1
|
Cheng JJ, Liang LJ, Lee CC. Associations of appendicular lean mass and abdominal adiposity with insulin resistance in older adults: A cross-sectional study. PLoS One 2024; 19:e0303874. [PMID: 38753649 PMCID: PMC11098336 DOI: 10.1371/journal.pone.0303874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/01/2024] [Indexed: 05/18/2024] Open
Abstract
Loss of lean muscle mass and accumulation of adipose tissue are changes associated with aging. Previous studies have documented various components of body composition as predictors for insulin resistance. The objective of this study was to investigate whether components of body composition-appendicular lean mass (ALM) and/or abdominal fat mass (AFM)-correlate with insulin resistance in older men and women. This was a cross-sectional study of 92 older men and women. Weight was classified according to body mass index (BMI)-normal (BMI <25), overweight (BMI 25-30), and obese (BMI >30). All body composition data was determined by dual energy x-ray absorptiometry (DEXA), and insulin resistance was assessed by the homeostatic model assessment of insulin resistance (HOMA-IR). Multivariable regression models with two-way interaction terms were employed to assess whether the associations between components of body composition and log HOMA varied by BMI categories. Adjusted regression showed that log HOMA was significantly associated with AFM (estimate ± standard error: 0.055 ± 0.026) and ALM (0.057 ± 0.029) for the overweight participants (p-values <0.05). Additionally, the adjusted associations between log HOMA and ALM were significantly greater for participants who were either obese or overweight compared to those with a normal BMI (p<0.002). Less consistent relationships were observed between insulin resistance and abdominal fat mass across BMI categories, whereas more consistent associations were observed between insulin resistance and appendicular lean mass in individuals with greater BMI. Further research is needed to clarify if lipid deposition within muscle tissue promotes muscle dysfunction and thereby increases risk for insulin resistance.
Collapse
Affiliation(s)
- Justin J. Cheng
- Geriatric Research Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
| | - Li-Jung Liang
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Cathy C. Lee
- Geriatric Research Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
- David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| |
Collapse
|
2
|
Kwon M, Joung CI, Shin H, Lee CC, Song YS, Lee YJ, Kang S, Kim JY, Lee S. Detection of novel drug-adverse drug reaction signals in rheumatoid arthritis and ankylosing spondylitis: analysis of Korean real-world biologics registry data. Sci Rep 2024; 14:2660. [PMID: 38302579 PMCID: PMC10834537 DOI: 10.1038/s41598-024-52822-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/24/2024] [Indexed: 02/03/2024] Open
Abstract
This study aimed to detect signals of adverse drug reactions (ADRs) associated with biological disease-modifying antirheumatic drugs (DMARDs) and targeted therapies in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients. Utilizing the KOrean College of Rheumatology BIOlogics & Targeted Therapy Registry (KOBIO) data, we calculated relative risks, excluded previously reported drug-ADR pairs, and externally validated remaining pairs using US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) and single centre's electronic health records (EHR) data. Analyzing data from 2279 RA and 1940 AS patients, we identified 35 significant drug-ADR pairs in RA and 26 in AS, previously unreported in drug labels. Among the novel drug-ADR pairs from KOBIO, 15 were also significant in the FAERS data. Additionally, 2 significant drug-laboratory abnormality pairs were found in RA using CDM MetaLAB analysis. Our findings contribute to the identification of 14 novel drug-ADR signals, expanding our understanding of potential adverse effects related to biological DMARDs and targeted therapies in RA and AS. These results emphasize the importance of ongoing pharmacovigilance for patient safety and optimal therapeutic interventions.
Collapse
Affiliation(s)
- M Kwon
- Department of Internal Medicine, School of Medicine, Konyang University, Daejeon, South Korea
- Konyang University Myunggok Medical Research Institute, Daejeon, South Korea
- Department of Biomedical Informatics, School of Medicine, Konyang University, Daejeon, South Korea
| | - C I Joung
- Department of Internal Medicine, School of Medicine, Konyang University, Daejeon, South Korea
| | - H Shin
- Healthcare Data Science Centre, Konyang University Hospital, Daejeon, South Korea
| | - C C Lee
- Department of Biomedical Informatics, School of Medicine, Konyang University, Daejeon, South Korea
| | - Y S Song
- Department of Pathology, School of Medicine, Konyang University, Daejeon, South Korea
| | - Y J Lee
- Department of Biomedical Informatics, School of Medicine, Konyang University, Daejeon, South Korea
- Department of Rehabilitation Medicine, School of Medicine, Konyang University, Daejeon, South Korea
| | - S Kang
- Department of Internal Medicine, School of Medicine, Konyang University, Daejeon, South Korea
| | - J Y Kim
- Department of Biomedical Informatics, School of Medicine, Konyang University, Daejeon, South Korea
- Healthcare Data Science Centre, Konyang University Hospital, Daejeon, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Konyang University, Daejeon, South Korea
| | - S Lee
- Department of Computer Engineering, Gachon University, (13120) 1342 Seongnamdaero, Sujeong-gu, Seongnam-si, Gyeonggi-do, South Korea.
| |
Collapse
|
3
|
Manning KM, Hall KS, Sloane R, Magistro D, Rabaglietti E, Lee CC, Castle S, Kopp T, Giffuni J, Katzel L, McDonald M, Miyamoto M, Pearson M, Jennings SC, Bettger JP, Morey MC. Longitudinal analysis of physical function in older adults: The effects of physical inactivity and exercise training. Aging Cell 2024; 23:e13987. [PMID: 37681737 PMCID: PMC10776115 DOI: 10.1111/acel.13987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/14/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
Abstract
Lack of exercise contributes to systemic inflammation and is a major cause of chronic disease. The long-term impact of initiating and sustaining exercise in late life, as opposed to sustaining a sedentary lifestyle, on whole-body health measures such as physical performance is not well known. This is an exploratory study to compare changes in physical performance among older adults initiating exercise late in life versus inactive older adults. Data from two observational cohorts were included in this analysis, representing two activity groups. The Active group cohort comprises older adults (n = 318; age 72.5 ± 7.2 years) enrolled in a supervised exercise program, "Gerofit." The inactive group comprises older adults (n = 146; age 74.5 ± 5.5 years) from the Italian study "Act on Ageing" (AOA) who self-reported being inactive. Participants in both groups completed physical performance battery at baseline and 1-year including: 6-min walk test, 30-s chair stand, and timed up-and-go. Two-sample t-tests measured differences between Gerofit and AOA at baseline and 1-year across all measures. Significant between-group effects were seen for all performance measures (ps = 0.001). The AOA group declined across all measures from baseline to 1 year (range -18% to -24% change). The Gerofit group experienced significant gains in function for all measures (range +10% to +31% change). Older adults who initiated routine, sustained exercise were protected from age-related declines in physical performance, while those who remained sedentary suffered cumulative deficits across strength, aerobic endurance, and mobility. Interventions to reduce sedentary behaviors and increase physical activity are both important to promote multi-system, whole-body health.
Collapse
Affiliation(s)
- Kenneth M. Manning
- Geriatric Research, Education, and Clinical CenterVA Health Care SystemDurhamNorth CarolinaUSA
| | - Katherine S. Hall
- Geriatric Research, Education, and Clinical CenterVA Health Care SystemDurhamNorth CarolinaUSA
- Department of Medicine, Center for the Study of Aging/Claude D. Pepper Older Americans Independence CenterDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Richard Sloane
- Geriatric Research, Education, and Clinical CenterVA Health Care SystemDurhamNorth CarolinaUSA
- Department of Medicine, Center for the Study of Aging/Claude D. Pepper Older Americans Independence CenterDuke University Medical CenterDurhamNorth CarolinaUSA
| | | | | | - Cathy C. Lee
- Geriatric Research, Education, and Clinical CenterVA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
- David Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Steven Castle
- Geriatric Research, Education, and Clinical CenterVA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
- David Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | | | - Jamie Giffuni
- Geriatric Research, Education and Clinical CenterVA Maryland Health Care SystemBaltimoreMarylandUSA
| | - Leslie Katzel
- Geriatric Research, Education and Clinical CenterVA Maryland Health Care SystemBaltimoreMarylandUSA
- School of MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Michelle McDonald
- Geritaric Rehabilitation and Clinical CenterVA Pacific Health Care SystemHonoluluHawaiiUSA
| | - Miles Miyamoto
- Geritaric Rehabilitation and Clinical CenterVA Pacific Health Care SystemHonoluluHawaiiUSA
| | - Megan Pearson
- Geriatric Research, Education, and Clinical CenterVA Health Care SystemDurhamNorth CarolinaUSA
| | - Stephen C. Jennings
- Geriatric Research, Education, and Clinical CenterVA Health Care SystemDurhamNorth CarolinaUSA
| | - Janet Prvu Bettger
- Department of Orthopedic SurgeryDuke University Medical CenterDurhamNorth CarolinaUSA
- Roybal CenterDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Miriam C. Morey
- Geriatric Research, Education, and Clinical CenterVA Health Care SystemDurhamNorth CarolinaUSA
- Department of Medicine, Center for the Study of Aging/Claude D. Pepper Older Americans Independence CenterDuke University Medical CenterDurhamNorth CarolinaUSA
| |
Collapse
|
4
|
Lee CC, Soon YY, Koh WY, Leong CN, Ng IW, Tey J. Thoracic Radiation Dose Fractionation Schedules for Limited-Stage Small Cell Lung Cancer: A Systematic Review and Network Meta-Analysis of Randomized Trials. Int J Radiat Oncol Biol Phys 2023; 117:e34. [PMID: 37785188 DOI: 10.1016/j.ijrobp.2023.06.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The Intergroup randomized controlled trial (RCT) established 45 Gy in 30 fractions (F) twice-daily (BID) as the standard thoracic radiation therapy (TRT) regimen with concurrent platinum-based chemotherapy (PBC) for limited-stage small cell lung cancer (LS-SCLC) in 1999. Since then, several RCTs were conducted to investigate novel TRT dose fractionation schedules (DoFS). However, it is unclear which is the optimal DoFS. This study aimed to compare the efficacy and safety of various DoFS of TRT in LS-SCLC using 45 Gy in 30F BID as the reference comparator. MATERIALS/METHODS We searched biomedical databases for eligible RCTs comparing at least two DoFS of TRT in LS-SCLC. The outcomes of interest were progression-free survival (PFS), overall survival (OS), treatment-related death, grade 3-5 pneumonitis and esophagitis. We employed GRADE approach to appraise the certainty of the evidence. Meta-analyses were performed using fixed effects frequentist network model. The ESMO-Magnitude of Clinical Benefit Score (MCBS) version 1.1 was used to judge the value of the novel DoFS. This study was registered with PROSPERO (CRD42022336338). RESULTS We identified six RCTs including 2,111 patients and six DoFS (45 Gy in 25F once-daily (OD), 42 Gy in 15F OD, 66 Gy in 33F OD, 60 Gy in 40F BID, 65 Gy in 26F OD and 70 Gy in 35F OD) that were compared with 45 Gy in 30F BID. There was high certainty evidence showing that 65 Gy in 26F OD (hazard ratio (HR), 0.67; 95% confidence interval (CI), 0.46-0.96) significantly improved PFS and 60 Gy in 40F BID (HR, 0.61; 95% CI, 0.41-0.91) significantly improved OS, compared to 45 Gy in 30F BID. There were no significant differences among the DoFS (42 Gy in 15F OD, 60 Gy in 40F BID, 65 Gy in 26F OD and 70 Gy in 35F OD) for PFS and OS. Both 65 Gy in 26F OD and 60 Gy in 40F BID were scored GRADE A on the ESMO-MCBS. The odds of grade 3-5 pneumonitis may be lower with 65 Gy in 26F OD (odds ratio (OR), 0.71; 95% CI, 0.12-4.32; low certainty) and higher with 60 Gy in 40F BID (OR, 6.60; 95% CI, 0.34-129.66); very low certainty). There were no significant differences among the DoFs (42 Gy in 15F OD, 66 Gy in 33F OD, 60 Gy in 40F BID, 65 Gy in 26F OD and 70 Gy in 35F OD) for treatment-related deaths or grade 3-5 esophagitis. CONCLUSION There was no evidence to suggest that there were significant differences among the newer DoFS for PFS and OS with 45 Gy in 30F BID as the reference. Both 65 Gy in 26F OD and 60 Gy in 40F BID were judged to provide clinically meaningful benefit based on ESMO-MCBS. Treatment with 65 Gy in 26F OD may be an option if once-daily treatment is preferred. Treatment with 60 Gy in 40F BD may be considered for select patients with excellent performance status.
