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Wong RK. First year update as cardiovascular perfusion's open access international journal. J Extra Corpor Technol 2024; 56:1. [PMID: 38488711 PMCID: PMC10941836 DOI: 10.1051/ject/2024002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
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Diao H, Dai W, Wurm D, Lu Y, Shrestha L, He A, Wong RK, Chen QM. Del Nido cardioplegia or potassium induces Nrf2 and protects cardiomyocytes against oxidative stress. Am J Physiol Cell Physiol 2023; 325:C1401-C1414. [PMID: 37842750 PMCID: PMC10861178 DOI: 10.1152/ajpcell.00436.2022] [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: 09/23/2022] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
Open heart surgery is often an unavoidable procedure for the treatment of coronary artery disease. The procedure-associated reperfusion injury affects postoperative cardiac performance and long-term outcomes. We addressed here whether cardioplegia essential for cardiopulmonary bypass surgery activates Nrf2, a transcription factor regulating the expression of antioxidant and detoxification genes. With commonly used cardioplegic solutions, high K+, low K+, Del Nido (DN), histidine-tryptophan-ketoglutarate (HTK), and Celsior (CS), we found that DN caused a significant increase of Nrf2 protein in AC16 human cardiomyocytes. Tracing the ingredients in DN led to the discovery of KCl at the concentration of 20-60 mM capable of significant Nrf2 protein induction. The antioxidant response element (ARE) luciferase reporter assays confirmed Nrf2 activation by DN or KCl. Transcriptomic profiling using RNA-seq revealed that oxidation-reduction as a main gene ontology group affected by KCl. KCl indeed elevated the expression of classical Nrf2 downstream targets, including TXNRD1, AKR1C, AKR1B1, SRXN1, and G6PD. DN or KCl-induced Nrf2 elevation is Ca2+ concentration dependent. We found that KCl decreased Nrf2 protein ubiquitination and extended the half-life of Nrf2 from 17.8 to 25.1 mins. Knocking out Keap1 blocked Nrf2 induction by K+. Nrf2 induction by DN or KCl correlates with the protection against reactive oxygen species generation or loss of viability by H2O2 treatment. Our data support that high K+ concentration in DN cardioplegic solution can induce Nrf2 protein and protect cardiomyocytes against oxidative damage.NEW & NOTEWORTHY Open heart surgery is often an unavoidable procedure for the treatment of coronary artery disease. The procedure-associated reperfusion injury affects postoperative cardiac performance and long-term outcomes. We report here that Del Nido cardioplegic solution or potassium is an effective inducer of Nrf2 transcription factor, which controls the antioxidant and detoxification response. This indicates that Del Nido solution is not only essential for open heart surgery but also exhibits cardiac protective activity.
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Affiliation(s)
- Hongting Diao
- Perfusion Sciences Graduate Program, Department of Pharmacology College of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Wujing Dai
- Perfusion Sciences Graduate Program, Department of Pharmacology College of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Daniel Wurm
- Perfusion Sciences Graduate Program, Department of Pharmacology College of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Yingying Lu
- Interdisciplinary Program in Statistics and Data Science, University of Arizona, Tucson, Arizona, United States
| | - Lenee Shrestha
- Perfusion Sciences Graduate Program, Department of Pharmacology College of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Amy He
- Perfusion Sciences Graduate Program, Department of Pharmacology College of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Raymond K Wong
- Perfusion Sciences Graduate Program, Department of Pharmacology College of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Qin M Chen
- Perfusion Sciences Graduate Program, Department of Pharmacology College of Medicine, University of Arizona, Tucson, Arizona, United States
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Wang H, Tucker WJ, Jonnagaddala J, Schutte AE, Jalaludin B, Liaw ST, Rye KA, Wong RK, Ong KL. Using machine learning to predict cardiovascular risk using self-reported questionnaires: Findings from the 45 and up study. Int J Cardiol 2023:S0167-5273(23)00723-4. [PMID: 37211050 DOI: 10.1016/j.ijcard.2023.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/07/2023] [Accepted: 05/17/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Machine learning has been shown to outperform traditional statistical methods for risk prediction model development. We aimed to develop machine learning-based risk prediction models for cardiovascular mortality and hospitalisation for ischemic heart disease (IHD) using self-reported questionnaire data. METHODS The 45 and Up Study was a retrospective population-based study in New South Wales, Australia (2005-2009). Self-reported healthcare survey data on 187,268 participants without a history of cardiovascular disease was linked to hospitalisation and mortality data. We compared different machine learning algorithms, including traditional classification methods (support vector machine (SVM), neural network, random forest and logistic regression) and survival methods (fast survival SVM, Cox regression and random survival forest). RESULTS A total of 3687 participants experienced cardiovascular mortality and 12,841 participants had IHD-related hospitalisation over a median follow-up of 10.4 years and 11.6 years respectively. The best model for cardiovascular mortality was a Cox survival regression with L1 penalty at a re-sampled case/non-case ratio of 0.3 achieved by under-sampling of the non-cases. This model had the Uno's and Harrel's concordance indexes of 0.898 and 0.900 respectively. The best model for IHD hospitalisation was a Cox survival regression with L1 penalty at a re-sampled case/non-case ratio of 1.0 with Uno's and Harrel's concordance indexes of 0.711 and 0.718 respectively. CONCLUSION Machine learning-based risk prediction models developed using self-reported questionnaire data had good prediction performance. These models may have the potential to be used in initial screening tests to identify high-risk individuals before undergoing costly investigation.
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Affiliation(s)
- Hongkuan Wang
- School of Computer Science & Engineering, University of New South Wales, Sydney, NSW, Australia
| | - William J Tucker
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
| | | | - Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia
| | - Bin Jalaludin
- School of Population Health, University of New South Wales, Sydney, NSW, Australia; Ingham Institute for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Siaw-Teng Liaw
- WHO Collaborating Centre for eHealth, School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Kerry-Anne Rye
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Raymond K Wong
- School of Computer Science & Engineering, University of New South Wales, Sydney, NSW, Australia.
| | - Kwok Leung Ong
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia.
