJ, Yao CCJ. 970 nm low-level laser affects bone metabolism in orthodontic tooth movement. Journal of Photochemistry and Photobiology B: Biology 2018; 186:41-50. [DOI: 10.1016/j.jphotobiol.2018.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/21/2018] [Accepted: 05/07/2018] [Indexed: 10/28/2022]
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Chen YJ, Chen HH, Hsu LF, Wang SH, Chen YJ, Lai EHH, Chang JZC, Yao CCJ. Airway increase after open bite closure with temporary anchorage devices for intrusion of the upper posteriors: Evidence from 2D cephalometric measurements and 3D magnetic resonance imaging. J Oral Rehabil 2018; 45:939-947. [PMID: 30133810 DOI: 10.1111/joor.12712] [Citation(s) in RCA: 4] [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] [Received: 03/30/2018] [Revised: 07/15/2018] [Accepted: 08/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to analyse morphological changes in the upper airways in patients with anterior open bite treated with temporary anchorage devices for intrusion of upper posterior teeth. MATERIALS AND METHODS Twelve nonobese (body mass index: <25) anterior open bite patients between the ages of 19 and 44 years (mean age: 22.83 ± 8.19 years) were recruited for this study. Cephalometric radiographs and magnetic resonance imaging (MRI) scans before and after anterior bite closure without bracketing on anterior teeth were used to measure the upper airway, which was divided into retropalatal and retroglossal regions. RESULTS The mandibular plane angle and lower facial height were significantly reduced by intrusion of the upper posteriors and autorotation of the mandible. The retroglossal airway width (AW2) and retroglossal area (RG area) measured on cephalometric radiographs both increased significantly after treatment. Retroglossal volume increased and the retroglossal width/length ratio decreased significantly in MRI analysis. All other measurements were not significantly changed. However, no statistically significant correlations were observed between all measurements in 2D and 3D images, with the exception of the AW2 linear measurement in 2D images correlating with the AP length in MRI axial view images (r = 0.56, P = 0.0430). CONCLUSION Counterclockwise rotation of the mandible after anterior open bite closed using orthodontic treatment changed the airway morphology. Retroglossal volume significantly increased and the airway shape became less elliptical after bite closure.
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Affiliation(s)
- Yunn-Jy Chen
- Division of Prosthodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsin-Ho Chen
- Division of Orthodontics, Dental Department, Taoyuan Armed Forces General Hospital, Lungtan, Taiwan
| | - Li-Fang Hsu
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Shin-Huei Wang
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Jane Chen
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Eddie Hsiang-Hua Lai
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Jenny Zwei-Chieng Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
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Abstract
The purpose of this study was to evaluate the effects of family-involved care on caregivers' self-efficacy, the degree of satisfaction with central-line care, and the occurrence of central-line-associated bloodstream infections (CLABSIs). We adopted a pretest-posttest quasi-experimental design, recruiting 62 participants from 2009 to 2010. Family caregivers in the experimental group received instructional guidance before collaboratively participating in patient care, whereas the control group received routine care. Our results indicated that in both groups, the overall posttest scores for self-efficacy were significantly higher than the pretest scores. The score for the question "When the patient moves around, how confident are you with ensuring catheter safety?" was significantly higher in the experimental group than in the control group. Satisfaction with the provision of central-line care was also significantly higher in the experimental group than in the control group. CLABSIs did not occur in either group of patients.
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Affiliation(s)
- Shu-Hwa Tan
- Taipei Medical University Hospital, Taiwan, R.O.C
| | - Kwo-Chen Lee
- China Medical University and Hospital, Taiwan, R.O.C
| | | | - Li-Fang Hsu
- Taipei Medical University Hospital, Taiwan, R.O.C
| | - Pi-Chu Lin
- Taipei Medical University, Taiwan, R.O.C.
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14
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Tan JKB, Guo KWQ, Hsu LF. Palpitations and narrow-complex tachycardia. Singapore Med J 2011; 52:241-245. [PMID: 21552783] [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]
Abstract
A 56-year-old patient with a history of Parkinson's disease presented with palpitations and an apparently irregular narrow-complex tachycardia on electrocardiogram. The discrepancy in ventricular rate between the limb and precordial leads was the result of myopotentials from his tremors mimicking the QRS complexes in the limb leads. These myopotentials can be differentiated from true QRS complexes by the fact that they are usually variable in amplitude and occur at a frequency similar to that of limb tremors.
