Background: Contrast nephropathy (CIN) post percutaneous coronary intervention (PCI) increases ad... more Background: Contrast nephropathy (CIN) post percutaneous coronary intervention (PCI) increases adverse clinical outcomes. We examine and compare the risks and clinical predictors of CIN among patients who undergo primary versus elective PCI and the effectiveness of prophylactic treatments. Methods: A cohort of 8798 patients who underwent PCI from May 1996 to April 2008 were enrolled. We divided patients into 3 groups(Grp). A: STEMI patient undergoing primary PCI. B: NSTEMI patients undergoing early elective PCI. C: stable patients without myocardial infarction(MI) undergoing elective PCI. Prophylactic saline hydration and oral N-acetylcysteine (NAC) treatment were given to Grp B and C if they have baseline renal impairment (glomerular filtration rate, GFR ≤60ml/min/1.73m 2 ). Grp A patients were unable to receive pre-PCI prophylaxis due to emergency situation. The occurrence of CIN and mortality were compared among 3 grps. Results: Mean age was 57.4±11.1 years. 3146(35.9%) were diab...
Additional file 1: Supplementary Table 1. Quality assessment using the ROBIN-1 tool. Supplementar... more Additional file 1: Supplementary Table 1. Quality assessment using the ROBIN-1 tool. Supplementary Table 2. Presentation, etiology, definition of success and duct disruption, and the site of disruption. Supplementary Table 3. The number of patients who underwent endoscopic drainage (total, transpapillary, transmural, and combined modality), duration of transmural stent placement, number of successes for each type of endoscopic drainage and procedural-related complication. Supplementary Table 4. The number of relevant patients, the number of each type of surgery that was performed, prior therapy before surgery, umber of successes with each surgical intervention, and procedure-related complications. Supplementary Table 5. Presentation, number of interventions, concomitant therapy, duration of drainage, number of successes, and complication of patients treated by percutaneous drainage. Supplementary Fig 1. Weighted rates of success for transmural drainage with endoscopic ultrasound (EU...
Background: Contrast induced nephropathy (CIN) is an important complication post percutaneous cor... more Background: Contrast induced nephropathy (CIN) is an important complication post percutaneous coronary intervention (PCI). We examine the risk factors for developing CIN in patients with normal baseline renal function so that prophylactic measures may be undertaken to prevent its development. Methods: A cohort of 5086 patients with normal baseline renal function (defined as serum creatinine <1.5mg/dl) who did not receive prophylactic treatment while undergoing PCI (primary or elective) between May 1996 to March 2007 in our centre was enrolled in the study. We examine the occurrence of CIN (defined as >25% increase from baseline creatinine within 48 hours post PCI) in 3036 subjects of this cohort with available creatinine data and aim to identify the clinical predictors. Results: CIN occurred in 7.3% of the patients. The mean age of these patients was 57.5 yrs, 78.7% were men, and 34.6% had diabetes mellitus. Clinical predictors for CIN were age (OR 6.4, 95% CI 0.1–13.3, p=0.04...
"A randomized, multicenter, placebo-controlled clinical trial of racotumomab-alum vaccine as swit... more "A randomized, multicenter, placebo-controlled clinical trial of racotumomab-alum vaccine as switch maintenance therapy in advanced non-small-cell-lung cancer patients"
Background: Oxidative stress has been implicated in the pathogenesis of acute pancreatitis (AP), ... more Background: Oxidative stress has been implicated in the pathogenesis of acute pancreatitis (AP), and ascorbic acid (AA), as an important endogenous antioxidant substance, has been shown to reduce AP severity in preclinical studies. However, the effects of AA supplementation in clinical settings remain controversial.Methods: PubMed, EMBASE, MEDLINE, and SCOPUS databases were searched, and both preclinical and clinical studies were included. For clinical trials, the primary outcome was incidence of organ failure, and for preclinical studies, the primary outcome was histopathological scores of pancreatic injuries.Results: Meta-analysis of clinical trials showed that compared with controls, AA administration did not reduce the incidence of organ failure or mortality during hospitalization but was associated with significantly reduced length of hospital stay. Meta-analysis of preclinical studies showed that AA supplementation reduced pancreatic injury, demonstrated as decreased histologi...
Background The present systematic review aimed to compare survival outcomes of invasive intraduct... more Background The present systematic review aimed to compare survival outcomes of invasive intraductal papillary mucinous neoplasms (IIPMNs) treated with adjuvant chemotherapy versus surgery alone and to identify pathologic features that may predict survival benefit from adjuvant chemotherapy. Method A systematic search of MEDLINE, PubMed, Scopus, and EMBASE was performed using the PRISMA framework. Studies comparing adjuvant chemotherapy and surgery alone for patients with IIPMNs were included. Primary endpoint was overall survival (OS). A narrative synthesis was performed to identify pathologic features that predicted survival benefits from adjuvant chemotherapy. Results Eleven studies and 3393 patients with IIPMNs were included in the meta-analysis. Adjuvant chemotherapy significantly reduced the risk of death in the overall cohort (HR 0.57, 95% CI 0.38–0.87, p = 0.009) and node-positive patients (HR 0.29, 95% CI 0.13–0.64, p = 0.002). Weighted median survival difference between adj...