Collapse
Affiliation(s)
- C C Lee
- Department of Radiation Oncology, National University Cancer Institute Singapore, Singapore, Singapore; National University Hospital, Singapore, Singapore
| | - Y Y Soon
- National University Hospital, Singapore, Singapore; Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - W Y Koh
- National University Hospital, Singapore, Singapore; Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - C N Leong
- Department of Radiation Oncology, National University Cancer Institute Singapore, Singapore, Singapore; National University Hospital, Singapore, Singapore
| | - I W Ng
- Department of Radiation Oncology, National University Cancer Institute Singapore, Singapore, Singapore; National University Hospital, Singapore, Singapore
| | - J Tey
- National University Hospital, Singapore, Singapore; Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| |
Collapse
|
5
|
Lehrer EJ, Gurewitz J, Kondziolka D, Niranjan A, Lunsford LD, Mathieu D, Deibert C, Ruiz-Garcia H, Patel SI, Bonney P, Hwang L, Zada G, Picozzi P, Prasad RN, Palmer JD, Lee CC, Rusthoven CG, Sheehan JP, Trifiletti DM, Ahluwalia M. Immune Checkpoint Inhibition and Single Fraction Stereotactic Radiosurgery in Non-Small Cell Lung Cancer Brain Metastases: An International Multicenter Study of 395 Patients. Int J Radiat Oncol Biol Phys 2023; 117:e127-e128. [PMID: 37784682 DOI: 10.1016/j.ijrobp.2023.06.923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Brain metastases most commonly arise from non-small cell lung cancer (NSCLC). In recent years, immune checkpoint inhibitors (ICI) have demonstrated improvements in overall survival (OS) in NSCLC. However, concerns remain about the risk of radiation necrosis (RN) when ICI are administered with stereotactic radiosurgery (SRS). MATERIALS/METHODS Logistic regression was used to evaluate prognostic factors associated with the development of any grade RN and symptomatic RN. Cumulative incidence of RN was evaluated using competing risks analysis and the Fine and Gray model, where the null hypothesis was rejected for p < 0.05. RESULTS There were 395 patients with 2,513 brain metastases treated across 11 international institutions included in the analysis. The median follow-up was 14.2 months. Median patient age was 67 years (Interquartile Range [IQR]: 61-73), 53.4% were male, the median Karnofsky Performance Status was 80 (IQR: 80-90), and 88.6% has active extracranial disease at the time of SRS. The median margin dose was 19 Gy (IQR: 18-20), 97.5% of patients were treated on the Gamma Knife ®, 3.8% underwent prior whole brain radiation therapy (WBRT). The median V12 Gy was 5.2 cm3 and 36.5% of patients had a V12 Gy ≥ 10 cm3, anti-PD-1 agents were administered in 91.6% of patients. A V12 Gy ³ 10 cm3 was associated with an increased risk of developing any grade RN; odds ratio (OR): 2.12, p = 0.04 and OR: 2.18; p = 0.03 on univariable and multivariable analysis, respectively. Similarly, a V12 Gy ≥ 10 cm3 was associated with an increased risk of developing symptomatic RN; OR: 3.80, p = 0.003 and OR: 3.95; p = 0.003 on univariable and multivariable analysis, respectively. Receipt of concurrent ICI and prior WBRT were not statistically significant. At 1-year, the cumulative incidence of any grade and symptomatic RN was 4.8% and 3.8%, respectively. The cumulative incidence of any grade RN was 3.8% vs. 5.3% for the concurrent and non-concurrent groups at 1-year, respectively (p = 0.35). The cumulative incidence of symptomatic RN was 3.8% vs. 3.6% for the concurrent and non-concurrent groups at 1-year, respectively (p = 0.95). CONCLUSION The risk of any grade and symptomatic RN following SRS and ICI administration for NSCLC brain metastases increases as the V12 Gy exceeds 10 cm3. Concurrent ICI and SRS does not appear to increase this risk. Radiosurgical planning techniques should aim to minimize the V12 Gy.
Collapse
Affiliation(s)
- E J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J Gurewitz
- NYU Langone Medical Center, New York, NY
| | - D Kondziolka
- Department of Neurosurgery, NYU Langone Health, New York, NY
| | - A Niranjan
- Center for Image-guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - L D Lunsford
- Center for Image-guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - D Mathieu
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | | | - H Ruiz-Garcia
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - S I Patel
- Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada
| | - P Bonney
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - L Hwang
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - G Zada
- Department of Neurosurgery, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - P Picozzi
- Humanitas Research Hospital, Rozzano, Italy
| | - R N Prasad
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - J D Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - C C Lee
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - C G Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - J P Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | - D M Trifiletti
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - M Ahluwalia
- Department of Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| |
Collapse
|
6
|
Wujanto C, Lee CC, Meng T, Ooi KH, Tan TH, Koh WY, Tseng MSF, Koh V, Yeoh T, Leong YH, Chia D, Ng IW, Ho F, Tey J, Soon YY. Adjuvant Breast Radiation Therapy for Early-Stage Breast Cancer or Ductal Carcinoma In-Situ in the Breast: A Systematic Review and Network Meta-Analysis of Randomized Trials. Int J Radiat Oncol Biol Phys 2023; 117:e214. [PMID: 37784885 DOI: 10.1016/j.ijrobp.2023.06.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) For selected patients with early-stage breast cancer (BC) or ductal carcinoma in-situ (DCIS) in the breast, adjuvant breast radiation therapy (RT) approaches include partial breast irradiation (PBI), altered fractionation (AF) whole breast irradiation (WBI) or tumor bed boost (TBB). However, it is unclear which is the optimal approach. This study aims to compare the effects of different PBI, AF-WBI and TBB options on ipsilateral breast tumor recurrence (IBTR), overall survival (OS) and patient reported cosmesis (PRC) outcomes. MATERIALS/METHODS We searched various biomedical electronic databases for eligible randomized trials (RCTs) from date of inception to January 2023. We constructed six separate random effects frequentist network meta-analyses (NMA) to compare the effects of various PBI options using WBI as the reference; various AF-WBI options using conventional fractionated (CF) WBI as the reference and various TBB options using no TBB as the reference on IBTR and OS. The GRADE approach was used to assess the certainty of evidence. The synthesis without meta-analysis approach was pre-specified for evaluation of PRC in anticipation of various assessment and reporting methods. RESULTS We included 34 RCTs comprising 49,899 participants and 11 treatment options. Evidence suggests that accelerated PBI (Hazard Ratio (HR) 1.36 (95% confidence interval (CI) 0.77 - 2.41, moderate certainty), moderately hypofractionated (MHF) PBI (HR 1.38 (0.60 - 3.19), moderate certainty) and intraoperative PBI (HR 1.47 (0.81 - 2.68), low certainty) was associated with a modest but not statistically significant increase in the hazards for IBTR when compared to WBI. There was moderate certainty evidence that there were no significant differences among the accelerated ultra-hypo fractionated (AUHF) WBI (HR 0.76 (0.50 - 1.14)), MHF-WBI (HR 0.99 (0.84 - 1.16)) or UHF-WBI (HR (1.35 (0.47 - 3.92)) when compared with CF-WBI for IBTR. The effects of sequential TBB (seqTBB) (HR 0.61 (0.52 - 0.70), high certainty) and simultaneous integrated TBB (simTBB) (HR 0.77 (0.55 - 1.09), moderate certainty) on IBTR were similar when compared to no TBB. There were no significant differences in OS between PBI options and WBI, AF-WBI options and CF-WBI, TBB options and no TBB. Among the PBI vs WBI trials, MHF-PBI and APBI may be associated with fewer adverse PRC events. Among the AF-WBI vs CF-WBI trials, half of the included trials reported fewer adverse PRC events with MHF-WBI. SeqTBB and simTBB had similar adverse PRC outcome. CONCLUSION There were no significant differences among the PBI, AF-WBI and TBB options for IBTR and OS. PBI and AF-WBI may be associated with less adverse PRC events compared with WBI and CF-WBI respectively. There was no evidence to suggest a difference between seqTBB and simTBB for PRC outcome. This study is registered with PROSPERO CRD 42021245074.
Collapse
Affiliation(s)
- C Wujanto
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - C C Lee
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - T Meng
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - K H Ooi
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - T H Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - W Y Koh
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - M S F Tseng
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - V Koh
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - T Yeoh
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Y H Leong
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - D Chia
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - I W Ng
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - F Ho
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - J Tey
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Y Y Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| |
Collapse
|
7
|
Singh C, Theriault BC, An Y, Yu JB, Knisely JPS, Shepard M, Wegner RE, Warnick RE, Peker S, Samanci Y, Trifiletti DM, Lee CC, Yang HC, Bernstein K, Kondziolka D, Tripathi M, Mathieu D, Mantziaris G, Pikis S, Sheehan JP, Chiang VL. Selected-Lesion SRS as a Novel Strategy in Treatment of Patients with Multiple Brain Metastases. Int J Radiat Oncol Biol Phys 2023; 117:e150-e151. [PMID: 37784735 DOI: 10.1016/j.ijrobp.2023.06.971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) With the increasing use of intracranial SRS (SRS) for treatment of patients with >10-15 brain metastases treatment; debate remains in the literature about how these patients should be treated. While many advocate for treatment of all lesions with either SRS or whole brain radiation therapy (WBRT), several groups are considering selected-lesion SRS (SL-SRS) where only a subset of intracranial lesions are treated. However, the current practice patterns of SL-SRS are not known. MATERIALS/METHODS A survey of 19 questions was created using open-ended and multiple-choice style questions on SL-SRS practices and indications. The survey was distributed to providers in the US and internationally who perform SRS frequently. Ten out of 50 institutions provided responses reflecting the practices of 16 providers. Descriptive statistics was used to compare answers to each question when applicable including percentages and ranges. RESULTS SL-SRS was performed at 8/10 institutions, (5 out of 6 US institutions and 3 out of 4 international institutions). Only 2 institutions had established clinical indications for SL-SRS (one in the US and one internationally) and one additional US institution reported clinical trials that require SL-SRS to study efficacy of CNS penetrating targeted therapies. One program reported research protocols for untreated brain metastases that would take priority over SL-SRS (program outside the US). Size of the lesion was cited as the most important factor (90%) when deciding to treat any single lesion. Next, lesion location and focal signs/symptoms were both considered moderately important. 80% ranked distance from prior SRS as the least important factor. Perilesional edema was also less important at most programs (90%). Lesion location and presence of symptoms were also considered important. There were several factors that would encourage providers to consider SL-SRS in a patient. Prior WBRT; progressing systemic disease and CNS-penetrating drug option available; and progressing systemic disease and immunotherapy option available were the most common responses. Most respondents cited "specific request by medical oncology" as well as "cooperative studies in this topic" as factors that might push them towards SL-SRS. Several institutions specified factors beyond the listed options. One institution reported that for patients with >20 lesions, they treated the largest lesions with SRS then follow with WBRT, termed the "pre-WBRT boost." Progression of untreated lesions was the most common reason why providers would bring back patients for additional treatment. CONCLUSION The responses to this survey demonstrate that patients with >15-20 intracranial lesions, prior WBRT, and worsening systemic disease with CNS penetrating systemic therapies available are being considered for SL-SRS.
Collapse
Affiliation(s)
- C Singh
- Yale University School of Medicine, New Haven, CT
| | | | - Y An
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - J B Yu
- Department of Radiation Oncology, Columbia University, New York, NY
| | - J P S Knisely
- Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY
| | - M Shepard
- Allegheny Health Network, Pittsburg, PA
| | - R E Wegner
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
| | - R E Warnick
- Jewish Hospital, Mayfield Clinic, Cincinnati, OH
| | - S Peker
- Koc University School of Medicine, Istanbul, Turkey
| | - Y Samanci
- Koc University School of Medicine, Istanbul, Turkey
| | - D M Trifiletti
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - C C Lee
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - H C Yang
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - K Bernstein
- Department of Radiation Oncology, NYU Langone Health, New York, NY
| | - D Kondziolka
- Department of Neurosurgery, NYU Langone Health, New York, NY
| | - M Tripathi
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D Mathieu
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - G Mantziaris
- Univers. Of Virginia Health System, Charlottesville, VA
| | - S Pikis
- Univers. Of Virginia Health System, Charlottesville, VA
| | - J P Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | - V L Chiang
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT
| |
Collapse
|
8
|
Vandiver AR, Hoang AN, Herbst A, Lee CC, Aiken JM, McKenzie D, Teitell MA, Timp W, Wanagat J. Nanopore sequencing identifies a higher frequency and expanded spectrum of mitochondrial DNA deletion mutations in human aging. Aging Cell 2023; 22:e13842. [PMID: 37132288 PMCID: PMC10265159 DOI: 10.1111/acel.13842] [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: 01/09/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 05/04/2023] Open
Abstract
Mitochondrial DNA (mtDNA) deletion mutations cause many human diseases and are linked to age-induced mitochondrial dysfunction. Mapping the mutation spectrum and quantifying mtDNA deletion mutation frequency is challenging with next-generation sequencing methods. We hypothesized that long-read sequencing of human mtDNA across the lifespan would detect a broader spectrum of mtDNA rearrangements and provide a more accurate measurement of their frequency. We employed nanopore Cas9-targeted sequencing (nCATS) to map and quantitate mtDNA deletion mutations and develop analyses that are fit-for-purpose. We analyzed total DNA from vastus lateralis muscle in 15 males ranging from 20 to 81 years of age and substantia nigra from three 20-year-old and three 79-year-old men. We found that mtDNA deletion mutations detected by nCATS increased exponentially with age and mapped to a wider region of the mitochondrial genome than previously reported. Using simulated data, we observed that large deletions are often reported as chimeric alignments. To address this, we developed two algorithms for deletion identification which yield consistent deletion mapping and identify both previously reported and novel mtDNA deletion breakpoints. The identified mtDNA deletion frequency measured by nCATS correlates strongly with chronological age and predicts the deletion frequency as measured by digital PCR approaches. In substantia nigra, we observed a similar frequency of age-related mtDNA deletions to those observed in muscle samples, but noted a distinct spectrum of deletion breakpoints. NCATS-mtDNA sequencing allows the identification of mtDNA deletions on a single-molecule level, characterizing the strong relationship between mtDNA deletion frequency and chronological aging.