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Affiliation(s)
- J K B Tan
- Department of Cardiology, National Heart Centre Singapore, 17 Third Hospital Avenue, Mistri Wing, Singapore 188752.
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15
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Wei HM, Wong P, Hsu LF, Shim W. Human bone marrow-derived adult stem cells for post-myocardial infarction cardiac repair: current status and future directions. Singapore Med J 2009; 50:935-942. [PMID: 19907881] [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]
Abstract
Stem cell-based cell therapy has emerged as a potentially therapeutic option for patients with acute myocardial infarction (AMI) and heart failure. With the completion of a number of trials using bone marrow (BM)-derived adult stem cells, critical examination of the overall clinical benefits, limitations and potential side effects of this revolutionary treatment will pave the way for future clinical research. At present, clinical trials have been conducted almost exclusively using BM stem cells. The primary endpoints of these trials are mainly safety and feasibility, with secondary endpoints in the efficacy of post-myocardial infarction (MI) cardiac repair. Intervention with BM-derived cells was mainly carried out by endogenously-mobilised BM cells with granulocyte-colony stimulating factor, and more frequently, by intracoronary infusion or direct intramyocardial injection of autologous BM cells. While these studies have been proven safe and feasible without notable side effects, mixed outcomes in terms of clinical benefits have been reported. The major clinical benefits observed are improved cardiac contractile function and suppressed left ventricular negative remodelling, including reduced infarct size and improved cardiac perfusion of infarct zone. Moderate and transient clinical benefits have been mostly observed in studies with intracoronary infusion or direct intramyocardial injection of BM cells. These effects are widely considered to be indirect effects of implanted cells in association with paracrine factors, cell fusion, passive ventricular remodelling, or the responses of endogenous cardiac stem cells. In contrast, evidence of cardiac regeneration characterised by differentiation of implanted stem cells into cardiomyocytes and other cardiac cell lineages, is weak or lacking. To elucidate a clear risk-benefit of this exciting therapy, future studies on the mechanisms of cardiac cell therapy will need to focus on confirming the ideal cell types in relation to dosage and timing for post-MI cardiac repair, developing more effective cell delivery techniques, and devising innovative cell tracking modalities that could unveil the fates of implanted cells such as survival, engraftment and functionality.
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Affiliation(s)
- H M Wei
- Research and Development Unit, National Heart Centre, 9 Hospital Drive, Blk C, #03-2, Singapore
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16
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Chin C, Kam RM, Hsu LF. Electrocardiographical case. Young woman with epilepsy. Singapore Med J 2007; 48:177-9; quiz 180. [PMID: 17304400] [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: 05/14/2023]
Abstract
A 24-year-old Chinese woman was referred for evaluation of palpitations. She had a background history of epilepsy. A 12-lead electrocardiogram (ECG) showed prolonged rate-corrected QT of 600 ms and a T-U complex. The ECG findings with her typical history suggest a diagnosis of congenital long QT syndrome. Diagnosis and treatment options are discussed.
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Affiliation(s)
- C Chin
- Department of Cardiology, National Heart Centre, Mistri Wing, Third Hospital Avenue, Singapore 168752
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17
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Ho KW, Hsu LF. Electrocardiographical case. A young man with chest pain. Singapore Med J 2006; 47:431-4; quiz 435. [PMID: 16645697] [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: 05/08/2023]
Abstract
A 31-year-old Chinese man presented with complaint of acute chest pain. 12-lead electrocardiogram (ECG) showed sinus rhythm, with widespread upward concave ST segment elevations. The ECG changes along with a history of acute chest pain in a young man with minimal coronary risk factors are suggestive of acute pericarditis. He subsequently developed a pericardial effusion. Diagnosis, treatment and complications of acute percarditis are discussed.
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Affiliation(s)
- K W Ho
- Department of Cardiology, National Heart Centre, Mistri Wing, Singapore.