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Wong RK, Selvanayagam J, Johnston KD, Everling S. Delay-related activity in marmoset prefrontal cortex. Cereb Cortex 2023; 33:3523-3537. [PMID: 35945687 PMCID: PMC10068290 DOI: 10.1093/cercor/bhac289] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 04/05/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Persistent delay-period activity in prefrontal cortex (PFC) has long been regarded as a neural signature of working memory (WM). Electrophysiological investigations in macaque PFC have provided much insight into WM mechanisms; however, a barrier to understanding is the fact that a portion of PFC lies buried within the principal sulcus in this species and is inaccessible for laminar electrophysiology or optical imaging. The relatively lissencephalic cortex of the New World common marmoset (Callithrix jacchus) circumvents such limitations. It remains unknown, however, whether marmoset PFC neurons exhibit persistent activity. Here, we addressed this gap by conducting wireless electrophysiological recordings in PFC of marmosets performing a delayed-match-to-location task on a home cage-based touchscreen system. As in macaques, marmoset PFC neurons exhibited sample-, delay-, and response-related activity that was directionally tuned and linked to correct task performance. Models constructed from population activity consistently and accurately predicted stimulus location throughout the delay period, supporting a framework of delay activity in which mnemonic representations are relatively stable in time. Taken together, our findings support the existence of common neural mechanisms underlying WM performance in PFC of macaques and marmosets and thus validate the marmoset as a suitable model animal for investigating the microcircuitry underlying WM.
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Affiliation(s)
- Raymond K Wong
- Graduate Program in Neuroscience, Western University, London, ON N6A 3K7, Canada
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, University of Western Ontario, London, ON N6A 5B7, Canada
| | - Janahan Selvanayagam
- Graduate Program in Neuroscience, Western University, London, ON N6A 3K7, Canada
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, University of Western Ontario, London, ON N6A 5B7, Canada
| | - Kevin D Johnston
- Graduate Program in Neuroscience, Western University, London, ON N6A 3K7, Canada
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, University of Western Ontario, London, ON N6A 5B7, Canada
- Department of Physiology and Pharmacology, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Stefan Everling
- Graduate Program in Neuroscience, Western University, London, ON N6A 3K7, Canada
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, University of Western Ontario, London, ON N6A 5B7, Canada
- Department of Physiology and Pharmacology, University of Western Ontario, London, ON N6A 3K7, Canada
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Wong RK. A brand-new era has begun for JECT. J Extra Corpor Technol 2023; 55:1-2. [PMID: 37034102 PMCID: PMC10061937 DOI: 10.1051/ject/2023006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Wong RK. New Era for JECT Announced. J Extra Corpor Technol 2022; 54:265-266. [PMID: 36742022 PMCID: PMC9891474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Wong RK. Open Access Publishing and New Perfusion Safety Initiative. J Extra Corpor Technol 2022; 54:173-174. [PMID: 36742215 PMCID: PMC9891488 DOI: 10.1182/ject-173-174] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Wong RK. Diversity and Inclusion to Reduce Disparities. J Extra Corpor Technol 2022; 54:3-4. [PMID: 36380832 PMCID: PMC9639684 DOI: 10.1182/ject-3-4] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Wong RK. Leadership and Mentoring. J Extra Corpor Technol 2021; 53:237-238. [PMID: 34992312 PMCID: PMC8717723 DOI: 10.1182/ject-53-237] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Selvanayagam J, Johnston KD, Wong RK, Schaeffer D, Everling S. Ketamine disrupts gaze patterns during face viewing in the common marmoset. J Neurophysiol 2021; 126:330-339. [PMID: 34133232 DOI: 10.1152/jn.00078.2021] [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: 01/10/2023] Open
Abstract
Faces are stimuli of critical importance for primates. The common marmoset (Callithrix jacchus) is a promising model for investigations of face processing, as this species possesses oculomotor and face-processing networks resembling those of macaques and humans. Face processing is often disrupted in neuropsychiatric conditions such as schizophrenia (SZ), and thus, it is important to recapitulate underlying circuitry dysfunction preclinically. The N-methyl-d-aspartate (NMDA) noncompetitive antagonist ketamine has been used extensively to model the cognitive symptoms of SZ. Here, we investigated the effects of a subanesthetic dose of ketamine on oculomotor behavior in marmosets during face viewing. Four marmosets received systemic ketamine or saline injections while viewing phase-scrambled or intact videos of conspecifics' faces. To evaluate effects of ketamine on scan paths during face viewing, we identified regions of interest in each face video and classified locations of saccade onsets and landing positions within these areas. A preference for the snout over eye regions was observed following ketamine administration. In addition, regions in which saccades landed could be significantly predicted by saccade onset region in the saline but not the ketamine condition. Effects on saccade control were limited to an increase in saccade peak velocity in all conditions and a reduction in saccade amplitudes during viewing of scrambled videos. Thus, ketamine induced a significant disruption of scan paths during viewing of conspecific faces but limited effects on saccade motor control. These findings support the use of ketamine in marmosets for investigating changes in neural circuits underlying social cognition in neuropsychiatric disorders.NEW & NOTEWORTHY Face processing, an important social cognitive ability, is impaired in neuropsychiatric conditions such as schizophrenia. The highly social common marmoset model presents an opportunity to investigate these impairments. We administered subanesthetic doses of ketamine to marmosets to model the cognitive symptoms of schizophrenia. We observed a disruption of scan paths during viewing of conspecifics' faces. These findings support the use of ketamine in marmosets as a model for investigating social cognition in neuropsychiatric disorders.