Background: The prognostic significance and the optimal treatment strategy for patients with atri... more Background: The prognostic significance and the optimal treatment strategy for patients with atrial fibrillation (AF) and heart failure (HF) remain controversial. Methods: We extracted data from a large prospective national database involving Taiwanese patients with AF who were hospitalized for acute HF with reduced ejection fraction. Baseline characteristics, AF types, medications, and 1-year outcomes of the patients were analyzed. Results: At baseline, 393 (26%) patients had AF, including 117 (29.8%) patients with paroxysmal AF (PAF) and 276 (70.2%) with nonparoxysmal AF (N-PAF). Patients with PAF were more likely to have ischemic cardiomyopathy (47.3% vs 29.7%, p = 0.021), chronic kidney disease (46.2% vs 29.0%, p = 0.001), and higher CHA 2 DS 2-VASc score (4.0 vs 3.6, p = 0.033) compared with patients with N-PAF; however, patients with N-PAF had larger left atrial diameter (50.5 vs 47.3 mm, p = 0.004) than patients with PAF. Patients with PAF were more likely to receive treatment with amiodarone (31.6% vs 13.8%, p < 0.001) and antiplatelet agents (54.1% vs 42.5%, p = 0.041) but less likely to receive treatment with renin-angiotensin system blockers (52.3% vs 64.9%, p = 0.021) and anticoagulants (33.3% vs 50%, p = 0.003) compared with patients with N-PAF at discharge. The 1-year mortality (26.2% vs 16.5%, p = 0.024) and non-HF-related death rates (13.1% vs 5%, p = 0.005) were significantly higher in patients with PAF, whereas HF and arrhythmic death rates were similar in both groups (13.1% vs 11.5%). Conclusion: Among patients with HF complicated with AF, those with PAF were more likely to receive antiarrhythmic agents, less likely to receive guideline-recommended therapy, but developed worse 1-year outcome compared with patients with N-PAF. These findings further emphasize the importance of optimal guideline-recommended medical therapy in patients with HF.
Journal of the Chinese Medical Association : JCMA, 2017
Heart failure (HF) is a global health problem. Guidelines for the management of HF have been esta... more Heart failure (HF) is a global health problem. Guidelines for the management of HF have been established in Western countries and in Taiwan. However, data from the Taiwan Society of Cardiology-Heart Failure with reduced Ejection Fraction (TSOC-HFrEF) registry showed suboptimal prescription of guideline-recommended medications. We aimed to analyze the reason of non-prescription and clinical outcomes as a result of under-prescription of medications. A total of 1509 patients hospitalized for acute HFrEF were recruited in 21 hospitals in Taiwan by the end of October 2014. Prescribed guideline-recommended medications and other relevant clinical parameters were collected and analyzed at discharge and 1 year after index hospitalization. At discharge, 62% of patients were prescribed with either angiotensin-converting enzyme-inhibitors (ACEI) or angiotensin receptor blockers (ARB); 60% were prescribed with beta-blockers and 49% were prescribed with mineralocorticoid receptor antagonists (MRA...
A 60-year-old Caucasian man underwent implantation of a biventricular implantable cardioverter de... more A 60-year-old Caucasian man underwent implantation of a biventricular implantable cardioverter defibrillator (ICD) for primary prevention of his underlying severe ischaemic cardiomyopathy. One year later, he presented with a problem of leftventricular lead failure. He also received inappropriate ICD shocks as a result of poor R-wave sensing in the ventricular leads and double counting from the right atrium. A chest x-ray (CXR) (figures 1, 2) showed that the right-ventricular shock lead was displaced to the right atrium, and the right atrial lead was displaced into the superior vena cava. The left-ventricular lead could not be identified in the CXR. During device extraction, the displaced leads and heavily twisted leads around the ICD box were identified via the fluoroscopy. The left-ventricular lead was retracted into the ICD pocket and was completely displaced out of the venous system. There were extensive coiling and retracting of all three ICD leads within the pocket. This was a classical manifestation of Twiddler 's syndrome (figure 3). 1 2 Twiddler's syndrome is a clinical condition that is commonly caused by excessive twisting of the pacemaker or ICD device in the pocket, resulting in dislodgement of leads and device malfunction. Laser-lead extraction was performed successfully in this patient, and a single-chamber ICD was subsequently implanted. The cause of Twiddler 's syndrome in this patient could be due to an improper implantation technique resulting in a pocket that was too large, thus causing the device to twist and subsequent removal of the leads. In addition, the patient had a history of psychiatric disorder; self-inflicted twisting of the ICD device could thus be another cause.