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18
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Rotter M, Jaïs P, Sanders P, Takahashi Y, Rostock T, Sacher F, Hocini M, Hsu LF, Clementy J, Haïssaguerre M. Echocardiographic advances in atrial fibrillation and supraventricular arrhythmias. Minerva Cardioangiol 2005; 53:109-15. [PMID: 15986005] [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: 05/03/2023]
Abstract
Advances in echocardiography have paved the way for the development of intracardiac catheters with ultrasound transducers mounted on its tip. With this technology it has become possible for the interventional electrophysiologist to perform continuous echocardiographic examination during a procedure without the need for general anaesthesia or additional staff. Intracardiac echocardiography (ICE) allows the monitoring of catheter movement in real-time, assessment of catheter-tissue contact and potentially prevents and recognizes complications like thrombus formation and pericardial effusion. In addition recent technologies allow acquiring the full spectrum of Doppler-imaging permitting evaluation of haemodynamic data during the procedure. All these advances have made ICE an ideal tool for the interventional electrophysiologist, serving as a diagnostic and imaging tool during invasive electrophysiological procedures. This review will summarize currently available technology of ICE and its indications and applications in electrophysiological procedures.
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Affiliation(s)
- M Rotter
- Unit of Cardiology of Haut-Lévêque, Victor Segalen University Bordeaux, Bordeaux, France.
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19
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Abstract
Recent advancements in our understanding of atrial fibrillation have led to the development of catheter ablation techniques that feasibly could achieve a cure for AF.
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20
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Hsu LF, Wang RH. [The effectiveness of an intervention program to promote physical activity among female adolescents in a vocational nursing school]. Hu Li Za Zhi 2004; 51:27-36. [PMID: 15614660] [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: 05/01/2023]
Abstract
The purpose of this research was to explore the impact of a physical activity program on exercise knowledge, exercise attitude, exercise self-efficacy, exercise behavior, and cardiorespiratory fitness among female students. A vocational nursing school was selected by purposeful sampling. The experimental group (n=88) and control group (n=89) each contained two classes which were randomly selected from 11th grade classes in the vocational nursing school. All participants completed a structured questionnaire, including an exercise knowledge scale, an exercise attitude scale, an exercise self-efficacy scale, and a cardiorespiratory fitness activities scale at both the pre-test and the post-test stages. An 800-meter running test was used to test the cardiorespiratory fitness of participants. One week after the pre-test, the experimental group received a 12-week physical activity program, while the control group did not receive any intervention. The statistical analysis included percentage, mean, one-way ANOVA, pair-t test and repeated-measures two-way ANOVA. The results showed that improvements in exercise attitude, exercise self-efficacy, exercise knowledge and 800-meter running among the experimental group were significantly higher than among the control group. However, there was no significant effect on the score for cardiorespiratory fitness activities. The results of this research could be used as a reference for school health professionals to promote physical activities for female adolescents.
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Affiliation(s)
- Li-Fang Hsu
- School of Nursing, Min-Hwei College of Health Care Management, Taiwan, ROC
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21
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Sanders P, Hsu LF, Hocini M, Jaïs P, Takahashi Y, Rotter M, Sacher F, Pasquié JL, Arentz T, Scavée C, Garrigue S, Clémenty J, Haïssaguerre M. Mapping and ablation of ventricular fibrillation. Minerva Cardioangiol 2004; 52:171-81. [PMID: 15194978] [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: 04/29/2023]
Abstract
Sudden cardiac death frequently results from ventricular fibrillation (VF). While VF is frequently the eventual mode of death in patients with abnormal ventricular substrates, it has also been described in patients with structurally normally hearts. Until recently, the management of patients who have survived sudden cardiac death has focused on treating the consequences by implantation of a defibrillator. However, such therapy remains restricted in many countries, is associated with a prohibitive cost to the community, and may be a cause of significant morbidity in patients with frequent episodes or storms of arrhythmia. Evidence emerging from the study of fibrillation both in the atria and the ventricle suggests an important role for triggers arising from the Purkinje network or the right ventricular outflow tract in the initiation of VF. Initial experience in patients with idiopathic VF and even those with VF associated with abnormal repolarization syndromes (LQT or Brugada syndrome) or myocardial infarction suggests that long term suppression of recurrent VF may be feasible by the elimination of these triggers. With the development of new mapping and ablation technologies, and greater physician experience, catheter ablation of VF, with the ultimate aim of curing such patients at risks of sudden cardiac death, may not be an unrealistic goal in the future.