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Affiliation(s)
- Janahan Selvanayagam
- Graduate Program in Neuroscience, Western University, London, Ontario, Canada.,Center for Functional and Metabolic Mapping, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Kevin D Johnston
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada.,Center for Functional and Metabolic Mapping, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Raymond K Wong
- Graduate Program in Neuroscience, Western University, London, Ontario, Canada.,Center for Functional and Metabolic Mapping, Robarts Research Institute, Western University, London, Ontario, Canada
| | - David Schaeffer
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stefan Everling
- Graduate Program in Neuroscience, Western University, London, Ontario, Canada.,Department of Physiology and Pharmacology, Western University, London, Ontario, Canada.,Center for Functional and Metabolic Mapping, Robarts Research Institute, Western University, London, Ontario, Canada
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Luo S, Chu VW, Li Z, Wang Y, Zhou J, Chen F, Wong RK. Multi-task learning by hierarchical Dirichlet mixture model for sparse failure prediction. Int J Data Sci Anal 2021. [DOI: 10.1007/s41060-020-00219-z] [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: 11/29/2022]
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Wong RK. Promoting Awareness of Disparities in Perfusion Research and Reporting. J Extra Corpor Technol 2021; 53:5-6. [PMID: 33814601 PMCID: PMC7995627 DOI: 10.1182/ject-531fte] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wong RK. Academic Perfusion at Its Best and a New Tradition. J Extra Corpor Technol 2020; 52:259-260. [PMID: 33343026 PMCID: PMC7728495 DOI: 10.1182/ject-524fte] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Wong RK. Letters to the JECT Editor. J Extra Corpor Technol 2020; 52:163-164. [PMID: 32981952 PMCID: PMC7499222 DOI: 10.1182/ject-523fte] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Wong RK. Capturing Our COVID-19 Efforts. J Extra Corpor Technol 2020; 52:87. [PMID: 32669732 PMCID: PMC7332163 DOI: 10.1182/ject-522fte] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Fong IH, Li T, Fong S, Wong RK, Tallón-Ballesteros AJ. Predicting concentration levels of air pollutants by transfer learning and recurrent neural network. Knowl Based Syst 2020. [DOI: 10.1016/j.knosys.2020.105622] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lan K, Liu L, Li T, Chen Y, Fong S, Marques JAL, Wong RK, Tang R. Multi-view convolutional neural network with leader and long-tail particle swarm optimizer for enhancing heart disease and breast cancer detection. Neural Comput Appl 2020. [DOI: 10.1007/s00521-020-04769-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Qiao J, Huang X, Wang J, Wong RK. Dual-PISA: An index for aggregation operations on time series data. INFORM SYST 2020. [DOI: 10.1016/j.is.2019.101427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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K Wong R. Publication Ethics. J Extra Corpor Technol 2019; 51:193-194. [PMID: 31915401 PMCID: PMC6936310] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Wong RK. Learning about Journal Metrics. J Extra Corpor Technol 2019; 51:131-132. [PMID: 31548733 PMCID: PMC6749158] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Sweeney RE, Nguyen V, Alouidor B, Budiman E, Wong RK, Yoon JY. Flow Rate and Raspberry Pi-based Paper Microfluidic Blood Coagulation Assay Device. IEEE Sens J 2019; 19:4743-4751. [PMID: 32863779 PMCID: PMC7450985 DOI: 10.1109/jsen.2019.2902065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Monitoring blood coagulation in response to an anticoagulant (heparin) and its reversal agent (protamine) is essential during and after surgery, especially with cardiopulmonary bypass (CPB). A current clinical standard is the use of activated clotting time (ACT), where the mechanical movement of a plunger through a whole blood-filled channel is monitored to evaluate the endpoint time of coagulation. As a rapid, simple, low-volume, and cost-effective alternative, we have developed a paper microfluidic assay and Raspberry Pi-based device with the aim of quantifying the extent of blood coagulation in response to varying doses of heparin and protamine. The flow rate of blood through the paper microfluidic channel is automatically monitored using Python-coded edge detection algorithm. For each set of assay, 8 μL of fresh human whole blood (untreated and undiluted) from human subjects is loaded onto each of 8 sample pads, which have been preloaded with varying amounts of heparin or protamine. Total assay time is 3-5 minutes including the time for sample loading and incubation.
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Affiliation(s)
- Robin E Sweeney
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ 85721, USA; Unchained Labs, Pleasanton, CA, USA
| | - Vina Nguyen
- Perfusion Sciences Graduate Program, Department of Medical Pharmacology, The University of Arizona College of Medicine, Tucson, AZ 85721, USA; Pacific Life Lines, San Carlos, CA, USA
| | - Benjamin Alouidor
- Perfusion Sciences Graduate Program, Department of Medical Pharmacology, The University of Arizona College of Medicine, Tucson, AZ 85721, USA; Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Elizabeth Budiman
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ 85721, USA
| | - Raymond K Wong
- Perfusion Sciences Graduate Program, Department of Medical Pharmacology, The University of Arizona College of Medicine, Tucson, AZ 85721, USA
| | - Jeong-Yeol Yoon
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ 85721, USA`
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Wong RK. JECT Authors: a Diverse, Highly Prized Group. J Extra Corpor Technol 2019; 51:59-60. [PMID: 31239576 PMCID: PMC6586264] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Lan K, Fong S, Liu LS, Wong RK, Dey N, Millham RC, Wong KK. A clustering based variable sub-window approach using particle swarm optimisation for biomedical sensor data monitoring. ENTERP INF SYST-UK 2019. [DOI: 10.1080/17517575.2019.1597388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Kun Lan
- Department of Computer and Information Science, University of Macau, Taipa, Macau, China
| | - Simon Fong
- Department of Computer and Information Science, University of Macau, Taipa, Macau, China
| | - Lian-Sheng Liu
- First Affiliated Hospital of Guangzhou University of TCM, Guangzhou, Guangdong, China
| | - Raymond K. Wong
- School of Computer Science and Engineering, University of New South Wales, Sydney, NSW, Australia
| | - Nilanjan Dey
- Department of Information Technology, Techno India College of Technology, Kolkata, West Bengal, India
| | - Richard C. Millham
- Department of Information Technology, Durban University of Technology, Durban, South Africa
| | - Kelvin K.L. Wong
- Faculty of Mathematics and Computer Science, Quanzhou Normal University, Quanzhou, Fujian, China
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Alouidor B, Sweeney RE, Tat T, Wong RK, Yoon JY. Microfluidic Point-of-Care Ecarin-Based Clotting and Chromogenic Assays for Monitoring Direct Thrombin Inhibitors. J Extra Corpor Technol 2019; 51:29-37. [PMID: 30936586 PMCID: PMC6436170] [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] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 01/17/2019] [Indexed: 06/09/2023]
Abstract
Direct thrombin inhibitors (DTIs), such as bivalirudin and dabigatran, have maintained steady inpatient and outpatient use as substitutes for heparin and warfarin, respectively, because of their high bioavailability and relatively safe "on-therapy" range. Current clinical methods lack the capacity to directly quantify plasma DTI concentrations across wide ranges. At present, the gold standard is the ecarin clotting time (ECT), where ecarin maximizes thrombin activity and clotting time is evaluated to assess DTIs' anticoagulation capability. This work focused on the development of a microfluidic paper analytic device (µPAD) that can quantify the extent of anticoagulation as well as DTI concentration within a patient's whole blood sample. Capillary action propels a small blood sample to flow through the nitrocellulose paper channels. Digital images of whole blood migration are then captured by our self-coded Raspberry Pi and/or the Samsung Galaxy S8 smartphone camera. Both the flow length and the blue absorbance from the plasma front on the μPAD were measured, allowing simultaneous, dual assays: ecarin clotting test (ECT) and ecarin chromogenic assay (ECA). Statistically significant (p < .05) changes in flow and absorbance were observed within our translational research study. Currently, there are no quantitative, commercially available point-of-care tests for the ECT and ECA within the United States. Both the ECT and ECA assays could be instrumental to differentiate between supratherapeutic and subtherapeutic incidents during bridging anticoagulant therapy and limit the unwarranted use of reversal agents.