ScienceDirect jo urnal homepage: www .e lsev ie r. co m/ lo cate/ I PE J i n d i a n p a c i n g ... more ScienceDirect jo urnal homepage: www .e lsev ie r. co m/ lo cate/ I PE J i n d i a n p a c i n g a n d e l e c t r o p h y s i o l o g y j o u r n a l 1 5 (2 0 1 5) 2 5 5 e2 5 8
N-acetylcysteine (NAC) and sodium bicarbonate (SOB) therapies may prevent contrast-induced nephro... more N-acetylcysteine (NAC) and sodium bicarbonate (SOB) therapies may prevent contrast-induced nephropathy (CIN). However, the efficacy of using combination over individual therapies was not established, and there was no large randomised study comparing abbreviated SOB therapy with conventional sustained saline pre-hydration with oral NAC. In a multi-centre, open-label, randomised, controlled trial (NCT00497328), we prospectively enrolled 548 patients with at least moderate renal impairment undergoing cardiac catheterisation with or without percutaneous coronary intervention. Patients were randomly assigned to 3 groups: 1) NAC: 154mEq/L sustained sodium chloride regime (1mL/kg/h 12h before, during and 6h after the procedure) with oral NAC at 1.2g bid for 3days (n=185); 2) SOB: 154mEq/L abbreviated SOB regime at 3mL/kg/h 1h before the procedure, and 1mL/kg/h during and 6h after the procedure (n=182); and 3) COM: combination of abbreviated SOB regime and oral NAC (n=181). The primary end point was incidence of CIN. The secondary end points were rise in serum creatinine, hospitalisation duration, haemodialysis, morbidity and mortality within 30days. The 3 groups had similar baseline characteristics: age 68±10years, 76% male, 48% diabetic and baseline glomerular filtration rate (GFR) 47.7±13.0mL/min. There were 41 (8.8%) patients with GFR&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30. The CIN incidences were NAC 6.5%, SOB 12.8% and COM 10.6%. The COM regimen was not superior to either the NAC (relative risk (RR)=1.61, 95% confidence interval (CI): 0.76 to 3.45, p=0.225) or SOB (RR=0.83, 95% CI: 0.44 to 1.56, p=0.593) regimens. The CIN incidence was lower in the NAC group than the SOB group (adjusted odds ratio (OR)=0.40, 95% CI: 0.17 to 0.92; p=0.032). Multivariate analysis showed contrast volume (OR=1.99, 95% CI: 1.33 to 2.96, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 per 100mL), female (OR=2.47, 95% CI: 1.22 to 5.00, p=0.012) and diabetes (OR=2.03, 95% CI: 1.03 to 3.99, p=0.041) were independent risk predictors. There were no differences in the secondary outcomes among the 3 groups. The combination regimen was not superior to individual regimens in preventing CIN in patients with baseline renal impairment. There was a trend suggesting that the 12-hour sustained sodium chloride pre-hydration regimen was more protective than the 1-hour abbreviated SOB regimen.
Annals of the Academy of Medicine, Singapore, 2012
A 77-year-old Indian man who was an ex-smoker has a medical history of hypertension, hyperlipidae... more A 77-year-old Indian man who was an ex-smoker has a medical history of hypertension, hyperlipidaemia, previous cerebral lacunar infarct and temporal (giant cell) arteritis which was complicated by optic neuritis. The giant cell arteritis was diagnosed 12 years ago. He has received chronic steroid treatment in the past. He presented with congestive heart failure in the current hospital admission. Case Report Clinical examination showed collapsing pulse at rate of 95 per minute. Bilateral basal crepitations were heard on chest auscultation. The jugular venous pressure was raised. Auscultation of the heart revealed a loud, grade 4/6 early diastolic murmur. The cardiac apex was displaced to the 6th intercostal space. Electrocardiogram (ECG) showed left ventricular hypertrophy and sinus tachycardia. Chest X-ray (CXR) showed cardiomegaly and moderate pulmonary congestion. The essential laboratory parameters are shown in Table 1. Echocardiogram showed severe aortic regurgitation with massively dilated aortic root and ascending aorta with a diameter of 92 mm (Fig. 1). The left ventricular ejection fraction was preserved at 50%. The left ventricle was dilated with left ventricular end systolic diameter of 45 mm and end diastolic diameter of 62 mm. The left atrium was dilated at 45 mm. The pulmonary artery systolic pressure was
European Heart Journal - Cardiovascular Imaging, 2011
Background In clinical heart failure (HF), inefficient propagation of blood through the left vent... more Background In clinical heart failure (HF), inefficient propagation of blood through the left ventricle (LV) may result from suboptimal vortex formation (VF) ability of the LV during early diastole. We aim to (i) validate echocardiographic-derived vortex formation time (adapted) (VFTa) in control subjects and (ii) examine its utility in both systolic and diastolic HF. Methods Transthoracic echocardiography was performed in 32 normal subjects and in 130 patients who were hospitalized with HF [91, reduced ejection fraction (rEF) and 39, preserved ejection fraction (pEF)]. In addition to biplane left ventricular ejection fraction (LVEF) and conventional parameters, the Tei index and tissue Doppler (TD) indices were measured. VFTa was obtained using the formula: 4 × (1 2 b)/p × a 3 × LVEF, where b is the fraction of total transmitral diastolic stroke volume contributed by atrial contraction (assessed by time velocity integral of the mitral E-and A-waves) and a is the biplane end-diastolic volume (EDV) 1/3 divided by mitral annular diameter during early diastole. VFTa was correlated with demographic, cardiac parameters, and a composite clinical endpoint comprising cardiac death and repeat hospitalization for HF. Results Mean VFTa was 2.67 + 0.8 in control subjects; reduced in HF, preserved EF HF, 2.21 + 0.8; HF with reduced EF, 1.25 + 0.6 (P , 0.001). It was not affected by age, gender, body surface area but was correlated positively with TD early diastolic myocardial velocities (E ′ , septal, r ¼ 0.46; lateral, r ¼ 0.43), systolic myocardial velocities (S ′ , septal, r ¼ 0.47; lateral, r ¼ 0.41), and inversely with the Tei index (r ¼ 20.41); all Ps , 0.001. Sixty-two HF patients (49%) met the composite endpoint. VFTa of ,1.32 was associated with significantly reduced event-free survival (Kaplan Meier log rank ¼ 16.3, P ¼ 0.0001) and predicted the endpoint with a sensitivity and specificity of 65 and 72%, respectively. Conclusion VFTa, a dimensionless index, incorporating LV geometry, systolic and diastolic parameters, may be useful in the diagnosis and prognosis of HF.