Collapse
Affiliation(s)
- Amy R. Vandiver
- Division of Dermatology, Department of MedicineUCLALos AngelesCaliforniaUSA
- Veterans Administration Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
| | - Austin N. Hoang
- Division of Geriatrics, Department of MedicineUCLALos AngelesCaliforniaUSA
| | - Allen Herbst
- US Geological Survey National Wildlife Health CenterMadisonWisconsinUSA
| | - Cathy C. Lee
- Veterans Administration Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
- Division of Geriatrics, Department of MedicineUCLALos AngelesCaliforniaUSA
| | - Judd M. Aiken
- Department of Agricultural, Food and Nutritional SciencesUniversity of AlbertaEdmontonAlbertaCanada
| | - Debbie McKenzie
- Department of Biological SciencesUniversity of AlbertaEdmontonAlbertaCanada
| | - Michael A. Teitell
- Molecular Biology InstituteUniversity of California at Los AngelesLos AngelesCaliforniaUSA
- Department of Pathology and Laboratory Medicine, David Geffen School of MedicineUniversity of California at Los AngelesLos AngelesCaliforniaUSA
- Department of Bioengineering, California NanoSystems Institute, Broad Center for Regenerative Medicine and Stem Cell ResearchUniversity of California at Los AngelesLos AngelesCaliforniaUSA
- Department of Pediatrics, David Geffen School of MedicineUniversity of California at Los AngelesLos AngelesCaliforniaUSA
- Jonsson Comprehensive Cancer Center, David Geffen School of MedicineUniversity of California at Los AngelesLos AngelesCaliforniaUSA
| | - Winston Timp
- Department of Molecular Biology and GeneticsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Genetic MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jonathan Wanagat
- Veterans Administration Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
- Division of Geriatrics, Department of MedicineUCLALos AngelesCaliforniaUSA
| |
Collapse
|
9
|
Fan YH, Wu PW, Huang YL, Lee CC, Lee TJ, Huang CC, Chang PH, Huang CC. Identifying a sphenoid sinus fungus ball using a nomogram model. Rhinology 2022; 61:153-160. [PMID: 36375133 DOI: 10.4193/rhin22.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: Sphenoid sinus fungus ball (SSFB) is a rare entity and usually presents with non-specific symptoms. SSFB could potentially lead to serious orbital and intracranial complications. Computed tomography (CT) scan is usually the first imaging test of the diagnostic workup in patients with specific clinical symptoms. This study aimed to compare the clinical characteristics and CT features between SSFB and unilateral (non-fungus ball) chronic sphenoid rhinosinusitis (USRS) and help differentiate between these two most common inflammatory diseases of the sphenoid sinus. Methods: By retrospective database review, 66 patients with a histopathologic diagnosis of isolated SSFB were recruited for analysis. Fifty-four patients who underwent endoscopic sinus surgery with clinical and histopathological diagnoses of USRS were enrolled as the control group. Clinical characteristics and CT features were evaluated. Results: Headache, rhinorrhoea, nasal obstruction, postnasal dripping, and hyposmia were the most common symptoms in both groups. In the univariate analysis, older age, lower white blood cell counts, irregular surface, bony dehiscence, lateral wall sclerosis, and intralesional hyperdensity (IH) were significant predictors for SSFB. Older age, irregular surface, and IH remained statistically significant in the multivariate analysis. Based on the results of the regression analysis, a nomogram for predicting the probability of SSFB was plotted. Conclusions: We developed a nomogram model as a novel preoperative diagnostic tool for identifying SSFB according to the predictors both in clinical characteristics and on CT features. This could help the clinicians in predicting the probability of SSFB, to reduce ineffective or delayed treatment and occurrence of complications.
Collapse
Affiliation(s)
- Y H Fan
- Department of Medical Education, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - P W Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y L Huang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - C C Lee
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan
| | - T J Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, China
| | - C C Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan
| | - P H Chang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan
| | - C C Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan
| |
Collapse
|
10
|
Fernandez D, Wilkins SS, Melrose RJ, Hall KM, Abbate LM, Morey MC, Castle SC, Zeng A, Lee CC. Physical Function Effects of Live Video Group Exercise Interventions for Older Adults: A Systematic Review and Veteran's Gerofit Group Case Study. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Daniel Fernandez
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Stacy Schantz Wilkins
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Departments of Internal Medicine and Psychiatry, Los Angeles, California, USA
| | - Rebecca J. Melrose
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Departments of Internal Medicine and Psychiatry, Los Angeles, California, USA
| | - Katherine M. Hall
- Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, North Carolina, USA
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
- Roybal Center, Duke University Medical Center, Durham, North Carolina, USA
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren M. Abbate
- Geriatric Research, Education, and Clinical Center, Eastern Colorado Health Care System, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - Miriam C. Morey
- Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, North Carolina, USA
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Steven C. Castle
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Departments of Internal Medicine and Psychiatry, Los Angeles, California, USA
| | - Angela Zeng
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Cathy C. Lee
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Departments of Internal Medicine and Psychiatry, Los Angeles, California, USA
| |
Collapse
|
11
|
Lim ZC, Hoo GS, Ang JH, Teng CB, Ang LW, Lee CC, Leo YS, Law HL, Ng OT, Wong CS. Safety and effectiveness of switching to Abacavir/Lamivudine plus rilpivirine for maintenance therapy in virologically suppressed HIV-1 individuals in Singapore (SEALS). AIDS Res Ther 2021; 18:80. [PMID: 34724931 PMCID: PMC8561921 DOI: 10.1186/s12981-021-00402-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The efficacy and tolerability of an antiretroviral regimen are important considerations for selection of HIV-1 infection maintenance therapy. Abacavir/lamivudine plus rilpivirine (ABC/3TC + RPV) has been shown in international studies to be effective and well-tolerated in virologically suppressed individuals. This study evaluated the effectiveness and safety of switching to ABC/3TC + RPV as maintenance therapy in virologically suppressed HIV-1 infected individuals in Singapore. METHODS In this retrospective, single-centre study, we included individuals who were prescribed ABC/3TC + RPV, had HIV-1 viral load (VL) < 50 copies/ml immediately pre-switch, and had no documented history of resistance mutations or virologic failure to any of the components. The follow-up period was 48 ± 12 weeks. The primary outcome was the proportion of individuals who maintained virologic suppression of HIV-1 VL < 50 copies/ml at the end of follow-up period based on on-treatment analysis. The secondary outcomes were the resistance profiles associated with virologic failure, changes in immunologic and metabolic parameters, and the safety profile of ABC/3TC + RPV. RESULTS A total of 222 individuals were included in the study. The primary outcome was achieved in 197 individuals [88.8%, 95% confidence interval: 83.7-92.4%]. There were 21 individuals (9.5%) who discontinued treatment for non-virologic reasons. The remaining 4 individuals experienced virologic failure, of whom, 3 of these individuals had developed emergent antiretroviral resistance and had HIV-1 VL > 500 copies/ml at the end of the 48 ± 12 weeks follow-up period. The remaining individual experienced sustained low level viremia and subsequently achieved viral suppression without undergoing resistance testing. A total of 49 adverse events were observed in 31 out of 222 individuals (14.0%), which led to 13 individuals discontinuing therapy. Neuropsychiatric adverse events were most commonly observed (53.1%). A statistically significant increase in CD4 was observed (p < 0.01), with a median absolute change of 31 cells/uL (interquartile range: - 31.50 to 140.75). No significant changes in lipid profiles were detected. CONCLUSION ABC/3TC + RPV is a safe and effective switch option for maintenance therapy in virologically suppressed HIV-1 individuals with in Singapore.
Collapse
Affiliation(s)
- Z C Lim
- Department of Pharmacy, Ng Teng Fong General Hospital, Singapore, Singapore
| | - G S Hoo
- Department of Pharmacy, National Centre of Infectious Diseases, Singapore, Singapore.
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore.
| | - J H Ang
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - C B Teng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - L W Ang
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore, Singapore
| | - C C Lee
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Y S Leo
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - H L Law
- Department of Pharmacy, National Centre of Infectious Diseases, Singapore, Singapore
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - O T Ng
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - C S Wong
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
12
|
Lee CC, Wu DY, Lee TM. Exercise intensities modulate cognitive function in spontaneously hypertensive rats through oxidative mediated synaptic plasticity in hippocampus. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Oxidative damage in the brain may lead to cognitive impairments. There was considerable debate regarding the beneficial effects of physical exercise on cognitive functions because exercise protocols have varied widely across studies.
Purpose
We investigated whether different exercise intensities alter performance on cognitive tasks.
Methods
The experiment was performed on spontaneously hypertensive rats (6 months at the established phase of hypertension) distributed into 3 groups: sedentary, low-intensity exercise, and high-intensity exercise.
Results
Systolic blood pressure measurements confirmed hypertension in spontaneously hypertensive rats. In comparison to normotensive Wistar-Kyoto rats, sedentary spontaneously hypertensive rats had similar escape latencies and a similar preference for the correct quadrant in the probe trial. Compared to the sedentary group, the low-intensity exercise group had significantly better improvements in spatial memory assessed by Morris water maze. Low-intensity exercise was associated with attenuated reactive oxygen species, as measured by dihydroethidine fluorescence and nitrotyrosine staining in the dentate gyrus of the hippocampus. This was coupled with increased numbers of neurons and dendritic spines as well as a significant upregulation of synaptic density. In contrast, the beneficial effects of low-intensity exercise are abolished in high-intensity exercise as shown by increased free radical levels and an impairment in spatial memory.
Conclusions
We concluded that exercise is an effective strategy to improve spatial memory in spontaneously hypertensive rats even at an established phase of hypertension. Low-intensity exercise exhibited better improvement on cognitive deficits than high-intensity exercise by attenuating free radical levels and improving downstream synaptic plasticity.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- C C Lee
- Kang-Ming Senior High School, Tainan, Taiwan
| | - D Y Wu
- Catholic Sheng Kung Girls' High School, Tainan, Taiwan
| | - T M Lee
- Cardiovascular Institute, An Nan Hospital, China Medical University, Tainan, Taiwan
| |
Collapse
|
13
|
Herbst A, Lee CC, Vandiver AR, Aiken JM, McKenzie D, Hoang A, Allison D, Liu N, Wanagat J. Mitochondrial DNA deletion mutations increase exponentially with age in human skeletal muscle. Aging Clin Exp Res 2021; 33:1811-1820. [PMID: 32965609 PMCID: PMC7985047 DOI: 10.1007/s40520-020-01698-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/26/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mitochondrial DNA (mtDNA) deletion mutations lead to electron transport chain-deficient cells and age-induced cell loss in multiple tissues and mammalian species. Accurate quantitation of somatic mtDNA deletion mutations could serve as an index of age-induced cell loss. Quantitation of mtDNA deletion molecules is confounded by their low abundance in tissue homogenates, the diversity of deletion breakpoints, stochastic accumulation in single cells, and mosaic distribution between cells. AIMS Translate a pre-clinical assay to quantitate mtDNA deletions for use in human DNA samples, with technical and biological validation, and test this assay on human subjects of different ages. METHODS We developed and validated a high-throughput droplet digital PCR assay that quantitates human mtDNA deletion frequency. RESULTS Analysis of human quadriceps muscle samples from 14 male subjects demonstrated that mtDNA deletion frequency increases exponentially with age-on average, a 98-fold increase from age 20-80. Sequence analysis of amplification products confirmed the specificity of the assay for human mtDNA deletion breakpoints. Titration of synthetic mutation mixtures found a lower limit of detection of at least 0.6 parts per million. Using muscle DNA from 6-month-old mtDNA mutator mice, we measured a 6.4-fold increase in mtDNA deletion frequency (i.e., compared to wild-type mice), biologically validating the approach. DISCUSSION/CONCLUSIONS The exponential increase in mtDNA deletion frequency is concomitant with the known muscle fiber loss and accelerating mortality that occurs with age. The improved assay permits the accurate and sensitive quantification of deletion mutations from DNA samples and is sufficient to measure changes in mtDNA deletion mutation frequency in healthy individuals across the lifespan and, therefore, patients with suspected mitochondrial diseases.
Collapse
Affiliation(s)
- Allen Herbst
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada
| | - Cathy C Lee
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, USA
- Division of Geriatrics, Department of Medicine, UCLA, Los Angeles, CA, USA
| | - Amy R Vandiver
- Division of Dermatology, Department of Medicine, UCLA, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA, 90095, USA
| | - Judd M Aiken
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada
| | - Debbie McKenzie
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - Austin Hoang
- Division of Geriatrics, Department of Medicine, UCLA, Los Angeles, CA, USA
| | - David Allison
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, USA
| | - Nianjun Liu
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, USA
| | - Jonathan Wanagat
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, USA.
- Division of Geriatrics, Department of Medicine, UCLA, Los Angeles, CA, USA.
| |
Collapse
|
14
|
Hsiao JQ, Huang YJ, Lee CC, Yu YT, Tsou CH, Liang HC, Chen YF. Powerful Q-switched Raman laser at 589 nm with a repetition rate between 200 and 500 kHz. Opt Lett 2021; 46:2063-2066. [PMID: 33929419 DOI: 10.1364/ol.423371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
We demonstrate a highly powerful acousto-optically Q-switched Nd:YVO4 yellow laser at 589 nm by using a Np-cut KGW crystal and a phase-matching lithium triborate crystal to performance the intracavity stimulated Raman scattering and second-harmonic generation, respectively. We experimentally verify that the design of the separate cavity is superior to the conventional design of the shared cavity. By using the separate cavity, the optical-to-optical efficiency can be generally higher than 32% for the repetition rate within 200-500 kHz. The maximum output power at 589 nm can be up to 15.1 W at an incident pump power of 40 W and a repetition rate of 400 kHz.
Collapse
|
15
|
Chen YF, Hsieh MX, Tu YC, Lee CC, Yu YT, Tsou CH, Liang HC. Pedagogically fast model to evaluate and optimize passively Q-switched Nd-doped solid-state lasers. Opt Lett 2021; 46:1588-1591. [PMID: 33793494 DOI: 10.1364/ol.422382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
The coupled rate equations with the spatial overlap effect for four-level passively Q-switched lasers are fully considered. A transcendental equation is derived for the residual fraction of the inversion density after the finish of the Q-switched pulse. Comprehensive calculations for the transcendental equation were executed to attain an analytical function for precisely fitting the residual fraction of the inversion density. With the fitting function, a pedagogical model with the correction for high output coupling is developed to straightforwardly analyze the output pulse energy and peak power. Detailed experiments are carried out to validate the model.