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Affiliation(s)
- Benjamin Alouidor
- Department of Pharmacology, Perfusion Sciences Program, College of Medicine, The University of Arizona, Tucson, Arizona; and
| | - Robin E. Sweeney
- Department of Biomedical Engineering, The University of Arizona, Tucson, Arizona
| | - Trinny Tat
- Department of Biomedical Engineering, The University of Arizona, Tucson, Arizona
| | - Raymond K. Wong
- Department of Pharmacology, Perfusion Sciences Program, College of Medicine, The University of Arizona, Tucson, Arizona; and
| | - Jeong-Yeol Yoon
- Department of Biomedical Engineering, The University of Arizona, Tucson, Arizona
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Wong RK. Introduction and Tributes. J Extra Corpor Technol 2019; 51:7-8. [PMID: 30936581 PMCID: PMC6436174] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Zhang L, Wang S, Wong RK, Yang F, Chang RN. Cognitively Adjusting Imprecise User Preferences for Service Selection. IEEE Trans Netw Serv Manage 2017. [DOI: 10.1109/tnsm.2017.2731050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Iwanski J, Knapp SM, Avery R, Oliva I, Wong RK, Runyan RB, Khalpey Z. Clinical outcomes meta-analysis: measuring subendocardial perfusion and efficacy of transmyocardial laser revascularization with nuclear imaging. J Cardiothorac Surg 2017; 12:37. [PMID: 28526044 PMCID: PMC5438520 DOI: 10.1186/s13019-017-0602-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Randomized and nonrandomized clinical trials have tried to assess whether or not TMR patients experience an increase in myocardial perfusion. However there have been inconsistencies reported in the literature due to the use of different nuclear imaging modalities to test this metric. The primary purpose of this meta-analysis was to determine whether SPECT, MUGA and PET scans demonstrate changes in myocardial perfusion between lased and non-lased subjects and whether laser type affects myocardial perfusion. The secondary purpose was to examine the overall effect of laser therapy on clinical outcomes including survival, hospital re-admission and angina reduction. METHODS Sixteen studies were included in the primary endpoint analysis after excluding all other non-imaging TMR papers. Standardized mean difference was used as the effect size for all quantitative outcomes and log odds ratio was used as the effect size for all binary outcomes. RESULTS Statistically significant improvements in myocardial perfusion were observed between control and treatment groups in myocardial perfusion at 6-month follow up using PET imaging with a porcine model. However non-significant differences were observed in patients at 3 and 12 months using SPECT, PET or MUGA scans. Both CO2 and Ho:YAG laser systems demonstrated an increase in myocardial perfusion however this effect was not statistically significant. In addition both laser types displayed statistically significant decreases in patient angina at 3, 6 and 12 months but non-significant increases in survival rates and decreases in hospital re-admissions. CONCLUSION In order to properly assess myocardial perfusion in TMR subjects, subendocardial perfusion needs to be analyzed via nuclear imaging. PET scans can provide this level of sensitivity and should be utilized in future studies to monitor and detect perfusion changes in lased and non-lased subjects.
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Affiliation(s)
- Jessika Iwanski
- Department of Medical Pharmacology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Shannon M Knapp
- BIO5 Institute, Statistics Consulting Lab, University of Arizona, Tucson, AZ, USA
| | - Ryan Avery
- Department of Nuclear Medicine, Banner University Medical Center, Medical Imaging, Tucson, AZ, USA
| | - Isabel Oliva
- Department of Nuclear Medicine, Banner University Medical Center, Medical Imaging, Tucson, AZ, USA
| | - Raymond K Wong
- Department of Medical Pharmacology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Raymond B Runyan
- Department of Cellular and Molecular Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Zain Khalpey
- Department of Medical Pharmacology, University of Arizona College of Medicine, Tucson, AZ, USA. .,Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA. .,Division of Cardiothoracic Surgery, Regenerative Medicine, Cellular & Molecular Medicine, University of Arizona College of Medicine, 1656 E. Mabel St, Rm 120, Medical Research Building, Tucson, AZ 85724, USA.
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Wang D, Fong S, Wong RK, Mohammed S, Fiaidhi J, Wong KKL. Robust High-dimensional Bioinformatics Data Streams Mining by ODR-ioVFDT. Sci Rep 2017; 7:43167. [PMID: 28230161 PMCID: PMC5322330 DOI: 10.1038/srep43167] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 10/25/2016] [Accepted: 01/20/2017] [Indexed: 11/21/2022] Open
Abstract
Outlier detection in bioinformatics data streaming mining has received significant attention by research communities in recent years. The problems of how to distinguish noise from an exception and deciding whether to discard it or to devise an extra decision path for accommodating it are causing dilemma. In this paper, we propose a novel algorithm called ODR with incrementally Optimized Very Fast Decision Tree (ODR-ioVFDT) for taking care of outliers in the progress of continuous data learning. By using an adaptive interquartile-range based identification method, a tolerance threshold is set. It is then used to judge if a data of exceptional value should be included for training or otherwise. This is different from the traditional outlier detection/removal approaches which are two separate steps in processing through the data. The proposed algorithm is tested using datasets of five bioinformatics scenarios and comparing the performance of our model and other ones without ODR. The results show that ODR-ioVFDT has better performance in classification accuracy, kappa statistics, and time consumption. The ODR-ioVFDT applied onto bioinformatics streaming data processing for detecting and quantifying the information of life phenomena, states, characters, variables and components of the organism can help to diagnose and treat disease more effectively.