Clinical cancer research : an official journal of the American Association for Cancer Research, Jan 15, 2014
Racotumomab-alum is an anti-idiotype vaccine targeting the NeuGcGM3 tumor-associated ganglioside.... more Racotumomab-alum is an anti-idiotype vaccine targeting the NeuGcGM3 tumor-associated ganglioside. This clinical trial was conducted to provide a preliminary estimate of efficacy and safety of racotumomab as switch maintenance for patients with advanced non-small cell lung cancer (NSCLC). Patients with stage IIIb/IV NSCLC who have at least stable disease after first-line chemotherapy were randomized 1:1 to racotumomab-alum (5 immunizations every 2 weeks and re-immunizations every 4 weeks) or placebo. Treatment was administered beyond progressive disease, until severe performance status worsening or toxicity. At progression, only five patients per group received further anticancer therapy. The primary endpoint was overall survival (OS). One-hundred and seventy-six patients were randomized to racotumomab-alum (n = 87) and placebo (n = 89). Median OS was 8.23 and 6.80 months, respectively [HR, 0.63; 95% confidence interval (CI), 0.46-0.87; P = 0.004]. Median progression-free survival (P...
Background: Resveratrol has shown benefits in reducing ventricular remodeling and arrhythmias. Ob... more Background: Resveratrol has shown benefits in reducing ventricular remodeling and arrhythmias. Objective: This study aimed to assess the therapeutic efficacy of resveratrol in reducing atrial fibrillation (AF) in a heart failure (HF) model and explore underlying mechanisms. Methods: HF rabbits were created 4 weeks after undergoing coronary ligation. Group 1 (n = 6) included (a) normal; (b) HF sham; (c) HF rabbits treated for 1 week with intraperitoneal injections of resveratrol; (d) resveratrol + wortmannin, and (e) resveratrol + diphenyleneiodonium chloride (DPI). All rabbits underwent epicardial catheter stimulation. Collagen content, mRNA and protein expression in ionic channels, and PI3K/AKT/eNOS signaling pathways were studied in left atrial appendage (LAA) preparations. To investigate acute drug effects on left atrial (LA) electrophysiology, Groups 2 a-e (n = 6) were subjected to Langendorff perfusion. Results: Higher AF inducibility was found in the HF group and groups that were administered PI3K and eNOS inhibitors than in the normal and resveratrol-treated groups (P < 0.001). Histological analysis of LAA revealed a decrease in fibrosis in resveratrol-treated groups compared 4 with the HF group (8.95% ± 1.53% vs. 26.62% ± 2.19%, P < 0.001). In real-time PCR analysis, ionic channels including Kv1.4, Kv1.5, KvLQT1, Kir2.1, Nav1.5, Cav1.2, NCX, SERCA2a, and PLB were upregulated by resveratrol. PI3K, AKT, and eNOS mRNA and protein expressions were upregulated by resveratrol but were inhibited by the co-administration of wortmannin and DPI. Conclusion: Resveratrol decreases LA fibrosis and regulates variation in ionic channels to reduce AF through the PI3K/AKT/eNOS signaling pathway.
Journal of Chromatography B: Biomedical Sciences and Applications, 2001
The CB.Hep-1 monoclonal antibody was coupled to CNBr-activated Sepharose CL 4B at three different... more The CB.Hep-1 monoclonal antibody was coupled to CNBr-activated Sepharose CL 4B at three different immobilization scales for purification of recombinant hepatitis B surface antigen. Standard laboratory apparatus to obtain immunosorbents of 1 l (scale I) and 3 l (scale II) as well as a stirrer tank to prepare 6 l immunosorbents (scale III) were used. The binding capacity at scale III was 2-and 1.5-fold higher with respect to the scales II and I, while a reduction in the ligand leakage of 5-and 2-folds was observed. Immunosorbents from scale II showed a significantly reduced adsorption, and an increased ligand leakage. Differences in the coupling efficiency were not observed. Antigen purity eluted from the immunosorbents was always above 85%.
Leadership & Organization Development Journal, 2010
PurposeThis study seeks to confirm the main factors in the followers' perception of leaders a... more PurposeThis study seeks to confirm the main factors in the followers' perception of leaders and to explore effects of collectivist values, age and work experience on followers' perception of leaders.Design/methodology/approachConfirmatory factor analysis is done for the 32‐item Romance of leadership scale and an exploratory multi‐level research in perceptions of 452 individuals in five cultural groups.FindingsThe study confirms the “influence” and the “interchangeability” of leaders as independent constructs in the followers' perception of leaders. The results indicate: older followers view leadership change more negatively than younger followers; with more work experience followers view the influence of leaders diminishing; differences in perception of followers from collectivist and individualistic cultures were inconclusive.Research limitations/implicationsA large proportion of the sample used in this study were young undergraduates with little work experience and exp...
Background: Contrast nephropathy (CIN) increases adverse clinical outcomes. We examine risks and ... more Background: Contrast nephropathy (CIN) increases adverse clinical outcomes. We examine risks and clinical predictors of CIN in patients undergoing percutaneous coronary intervention (PCI) and effectiveness of prophylactic therapy. Methods: A cohort of 8,798 patients who underwent PCI from May 2000 to April 2008 was enrolled. We divided patients into 3 groups. A: STEMI patient undergoing primary PCI; B: UA/NSTEMI patients undergoing early PCI; C: Patients without MI undergoing elective PCI. Pre-PCI saline hydration was given to group B and C if baseline glomerular filtration rate (GFR) <60 ml/min/1.73 m 2 .