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Affiliation(s)
- P Sanders
- Hôpital Cardiologique du Haut-Lévêque, Bordeaux, France
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22
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Tang EY, Hsu LF, Lam KN, Pang WS. Critically ill elderly who require mechanical ventilation: the effects of age on survival outcomes and resource utilisation in the medical intensive care unit of a general hospital. Ann Acad Med Singap 2003; 32:691-6. [PMID: 14626803] [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: 04/27/2023]
Abstract
INTRODUCTION Advanced age has been a criterion for denying admission to the medical intensive care unit (MICU) due to the perceived poorer outcome and increased resource utilisation. We studied the relationship between age and outcome of the critically ill mechanically-ventilated patients admitted to the MICU. MATERIALS AND METHODS This prospective study included patients admitted to the MICU for mechanical ventilation between 1994 and 1998. These were divided into 2 cohorts, with 206 patients aged 65 and above and 159 below 65 years. Outcome measures were MICU and hospital mortality and length of stay (LOS) in the MICU and hospital. Logistic and linear regression analyses were performed to determine the association between age and MICU and hospital mortality, as well as MICU and hospital LOS. Factors adjusted for included gender, smoking history, pre-hospitalisation functional status, ambulatory status, use of inotropes and APACHE II (m) scores (APACHE II scores were modified to exclude age points). RESULTS Multivariate analysis revealed no statistically significant relationship between age and MICU or hospital mortality and LOS. However, APACHE IIM scores were significantly related to both MICU and hospital mortality (OR, 1.1; CI, 1.07-1.14 and OR, 1.1; CI, 1.09-1.18 respectively), but did not predict MICU or hospital LOS. CONCLUSION Severity of acute illness and chronic co-morbidities, but not age, are predictors of MICU and hospital mortality in elderly ventilated patients.
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Affiliation(s)
- E Y Tang
- Department of Geriatric Medicine, Alexandra Hospital, 378 Alexandra Road, Singapore 159964.
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23
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Tan HH, Hsu LF, Kam RM, Chua T, Teo WS. A case series of sotalol-induced torsade de pointes in patients with atrial fibrillation--a tale with a twist. Ann Acad Med Singap 2003; 32:403-7. [PMID: 12854385] [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: 03/03/2023]
Abstract
INTRODUCTION Sotalol is a potent antiarrhythmic often used in patients with atrial fibrillation. However, it has been associated with a risk of provoking other potentially dangerous arrhythmias, especially if used in high doses and in patients with uncorrected electrolyte imbalance or impaired renal and cardiac function. CLINICAL PICTURE We present 4 patients with atrial fibrillation treated with sotalol who developed torsade de pointes due to marked prolongation of the QT interval. While 1 patient had renal failure, all had normal left ventricular function. One patient had been treated with sotalol for more than 10 months before developing torsade de pointes precipitated by hypokalaemia, while another had tolerated sotalol for a 3-month period before the drug was discontinued, and only developed torsade de pointes when the drug was restarted 2 years later. Significantly, the doses used in all patients were relatively low, in contrast to most other reported cases where higher doses were used. CONCLUSION As with all antiarrhythmic therapy, these cases illustrate the need for close follow-up of patients treated with sotalol, even if relatively low doses are used. In addition, patients who had previously tolerated the drug well are still susceptible to its proarrhythmic effects.