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Affiliation(s)
- Dantong Wang
- Department of Computer and Information Science, Univeristy of Macau, SAR, Macau
| | - Simon Fong
- Department of Computer and Information Science, Univeristy of Macau, SAR, Macau
| | - Raymond K Wong
- School of Computer Science and Engineering, University of New South Wales, Australia
| | - Sabah Mohammed
- Department of Computer Science, Lakehead University, Thunder Bay, Canada
| | - Jinan Fiaidhi
- Department of Computer Science, Lakehead University, Thunder Bay, Canada
| | - Kelvin K L Wong
- School of Medicine, University of Western Sydney, New South Wales, Australia
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Jayaraman T, Wong RK, Drossman DA, Lee YY. Communication breakdown between physicians and IBS sufferers: what is the conundrum and how to overcome it? J R Coll Physicians Edinb 2017; 47:138-141. [DOI: 10.4997/jrcpe.2017.206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Iwanski J, Wong RK, Larson DF, Ferng AS, Runyan RB, Goldstein S, Khalpey Z. Remodeling an infarcted heart: novel hybrid treatment with transmyocardial revascularization and stem cell therapy. Springerplus 2016; 5:738. [PMID: 27376006 PMCID: PMC4909685 DOI: 10.1186/s40064-016-2355-6] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 05/17/2016] [Indexed: 01/04/2023]
Abstract
Transmyocardial revascularization (TMR) has emerged as an additional therapeutic option for patients suffering from diffuse coronary artery disease (CAD), providing immediate angina relief. Recent studies indicate that the volume of surgical cases being performed with TMR have been steadily rising, utilizing TMR as an adjunctive therapy. Therefore the purpose of this review is to provide an up-to-date appreciation of the current state of TMR and its future developmental directions on CAD treatment. The current potential of this therapy focuses on the implementation of stem cells, in order to create a synergistic angiogenic effect while increasing myocardial repair and regeneration. Although TMR procedures provide increased vascularization within the myocardium, patients suffering from ischemic cardiomyopathy may not benefit from angiogenesis alone. Therefore, the goal of introducing stem cells is to restore the functional state of a failing heart by providing these cells with a favorable microenvironment that will enhance stem cell engraftment.
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Affiliation(s)
- Jessika Iwanski
- Department of Pharmacology, University of Arizona College of Medicine, Tucson, AZ USA ; Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona College of Medicine, P.O. Box 245071, 1501N. Campbell Avenue, Tucson, AZ 85724-5071 USA
| | - Raymond K Wong
- Department of Pharmacology, University of Arizona College of Medicine, Tucson, AZ USA
| | - Douglas F Larson
- Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona College of Medicine, P.O. Box 245071, 1501N. Campbell Avenue, Tucson, AZ 85724-5071 USA
| | - Alice S Ferng
- Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona College of Medicine, P.O. Box 245071, 1501N. Campbell Avenue, Tucson, AZ 85724-5071 USA ; Department of Physiological Sciences, University of Arizona College of Medicine, Tucson, AZ USA
| | - Raymond B Runyan
- Department of Cellular and Molecular Medicine, University of Arizona College of Medicine, Tucson, AZ USA
| | | | - Zain Khalpey
- Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona College of Medicine, P.O. Box 245071, 1501N. Campbell Avenue, Tucson, AZ 85724-5071 USA ; Department of Physiological Sciences, University of Arizona College of Medicine, Tucson, AZ USA ; Banner University Medical Center, 1501N. Campbell Avenue, Room 4302A, Tucson, AZ 85724 USA ; Medical Research Building, 1656 E. Mabel St, Rm 120, Tucson, AZ USA
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Li J, Liu LS, Fong S, Wong RK, Mohammed S, Fiaidhi J, Sung Y, Wong KKL. WITHDRAWN: Adaptive Swarm Balancing Algorithms for rare-event prediction in imbalanced healthcare data. Comput Med Imaging Graph 2016:S0895-6111(16)30037-4. [PMID: 27236411 DOI: 10.1016/j.compmedimag.2016.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/27/2016] [Accepted: 05/05/2016] [Indexed: 11/25/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Jinyan Li
- Department of Computer and Information Science, University of Macau, Taipa, Macao.
| | - Lian-Sheng Liu
- First Affiliated Hospital of Guangzhou University of TCM, Guangzhou 510405, Guangdong, China.
| | - Simon Fong
- Department of Computer and Information Science, University of Macau, Taipa, Macao.
| | - Raymond K Wong
- School of Computer Science and Engineering, University of New South Wales, Sydney, NSW 2000, Australia.
| | - Sabah Mohammed
- Department of Computer Science, Lakehead University, Thunder Bay, Canada.
| | - Jinan Fiaidhi
- Department of Computer Science, Lakehead University, Thunder Bay, Canada.
| | - Yunsick Sung
- Computer Engineering Division, Keimyung University, Daegu, South Korea.
| | - Kelvin K L Wong
- School of Medicine, University of Western Sydney, New South Wales, Australia.