Collapse
|
16
|
Herbst A, Prior SJ, Lee CC, Aiken JM, McKenzie D, Hoang A, Liu N, Chen X, Xun P, Allison DB, Wanagat J. Skeletal muscle mitochondrial DNA copy number and mitochondrial DNA deletion mutation frequency as predictors of physical performance in older men and women. GeroScience 2021; 43:1253-1264. [PMID: 33740224 DOI: 10.1007/s11357-021-00351-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/04/2021] [Indexed: 12/31/2022] Open
Abstract
Mitochondrial DNA (mtDNA) quality and quantity relate to two hallmarks of aging-genomic instability and mitochondrial dysfunction. Physical performance relies on mitochondrial integrity and declines with age, yet the interactions between mtDNA quantity, quality, and physical performance are unclear. Using a validated digital PCR assay specific for mtDNA deletions, we tested the hypothesis that skeletal muscle mtDNA deletion mutation frequency (i.e., a measure of mtDNA quality) or mtDNA copy number predicts physical performance in older adults. Total DNA was isolated from vastus lateralis muscle biopsies and used to quantitate mtDNA copy number and mtDNA deletion frequency by digital PCR. The biopsies were obtained from a cross-sectional cohort of 53 adults aged 50 to 86 years. Before the biopsy procedure, physical performance measurements were collected, including VO2max, modified physical performance test score, 6-min walk distance, gait speed, grip strength, and total lean and leg mass. Linear regression models were used to evaluate the relationships between age, sex, and the outcomes. We found that mtDNA deletion mutation frequency increased exponentially with advancing age. On average from ages 50 to 86, deletion frequency increased from 0.008 to 0.15%, an 18-fold increase. Females may have lower deletion frequencies than males at older ages. We also measured declines in VO2max and mtDNA copy number with age in both sexes. The mtDNA deletion frequency measured from single skeletal muscle biopsies predicted 13.3% of the variation in VO2max. Copy number explained 22.6% of the variation in mtDNA deletion frequency and 10.4% of the lean mass variation. We found predictive relationships between age, mtDNA deletion mutation frequency, mtDNA copy number, and physical performance. These data are consistent with a role for mitochondrial function and genome integrity in maintaining physical performance with age. Analyses of mtDNA quality and quantity in larger cohorts and longitudinal studies could extend our understanding of the importance of mitochondrial DNA in human aging and longevity.
Collapse
Affiliation(s)
- Allen Herbst
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Steven J Prior
- Department of Kinesiology, University of Maryland School of Public Health, College Park, MD, USA.,Baltimore Veterans Affairs Medical Center Geriatric Research, Education and Clinical Center, Baltimore, MD, USA
| | - Cathy C Lee
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Division of Geriatrics, Department of Medicine, University of California, Los Angeles, 650 Charles E. Young Drive South, Rm 34-115, Los Angeles, CA, 90095, USA
| | - Judd M Aiken
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Debbie McKenzie
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Austin Hoang
- Division of Geriatrics, Department of Medicine, University of California, Los Angeles, 650 Charles E. Young Drive South, Rm 34-115, Los Angeles, CA, 90095, USA
| | - Nianjun Liu
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, USA
| | - Xiwei Chen
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, USA
| | - Pengcheng Xun
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, USA
| | - David B Allison
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, USA
| | - Jonathan Wanagat
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,Division of Geriatrics, Department of Medicine, University of California, Los Angeles, 650 Charles E. Young Drive South, Rm 34-115, Los Angeles, CA, 90095, USA.
| |
Collapse
|
17
|
Lee CC, Xhori O, Tannyhill RJ, Kaban LB, Peacock ZS. Variables associated with stability after Le Fort I osteotomy for skeletal class III malocclusion. Int J Oral Maxillofac Surg 2021; 50:1203-1209. [PMID: 33658151 DOI: 10.1016/j.ijom.2021.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/12/2020] [Accepted: 02/02/2021] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to assess skeletal stability and predictors of relapse in patients undergoing an isolated Le Fort I osteotomy. A retrospective cohort study of 92 subjects undergoing Le Fort I osteotomy for Class III malocclusion was implemented. Predictor variables were demographic and perioperative factors. The primary outcome variable was postoperative skeletal position with relapse defined as >2mm sagittal and/or vertical change at A-point on serial lateral cephalograms at immediate postoperative, 1 year, and latest follow-up time points. Mean advancement at A-point was 6.28±2.63mm and mean lengthening was 0.92±1.76mm. Eight subjects (8.70%) had relapse (>2mm) in the sagittal plane, and two subjects (2.17%) in the vertical plane. No subjects required reoperation for relapse as overbite and overjet remained in an acceptable range due to dental compensation. In regression analysis, magnitude of maxillary advancement was an independent predictor of relapse in the sagittal plane (P=0.008). There were no significant predictors of relapse in the vertical plane. This study suggests that isolated Le Fort I osteotomy for correction of skeletal Class III malocclusion is a stable procedure and that greater advancement is an independent risk factor for sagittal relapse.
Collapse
Affiliation(s)
- C C Lee
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - O Xhori
- Harvard School of Dental Medicine, Boston, MA, USA
| | - R J Tannyhill
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - L B Kaban
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Z S Peacock
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
18
|
Chen YF, Li D, Lee YM, Lee CC, Huang HY, Tsou CH, Liang HC. Highly efficient solid-state Raman yellow-orange lasers created by enhancing the cavity reflectivity. Opt Lett 2021; 46:797-800. [PMID: 33577517 DOI: 10.1364/ol.415437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Abstract
A new, to the best of our knowledge, output coupler (OC) with enhancement of the cavity reflectivity is proposed to remarkably elevate the output powers and efficiencies of diode-pumped Nd:GdVO4/KGW Raman yellow-orange lasers. The cavity reflectivity is effectively increased by using the double-sided dichroic coating on the OC. In comparison with the conventional single-sided coating, the conversion efficiency can be boosted from 15% to 26.3% in the experiment of a yellow laser at 578.8 nm, and the maximum output power can be increased from 5.7 to 10.5 W in the quasi-continuous-wave mode with 50% duty cycle and frequency of 500 Hz. Furthermore, in the operation of an orange laser at 588 nm, the maximum output power can be improved from 5.6 to 7.0 W by replacing the conventional OC with the new one.
Collapse
|
19
|
Wilkins SS, Melrose RJ, Hall KS, Blanchard E, Castle SC, Kopp T, Katzel LI, Holder A, Alexander N, McDonald MKS, Tayade A, Forman DE, Abbate LM, Harris R, Valencia WM, Morey MC, Lee CC. PTSD Improvement Associated with Social Connectedness in Gerofit Veterans Exercise Program. J Am Geriatr Soc 2020; 69:1045-1050. [PMID: 33368144 DOI: 10.1111/jgs.16973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) is common in Veterans. Symptoms can perpetuate into late life, negatively impacting physical and mental health. Exercise and social support are beneficial in treating anxiety disorders such as PTSD in the general population, although less is known about the impact on Veterans who have lived with PTSD for decades. This study assessed associations between social connectedness, physical function and self-reported change in PTSD symptoms among older Veterans specifically participating in Gerofit. DESIGN Prospective clinical intervention. SETTING Twelve sites of Veterans Affairs (VA) Gerofit exercise program across the United States. PARTICIPANTS Three hundred and twenty one older Veteran Gerofit participants (mean age = 74) completed physical assessments and questionnaires regarding physical and emotional symptoms and their experience. MEASUREMENTS Measures of physical function, including 30-second chair stands, 10-m and 6-min walk were assessed at baseline and 3 months; change in PTSD symptoms based on the Diagnostic Statistical Manual-5 (DSM-5) assessed by a self-report questionnaire; and social connection measured by the Relatedness Subscale of the Psychological Need Satisfaction in Exercise scale (PNSE) were evaluated after 3 months of participation in Gerofit. RESULTS Ninety five (29.6%) Veterans reported PTSD. Significant improvement was noted in self-rated PTSD symptoms at 3 months (P < .05). Moderate correlation (r = .44) was found between social connectedness with other participants in Gerofit and PTSD symptom improvement for those Veterans who endorsed improvement (n = 59). All participants improved on measures of physical function. In Veterans who endorsed PTSD there were no significant associations between physical function improvement and PTSD symptoms. CONCLUSION Veterans with PTSD that participated in Gerofit group exercise reported symptom improvement, and social connectedness was significantly associated with this improvement. In addition to physical health benefits, the social context of Gerofit may offer a potential resource for improving PTSD symptoms in older Veterans that warrants further study.
Collapse
Affiliation(s)
- Stacy Schantz Wilkins
- VA Greater Los Angeles Healthcare System; Geriatric Research, Education, and Clinical Center and Mental Health, Los Angeles, California, USA.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Rebecca J Melrose
- VA Greater Los Angeles Healthcare System; Geriatric Research, Education, and Clinical Center and Mental Health, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Katherine S Hall
- Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, North Carolina, USA.,Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Erin Blanchard
- VA Greater Los Angeles Healthcare System; Geriatric Research, Education, and Clinical Center and Mental Health, Los Angeles, California, USA
| | - Steven C Castle
- VA Greater Los Angeles Healthcare System; Geriatric Research, Education, and Clinical Center and Mental Health, Los Angeles, California, USA.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Teresa Kopp
- Department of Physical Medicine and Rehabilitation, VA Medical Center, Canandaigua, New York, USA
| | - Leslie I Katzel
- Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alice Holder
- Department of Physical Therapy, VA Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Neil Alexander
- Geriatric Research, Education, and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle K S McDonald
- Geriatric Rehabilitation and Clinical Center, VA Pacific Health Care System, Honolulu, Hawaii, USA
| | - Arti Tayade
- Geriatrics and Extended Care, VA Puget Sound Health Care System, Seattle, Washington, USA.,Division of Gerontology & Geriatric Medicine, University of Washington, Seattle, Washington, USA
| | - Daniel E Forman
- Pittsburgh Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.,Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Lauren M Abbate
- Geriatric Research, Education, and Clinical Center, Eastern Colorado Health Care System, Aurora, Colorado, USA.,Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - Rebekah Harris
- Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Willy M Valencia
- Geriatric Research, Education, and Clinical Center, Miami Healthcare System, Florida, USA.,University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Miriam C Morey
- Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, North Carolina, USA.,Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Cathy C Lee
- VA Greater Los Angeles Healthcare System; Geriatric Research, Education, and Clinical Center and Mental Health, Los Angeles, California, USA.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| |
Collapse
|
20
|
Chen YF, Huang HY, Lee CC, Hsiao JQ, Tsou CH, Liang HC. High-power diode-pumped Nd:GdVO 4/KGW Raman laser at 578 nm. Opt Lett 2020; 45:5562-5565. [PMID: 33001947 DOI: 10.1364/ol.406173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/04/2020] [Indexed: 06/11/2023]
Abstract
A diode-pumped neodymium-doped gadolinium vanadate (Nd:GdVO4) laser is developed as a compact efficient yellow light at 578 nm by means of intracavity stimulated Raman scattering (SRS) in a potassium gadolinium tungstate (KGW) crystal and the second-harmonic generation in a lithium triborate crystal. The SRS process with a shift of 768cm-1 is achieved by setting the polarization of the fundamental wave along the Ng axis of the KGW crystal. The self-Raman effect arising from the Nd:GdVO4 crystal is systematically explored by employing two kinds of coating specification for the output coupler. With a specific coating on the output coupler to suppress the self-Raman effect, the maximum output power at 578 nm can reach 3.1 W at a pump power of 32 W. Moreover, two different lengths for the Nd:GdVO4 crystal are individually used to verify the influence of the self-Raman effect on the lasing efficiency.
Collapse
|
21
|
Chen YF, Chen CM, Lee CC, Huang HY, Li D, Hsiao JQ, Tsou CH, Liang HC. Efficient solid-state Raman yellow laser at 579.5 nm. Opt Lett 2020; 45:5612-5615. [PMID: 33001961 DOI: 10.1364/ol.405970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/04/2020] [Indexed: 06/11/2023]
Abstract
A highly efficient diode-pumped Nd:YVO4/KGW Raman yellow laser is developed to produce a 6.8 W yellow light at 579.5 nm accompanied by a 3.2 W Stokes wave at 1159 nm under an incident pump power of 30 W. The intracavity stimulated Raman scattering with the shift of 768cm-1 is generated by setting the polarization of the fundamental wave along the Ng direction of an Np-cut KGW crystal. The Nd:YVO4 gain medium is coated as a cavity mirror to reduce the cavity losses for the fundamental wave. More importantly, the KGW crystal is specially coated to prevent the Stokes wave from propagating through the gain medium to minimize the cavity losses for the Stokes wave.
Collapse
|
22
|
Chen YF, Lee CC, Hsiao JQ, Huang HY, Tsou CH, Liang HC, Huang KF. Exploiting a monolithic passively Q-switched Nd:YAG laser to mimic a single neuron cell under periodic stimulation. Opt Lett 2020; 45:4032-4035. [PMID: 32667347 DOI: 10.1364/ol.399253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/20/2020] [Indexed: 06/11/2023]
Abstract
A monolithic passively Q-switched Nd:YAG laser under periodic pulse pumping is originally exploited to emulate the response of a single neuron cell stimulated by periodic pulse inputs. Experimental results reveal that the output characteristics of the monolithic passively Q-switched laser can analogously manifest not only the firing patterns but also the frequency-locked plateaus of the single neuron cell. Moreover, the sine circle map is innovatively used to generate the output pulse sequences that can exactly correspond to experimental firing patterns. The present exploration indicates that a monolithic passively Q-switched solid-state laser is highly feasible to be developed as a compact artificial neuron cell.
Collapse
|
23
|
Chen YF, Chien PY, Lee CC, Huang KF, Liang HC. Timing jitter reduction of passively Q-switched solid-state lasers by coupling resonance between pumping and firing rates. Opt Lett 2020; 45:2902-2905. [PMID: 32412497 DOI: 10.1364/ol.394613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
The coupling resonance between pumping and firing rates is originally proposed to achieve the timing jitter reduction of a Nd:YVO4 laser passively Q-switched with a saturable absorber. When the pumping rate is higher than the spontaneous emission rate, it is experimentally confirmed that the pulse firing rate can be fractionally locked with the pumping rate by controlling the pump power. The locking characteristics of the firing rate display a variety of complex plateaus that can be excellently manifested with the sine-circle map. From numerical analyses, the coupling strength can be verified to be effectively enhanced by reducing the duty cycle of the pumping rate.