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Affiliation(s)
- H H Tan
- Department of Cardiology, National Heart Centre, Mistri Wing, 17 Third Hospital Avenue, Singapore 168752
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24
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Teo WS, Kam R, Hsu LF. Treatment of heart failure--role of biventricular pacing for heart failure not responding well to drug therapy. Singapore Med J 2003; 44:114-22. [PMID: 12953723] [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: 03/04/2023]
Abstract
OBJECTIVE Patients with heart failure may have conduction abnormalities in up to 30%, further aggravating cardiac output. Drugs worsen these abnormalities and resynchronisation therapy with biventricular pacing improves cardiac function by effecting a more coordinated and efficient ventricular contraction. We report here the technique of biventricular pacing and its results. METHODOLOGY Patients with NYHA Class III to IV heart failure, widened QRS (> or = 130 ms) complex on the ECG and impaired LVEF < or = 40% were enrolled. RESULTS Biventricular pacing was performed in 29 patients (26 males, three females) from August 1999 to December 2001. The mean age of the patients was 59.6 +/- 12.8 years and 62% had underlying ischemic heart disease. All were in NYHA class III or more. Twenty-three had LBBB, four RBBB and two had widened paced QRS complex. The QRS duration was 161 +/- 21 ms and LVEF was 22 +/- 8%. All the left ventricular leads were implanted successfully. The procedure time was 167.0 +/- 79.6 mins and the fluoroscopy time was 43.8 +/- 41.4 mins. There were no significant complications. The NYHA class improved from a mean of 3.1 to 2.0 and exercise time from 252 +/- 95 seconds to 392 +/- 152 seconds at six months post implant (p=0.049). On follow-up (one month to 28 months), 25 (86%) patients had improvement in heart failure symptoms and 26 (90%) of the patients remained alive. CONCLUSION Biventricular pacing can be safely performed and results in improvement in symptoms and exercise tolerance in heart failure patients with ventricular dyssynchrony not responding to drug therapy.
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Affiliation(s)
- W S Teo
- Department of Cardiology, National Heart Centre, Mistri Wing, 17 Third Hospital Avenue, Singapore 168752.
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25
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Tan JL, Hsu LF, Kam RML, Teo WS. Immediate and mid-term safety and efficacy of single lead VDD pacemakers for patients with atrioventricular block and normal sinus node function--a single centre experience. Ann Acad Med Singap 2003; 32:101-5. [PMID: 12625106] [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: 03/01/2023]
Abstract
INTRODUCTION Single lead atrial synchronous ventricular pacing (VDD) is increasingly being used in place of conventional dual chamber pacing (DDD) for patients with atrioventricular block and preserved sinus node function. Compared to the latter, VDD pacemakers provide similar haemodynamic benefits derived from atrial synchronous pacing, with the added benefit of an easier implant procedure. OBJECTIVE To review the use, safety and efficacy of VDD pacing in a single tertiary referral centre. MATERIALS AND METHODS A review of all patients with atrioventricular block and normal sinus node function implanted with a VDD pacemaker over a 2-year period at a local tertiary cardiac referral centre. Data on complications, atrial sensing performance and maintenance of atrioventricular synchrony during implant and at subsequent follow-up visits were obtained from a prospectively maintained registry and analysed. RESULTS Forty-one patients (17 males, 24 females) with a mean age of 72 +/- 9 years received VDD pacing for various forms of high-grade atrioventricular block. The average implantation time was 46.8 +/- 17.1 minutes, and a pneumothorax in 1 patient was the only complication. Electrical measurements at implantation and subsequent follow-up visits revealed an initial rapid decrease in atrial signal amplitude (mean atrial P wave at implant 3.1 +/- 1.1 mV, predischarge 1.9 +/- 1.3 mV) which began to stabilise after 3 months, reaching a mean atrial P wave value of 1.3 +/- 0.3 mV at 24 months. The atrial sensing performance (percentage of atrial synchronous ventricular complexes) was 97% over a mean follow-up period of 9.9 months. Four patients (10%) developed paroxysmal atrial tachyarrhythmias. Sinus node dysfunction was not observed in any of our patients during the follow-up period. CONCLUSION In patients with atrioventricular block and preserved sinus node function, single lead VDD pacing is safe and effective in maintaining a physiological atrial synchronous pacing mode.