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Tran PL, Pietropaolo MG, Valerio L, Brengle W, Wong RK, Kazui T, Khalpey ZI, Redaelli A, Sheriff J, Bluestein D, Slepian MJ. Hemolysate-mediated platelet aggregation: an additional risk mechanism contributing to thrombosis of continuous flow ventricular assist devices. Perfusion 2015; 31:401-8. [PMID: 26590166 DOI: 10.1177/0267659115615206] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 11/16/2022]
Abstract
Despite the clinical success and growth in the utilization of continuous flow ventricular assist devices (cfVADs) for the treatment of advanced heart failure, hemolysis and thrombosis remain major limitations. Inadequate and/or ineffective anticoagulation regimens, combined with high pump speed and non-physiological flow patterns, can result in hemolysis which often is accompanied by pump thrombosis. An unexpected increase in cfVADs thrombosis was reported by multiple major VAD implanting centers in 2014, highlighting the association of hemolysis and a rise in lactate dehydrogenase (LDH) presaging thrombotic events. It is well established that thrombotic complications arise from the abnormal shear stresses generated by cfVADs. What remains unknown is the link between cfVAD-associated hemolysis and pump thrombosis. Can hemolysis of red blood cells (RBCs) contribute to platelet aggregation, thereby, facilitating prothrombotic complications in cfVADs? Herein, we examine the effect of RBC-hemolysate and selected major constituents, i.e., lactate dehydrogenase (LDH) and plasma free hemoglobin (pHb) on platelet aggregation, utilizing electrical resistance aggregometry. Our hypothesis is that elements of RBCs, released as a result of shear-mediated hemolysis, will contribute to platelet aggregation. We show that RBC hemolysate and pHb, but not LDH, are direct contributors to platelet aggregation, posing an additional risk mechanism for cfVAD thrombosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Marvin J Slepian
- University of Arizona, Tucson, AZ, USA Stony Brook University, Stony Brook, NY, USA
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Tran PL, Kazui T, Perovic V, Mikail P, Lick S, Smith R, Betterton EW, Venkat R, Iwanski J, Wong RK, Slepian MJ, Khalpey Z. Case Report: Disparate flow in HeartMate II patient with extensive left ventricle repair. Perfusion 2015; 31:349-52. [PMID: 26531760 DOI: 10.1177/0267659115614639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This case study reports the operative management of a 63-year-old male patient following implantation of the HeartMate II (HMII) left ventricular assist device (LVAD), with a non-compliant left ventricle (LV) and a reduced right ventricular (RV) end-diastolic volume. Intraoperatively, the patient had a thin, fragile LV wall with laminated clot; a ventricular septal defect was encountered during removal of the clot. Along with an aortic valve repair, the LV and the septum were reconstructed with multiple bovine pericardium patches, thus, moderately reducing the RV and LV stroke volume. A difference in cardiac output via a Swan-Ganz catheter (approximately 1.5 l/min) was observed as opposed to the HMII's estimated flow. The result was later replicated and verified ITALIC! in vitrovia the Donovan Mock Circulation System (DMCS), where about 2 l/min lower flow on the HMII system was observed. In conclusion, the HMII flow rate displayed can be inaccurate and should only be used for trending.
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Affiliation(s)
- Phat L Tran
- Department of Medicine, University of Arizona, Tucson, AZ, USA Artificial Heart Program, University of Arizona, Tucson, AZ, USA Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Toshinobu Kazui
- Artificial Heart Program, University of Arizona, Tucson, AZ, USA CardioThoracic Surgery, University of Arizona, Tucson, AZ, USA
| | - Viktor Perovic
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Philmon Mikail
- Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - Scott Lick
- Department of Medicine, University of Arizona, Tucson, AZ, USA Artificial Heart Program, University of Arizona, Tucson, AZ, USA CardioThoracic Surgery, University of Arizona, Tucson, AZ, USA
| | - Richard Smith
- Artificial Heart Program, University of Arizona, Tucson, AZ, USA CardioThoracic Surgery, University of Arizona, Tucson, AZ, USA
| | | | - Raj Venkat
- Artificial Heart Program, University of Arizona, Tucson, AZ, USA
| | - Jessika Iwanski
- Artificial Heart Program, University of Arizona, Tucson, AZ, USA Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Raymond K Wong
- Artificial Heart Program, University of Arizona, Tucson, AZ, USA Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Marvin J Slepian
- Department of Medicine, University of Arizona, Tucson, AZ, USA Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - Zain Khalpey
- Department of Medicine, University of Arizona, Tucson, AZ, USA Artificial Heart Program, University of Arizona, Tucson, AZ, USA CardioThoracic Surgery, University of Arizona, Tucson, AZ, USA Biomedical Engineering, University of Arizona, Tucson, AZ, USA
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Wilder-Smith CH, Li X, Shen L, Cao Y, Ho KY, Wong RK. Dysfunctional endogenous pain modulation in patients with functional dyspepsia. Neurogastroenterol Motil 2014; 26:489-98. [PMID: 24351013 DOI: 10.1111/nmo.12291] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 11/23/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endogenous pain modulation (EPM) is central to the processing of sensory information. Visceral and somatic EPM are abnormal in irritable bowel syndrome, but have not been studied in functional dyspepsia (FD). METHODS Visceral EPM was assessed in 34 FD patients and 42 healthy controls. Gastric pain was induced with oral capsaicin and EPM was studied by adding heterotopic thermal foot stimulation or distraction by STROOP test. Somatic EPM was assessed using foot heat stimulation with heterotopic hand electrical stimulation. KEY RESULTS Endogenous pain modulation by distraction reduced mean gastric pain by 11.9 on the 0-100 visual analog scale (95% CI: 3.8-20.1) in controls (p = 0.006) and by 2.0 (-6.18 to 10.44) in FD (p = 0.6), with greater EPM in controls than in FD (difference -13.3 [-26.1 to -0.5]; p = 0.04). Endogenous pain modulation by heterotopic foot stimulation reduced gastric pain by 6.5 (-0.7 to 13.6) in controls (p = 0.07) and by 7.1 (-2.29 to 16.47) in FD (p = 0.1), with no significant difference in EPM between controls and FD (-2.0 [-14.5 to 10.5]; p = 0.75). In patients with prominent FD pain, greater pain correlated with decreased visceral EPM by distraction (r = 0.51, p = 0.04). Somatic EPM by heterotopic stimulation significantly decreased foot pain in controls (p = 0.004), but not in FD (p = 0.80). CONCLUSIONS & INFERENCES In FD, visceral pain modulation by distraction was dysfunctional compared to controls. Somatic pain modulation was also decreased in FD. These data and the correlation of abnormal pain modulation by distraction with clinical pain in pain-predominant FD suggest a potential pathophysiological significance of abnormal pain modulation in FD.