Collapse
|
24
|
Lee CC, Hoang A, Segovia D, Herbst A, Barthelemy F, Gibbs E, Crosbie R, Nelson SF, Miceli C, Wanagat J. Enhanced Methods for Needle Biopsy and Cryopreservation of Skeletal Muscle in Older Adults. J Cytol Histol 2020; 11. [PMID: 32566369 PMCID: PMC7304549 DOI: 10.37421/jch.2020.11.553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 11/19/2022]
Abstract
Human muscle biopsies are increasingly important for diagnosis, research, and to monitor therapeutic trials. We examined the use of a self-contained, vacuum-assisted biopsy system and a novel muscle freezing technique to improve, simplify, and standardize human muscle biopsy collection and cryopreservation in older adults. The VACORA vacuum-assisted biopsy system was deployed in muscle biopsies of 12 individuals ranging in age from 57 to 80 years. This office-based approach was well tolerated as it is minimally invasive, uses only local anesthetic, and has a quick recovery. To maximize biopsy sample quality and reproducibility, we developed a novel muscle sample freezing protocol. Fresh muscle biopsy samples were placed into readily available tissue cassettes followed by direct freezing in liquid nitrogen. After this modified snap freezing protocol, frozen muscle samples were enrobed in embedding medium for cryosectioning. We examined the effect of this freezing approach in histological sections of rodent and human muscle samples. The VACORA Biopsy System provided as many as four skeletal muscle core samples from a single biopsy site. Biopsy samples from 12 older adults weighed an average of 147.5 ± 11 mg each and had a consistent size and shape. There were no complications, and the residual scar is less than 10 mm. The freezing method using standard tissue cassettes with direct freezing in liquid nitrogen yielded high quality cryopreserved muscle tissue suitable for histological analysis without the need for isopentane and with little to no freeze-thaw damage. These enhancements have streamlined and improved the consistency of our muscle biopsy protocol and provide sufficient high-quality sample for multi-dimensional downstream studies of human muscle in aging and disease.
Collapse
Affiliation(s)
- Cathy C Lee
- VA Greater Los Angeles, Department of Veterans Affairs, Los Angeles, CA, USA.,Division of Geriatrics, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Austin Hoang
- Division of Geriatrics, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - David Segovia
- VA Greater Los Angeles, Department of Veterans Affairs, Los Angeles, CA, USA
| | - Allen Herbst
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Florian Barthelemy
- Center for Duchenne Muscular Dystrophy, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine and College of Letters and Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Elizabeth Gibbs
- Center for Duchenne Muscular Dystrophy, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Integrative Biology and Physiology, University of California, Los Angeles, CA, USA
| | - Rachelle Crosbie
- Center for Duchenne Muscular Dystrophy, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Integrative Biology and Physiology, University of California, Los Angeles, CA, USA.,Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Stanley F Nelson
- Center for Duchenne Muscular Dystrophy, University of California, Los Angeles, Los Angeles, CA, USA.,Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, USA.,Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Carrie Miceli
- Center for Duchenne Muscular Dystrophy, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine and College of Letters and Sciences, University of California, Los Angeles, Los Angeles, CA, USA.,Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jonathan Wanagat
- VA Greater Los Angeles, Department of Veterans Affairs, Los Angeles, CA, USA.,Division of Geriatrics, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| |
Collapse
|
25
|
Lee CC, Chui WWH, Wong SL, Wong TCB, Lau SPF, Kwong PK, Hung SF, Yau SSW. Multi-disciplinary Psychiatric Case Management Model in Hong Kong: Service Coverage and Risk Stratification. East Asian Arch Psychiatry 2020; 30:12-19. [PMID: 32229642 DOI: 10.12809/eaap1848] [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: 11/05/2022]
Abstract
INTRODUCTION Community mental health services in Hong Kong follow a multi-disciplinary case management model. We investigated whether at-risk patients received higher intensity care and whether risk stratification concorded between personalised care programmes and integrated community centres of mental wellness. METHODS Records of all patients in North Lantau and Mongkok districts who received case management services (from personalised care programmes and/or integrated community centres of mental wellness) between 1 April 2014 and 30 June 2015 were reviewed. Patients' levels of risk, demographic data, and clinical characteristics were analysed. RESULTS Identified at-risk patients received high-intensity care from personalised care programmes and integrated community centres of mental wellness. Case management was coordinated between the Hospital Authority and non-government organisations. However, risk stratification did not correlate with assessment rating scores of psychopathology or psychosocial functioning. Assessment rating scales appear unsuitable to provide any optimal cut-off scores for risk stratification. CONCLUSIONS Risk stratification should be a structured clinical judgement based on comprehensive and accurate information of protective and risk factors, rather than relying on cut-off scores of assessment rating scales.
Collapse
Affiliation(s)
- C C Lee
- Kwai Chung Hospital, Hong Kong
| | | | | | - T C B Wong
- New Life Psychiatric Rehabilitation Association, Hong Kong
| | | | | | - S F Hung
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
| | - S S W Yau
- New Life Psychiatric Rehabilitation Association, Hong Kong
| |
Collapse
|
26
|
Wu KK, Cheng JP, Leung J, Chow LP, Lee CC. Patients' Reports of Traumatic Experience and Posttraumatic Stress in Psychiatric Settings. East Asian Arch Psychiatry 2020; 30:3-11. [PMID: 32229641 DOI: 10.12809/eaap1880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine the prevalence of traumatic experience (TE) among patients in psychiatric settings in Hong Kong and the associations between TE and levels of distress and anxiety and depressive symptoms. METHODS 129 patients who have received inpatient psychiatric services were recruited. Their lifetime TE was assessed using the Life Event Checklist (LEC), and TE in psychiatric settings using the Psychiatric Experiences Questionnaire (PEQ). Their level of distress symptoms was assessed using the Impact of Event Scale-Revised (IES-R), and the level of anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale (HADS). RESULTS The prevalence of direct and indirect TE was 84.5%, as was the prevalence of TE in psychiatric settings. Common TE in psychiatric settings included witnessing another patient being taken down (61.2%), being put in restraints of any kind (41.1%), and witnessing another patient being physically assaulted by another patient (36.4%). TE in psychiatric settings associated with high prevalence of severe or extreme distress 1 week after the event included being forced to take medication against their will (52.2%), being threatened with physical violence (52.2%), and experiencing a physical assault (50.0%). Lifetime TE (the total number of LEC items reported) was associated with severity of distress and anxiety and depressive symptoms, whereas TE in psychiatric settings (the total number of PEQ items reported) was associated with severity of distress only. The total number of LEC items reported is the only predictor of levels of distress and anxiety and depressive symptoms. CONCLUSIONS Lifetime TE and TE in psychiatric settings are common among patients with SMI. Trauma-informed care is suggested for mental health services.
Collapse
Affiliation(s)
- K K Wu
- Kwai Chung Hospital, Hong Kong
| | | | - J Leung
- Kwai Chung Hospital, Hong Kong
| | | | - C C Lee
- Kwai Chung Hospital, Hong Kong
| |
Collapse
|
27
|
Manning KM, McNeill DL, Pinheiro SO, Heflin MT, Valencia WM, Lee CC, Castle SC, Katzel L, Giffuni J, Morey MC. An innovative educational clinical experience promoting geriatric exercise. Gerontol Geriatr Educ 2020; 41:20-31. [PMID: 29028419 DOI: 10.1080/02701960.2017.1391802] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Formal educational training in physical activity promotion is relatively sparse throughout the medical education system. The authors describe an innovative clinical experience in physical activity directed at medical clinicians on a geriatrics rotation. The experience consists of a single 2 1/2 hour session, in which learners are partnered with geriatric patients engaged in a formal supervised exercise program. The learners are guided through an evidence-based exercise regimen tailored to functional status. This experience provides learners with an opportunity to interact with geriatric patients outside the hospital environment to counterbalance the typical geriatric rotation in which geriatric patients are often seen in clinics or hospitals. In this experience, learners are exposed to fit and engaged geriatric patients successfully living in the community despite chronic or disabling conditions. A survey of 105 learners highlighted positive responses to the experience, with 96% of survey respondents indicating that the experience increased their confidence in their ability to serve as advocates for physical activity for older adults, and 89.5% of responders to a follow-up survey indicating that the experience changed their perception of geriatric patients. Modifications to the experience, implemented at partnering facilities are described. The positive feedback from this experience warrants consideration for implementation in other settings.
Collapse
Affiliation(s)
- Kenneth M Manning
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, North Carolina USA
| | - Darien L McNeill
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, North Carolina USA
- University of North Carolina School of Medicine, Chapel Hill, North Carolina USA
| | - Sandro O Pinheiro
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, North Carolina USA
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina USA
- Department of Medicine, Duke University Medical Center, Durham, North Carolina USA
| | - Mitchell T Heflin
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, North Carolina USA
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina USA
- Department of Medicine, Duke University Medical Center, Durham, North Carolina USA
| | - Willy M Valencia
- Geriatric Research, Education, and Clinical Center, VA Healthcare System, Miami, Florida USA
- Division of Epidemiology, Division of Geriatric Medicine, University of Miami Miller School of Medicine, Miami, Florida USA
| | - Cathy C Lee
- Geriatric Research, Education, and Clinical Center, Greater Los Angeles VA Healthcare System, Los Angeles, California USA
- David Geffen School of Medicine at the University of California, Los Angeles, California USA
| | - Steven C Castle
- Geriatric Research, Education, and Clinical Center, Greater Los Angeles VA Healthcare System, Los Angeles, California USA
- David Geffen School of Medicine at the University of California, Los Angeles, California USA
| | - Leslie Katzel
- Geriatric Research and Education Clinical Center, Baltimore VA Medical Center, Baltimore, Maryland
- Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine and Geriatric Research and Education Clinical Center, Baltimore, Maryland USA
| | | | - Miriam C Morey
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, North Carolina USA
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina USA
- Department of Medicine, Duke University Medical Center, Durham, North Carolina USA
| |
Collapse
|
28
|
Jennings SC, Manning KM, Bettger JP, Hall KM, Pearson M, Mateas C, Briggs BC, Oursler KK, Blanchard E, Lee CC, Castle S, Valencia WM, Katzel LI, Giffuni J, Kopp T, McDonald M, Harris R, Bean JF, Althuis K, Alexander NB, Padala KP, Abbate LM, Wellington T, Kostra J, Allsup K, Forman DE, Tayade AS, Wesley AD, Holder A, Morey MC. Rapid Transition to Telehealth Group Exercise and Functional Assessments in Response to COVID-19. Gerontol Geriatr Med 2020; 6:2333721420980313. [PMID: 33403222 PMCID: PMC7739082 DOI: 10.1177/2333721420980313] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/08/2020] [Accepted: 11/12/2020] [Indexed: 12/25/2022] Open
Abstract
Exercise is critical for health maintenance in late life. The COVID-19 shelter in place and social distancing orders resulted in wide-scale interruptions of exercise therapies, placing older adults at risk for the consequences of decreased mobilization. The purpose of this paper is to describe rapid transition of the Gerofit facility-based group exercise program to telehealth delivery. This Gerofit-to-Home (GTH) program continued with group-based synchronous exercise classes that ranged from 1 to 24 Veterans per class and 1 to 9 classes offered per week in the different locations. Three hundred and eight of 1149 (27%) Veterans active in the Gerofit facility-based programs made the transition to the telehealth delivered classes. Participants' physical performance testing continued remotely as scheduled with comparisons between most recent facility-based and remote testing suggesting that participants retained physical function. Detailed protocols for remote physical performance testing and sample exercise routines are described. Translation to remote delivery of exercise programs for older adults could mitigate negative health effects.
Collapse
Affiliation(s)
| | | | - Janet Prvu Bettger
- VA Health Care System, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
- Duke University, Durham, NC, USA
| | - Katherine M. Hall
- VA Health Care System, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
- Duke University, Durham, NC, USA
| | | | | | | | - Krisann K. Oursler
- Salem VA Medical Center, VA, USA
- Virginia Tech Carilion School of Medicine, Roanoke, USA
| | | | - Cathy C. Lee
- VA Greater Los Angeles Healthcare System, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Steven Castle
- VA Greater Los Angeles Healthcare System, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Willy M. Valencia
- Miami Healthcare System, FL, USA
- University of Miami, Miller School of Medicine, FL, USA
| | - Leslie I. Katzel
- VA Maryland Health Care System, Baltimore, USA
- University of Maryland School of Medicine, Baltimore, USA
| | - Jamie Giffuni
- VA Maryland Health Care System, Baltimore, USA
- University of Maryland School of Medicine, Baltimore, USA
| | | | | | | | - Jonathan F. Bean
- VA Boston Healthcare System, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Katherine Althuis
- VA Ann Arbor Healthcare System, MI, USA
- University of Michigan, Ann Arbor, USA
| | - Neil B. Alexander
- VA Ann Arbor Healthcare System, MI, USA
- University of Michigan, Ann Arbor, USA
| | - Kalpana P. Padala
- Central Arkansas Veterans Healthcare System, Little Rock, USA
- University of Arkansas for Medical Sciences, Little Rock, USA
| | - Lauren M. Abbate
- Eastern Colorado Health Care System, Aurora, USA
- Unverisity of Colorado, Aurora, USA
| | | | - James Kostra
- VA Pittsburgh Healthcare System, PA, USA
- University of Pittsburgh, PA, USA
| | | | - Daniel E. Forman
- VA Pittsburgh Healthcare System, PA, USA
- University of Pittsburgh, PA, USA
- University of Pittsburgh Medical Center, PA, USA
| | - Arti S. Tayade
- VA Puget Sound Health Care System, Seattle, WA, USA
- University of Washington, Seattle, USA
| | | | | | - Miriam C. Morey
- VA Health Care System, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
29
|
Abstract
We report four cases of fatal pulmonary embolism confirmed by autopsy among inpatients in a Hong Kong psychiatric hospital from 2010 to 2014. None of the four patients had a medical or premorbid condition associated with vascular thromboembolism or causing prolonged immobilisation. Only two patients were taking long-term antipsychotic medication, but all were physically restrained shortly before the event.