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Affiliation(s)
- J L Tan
- Department of Cardiology, National Heart Centre, Mistri Wing, 17 Third Hospital Avenue, Singapore 168752
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26
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Hsu LF, Mak KH, Lau KW, Sim LL, Chan C, Koh TH, Chuah SC, Kam R, Ding ZP, Teo WS, Lim YL. Clinical outcomes of patients with diabetes mellitus and acute myocardial infarction treated with primary angioplasty or fibrinolysis. Heart 2002; 88:260-5. [PMID: 12181218 PMCID: PMC1767339 DOI: 10.1136/heart.88.3.260] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [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: 11/04/2022] Open
Abstract
OBJECTIVE To compare the early and late outcomes of primary percutaneous transluminal coronary angioplasty (PTCA) with fibrinolytic treatment among diabetic patients with acute myocardial infarction (AMI). DESIGN Retrospective observational study with data obtained from prospective registries. SETTING Tertiary cardiovascular institution with 24 hour acute interventional facilities. PATIENTS 202 consecutive diabetic patients with AMI receiving reperfusion treatment within six hours of symptom onset. INTERVENTIONS Fibrinolytic treatment was administered to 99 patients, and 103 patients underwent primary PTCA. Most patients undergoing PTCA received adjunctive stenting (94.2%) and glycoprotein IIb/IIIa inhibition (63.1%). MAIN OUTCOME MEASURES Death, non-fatal reinfarction, and target vessel revascularisation at 30 days and one year were assessed. RESULTS Baseline characteristics were similar in these two treatment groups except that the proportion of patients with Killip class III or IV was considerably higher in those treated with PTCA (15.5% v 6.1%, p = 0.03) and time to treatment was significantly longer (103.7 v 68.0 minutes, p < 0.001). Among those treated with PTCA, the rates for in-hospital recurrent ischaemia (5.8% v 17.2%, p = 0.011) and target vessel revascularisation at one year (19.4% v 36.4%, p = 0.007) were lower. Death or reinfarction at one year was also reduced among those treated with PTCA (17.5% v 31.3%, p = 0.02), with an adjusted relative risk of 0.29 (95% confidence interval 0.15 to 0.57) compared with fibrinolysis. CONCLUSION Among diabetic patients with AMI, primary PTCA was associated with reduced early and late adverse events compared with fibrinolytic treatment.
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Affiliation(s)
- L F Hsu
- Department of Cardiology, National Heart Centre, Singapore
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Tan CS, Hsu LF, Kam RML, Teo WS. Two case reports on incessant left ventricular tachycardia: curative therapy with radiofrequency ablation. Ann Acad Med Singap 2002; 31:111-4. [PMID: 11885485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Incessant ventricular tachycardia is a rare arrhythmia which can be life threatening. Treatment with anti-arrhythmic agents may occasionally fail. CLINICAL PICTURE We report 2 cases of incessant ventricular tachycardia. The first case was a young man with idiopathic left ventricular tachycardia who was in incessant ventricular tachycardia despite treatment with multiple anti-arrhythmic drugs and developed dilated cardiomyopathy. The second case was an asymptomatic girl with the incidental finding of an incessant ventricular tachycardia which originated from the left ventricular outflow tract. TREATMENT AND OUTCOME Both patients underwent electrophysiologic study and radiofrequency ablation with complete termination of the tachycardia. CONCLUSION Radiofrequency catheter ablation in experienced centres should be the first-line therapy for incessant ventricular tachycardia.