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Affiliation(s)
- C H Wilder-Smith
- Brain-Gut Research Group, Bern, Switzerland; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Li X, Kan EM, Lu J, Cao Y, Wong RK, Keshavarzian A, Wilder-Smith CH. Combat-training increases intestinal permeability, immune activation and gastrointestinal symptoms in soldiers. Aliment Pharmacol Ther 2013; 37:799-809. [PMID: 23432460 DOI: 10.1111/apt.12269] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [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: 07/16/2012] [Revised: 07/30/2012] [Accepted: 02/07/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Gastrointestinal (GI) symptoms are common in soldiers in combat or high-pressure operational situations and often lead to compromised performance. Underlying mechanisms are unclear, but neuroendocrine dysregulation, immune activation and increased intestinal permeability may be involved in stress-related GI dysfunction. AIM To study the effects of prolonged, intense, mixed psychological and physical stress on intestinal permeability, systemic inflammatory and stress markers in soldiers during high-intensity combat-training. METHODS In 37 male army medical rapid response troops, GI symptoms, stress markers, segmental intestinal permeability using the 4-sugar test (sucrose, lactulose, mannitol and sucralose) and immune activation were assessed during the 4th week of an intense combat-training and a rest period. RESULTS Combat-training elicited higher stress, anxiety and depression scores (all P < 0.01) as well as greater incidence and severity of GI symptoms [irritable bowel syndrome symptom severity score (IBS-SSS), P < 0.05] compared with rest. The IBS-SSS correlated with depression (r = 0.41, P < 0.01) and stress (r = 0.40, P < 0.01) ratings. Serum levels of cortisol, interleukin-6, and tumour necrosis factor-α, and segmental GI permeability increased during combat-training compared with rest (all P < 0.05). The lactulose:mannitol ratio was higher in soldiers with GI symptoms (IBS-SSS ≥75) during combat-training than those without (IBS-SSS <75) (P < 0.05). CONCLUSIONS Prolonged combat-training not only induces the expected increases in stress, anxiety and depression, but also GI symptoms, pro-inflammatory immune activation and increased intestinal permeability. Identification of subgroups of individuals at high-risk of GI compromise and of long-term deleterious effects of operational stress as well as the development of protective measures will be the focus of future studies.
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Affiliation(s)
- X Li
- Neurogastroenterology Research Unit, Department of Medicine, National University of Singapore, Singapore
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Abstract
Esophageal dilation is an effective therapy for dysphagia in patients with stenosing eosinophilic esophagitis (EoE). Historically, there have been significant concerns of increased perforation rates when dilating EoE patients. More recent studies suggest that improved techniques and increased awareness have decreased complication rates. The aim of this study was to explore the safety of dilation in our population of EoE patients. A retrospective review of all adult EoE patients enrolled in a registry from 2006 to 2010 was performed. All patients who underwent esophageal dilation during this time period were identified and included in the analysis. Our hospital inpatient/outpatient medical records, radiology reports, and endoscopy reports were searched for evidence of any complication following dilation. Perforation, hemorrhage, and hospitalization were identified as a major complication, and chest pain was considered a minor complication. One hundred and ninety-six patients (41 years [12]; mean age [standard deviation], 80% white, 85% male) were identified. In this cohort, 54 patients (28%) underwent 66 total dilations (seven patients underwent two dilations, one patient underwent three dilations, and one patient underwent four dilations). Three dilation techniques were used (Maloney [24], Savary [29] and through-the-scope [13]). There were no major complications encountered. Chest pain was noted in two patients (4%). There were no endoscopic features (rings, furrows, plaques) associated with any complication. Type of dilator, size of dilator, number of prior dilations, and age of patient were also not associated with complications. Endoscopic dilation using a variety of dilators can be safely performed with minimal complications in patients with EoE.
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Affiliation(s)
- M R Ally
- Gastroenterology Service General Internal Medicine Service, Department of Medicine, Walter Reed National Military Medical Center Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA.
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Hicks RP, Abercrombie JJ, Wong RK, Leung KP. Antimicrobial peptides containing unnatural amino acid exhibit potent bactericidal activity against ESKAPE pathogens. Bioorg Med Chem 2012. [PMID: 23199484 DOI: 10.1016/j.bmc.2012.10.039] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A series of 36 synthetic antimicrobial peptides containing unnatural amino acids were screened to determine their effectiveness to treat Enterococcus faecium, Staphylococcus aureus, Klebsiella pnemoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species (ESKAPE) pathogens, which are known to commonly infect chronic wounds. The primary amino acid sequences of these peptides incorporate either three or six dipeptide units consisting of the unnatural amino acids Tetrahydroisoquinolinecarboxylic acid (Tic) and Octahydroindolecarboxylic acid (Oic). The Tic-Oic dipeptide units are separated by SPACER amino acids with specific physicochemical properties that control how these peptides interact with bacterial cell membranes of different chemical compositions. These peptides exhibited minimum inhibitory concentrations (MIC) against these pathogens in the range from >100 to 6.25 μg/mL. The observed diversity of MIC values for these peptides against the various bacterial strains are consistent with our hypothesis that the complementarity of the physicochemical properties of the peptide and the lipid of the bacteria's cell membrane determines the resulting antibacterial activity of the peptide.
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Affiliation(s)
- R P Hicks
- Department of Chemistry, East Carolina University, Science and Technology Building, Greenville, NC 27858, USA
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Wong RK, Drossman DA. Commentary: short-term stability of subtypes in the irritable bowel syndrome. Aliment Pharmacol Ther 2012; 35:849-50; discussion 850-1. [PMID: 22404408 DOI: 10.1111/j.1365-2036.2012.05004.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- R K Wong
- Gastroenterology & Hepatology, National University Health System, Singapore, Singapore
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Affiliation(s)
- Mohammad Q Najib
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
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Mookadam F, Kendall CB, Wong RK, Kalya A, Warsame T, Arabia FA, Lusk J, Moustafa S, Steidley E, Quader N, Chandrasekaran K. Left ventricular assist devices: physiologic assessment using echocardiography for management and optimization. Ultrasound Med Biol 2012; 38:335-345. [PMID: 22230137 DOI: 10.1016/j.ultrasmedbio.2011.11.009] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 10/12/2011] [Accepted: 11/15/2011] [Indexed: 05/31/2023]
Abstract
Left ventricular assist devices (LVAD) are being deployed increasingly in patients with severe left ventricular dysfunction and medically refractory congestive heart failure of any etiology. The United States Food and Drug Administration (FDA) recently approved the use of the Thoratec Heartmate II (Thoratec Corporation, Pleasanton, CA, USA) for outpatient use. Echocardiography is fundamental during each stage of patient management, pre-LVAD placement, during LVAD placement, for postoperative LVAD optimization and long-term follow-up. We present a pragmatic and systematic echocardiographic approach that serves as a guide for the management of left ventricular assist devices.