Collapse
Affiliation(s)
- C C Lee
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - R Fung
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - S W Pang
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - T L Lo
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| |
Collapse
|
30
|
Addison O, Serra MC, Katzel L, Giffuni J, Lee CC, Castle S, Valencia WM, Kopp T, Cammarata H, McDonald M, Oursler KA, Jain C, Bettger JP, Pearson M, Manning KM, Intrator O, Veazie P, Sloane R, Li J, Morey MC. Mobility Improvements are Found in Older Veterans After 6-Months of Gerofit Regardless of BMI Classification. J Aging Phys Act 2019; 27:848-854. [PMID: 31170861 PMCID: PMC7184640 DOI: 10.1123/japa.2018-0317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Veterans represent a unique population of older adults as they are more likely to self-report disability and be overweight or obese compared to the general population. We sought to compare changes in mobility function across the obesity spectrum in older Veterans participating in six-months of Gerofit, a clinical exercise program. 270 Veterans completed baseline, three, and six-month functional assessment and were divided post-hoc into groups: normal weight, overweight, and obese. Physical function assessment included: ten-meter walk time, six-minute walk distance, 30-second chair stands, and eight-foot up-and-go time. No significant weight x time interactions were found for any measure. However, significant (P<0.02) improvements were found for all mobility measures from baseline to three-months and maintained at six-months. Six-months of participation in Gerofit, if enacted nationwide, appears to be one way to improve mobility and function in older Veterans at high risk for disability regardless of weight status.
Collapse
Affiliation(s)
- Odessa Addison
- 1 Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD
- 2 School of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Monica C Serra
- 3 Atlanta VA Medical Center, Atlanta, GA
- 4 School of Medicine, Emory University, Atlanta, GA
| | - Leslie Katzel
- 1 Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD
- 2 School of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jamie Giffuni
- 1 Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD
| | - Cathy C Lee
- 5 Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, CA
- 6 David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Steven Castle
- 5 Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, CA
- 6 David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Willy M Valencia
- 7 Geriatric Research, Education, and Clinical Center, Miami Healthcare System, FL
- 8 University of Miami, Miller School of Medicine, Miami, FL
| | | | | | - Michelle McDonald
- 10 Geritaric Rehabilitation and Clinical Center, VA Pacific Health Care System, Honolulu, HI
| | - Kris A Oursler
- 11 Geriatric Research and Education, VA Medical Center, Salem, VA
| | - Chani Jain
- 11 Geriatric Research and Education, VA Medical Center, Salem, VA
| | - Janet Prvu Bettger
- 12 Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC
| | - Megan Pearson
- 13 Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, NC
| | - Kenneth M Manning
- 13 Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, NC
| | - Orna Intrator
- 14 Geriatrics and Extended Care Data and Analyses Center, VA Medical Center, Canandaigua, University of Rochester, Medical Center, Rochester, NY
- 15 Center for the Study of Aging / Claude D. Pepper Older Americans Independence Center
| | - Peter Veazie
- 14 Geriatrics and Extended Care Data and Analyses Center, VA Medical Center, Canandaigua, University of Rochester, Medical Center, Rochester, NY
- 15 Center for the Study of Aging / Claude D. Pepper Older Americans Independence Center
| | - Richard Sloane
- 16 Department of Medicine, Duke University Medical Center, Durham, NC
| | - Jiejin Li
- 14 Geriatrics and Extended Care Data and Analyses Center, VA Medical Center, Canandaigua, University of Rochester, Medical Center, Rochester, NY
- 15 Center for the Study of Aging / Claude D. Pepper Older Americans Independence Center
| | - Miriam C Morey
- 13 Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, NC
- 16 Department of Medicine, Duke University Medical Center, Durham, NC
| |
Collapse
|
31
|
Castle S, Lee CC, Blanchard EH, Roberts CK, Jones MJ, Schroeder ET. FEASIBILITY OF VIRTUAL REALITY TREADMILL TRAINING IN OLDER ADULTS WITH MOBILITY AND FITNESS DEFICITS. Innov Aging 2019. [PMCID: PMC6840501 DOI: 10.1093/geroni/igz038.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Only 23.6% of adults and <10% of adults age >75 years meet physical activity (PA) guidelines (aerobic & muscle-strengthening). Health benefit gym memberships has not improved participation. Therefore, Blue Goji developed a Virtual Reality (VR) treadmill to improve PA through fitness gamification with cognitive involvement in postural control to improve balance. Feasibility testing was done with seven older Veterans and one spouse, mean age of 81.3 years who participate in the VA Gerofit program & were near the 50th percentile (by age & gender) in strength, balance and endurance. Even those with lower levels of fitness, balance or chronic conditions (i.e., kyphosis or vision impairment) strongly supported this for enjoyment, benefit, comfort, safety and strongly recommended this (mean of 4.65 out of 5). The Gamification approach supports anti-ageism and intergenerational fitness activities. Further study on the additive effect on exercise intensity and improvement in fitness, balance and cognition is needed.
Collapse
Affiliation(s)
- Steven Castle
- University of California, Los Angeles, Los Angeles, California, United States
| | - Cathy C Lee
- VA Greater Los Angeles/UCLA, Los Angeles, California, United States
| | - Erin H Blanchard
- VA Greater Los Angeles Healthcare System, Los Angeles, California, United States
| | - Christian K Roberts
- VA Greater Los Angeles Healthcare System, Los Angeles, California, United States
| | - Malcolm J Jones
- Exercise Physiology, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, United States
| | - E T Schroeder
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, United States
| |
Collapse
|
32
|
Shiozaki M, Inoue K, Suwa S, Lee CC, Chiang SJ, Shimizu M, Fukuda K, Hiki M, Kubota N, Tamura H, Fujiwara Y, Sumiyoshi M, Daida H. P2677A combination of HEART score and a 0-hour/1-hour algorithm for early and safe triage tool for patients in observe zone. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The European Society Cardiology guidelines recommend that a 0-hour/1-hour (0–1hr) algorithm using high sensitivity cardiac troponin T (hs-cTnT) improves the early triage of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). However, diagnostic uncertainty remains in the 25–30% of patients assigned to “observe” group.
Purpose
To establish a step wise risk score system using HEART score and 0-hour/1-hour algorithm to identify the low risk group from observation group.
Methods
This study was a prospective, multi-center, observational study of patients with suspected NSTE-ACS admitted to five hospitals in Japan and Taiwan from 2014 to 2018, respectively. We applied the algorithm and calculated HEART score simultaneously. Patients were divided into three groups according to the algorithm: hs-cTnT below 12 ng/L and delta 1 hour below 3 ng/L were the “rule out” group; hs-cTnT at least 52 ng/L or delta 1 hour at least 5 ng/L were in the “rule in” group; the remaining patients were classified as the “observe” group. All patients underwent a clinical assessment the included medical history, physical examination, 12-lead ECG, continuous ECG monitoring, pulse oximetry, standard blood test, chest radiography, cardiac and abdominal ultrasonography. Patients presenting with congestive heart failure, terminal kidney disease on hemodialysis state, arrhythmia, or infection disease (which causes to increase troponin level) were excluded. Thirty-day MACE was defined as acute myocardial infarction, unstable angina (UA), or death.
Results
Of the 1,332 patients enrolled, 933 patients were analyzed after exclusion. NSTE-ACS was the final diagnosis for 122 (13.1%) patients and none of death. The HEART score less than 4 points in observation groups identified as very low risk with a negative predictive value (NPV) of 98.1% (95% confidential interval (CI); 90.1%-100%) and sensitivity of 98.0% (95% CI; 89.6%-100%). There were only one patient (0.5%) with AMI. In case of the HEART score less than 5 points, it could also identify as very low risk with a NPV of 96.7% (95% CI; 90.8%-99.3%%) and sensitivity of 94.1% (95% CI; 83.8%-98.8%). There were only three patients (1.2%) with AMI.
Conclusion
A combination of HEART score and the 0-hour/1-hour algorithm strategy rapidly identified the patient in observation group of 30-day MACE including UA where nor further cardiac testing would be needed.
Acknowledgement/Funding
JSPS KAKENHI Grant Number JP18K09554
Collapse
Affiliation(s)
- M Shiozaki
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - K Inoue
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - S Suwa
- Juntendo University Shizuoka Hospital, Cardiology, Shizuoka, Japan
| | - C C Lee
- National Taiwan University Hospital, Emergency Medicine, Taipei, Taiwan
| | | | - M Shimizu
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - K Fukuda
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Hiki
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - N Kubota
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - H Tamura
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - Y Fujiwara
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Sumiyoshi
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - H Daida
- Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
33
|
Shiozaki M, Inoue K, Suwa S, Lee CC, Chiang SJ, Shimizu M, Fukuda K, Hiki M, Kubota N, Tamura H, Fujiwara Y, Sumiyoshi M, Daida H. P2676Prospective validation of the 2015 ESC 0-hour/1-hour algorithm using high-sensitivity cardiac troponin T in Asian countries. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background/Introduction
Implementation of the 2015 ESC 0-hour/1-hour algorithm using high-sensitivity troponin (hs-cTn) T in Asian countries presents a challenge for clinical practice.
Purpose
We aimed to prospectively validate the 0-hour/1-hour algorithm in Asian countries.
Methods
We conducted a prospective, multi-center, international cohort already utilizing 0-hour/1-hour algorithm using hs-cTnT for evaluation of patients with suspected of non-ST elevation acute coronary syndrome (NSTE-ACS). All patients underwent a clinical assessment the included medical history, physical examination, 12-lead ECG, continuous ECG monitoring, pulse oximetry, standard blood test, chest radiography, cardiac and abdominal ultrasonography. Patients presenting with congestive heart failure, terminal kidney disease on hemodialysis state, arrhythmia, or infection disease (which cause to increase troponin level) were excluded. Patients were divided into three groups according to the algorithm: hs-cTnT below 12 ng/L and delta 1 hour below 3 ng/L were the “rule out” group; hs-cTnT at least 52 ng/L or delta 1 hour at least 5 ng/L were in the “rule in” group; the remaining patients were classified as the “observational” group. The final diagnosis was then adjudicated by 2 independent cardiologists using all available information, including coronary angiography, coronary computed tomography, stress electrocardiography and follow-up data. The presence of acute myocardial infarction (AMI) was defined according to the Fourth Universal Definition of Myocardial Infarction.
Results
Of the 1,332 patients enrolled in 2014 to 2018, 933 patients were analyzed after exclusion. AMI was the final diagnosis for 122 (13.1%) patients. The algorithm ruled out AMI in 401 patients with a negative predictive value and sensitivity of 100% (95% confidential interval [CI], 98.6%-100%) and 100% (95% CI, 94.0%-100%), respectively, in the rule-out group. None of the patients were diagnosed with AMI. Among the 211 patients classified into the rule-in group, 90 were diagnosed as having AMI. The positive predictive value and specificity were 43.1% (95% CI, 36.2%-50.2%) and 78.3% (95% CI, 74.5%-81.7%), respectively. The median length of hospital stay was 159 min (142–180) in rule out group.
Conclusion(s)
Our findings suggest that the 0-hour/1-hour algorithm using hs-cTnT provides very high safety and efficacy for the triage toward rapid rule-out to rule-in of AMI.
Acknowledgement/Funding
JSPS KAKENHI Grant Number JP18K09554
Collapse
Affiliation(s)
- M Shiozaki
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - K Inoue
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - S Suwa
- Juntendo University Shizuoka Hospital, Cardiology, Shizuoka, Japan
| | - C C Lee
- National Taiwan University Hospital, Emergency Medicine, Taipei, Taiwan
| | | | - M Shimizu
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - K Fukuda
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Hiki
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - N Kubota
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - H Tamura
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - Y Fujiwara
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Sumiyoshi
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - H Daida
- Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
34
|
Tang CP, Hung SF, Lee CC, Ho TP, Leung PWL. 15-year computer-record study of adolescents exposed to peer suicide. Hong Kong Med J 2019; 25 Suppl 3:11-12. [PMID: 30792365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
| | | | | | - T P Ho
- Department of Psychiatry, The University of Hong Kong
| | - P W L Leung
- Department of Psychology, The Chinese University of Hong Kong
| |
Collapse
|
35
|
Fan PY, Lee CC, Liu SH, Li IJ, Weng CH, Tu KH, Hsieh MY, Kuo CF, Chang TY, Tian YC, Yang CW, Wu HH. Preventing arteriovenous shunt failure in hemodialysis patients: a population-based cohort study. J Thromb Haemost 2019; 17:77-87. [PMID: 30472783 DOI: 10.1111/jth.14347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Indexed: 11/29/2022]
Abstract
Essentials Uncertainty remains about antiplatelets for vascular access patency in hemodialysis patients. 95 971 people under hemodialysis were followed in a claims database in Taiwan. Aspirin reduced vascular access failure rate and did not increase major bleeding rate. Clopidogrel, Aggrenox, and warfarin might increase major bleeding rate. SUMMARY: Background Dialysis adequacy is a major determinant of survival for patients with end-stage renal disease. Good vascular access is essential to achieve adequate dialysis. Objectives This study evaluated the impacts of different drugs on the vascular access failure rate of an arteriovenous fistula or an arteriovenous graft and the rate of major bleeding in hemodialysis patients. Patients and methods We studied patients with end-stage renal disease registered in the Taiwan National Health Insurance program from 1 January 1997 to 31 December 2012. A total of 95 971 patients were enrolled in our study. Vascular access dysfunction was defined as the need for thrombectomy or percutaneous angioplasty. Major bleeding was defined as emergency department visits or hospitalization with a primary diagnosis of gastrointestinal bleeding or intracerebral hemorrhage. The adjusted odds ratios between person-quarters with or without antiplatelet or oral anticoagulant use were calculated using a generalized estimating equation. Results The odds ratio of vascular access failure was 0.21 (0.11-0.39) for aspirin, 0.76 (0.74-0.79) for clopidogrel, 0.67 (0.59-0.77) for dipyridamole, 0.67 (0.53-0.86) for Aggrenox and 0.96 (0.90-1.03) for warfarin. The highest odds ratio for intracerebral hemorrhage was 5.33 (1.25-22.72) in younger patients using Aggrenox. The highest odds ratio for gastrointestinal bleeding was 1.34 (1.10-1.64) for clopidogrel. Conclusion Antiplatelet agents, but not warfarin, might reduce the vascular access thrombosis rate. The gastrointestinal bleeding rate was increased in the group using clopidogrel. Aggrenox should be used with caution in young individuals because it might increase the rate of intracerebral hemorrhage.