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Affiliation(s)
- C S Tan
- Department of Cardiology, National Heart Centre, Mistri Wing, 17 Third Hospital Avenue, Singapore 168752
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Hsu LF, Koh TH, Lim YL. Cardiac marker point-of-care testing: evaluation of rapid on-site biochemical marker analysis for diagnosis of acute myocardial infarction. Ann Acad Med Singap 2000; 29:421-7. [PMID: 11056768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Up to 40% of patients with acute myocardial infarction (AMI) present with non-diagnostic electrocardiograms (ECGs). The diagnosis in such cases is usually made with the aid of biochemical markers. Newer and more rapid assays for such markers have now enabled testing to be done on-site instead of in the laboratory. This potentially enables the clinician to rapidly diagnose and triage patients. We evaluated the diagnostic precision of this point-of-care testing strategy using one such analyser, the Stratus CS (Dade Behring) in a prospective study. MATERIALS AND METHODS The study population consisted of 51 consecutive patients admitted for suspected AMI with non-diagnostic ECGs. Two blood samples from each patient were drawn simultaneously on admission. The first sample was assayed for myoglobin, troponin I (TnI) and creatine kinase-MB (CKMB) mass by the point-of-care instrument (Stratus CS), and the second sample was sent for standard testing for AMI, comprising a troponin-T (TnT) qualitative test and the analysis of CKMB by the hospital laboratory. Utilising the recommended cut-off values for the individual assays, the results of these 2 sets of tests were evaluated based on whether they were positive or negative for AMI and compared against the patient's final diagnosis at discharge. Various combinations of markers were assessed. RESULTS On evaluation of individual markers, myoglobin was the most sensitive (75%) at 0 to 6 hours after onset of symptoms, while TnI (95%), TnT (80%) and CKMB-mass (90%) performed better at 7 to 12 hours. Point-of-care testing utilising a combination of markers was highly sensitive and specific. Both dual-marker panels of myoglobin with TnI and myoglobin with CKMB-mass yielded equivalent overall sensitivities and specificities of 90% and 95% respectively. A triple-marker panel of myoglobin, TnI and CKMB-mass had a sensitivity of 93% and specificity of 95%. All point-of-care testing panels had good positive and negative predictive values, and showed comparable diagnostic efficacy with the standard testing presently utilised for the diagnosis of AMI. The average time for results to become available was up to 26 minutes for point-of-care testing and 65 minutes for standard testing. CONCLUSION Point-of-care testing utilising a panel of 2 or 3 cardiac markers has comparable diagnostic precision to the presently utilised testing strategy for AMI, with earlier availability of results.
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Affiliation(s)
- L F Hsu
- Department of Cardiology, National Heart Centre, Singapore.
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Hsu LF, Sin Fai Lam KN, Rajasoorya C, Chew LS. Hypertension in the young adult--come feel the pulse. Singapore Med J 2000; 41:235-8. [PMID: 11063175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Hypertension occurring in teenagers and young adults is uncommon. Though the most common form is still essential hypertension, secondary causes are more commonly found here than in older adults. Renal, cardiovascular and endocrine diseases constitute most of these causes. Coarctation of the aorta is the most common cardiovascular cause of hypertension, and its importance lies in the fact that it is correctable, and that its persistence often leads to dangerous complications and early death. The cardinal sign of differential pulse and blood pressures between the upper and lower limbs can be detected clinically. Hence, the importance of a detailed physical examination in all young hypertensives, including palpation of all the pulses, cannot be overemphasized. We present 2 hypertensive young men who were found to have isolated coarctation of the aorta. The lesion in the first patient was located postductally just distal to the left subclavian artery. This area has been found to be the most common site of coarctation. The second patient had an unusual mid-thoracic coarctation. The clinical and radiological features as well as complications are highlighted. In young hypertensive patients, a high index of suspicion may enable the physician to make a timely diagnosis and hence avert the potentially disastrous complications that may arise in undetected cases.
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Affiliation(s)
- L F Hsu
- Départment of Medicine, Alexandra Hospital, Singapore
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Hsu LF, Kam RM, Teo WS. Electrocardiographic case: diagnosis of acute myocardial infarction in the presence of left bundle branch block. Singapore Med J 2000; 41:139-41. [PMID: 11063201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The electrocardiographic features associated with acute myocardial infarction (AMI) are often easily recognised. However, interpretation is made more difficult in the presence of confounding patterns such as a left bundle branch block (LBBB). This may result in missed cases which may otherwise have benefited from acute revascularisation therapy. Though not straightforward, the diagnosis of AMI in the presence of LBBB can be made with a reasonable amount of accuracy. We report a case of acute myocardial infarction with LBBB that was appropriately diagnosed and underwent acute revascularisation by angioplasty. A detailed knowledge of the typical electrocardiographic features associated with LBBB, especially the ST segment morphologies, is very important. This will greatly aid recognition of an evolving AMI and help us decide on the most appropriate therapy.