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Affiliation(s)
- Farouk Mookadam
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA.
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Wei A, Fascetti AJ, Villaverde C, Wong RK, Ramsey JJ. Effect of water content in a canned food on voluntary food intake and body weight in cats. Am J Vet Res 2011; 72:918-23. [DOI: 10.2460/ajvr.72.7.918] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wong RK, Sleep JR, Visner AJ, Raasch DJ, Lanza LA, DeValeria PA, Torloni AS, Arabia FA. Thrombography reveals thrombin generation potential continues to deteriorate following cardiopulmonary bypass surgery despite adequate hemostasis. J Extra Corpor Technol 2011; 43:19-25. [PMID: 21449230 PMCID: PMC4680086] [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] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 12/14/2010] [Indexed: 05/30/2023]
Abstract
The intrinsic and extrinsic activation pathways of the hemostatic system converge when prothrombin is converted to thrombin. The ability to generate an adequate thrombin burst is the most central aspect of the coagulation cascade. The thrombin-generating potential in patients following cardiopulmonary bypass (CPB) may be indicative of their hemostatic status. In this report, thrombography, a unique technique for directly measuring the potential of patients' blood samples to generate adequate thrombin bursts, is used to characterize the coagulopathic profile in post-CPB patients. Post-CPB hemostasis is typically achieved with protamine reversal of heparin anticoagulation and occasionally supplemented with blood product component transfusions. In this pilot study, platelet poor plasma samples were derived from 11 primary cardiac surgery patients at five time points: prior to CPB, immediately post-protamine, upon arrival to the intensive care unit (ICU), 3 hours post-ICU admission, and 24 hours after ICU arrival. Thrombography revealed that the Endogenous Thrombin Potential (ETP) was not different between [Baseline] and [PostProtamine] but proceeded to deteriorate in the immediate postoperative period. At the [3HourPostICU] time point, the ETP was significantly lower than the [Baseline] values, 1233 +/- 591 versus 595 +/- 379 nM.min (mean +/- SD; n=9, p < .005), despite continued adequacy of hemostasis. ETPs returned to baseline values the day after surgery. Transfusions received, conventional blood coagulation testing results, and blood loss volumes are also presented. Despite adequate hemostasis, thrombography reveals an underlying coagulopathic process that could put some cardiac surgical patients at risk for postoperative bleeding. Thrombography is a novel technique that could be developed into a useful tool for perfusionists and physicians to identify coagulopathies and optimize blood management following CPB.
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Affiliation(s)
- Raymond K Wong
- Surgical Services, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
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Penev A, Wong RK. Structure vs. content in hierarchical corpora. INFORM RETRIEVAL J 2010. [DOI: 10.1007/s10791-010-9132-x] [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: 11/30/2022]
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Sagar SM, Wong RK, Lee P, Chen B, Yi G, Cook R. A phase II randomised study of acupuncture-like transcutaneous nerve stimulation (ALTENS) for the prevention of radiation-induced xerostomia in patients receiving radical radiotherapy for head and neck cancer. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.2042-7166.2007.tb05914.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Traditional Chinese Medicine (tcm) may be integrated with conventional Western medicine to enhance the care of patients with cancer. Although tcm is normally implemented as a whole system, recent reductionist research suggests mechanisms for the effects of acupuncture, herbs, and nutrition within the scientific model of biomedicine. The health model of Chinese medicine accommodates physical and pharmacologic interventions within the framework of a body–mind network. A Cartesian split does not occur within this model, but to allow for scientific exploration within the restrictions of positivism, reductionism, and controls for confounding factors, the components must necessarily be separated. Still, whole-systems research is important to evaluate effectiveness when applying the full model in clinical practice. Scientific analysis provides a mechanistic understanding of the processes that will improve the design of clinical studies and enhance safety. Enough preliminary evidence is available to encourage quality clinical trials to evaluate the efficacy of integrating tcm into Western cancer care.
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Affiliation(s)
- S M Sagar
- Departments of Oncology and Medicine, McMaster University; Juravinski Cancer Program, Hamilton Health Sciences Corporation; and The Brain-Body Institute, St. Joseph's Healthcare System, Hamilton, ON.
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Jaroszewski DE, Halabi WJ, Blair JE, Coakley BJ, Wong RK, Parish JM, Vaszar LT, Kusne S, Vikram HR, DeValeria PA, Lanza LA, Arabia FA. Surgery for Pulmonary Coccidioidomycosis: A 10-Year Experience. Ann Thorac Surg 2009; 88:1765-72. [DOI: 10.1016/j.athoracsur.2009.07.075] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 07/27/2009] [Accepted: 07/28/2009] [Indexed: 10/20/2022]
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Abstract
BACKGROUND/AIMS To determine the incidence, clinical presentation and histopathological profile of patients developing orbital recurrence following enucleation for retinoblastoma. METHODS A cohort of 1674 consecutive patients undergoing enucleations between 1914 and 2006 was retrospectively reviewed to identify cases of orbital recurrence. A detailed chart review of all identified patients with orbital recurrence following enucleation was performed. The main outcome measures were histopathological features of the enucleated globe, clinical presentation, status of metastatic disease and clinical outcomes of treatment at last follow-up. RESULTS There were 71 cases of orbital recurrence identified in the study, for an incidence of 4.2% (71 of 1674 cases). The diagnosis of orbital recurrence was made between 1 and 24 months after enucleation (mean 6 months), with 69 of the 71 patients (97%) being diagnosed within the first 12 months. Over a follow-up period of 3-208 months (mean 34.8 months), 60 of 71 patients developed metastatic disease (85%), and 53 of 71 patients died from metastatic retinoblastoma (75%). For the subgroup of cases diagnosed as having orbital recurrences after 1984, 10 of 11 patients (91%) are alive and well. CONCLUSIONS All patients undergoing enucleation for retinoblastoma need to be followed carefully for the first 2 years after surgery for the possibility of orbital relapse. The majority of retinoblastoma patients with orbital tumour recurrence develop systemic metastatic disease, although mortalities appear to be improving in the modern era.
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Affiliation(s)
- J W Kim
- Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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