Collapse
Affiliation(s)
- P Y Fan
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
| | - C C Lee
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, , Taiwan
| | - S H Liu
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, , Taiwan
| | - I-J Li
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
| | - C H Weng
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, , Taiwan
| | - K H Tu
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, , Taiwan
| | - M Y Hsieh
- Big Data Research Office, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
| | - C F Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - T-Y Chang
- Department of Neurology, Stroke Center, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y C Tian
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
| | - C W Yang
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
| | - H H Wu
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, , Taiwan
| |
Collapse
|
36
|
Briggs BC, Jain C, Morey MC, Blanchard EH, Lee CC, Valencia WM, Oursler KK. Providing Rural Veterans With Access to Exercise Through Gerofit. Fed Pract 2018; 35:16-23. [PMID: 30766328 PMCID: PMC6366594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Clinical video telehealth can be used to deliver functional circuit exercise training to older veterans in remote locations.
Collapse
Affiliation(s)
- Brandon C Briggs
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Chani Jain
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Miriam C Morey
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Erin H Blanchard
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Cathy C Lee
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Willy M Valencia
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Krisann K Oursler
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| |
Collapse
|
37
|
Briggs B, Jain C, C Morey M, Blanchard EH, Lee CC, Marcos Valencia W, Oursler KK. PROVIDING RURAL VETERANS ACCESS TO GEROFIT THROUGH CLINICAL VIDEO TELE-HEALTH. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B Briggs
- Geriatric Research and Education, Salem VA Medical Center, Salem, Virginia, United States
| | - C Jain
- Geriatric Research and Education, Salem VA Medical Center, Salem, VA, USA
| | - Miriam C Morey
- Geriatric Research, Education, and Clinical Center Durham Veterans Affairs Healthcare System, Durham, NC; Center for the Study of Aging and Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - E H Blanchard
- Geriatric Research, Education, and Clinical Center, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - C C Lee
- Geriatric Research, Education, and Clinical Center, Greater Los Angeles Healthcare System; Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - W Marcos Valencia
- Miami VA Healthcare System, Geriatric Research, Education, and Clinical Center; Division of Epidemiology and Division of Geriatric Medicine, University of Miami School of Medicine, Miami, FL, USA
| | - K K Oursler
- Geriatric Research and Education, Salem VA Medical Center Salem, VA, USA; Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| |
Collapse
|
38
|
Andonian N, Lee CC, Blanchard E, Roberts C, Singh S, Russell M, Bojalian M, Castle SC. GEROFIT PREHABILITATION TO IMPROVE POST-OPERATIVE OUTCOMES IN AN OLDER/AT-RISK POPULATION. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Andonian
- UCLA, Los Angeles, California, United States
| | - C C Lee
- Geriatric Medicine UCLA/Veterans Affairs, Los Angeles, CA, USA
| | - E Blanchard
- Geriatric Medicine UCLA/Veterans Affairs, Los Angeles, CA, USA
| | - C Roberts
- Geriatric Medicine UCLA/Veterans Affairs, Los Angeles, CA, USA
| | - S Singh
- UCLA Department of Anesthesiology and Perioperative Medicine, Los Angeles, CA, USA; Greater Los Angeles VA Health System, Los Angeles, CA, USA
| | - M Russell
- Greater Los Angeles VA Health System, Los Angeles, CA, USA
| | - M Bojalian
- Greater Los Angeles VA Health System, Los Angeles, CA, USA
| | - S C Castle
- Geriatric Medicine UCLA/Veterans Affairs, Los Angeles, CA, USA
| |
Collapse
|
39
|
Hsieh RW, Hsu TC, Lee M, Hsu WT, Chen ST, Huang HS, Hsieh AL, Lee CC. 4068Outcome and economic comparison for type B aortic dissection patients receiving open surgery, thoracic endovascular aortic repair, and medical treatment. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R W Hsieh
- Albert Einstein Medical Center, Internal Medicine, Philadelphia, United States of America
| | - T C Hsu
- National Taiwan University Hospital, Emergency Medicine, Taipei, Taiwan ROC
| | - M Lee
- Medical Wisdom Consultants Inc., Houston, United States of America
| | - W T Hsu
- Harvard Medical School, Epidemiology, Boston, United States of America
| | - S T Chen
- Harvard Medical School, Epidemiology, Boston, United States of America
| | - H S Huang
- National Taiwan University, Medicine, Taipei, Taiwan ROC
| | - A L Hsieh
- Albert Einstein Medical Center, Neurology, Philadelphia, United States of America
| | - C C Lee
- National Taiwan University Hospital, Emergency Medicine, Taipei, Taiwan ROC
| |
Collapse
|
40
|
Cheng JJ, Castle SC, Blanchard EH, Segovia D, Lee CC. Setting and Method of Measurement Affect Blood Pressure Readings in Older Veterans. Fed Pract 2018; 35:16-21. [PMID: 30766360 PMCID: PMC6368018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The present study demonstrated that standardized measurements of blood pressure were lower than the routine method used in most office settings.
Collapse
Affiliation(s)
- Justin J Cheng
- is a Medical Student at Florida International University Herbert Wertheim College of Medicine in Miami. is the Clinical Director of the Geriatric Research, Education, and Clinical Center; is Director and is a Kinesiology Exercise Specialist of the Gerofit Program; and is a Research Associate, all at Greater Los Angeles VA Healthcare System in California. is an Associate Professor of Medicine, and Dr. Castle is a Professor of Medicine at the David Geffen School of Medicine at UCLA
| | - Steven C Castle
- is a Medical Student at Florida International University Herbert Wertheim College of Medicine in Miami. is the Clinical Director of the Geriatric Research, Education, and Clinical Center; is Director and is a Kinesiology Exercise Specialist of the Gerofit Program; and is a Research Associate, all at Greater Los Angeles VA Healthcare System in California. is an Associate Professor of Medicine, and Dr. Castle is a Professor of Medicine at the David Geffen School of Medicine at UCLA
| | - Erin H Blanchard
- is a Medical Student at Florida International University Herbert Wertheim College of Medicine in Miami. is the Clinical Director of the Geriatric Research, Education, and Clinical Center; is Director and is a Kinesiology Exercise Specialist of the Gerofit Program; and is a Research Associate, all at Greater Los Angeles VA Healthcare System in California. is an Associate Professor of Medicine, and Dr. Castle is a Professor of Medicine at the David Geffen School of Medicine at UCLA
| | - David Segovia
- is a Medical Student at Florida International University Herbert Wertheim College of Medicine in Miami. is the Clinical Director of the Geriatric Research, Education, and Clinical Center; is Director and is a Kinesiology Exercise Specialist of the Gerofit Program; and is a Research Associate, all at Greater Los Angeles VA Healthcare System in California. is an Associate Professor of Medicine, and Dr. Castle is a Professor of Medicine at the David Geffen School of Medicine at UCLA
| | - Cathy C Lee
- is a Medical Student at Florida International University Herbert Wertheim College of Medicine in Miami. is the Clinical Director of the Geriatric Research, Education, and Clinical Center; is Director and is a Kinesiology Exercise Specialist of the Gerofit Program; and is a Research Associate, all at Greater Los Angeles VA Healthcare System in California. is an Associate Professor of Medicine, and Dr. Castle is a Professor of Medicine at the David Geffen School of Medicine at UCLA
| |
Collapse
|
41
|
Wu PT, Segovia DE, Lee CC, Nguyen KL. Consistency of Continuous Ambulatory Interstitial Glucose Monitoring Sensors. Biosensors (Basel) 2018; 8:bios8020049. [PMID: 29772654 PMCID: PMC6023027 DOI: 10.3390/bios8020049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 11/16/2022]
Abstract
AIMS The abdominal region is the most common location for continuous glucose monitor (CGM) sensor insertion. However, a paucity of post-marketing data is available to demonstrate intra-individual consistency of CGM readings at different abdominal insertion sites. METHODS Healthy adults (fasting glucose (FG) < 5.5 mmol/L; BMI < 30 kg/m²) were recruited and a CGM sensor was placed on each side of the abdomen. Postprandial and continuous 48-h interstitial glucose levels were analyzed. RESULTS There was no significant difference in the 3-h postprandial glucose (PPG) level derived from the left versus right CGM, which remained non-significant after adjusting for waist circumference or FG. Among the glucose levels recorded over 48-h, values on the left site were greater in 3.6% of the data points (p < 0.05). After adjusting for waist circumference, only 0.5% of the glucose values remained significantly greater on the left (p < 0.05). When adjusted for FG, similar results were observed. For both PPG and 48-h readings, the mean absolute relative difference was not significant between the two abdominal sites. CONCLUSIONS CGM-derived glucose measures were highly consistent between the left and right abdomen during both the postprandial and post-absorptive periods.
Collapse
Affiliation(s)
- Pei T Wu
- Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA 90024, USA.
| | - David E Segovia
- Department of Geriatrics, David Geffen School of Medicine at UCLA and Geriatric Research Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA 90095, USA.
| | - Cathy C Lee
- Department of Geriatrics, David Geffen School of Medicine at UCLA and Geriatric Research Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA 90095, USA.
| | - Kim-Lien Nguyen
- Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA 90024, USA.
| |
Collapse
|
42
|
Ogundele OM, Lee CC. CaMKIIα expression in a mouse model of NMDAR hypofunction schizophrenia: Putative roles for IGF-1R and TLR4. Brain Res Bull 2018; 137:53-70. [PMID: 29137928 PMCID: PMC5835406 DOI: 10.1016/j.brainresbull.2017.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 08/26/2017] [Revised: 11/03/2017] [Accepted: 11/08/2017] [Indexed: 12/29/2022]
Abstract
Schizophrenia (SCZ) is a neuropsychiatric disorder that is linked to social behavioral deficits and other negative symptoms associated with hippocampal synaptic dysfunction. Synaptic mechanism of schizophrenia is characterized by loss of hippocampal N-Methyl-d-Aspartate Receptor (NMDAR) activity (NMDAR hypofunction) and dendritic spines. Previous studies show that genetic deletion of hippocampal synaptic regulatory calcium-calmodulin dependent kinase II alpha (CaMKIIα) cause synaptic and behavioral defects associated with schizophrenia in mice. Although CaMKIIα is involved in modulation of NMDAR activity, it is equally linked to inflammatory and neurotropin signaling in neurons. Based on these propositions, we speculate that non-neurotransmitter upstream receptors associated with neurotropic and inflammatory signaling activities of CaMKIIα may alter its synaptic function. Besides, how these receptors (i.e. inflammatory and neurotropic receptors) alter CaMKIIα function (phosphorylation) relative to hippocampal NMDAR activity in schizophrenia is poorly understood. Here, we examined the relationship between toll-like receptor (TLR4; inflammatory), insulin-like growth factor receptor 1 (IGF-1R; neurotropic) and CaMKIIα expression in the hippocampus of behaviorally deficient schizophrenic mice after we induced schizophrenia through NMDAR inhibition. Schizophrenia was induced in WT (C57BL/6) mice through intraperitoneal administration of 30mg/Kg ketamine (NMDAR antagonist) for 5days (WT/SCZ). Five days after the last ketamine treatment, wild type schizophrenic mice show deficiencies in sociability and social novelty behavior. Furthermore, there was a significant decrease in hippocampal CaMKIIα (p<0.001) and IGF-1R (p<0.001) expression when assessed through immunoblotting and confocal immunofluorescence microscopy. Additionally, WT schizophrenic mice show an increased percentage of phosphorylated CaMKIIα in addition to upregulated TLR4 signaling (TLR4, NF-κB, and MAPK/ErK) in the hippocampus. To ascertain the functional link between TLR4, IGF-1R and CaMKIIα relative to NMDAR hypofunction in schizophrenia, we created hippocampal-specific TLR4 knockdown mouse using AAV-driven Cre-lox technique (TLR4 KD). Subsequently, we inhibited NMDAR function in TLR4 KD mice in an attempt to induce schizophrenia (TLR4 KD SCZ). Interestingly, IGF-1R and CaMKIIα expressions were preserved in the TLR4 KD hippocampus after attenuation of NMDAR function. Furthermore, TLR4 KD SCZ mice showed no prominent defects in sociability and social novelty behavior when compared with the control (WT). Our results show that a sustained IGF-1R expression may preserve the synaptic activity of CaMKIIα while TLR4 signaling ablates hippocampal CaMKIIα expression in NMDAR hypofunction schizophrenia. Together, we infer that IGF-1R depletion and increased TLR4 signaling are non-neurotransmitter pro-schizophrenic cues that can reduce synaptic CaMKIIα activity in a pharmacologic mouse model of schizophrenia.