Background: Contrast nephropathy (CIN) post percutaneous coronary intervention (PCI) increases ad... more Background: Contrast nephropathy (CIN) post percutaneous coronary intervention (PCI) increases adverse clinical outcomes. We examine and compare the risks and clinical predictors of CIN among patients who undergo primary versus elective PCI and the effectiveness of prophylactic treatments. Methods: A cohort of 8798 patients who underwent PCI from May 1996 to April 2008 were enrolled. We divided patients into 3 groups(Grp). A: STEMI patient undergoing primary PCI. B: NSTEMI patients undergoing early elective PCI. C: stable patients without myocardial infarction(MI) undergoing elective PCI. Prophylactic saline hydration and oral N-acetylcysteine (NAC) treatment were given to Grp B and C if they have baseline renal impairment (glomerular filtration rate, GFR ≤60ml/min/1.73m 2 ). Grp A patients were unable to receive pre-PCI prophylaxis due to emergency situation. The occurrence of CIN and mortality were compared among 3 grps. Results: Mean age was 57.4±11.1 years. 3146(35.9%) were diab...
Additional file 1: Supplementary Table 1. Quality assessment using the ROBIN-1 tool. Supplementar... more Additional file 1: Supplementary Table 1. Quality assessment using the ROBIN-1 tool. Supplementary Table 2. Presentation, etiology, definition of success and duct disruption, and the site of disruption. Supplementary Table 3. The number of patients who underwent endoscopic drainage (total, transpapillary, transmural, and combined modality), duration of transmural stent placement, number of successes for each type of endoscopic drainage and procedural-related complication. Supplementary Table 4. The number of relevant patients, the number of each type of surgery that was performed, prior therapy before surgery, umber of successes with each surgical intervention, and procedure-related complications. Supplementary Table 5. Presentation, number of interventions, concomitant therapy, duration of drainage, number of successes, and complication of patients treated by percutaneous drainage. Supplementary Fig 1. Weighted rates of success for transmural drainage with endoscopic ultrasound (EU...
Background: Contrast induced nephropathy (CIN) is an important complication post percutaneous cor... more Background: Contrast induced nephropathy (CIN) is an important complication post percutaneous coronary intervention (PCI). We examine the risk factors for developing CIN in patients with normal baseline renal function so that prophylactic measures may be undertaken to prevent its development. Methods: A cohort of 5086 patients with normal baseline renal function (defined as serum creatinine <1.5mg/dl) who did not receive prophylactic treatment while undergoing PCI (primary or elective) between May 1996 to March 2007 in our centre was enrolled in the study. We examine the occurrence of CIN (defined as >25% increase from baseline creatinine within 48 hours post PCI) in 3036 subjects of this cohort with available creatinine data and aim to identify the clinical predictors. Results: CIN occurred in 7.3% of the patients. The mean age of these patients was 57.5 yrs, 78.7% were men, and 34.6% had diabetes mellitus. Clinical predictors for CIN were age (OR 6.4, 95% CI 0.1–13.3, p=0.04...
"A randomized, multicenter, placebo-controlled clinical trial of racotumomab-alum vaccine as swit... more "A randomized, multicenter, placebo-controlled clinical trial of racotumomab-alum vaccine as switch maintenance therapy in advanced non-small-cell-lung cancer patients"
Background: Oxidative stress has been implicated in the pathogenesis of acute pancreatitis (AP), ... more Background: Oxidative stress has been implicated in the pathogenesis of acute pancreatitis (AP), and ascorbic acid (AA), as an important endogenous antioxidant substance, has been shown to reduce AP severity in preclinical studies. However, the effects of AA supplementation in clinical settings remain controversial.Methods: PubMed, EMBASE, MEDLINE, and SCOPUS databases were searched, and both preclinical and clinical studies were included. For clinical trials, the primary outcome was incidence of organ failure, and for preclinical studies, the primary outcome was histopathological scores of pancreatic injuries.Results: Meta-analysis of clinical trials showed that compared with controls, AA administration did not reduce the incidence of organ failure or mortality during hospitalization but was associated with significantly reduced length of hospital stay. Meta-analysis of preclinical studies showed that AA supplementation reduced pancreatic injury, demonstrated as decreased histologi...
Background The present systematic review aimed to compare survival outcomes of invasive intraduct... more Background The present systematic review aimed to compare survival outcomes of invasive intraductal papillary mucinous neoplasms (IIPMNs) treated with adjuvant chemotherapy versus surgery alone and to identify pathologic features that may predict survival benefit from adjuvant chemotherapy. Method A systematic search of MEDLINE, PubMed, Scopus, and EMBASE was performed using the PRISMA framework. Studies comparing adjuvant chemotherapy and surgery alone for patients with IIPMNs were included. Primary endpoint was overall survival (OS). A narrative synthesis was performed to identify pathologic features that predicted survival benefits from adjuvant chemotherapy. Results Eleven studies and 3393 patients with IIPMNs were included in the meta-analysis. Adjuvant chemotherapy significantly reduced the risk of death in the overall cohort (HR 0.57, 95% CI 0.38–0.87, p = 0.009) and node-positive patients (HR 0.29, 95% CI 0.13–0.64, p = 0.002). Weighted median survival difference between adj...