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Affiliation(s)
- L F Hsu
- Department of Cardiology, National Heart Centre, Mistri Wing, Singapore
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Hsu LF, Lee HS, Chia SE, Lam KN. Acute mercury vapour poisoning in a shipyard worker--a case report. Ann Acad Med Singap 1999; 28:294-8. [PMID: 10497687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Acute mercury vapour poisoning is a serious, potentially fatal but fortunately rarely encountered problem. It is most commonly due to industrial accidents. The vapour is a direct respiratory tract irritant as well as a cell poison, exerting its greatest effects in the lungs, nervous system, kidneys and liver. We present a case of mercury vapour poisoning in a shipyard workers presenting as an acute chemical pneumonitis, which resolved with aggressive supportive therapy. Further investigations later revealed transient mild neuropsychiatric symptoms, and residual peripheral neuropathy. No chelation therapy was instituted. The detailed investigative work that led to the discovery of the source of mercury is also presented. This case alerts us to the potential hazard to shipyard workers who may work in ships previously carrying oil contaminated with mercury. There have been no previous reports of mercury poisoning in shipyard workers. A high index of suspicion leading to early diagnosis and institution of appropriate supportive measures in suspected cases can be life-saving.
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Affiliation(s)
- L F Hsu
- Department of Medicine, Alexandra Hospital, Singapore
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Hsu LF, Rajasoorya C. A case series of Paget's disease of bone: diagnosing a rather uncommon condition in Singapore. Ann Acad Med Singap 1998; 27:289-93. [PMID: 9663329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Paget's disease of bone is an uncommon condition in the Asian population, with only 2 cases reported in medical literature so far. We discuss 5 cases of Paget's disease who presented over an 8-year period with a wide and interesting variety of clinical features. Though 4 out of the 5 patients were asymptomatic, all of them had characteristic radiological features and elevated serum alkaline phosphatase levels of varying degrees. Diagnosis was based on the clinical features, the elevated serum alkaline phosphatase levels, and most importantly, the distinctive radiographic features, which are almost pathognomonic of the condition. The incidence of Paget's disease is probably under-reported in Asia and Singapore, as it is rarely encountered and can be easily overlooked due to its usually asymptomatic and benign nature. A high index of suspicion and an active search for its typical features are thus essential for its detection.
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Affiliation(s)
- L F Hsu
- Department of Medicine, Alexandra Hospital, Singapore
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Abstract
This study examined the stability and protein binding of taxol in aqueous solution and tissue culture medium. After storage for 19 h in 1% methanolic aqueous solution, the concentration of taxol declined to about 40% in 1.5 mL glass vials, 67% in 1.5 mL polypropylene tubes, and 55% in 1.5 mL siliconized polypropylene tubes. There was no difference in the decline at two initial concentrations of 0.18 and 1.8 micrograms/mL. The concentration declines were biphasic; the initial phase showed a half-life of 1-2 min and the second phase showed a half-life of 30-350 min. A methanol wash recovered 0%, 16%, and 31% of taxol from glass vials and unsiliconized and siliconized polypropylene tubes, respectively. In culture medium without fetal bovine serum, the concentration of taxol stored in polystyrene tissue culture plates declined to 73% after 24 h, whereas no concentration decline was observed in the presence of 9% fetal bovine serum (FBS). Protein binding of taxol in FBS-containing culture medium was saturable, varying from 79% at 0.5 microgram/mL to 20% at 15 micrograms/mL. These data indicated (a) rapid and nonspecific adsorption of taxol to plastic and glass surfaces, (b) stabilization of taxol in culture medium by FBS, and (c) saturable protein binding of taxol in culture medium.
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Affiliation(s)
- D Song
- College of Pharmacy, Ohio State University, Columbus 43210, USA
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Juang JH, Hsu LF, Lin JD, Huang BY, Huang MJ, Huang HS. [Comparison of glucose reflectance meters for self-monitoring of blood glucose in diabetics]. Taiwan Yi Xue Hui Za Zhi 1987; 86:667-71. [PMID: 3655711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Zheng JR, Liu JH, Hsu LF, Gao JW, Jiang BL. [Toxicity of total glycosides in Tripterygium wilfordii]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 1983; 5:73-8. [PMID: 6226402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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