Background: The prognostic significance and the optimal treatment strategy for patients with atri... more Background: The prognostic significance and the optimal treatment strategy for patients with atrial fibrillation (AF) and heart failure (HF) remain controversial. Methods: We extracted data from a large prospective national database involving Taiwanese patients with AF who were hospitalized for acute HF with reduced ejection fraction. Baseline characteristics, AF types, medications, and 1-year outcomes of the patients were analyzed. Results: At baseline, 393 (26%) patients had AF, including 117 (29.8%) patients with paroxysmal AF (PAF) and 276 (70.2%) with nonparoxysmal AF (N-PAF). Patients with PAF were more likely to have ischemic cardiomyopathy (47.3% vs 29.7%, p = 0.021), chronic kidney disease (46.2% vs 29.0%, p = 0.001), and higher CHA 2 DS 2-VASc score (4.0 vs 3.6, p = 0.033) compared with patients with N-PAF; however, patients with N-PAF had larger left atrial diameter (50.5 vs 47.3 mm, p = 0.004) than patients with PAF. Patients with PAF were more likely to receive treatment with amiodarone (31.6% vs 13.8%, p < 0.001) and antiplatelet agents (54.1% vs 42.5%, p = 0.041) but less likely to receive treatment with renin-angiotensin system blockers (52.3% vs 64.9%, p = 0.021) and anticoagulants (33.3% vs 50%, p = 0.003) compared with patients with N-PAF at discharge. The 1-year mortality (26.2% vs 16.5%, p = 0.024) and non-HF-related death rates (13.1% vs 5%, p = 0.005) were significantly higher in patients with PAF, whereas HF and arrhythmic death rates were similar in both groups (13.1% vs 11.5%). Conclusion: Among patients with HF complicated with AF, those with PAF were more likely to receive antiarrhythmic agents, less likely to receive guideline-recommended therapy, but developed worse 1-year outcome compared with patients with N-PAF. These findings further emphasize the importance of optimal guideline-recommended medical therapy in patients with HF.
Journal of the Chinese Medical Association : JCMA, 2017
Heart failure (HF) is a global health problem. Guidelines for the management of HF have been esta... more Heart failure (HF) is a global health problem. Guidelines for the management of HF have been established in Western countries and in Taiwan. However, data from the Taiwan Society of Cardiology-Heart Failure with reduced Ejection Fraction (TSOC-HFrEF) registry showed suboptimal prescription of guideline-recommended medications. We aimed to analyze the reason of non-prescription and clinical outcomes as a result of under-prescription of medications. A total of 1509 patients hospitalized for acute HFrEF were recruited in 21 hospitals in Taiwan by the end of October 2014. Prescribed guideline-recommended medications and other relevant clinical parameters were collected and analyzed at discharge and 1 year after index hospitalization. At discharge, 62% of patients were prescribed with either angiotensin-converting enzyme-inhibitors (ACEI) or angiotensin receptor blockers (ARB); 60% were prescribed with beta-blockers and 49% were prescribed with mineralocorticoid receptor antagonists (MRA...
A 60-year-old Caucasian man underwent implantation of a biventricular implantable cardioverter de... more A 60-year-old Caucasian man underwent implantation of a biventricular implantable cardioverter defibrillator (ICD) for primary prevention of his underlying severe ischaemic cardiomyopathy. One year later, he presented with a problem of leftventricular lead failure. He also received inappropriate ICD shocks as a result of poor R-wave sensing in the ventricular leads and double counting from the right atrium. A chest x-ray (CXR) (figures 1, 2) showed that the right-ventricular shock lead was displaced to the right atrium, and the right atrial lead was displaced into the superior vena cava. The left-ventricular lead could not be identified in the CXR. During device extraction, the displaced leads and heavily twisted leads around the ICD box were identified via the fluoroscopy. The left-ventricular lead was retracted into the ICD pocket and was completely displaced out of the venous system. There were extensive coiling and retracting of all three ICD leads within the pocket. This was a classical manifestation of Twiddler 's syndrome (figure 3). 1 2 Twiddler's syndrome is a clinical condition that is commonly caused by excessive twisting of the pacemaker or ICD device in the pocket, resulting in dislodgement of leads and device malfunction. Laser-lead extraction was performed successfully in this patient, and a single-chamber ICD was subsequently implanted. The cause of Twiddler 's syndrome in this patient could be due to an improper implantation technique resulting in a pocket that was too large, thus causing the device to twist and subsequent removal of the leads. In addition, the patient had a history of psychiatric disorder; self-inflicted twisting of the ICD device could thus be another cause.
ScienceDirect jo urnal homepage: www .e lsev ie r. co m/ lo cate/ I PE J i n d i a n p a c i n g ... more ScienceDirect jo urnal homepage: www .e lsev ie r. co m/ lo cate/ I PE J i n d i a n p a c i n g a n d e l e c t r o p h y s i o l o g y j o u r n a l 1 5 (2 0 1 5) 2 5 5 e2 5 8
N-acetylcysteine (NAC) and sodium bicarbonate (SOB) therapies may prevent contrast-induced nephro... more N-acetylcysteine (NAC) and sodium bicarbonate (SOB) therapies may prevent contrast-induced nephropathy (CIN). However, the efficacy of using combination over individual therapies was not established, and there was no large randomised study comparing abbreviated SOB therapy with conventional sustained saline pre-hydration with oral NAC. In a multi-centre, open-label, randomised, controlled trial (NCT00497328), we prospectively enrolled 548 patients with at least moderate renal impairment undergoing cardiac catheterisation with or without percutaneous coronary intervention. Patients were randomly assigned to 3 groups: 1) NAC: 154mEq/L sustained sodium chloride regime (1mL/kg/h 12h before, during and 6h after the procedure) with oral NAC at 1.2g bid for 3days (n=185); 2) SOB: 154mEq/L abbreviated SOB regime at 3mL/kg/h 1h before the procedure, and 1mL/kg/h during and 6h after the procedure (n=182); and 3) COM: combination of abbreviated SOB regime and oral NAC (n=181). The primary end point was incidence of CIN. The secondary end points were rise in serum creatinine, hospitalisation duration, haemodialysis, morbidity and mortality within 30days. The 3 groups had similar baseline characteristics: age 68±10years, 76% male, 48% diabetic and baseline glomerular filtration rate (GFR) 47.7±13.0mL/min. There were 41 (8.8%) patients with GFR&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30. The CIN incidences were NAC 6.5%, SOB 12.8% and COM 10.6%. The COM regimen was not superior to either the NAC (relative risk (RR)=1.61, 95% confidence interval (CI): 0.76 to 3.45, p=0.225) or SOB (RR=0.83, 95% CI: 0.44 to 1.56, p=0.593) regimens. The CIN incidence was lower in the NAC group than the SOB group (adjusted odds ratio (OR)=0.40, 95% CI: 0.17 to 0.92; p=0.032). Multivariate analysis showed contrast volume (OR=1.99, 95% CI: 1.33 to 2.96, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 per 100mL), female (OR=2.47, 95% CI: 1.22 to 5.00, p=0.012) and diabetes (OR=2.03, 95% CI: 1.03 to 3.99, p=0.041) were independent risk predictors. There were no differences in the secondary outcomes among the 3 groups. The combination regimen was not superior to individual regimens in preventing CIN in patients with baseline renal impairment. There was a trend suggesting that the 12-hour sustained sodium chloride pre-hydration regimen was more protective than the 1-hour abbreviated SOB regimen.
Annals of the Academy of Medicine, Singapore, 2012
A 77-year-old Indian man who was an ex-smoker has a medical history of hypertension, hyperlipidae... more A 77-year-old Indian man who was an ex-smoker has a medical history of hypertension, hyperlipidaemia, previous cerebral lacunar infarct and temporal (giant cell) arteritis which was complicated by optic neuritis. The giant cell arteritis was diagnosed 12 years ago. He has received chronic steroid treatment in the past. He presented with congestive heart failure in the current hospital admission. Case Report Clinical examination showed collapsing pulse at rate of 95 per minute. Bilateral basal crepitations were heard on chest auscultation. The jugular venous pressure was raised. Auscultation of the heart revealed a loud, grade 4/6 early diastolic murmur. The cardiac apex was displaced to the 6th intercostal space. Electrocardiogram (ECG) showed left ventricular hypertrophy and sinus tachycardia. Chest X-ray (CXR) showed cardiomegaly and moderate pulmonary congestion. The essential laboratory parameters are shown in Table 1. Echocardiogram showed severe aortic regurgitation with massively dilated aortic root and ascending aorta with a diameter of 92 mm (Fig. 1). The left ventricular ejection fraction was preserved at 50%. The left ventricle was dilated with left ventricular end systolic diameter of 45 mm and end diastolic diameter of 62 mm. The left atrium was dilated at 45 mm. The pulmonary artery systolic pressure was
European Heart Journal - Cardiovascular Imaging, 2011
Background In clinical heart failure (HF), inefficient propagation of blood through the left vent... more Background In clinical heart failure (HF), inefficient propagation of blood through the left ventricle (LV) may result from suboptimal vortex formation (VF) ability of the LV during early diastole. We aim to (i) validate echocardiographic-derived vortex formation time (adapted) (VFTa) in control subjects and (ii) examine its utility in both systolic and diastolic HF. Methods Transthoracic echocardiography was performed in 32 normal subjects and in 130 patients who were hospitalized with HF [91, reduced ejection fraction (rEF) and 39, preserved ejection fraction (pEF)]. In addition to biplane left ventricular ejection fraction (LVEF) and conventional parameters, the Tei index and tissue Doppler (TD) indices were measured. VFTa was obtained using the formula: 4 × (1 2 b)/p × a 3 × LVEF, where b is the fraction of total transmitral diastolic stroke volume contributed by atrial contraction (assessed by time velocity integral of the mitral E-and A-waves) and a is the biplane end-diastolic volume (EDV) 1/3 divided by mitral annular diameter during early diastole. VFTa was correlated with demographic, cardiac parameters, and a composite clinical endpoint comprising cardiac death and repeat hospitalization for HF. Results Mean VFTa was 2.67 + 0.8 in control subjects; reduced in HF, preserved EF HF, 2.21 + 0.8; HF with reduced EF, 1.25 + 0.6 (P , 0.001). It was not affected by age, gender, body surface area but was correlated positively with TD early diastolic myocardial velocities (E ′ , septal, r ¼ 0.46; lateral, r ¼ 0.43), systolic myocardial velocities (S ′ , septal, r ¼ 0.47; lateral, r ¼ 0.41), and inversely with the Tei index (r ¼ 20.41); all Ps , 0.001. Sixty-two HF patients (49%) met the composite endpoint. VFTa of ,1.32 was associated with significantly reduced event-free survival (Kaplan Meier log rank ¼ 16.3, P ¼ 0.0001) and predicted the endpoint with a sensitivity and specificity of 65 and 72%, respectively. Conclusion VFTa, a dimensionless index, incorporating LV geometry, systolic and diastolic parameters, may be useful in the diagnosis and prognosis of HF.
Clinical cancer research : an official journal of the American Association for Cancer Research, Jan 15, 2014
Racotumomab-alum is an anti-idiotype vaccine targeting the NeuGcGM3 tumor-associated ganglioside.... more Racotumomab-alum is an anti-idiotype vaccine targeting the NeuGcGM3 tumor-associated ganglioside. This clinical trial was conducted to provide a preliminary estimate of efficacy and safety of racotumomab as switch maintenance for patients with advanced non-small cell lung cancer (NSCLC). Patients with stage IIIb/IV NSCLC who have at least stable disease after first-line chemotherapy were randomized 1:1 to racotumomab-alum (5 immunizations every 2 weeks and re-immunizations every 4 weeks) or placebo. Treatment was administered beyond progressive disease, until severe performance status worsening or toxicity. At progression, only five patients per group received further anticancer therapy. The primary endpoint was overall survival (OS). One-hundred and seventy-six patients were randomized to racotumomab-alum (n = 87) and placebo (n = 89). Median OS was 8.23 and 6.80 months, respectively [HR, 0.63; 95% confidence interval (CI), 0.46-0.87; P = 0.004]. Median progression-free survival (P...
Background: Resveratrol has shown benefits in reducing ventricular remodeling and arrhythmias. Ob... more Background: Resveratrol has shown benefits in reducing ventricular remodeling and arrhythmias. Objective: This study aimed to assess the therapeutic efficacy of resveratrol in reducing atrial fibrillation (AF) in a heart failure (HF) model and explore underlying mechanisms. Methods: HF rabbits were created 4 weeks after undergoing coronary ligation. Group 1 (n = 6) included (a) normal; (b) HF sham; (c) HF rabbits treated for 1 week with intraperitoneal injections of resveratrol; (d) resveratrol + wortmannin, and (e) resveratrol + diphenyleneiodonium chloride (DPI). All rabbits underwent epicardial catheter stimulation. Collagen content, mRNA and protein expression in ionic channels, and PI3K/AKT/eNOS signaling pathways were studied in left atrial appendage (LAA) preparations. To investigate acute drug effects on left atrial (LA) electrophysiology, Groups 2 a-e (n = 6) were subjected to Langendorff perfusion. Results: Higher AF inducibility was found in the HF group and groups that were administered PI3K and eNOS inhibitors than in the normal and resveratrol-treated groups (P < 0.001). Histological analysis of LAA revealed a decrease in fibrosis in resveratrol-treated groups compared 4 with the HF group (8.95% ± 1.53% vs. 26.62% ± 2.19%, P < 0.001). In real-time PCR analysis, ionic channels including Kv1.4, Kv1.5, KvLQT1, Kir2.1, Nav1.5, Cav1.2, NCX, SERCA2a, and PLB were upregulated by resveratrol. PI3K, AKT, and eNOS mRNA and protein expressions were upregulated by resveratrol but were inhibited by the co-administration of wortmannin and DPI. Conclusion: Resveratrol decreases LA fibrosis and regulates variation in ionic channels to reduce AF through the PI3K/AKT/eNOS signaling pathway.
Journal of Chromatography B: Biomedical Sciences and Applications, 2001
The CB.Hep-1 monoclonal antibody was coupled to CNBr-activated Sepharose CL 4B at three different... more The CB.Hep-1 monoclonal antibody was coupled to CNBr-activated Sepharose CL 4B at three different immobilization scales for purification of recombinant hepatitis B surface antigen. Standard laboratory apparatus to obtain immunosorbents of 1 l (scale I) and 3 l (scale II) as well as a stirrer tank to prepare 6 l immunosorbents (scale III) were used. The binding capacity at scale III was 2-and 1.5-fold higher with respect to the scales II and I, while a reduction in the ligand leakage of 5-and 2-folds was observed. Immunosorbents from scale II showed a significantly reduced adsorption, and an increased ligand leakage. Differences in the coupling efficiency were not observed. Antigen purity eluted from the immunosorbents was always above 85%.
Leadership & Organization Development Journal, 2010
PurposeThis study seeks to confirm the main factors in the followers' perception of leaders a... more PurposeThis study seeks to confirm the main factors in the followers' perception of leaders and to explore effects of collectivist values, age and work experience on followers' perception of leaders.Design/methodology/approachConfirmatory factor analysis is done for the 32‐item Romance of leadership scale and an exploratory multi‐level research in perceptions of 452 individuals in five cultural groups.FindingsThe study confirms the “influence” and the “interchangeability” of leaders as independent constructs in the followers' perception of leaders. The results indicate: older followers view leadership change more negatively than younger followers; with more work experience followers view the influence of leaders diminishing; differences in perception of followers from collectivist and individualistic cultures were inconclusive.Research limitations/implicationsA large proportion of the sample used in this study were young undergraduates with little work experience and exp...
Background: Contrast nephropathy (CIN) increases adverse clinical outcomes. We examine risks and ... more Background: Contrast nephropathy (CIN) increases adverse clinical outcomes. We examine risks and clinical predictors of CIN in patients undergoing percutaneous coronary intervention (PCI) and effectiveness of prophylactic therapy. Methods: A cohort of 8,798 patients who underwent PCI from May 2000 to April 2008 was enrolled. We divided patients into 3 groups. A: STEMI patient undergoing primary PCI; B: UA/NSTEMI patients undergoing early PCI; C: Patients without MI undergoing elective PCI. Pre-PCI saline hydration was given to group B and C if baseline glomerular filtration rate (GFR) <60 ml/min/1.73 m 2 .
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