Collapse
Affiliation(s)
- O M Ogundele
- Department of Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, LA, United States.
| | - C C Lee
- Department of Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, LA, United States.
| |
Collapse
|
43
|
Morey MC, Lee CC, Castle S, Valencia WM, Katzel L, Giffuni J, Kopp T, Cammarata H, McDonald M, Oursler KA, Wamsley T, Jain C, Bettger JP, Pearson M, Manning KM, Intrator O, Veazie P, Sloane R, Li J, Parker DC. Should Structured Exercise Be Promoted As a Model of Care? Dissemination of the Department of Veterans Affairs Gerofit Program. J Am Geriatr Soc 2018; 66:1009-1016. [PMID: 29430642 DOI: 10.1111/jgs.15276] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 01/05/2023]
Abstract
Exercise provides a wide range of health-promoting benefits, but support is limited for clinical programs that use exercise as a means of health promotion. This stands in contrast to restorative or rehabilitative exercise, which is considered an essential medical service. We propose that there is a place for ongoing, structured wellness and health promotion programs, with exercise as the primary therapeutic focus. Such programs have long-lasting health benefits, are easily implementable, and are associated with high levels of participant satisfaction. We describe the dissemination and implementation of a long-standing exercise and health promotion program, Gerofit, for which significant gains in physical function that have been maintained over 5 years of follow-up, improvements in well-being, and a 10-year 25% survival benefit among program adherents have been documented. The program has been replicated at 6 Veterans Affairs Medical Centers. The pooled characteristics of enrolled participants (n = 691) demonstrate substantial baseline functional impairment (usual gait speed 1.05 ± 0.3 m/s, 8-foot up and go 8.7 ± 6.7 seconds, 30-second chair stands 10.7 ± 5.1, 6-minute walk distance 404.31 ± 141.9 m), highlighting the need for such programs. Change scores over baseline for 3, 6, and 12 months of follow-up are clinically and statistically significant (P < .05 all measures) and replicate findings from the parent program. Patient satisfaction ratings of high ranged from 88% to 94%. We describe the implementation process and present 1-year outcomes. We suggest that such programs be considered essential elements of healthcare systems.
Collapse
Affiliation(s)
- Miriam C Morey
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Durham, North Carolina.,Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Cathy C Lee
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,David Geffen School of Medicine, University of California, Los Angeles, California
| | - Steven Castle
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,David Geffen School of Medicine, University of California, Los Angeles, California
| | - Willy M Valencia
- Geriatric Research, Education, and Clinical Center, Miami Healthcare System, Miami, Florida.,University of Miami, Miller School of Medicine, Miami, Florida
| | - Leslie Katzel
- Geriatric Research, Education and Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland.,School of Medicine, University of Maryland, Baltimore, Maryland
| | - Jamie Giffuni
- Geriatric Research, Education and Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland
| | - Teresa Kopp
- Veterans Affairs Medical Center, Canandaigua, New York
| | | | - Michelle McDonald
- Geriatric Rehabilitation and Clinical Center, Veterans Affairs Pacific Health Care System, Honolulu, Hawaii
| | - Kris A Oursler
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salem, Virginia
| | - Timothy Wamsley
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salem, Virginia
| | - Chani Jain
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salem, Virginia
| | - Janet P Bettger
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Megan Pearson
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Durham, North Carolina
| | - Kenneth M Manning
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Durham, North Carolina
| | - Orna Intrator
- Geriatrics and Extended Care Data and Analysis Center, Veterans Affairs Medical Center, Canandaigua, New York.,University of Rochester Medical Center, Rochester, New York
| | - Peter Veazie
- Geriatrics and Extended Care Data and Analysis Center, Veterans Affairs Medical Center, Canandaigua, New York.,University of Rochester Medical Center, Rochester, New York
| | - Richard Sloane
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jiejin Li
- Geriatrics and Extended Care Data and Analysis Center, Veterans Affairs Medical Center, Canandaigua, New York.,University of Rochester Medical Center, Rochester, New York
| | - Daniel C Parker
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Durham, North Carolina
| |
Collapse
|
44
|
Nagarajan R, Carpenter CL, Lee CC, Michael N, Sarma MK, Souza R, Xu E, Velan SS, Hahn TJ, Go VL, Thomas MA. Assessment of Lipid and Metabolite Changes in Obese Calf Muscle Using Multi-Echo Echo-planar Correlated Spectroscopic Imaging. Sci Rep 2017; 7:17338. [PMID: 29229948 PMCID: PMC5725420 DOI: 10.1038/s41598-017-17529-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 03/16/2016] [Accepted: 11/23/2017] [Indexed: 12/13/2022] Open
Abstract
Obesity-related conditions including heart disease, stroke, and type 2 diabetes are leading causes of preventable death. Recent evidence suggests that altered myocellular lipid metabolism in obesity may lead to increased insulin resistance (IR) that predisposes to these disorders. To test the hypothesis that muscles rich in type I vs. type II muscle fibers would exhibit similar changes in intramyocellular lipid (IMCL) and extramyocellular lipid (EMCL) content in obesity, we utilized a new four-dimensional multi echo echo-planar correlated spectroscopic imaging technique that allows separate determination of IMCL and EMCL content in individual calf muscles in obese vs. normal healthy human subjects. Calf muscles were scanned in 32 obese and 11 healthy subjects using a 3T MRI/MRS scanner, and IR in the obese subjects was documented by glucose tolerance testing. In obese subjects, elevation of both IMCL and EMCL content was observed in the gastrocnemius and tibialis anterior muscles (with mixed type I and II fiber content), while a significant increase in only IMCL content (+48%, p < 0.001) was observed in the soleus muscle (predominantly type I fibers). These observations indicate unexpected differences in changes in myolipid metabolism in type I vs. type II rich muscle regions in obesity, perhaps related to IR, and warrant further investigation.
Collapse
Affiliation(s)
- Rajakumar Nagarajan
- Radiological Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Catherine L Carpenter
- UCLA Schools of Nursing, Medicine, and Public Health, Los Angeles, CA, United States
| | - Cathy C Lee
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,UCLA Department of Medicine, Los Angeles, CA, United States
| | - Navin Michael
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - Manoj K Sarma
- Radiological Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Raissa Souza
- Radiological Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Edward Xu
- Radiological Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - S Sendhil Velan
- Laboratory of Molecular Imaging, Singapore Bioimaging Consortium, Singapore, Singapore.,Departments of Physiology & Medicine, National University of, Singapore, Singapore
| | - Theodore J Hahn
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,UCLA Department of Medicine, Los Angeles, CA, United States
| | - Vay-Liang Go
- UCLA Department of Medicine, Los Angeles, CA, United States
| | - M Albert Thomas
- Radiological Sciences, University of California Los Angeles, Los Angeles, CA, United States.
| |
Collapse
|
45
|
Lee SH, Hsu WT, Lai CC, Esmaily-Fard A, Tsai YW, Chiu CC, Wang J, Chang SS, Lee CC. Erratum to: Use of antipsychotics increases the risk of fracture: a systematic review and meta-analysis. Osteoporos Int 2017; 28:1763. [PMID: 28233021 DOI: 10.1007/s00198-017-3938-y] [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: 10/20/2022]
Affiliation(s)
- S-H Lee
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, National Yang Ming University, Taipei, Taiwan
| | - W-T Hsu
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan
| | - C-C Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - A Esmaily-Fard
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y-W Tsai
- Department of Family Medicine, Chang Gung Memorial Hospital, University College of Medicine, Taoyuan, Taiwan
| | - C-C Chiu
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
| | - J Wang
- University of Nevada School of Medicine, Las Vegas, Nevada, USA
| | - S-S Chang
- Department of Family Medicine, Chang Gung Memorial Hospital, No.5. Fu-Hsing street, Kuei Shan Hsiang, Taoyuan, Hsien, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - C C Lee
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan.
| |
Collapse
|
46
|
Lee SH, Hsu WT, Lai CC, Esmaily-Fard A, Tsai YW, Chiu CC, Wang J, Chang SS, Lee CC. Use of antipsychotics increases the risk of fracture: a systematic review and meta-analysis. Osteoporos Int 2017; 28:1167-1178. [PMID: 28083669 DOI: 10.1007/s00198-016-3881-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/11/2016] [Indexed: 01/19/2023]
Abstract
UNLABELLED Our systematic review and meta-analysis of observational studies indicated that the use of antipsychotics was associated with a nearly 1.5-fold increase in the risk of fracture. First-generation antipsychotics (FGAs) appeared to carry a higher risk of fracture than second-generation antipsychotics (SGAs). INTRODUCTION The risk of fractures associated with the use of antipsychotic medications has inconsistent evidence between different drug classes. A systematic review and meta-analysis was conducted to evaluate whether there is an association between the use of antipsychotic drugs and fractures. METHODS Searches were conducted through the PubMed and EMBASE databases to identify observational studies that had reported a quantitative estimate of the association between use of antipsychotics and fractures. The summary risk was derived from random effects meta-analysis. RESULTS The search yielded 19 observational studies (n = 544,811 participants) with 80,835 fracture cases. Compared with nonuse, use of FGAs was associated with a significantly higher risk for hip fractures (OR 1.67, 95% CI, 1.45-1.93), and use of second generation antipsychotics (SGAs) was associated with an attenuated but still significant risk for hip fractures (OR 1.33, 95% CI, 1.11-1.58). The risk of fractures associated with individual classes of antipsychotic users was heterogeneous, and odds ratios ranged from 1.24 to 2.01. Chlorpromazine was associated with the highest risk (OR 2.01, 95% CI 1.43-2.83), while Risperidone was associated with the lowest risk of fracture (OR 1.24, 95% CI 0.95-1.83). CONCLUSIONS FGA users were at a higher risk of hip fracture than SGA users. Both FGAs and SGAs were associated with an increased risk of fractures, especially among the older population. Therefore, the benefit of the off-label use of antipsychotics in elderly patients should be weighed against any risks for fracture.
Collapse
Affiliation(s)
- S-H Lee
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, National Yang Ming University, Taipei, Taiwan
| | - W-T Hsu
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan
| | - C-C Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - A Esmaily-Fard
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y-W Tsai
- Department of Family Medicine, Chang Gung Memorial Hospital, University College of Medicine, Taoyuan, Taiwan
| | - C-C Chiu
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
| | - J Wang
- University of Nevada School of Medicine, Las Vegas, Nevada, USA
| | - S-S Chang
- Department of Family Medicine, Chang Gung Memorial Hospital, No.5. Fu-Hsing street, Kuei Shan Hsiang, Taoyuan, Hsien, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - C C Lee
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan.
| |
Collapse
|
47
|
Wu PT, Chronley MK, Chen JJ, Croymans DM, Lee CC, Roberts CK. Associations Between Strength Fitness, Body Composition and the Determinants of Glycemic Control in Overweight/Obese Individuals. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000487729.77883.34] [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: 11/21/2022]
|
48
|
Kong CL, Lee CC, Ip YC, Chow LP, Leung CH, Lam YC. Validation of the Hong Kong Cantonese Version of World Health Organization Five Well-Being Index for People with Severe Mental Illness. East Asian Arch Psychiatry 2016; 26:18-21. [PMID: 27086756] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The World Health Organization Five Well-Being Index (WHO-5) has been developed to measure psychological wellbeing. Translation and linguistic validation of the WHO-5 into a Cantonese version has been accomplished for local use but it is not yet validated in people with severe mental illness in Hong Kong. This study aimed to examine the applicability of WHO-5 in measuring the psychological wellbeing dimension of people with severe mental illness. A brief and easily administrated tool to measure psychological wellbeing of people with severe mental illness can be used to provide an outcome measure in research studies and clinical trials. METHODS Subjects were randomly recruited from the Extended-Care Patient Intensive Treatment, Early Diversion and Rehabilitation Stepping-Stone Project (EXITERS) and the Rehabilitation Activity Centre (RAC) of Kwai Chung Hospital in Hong Kong. They were invited to complete the abbreviated version of Hong Kong Chinese World Health Organization Quality of Life (WHOQOL-BREF [HK]) and WHO-5 (Cantonese version) separately and concurrent validity was examined. RESULTS A total of 84 subjects were recruited, 42 each from EXITERS and RAC. In all, 49 (58%) were male and 35 (42%) were female. The mean ± standard deviation age was 43.2 ± 9.7 years. Their mean duration of mental illness was 16.4 ± 10.5 years and the mean years of education was 10.17 ± 2.5 years, i.e. about junior secondary school level in Hong Kong. The internal consistency of the WHO-5 was satisfactory (0.86) and was comparable with previous reports. Regarding validity, 1-factor structure with an eigenvalue of 3.24 explained 64.8% of total variance of WHO-5 for people with severe mental illness. Concurrent validity was established with moderate correlation (0.41-0.51) between WHO-5 and 4 domains of the WHOQOL-BREF (HK). CONCLUSION The WHO-5 (Cantonese version) is a reliable and valid tool to assess the psychological wellbeing of people with severe mental illness in Hong Kong. It can be used to monitor the effectiveness of psychological intervention aimed at improving the wellbeing of such patients.
Collapse
Affiliation(s)
- C L Kong
- Kwai Chung Hospital, Hong Kong SAR, PR China
| | - C C Lee
- Kwai Chung Hospital, Hong Kong SAR, PR China
| | - Y C Ip
- Kwai Chung Hospital, Hong Kong SAR, PR China
| | - L P Chow
- Kwai Chung Hospital, Hong Kong SAR, PR China
| | - C H Leung
- Kwai Chung Hospital, Hong Kong SAR, PR China
| | - Y C Lam
- Kwai Chung Hospital, Hong Kong SAR, PR China
| |
Collapse
|
49
|
Chen PS, Chang HH, Huang CC, Lee CC, Lee SY, Chen SL, Huang SY, Yang YK, Lu RB. A longitudinal study of the association between the GNB3 C825T polymorphism and metabolic disturbance in bipolar II patients treated with valproate. Pharmacogenomics J 2016; 17:155-161. [PMID: 26856249 DOI: 10.1038/tpj.2015.96] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 10/06/2015] [Accepted: 11/16/2015] [Indexed: 12/30/2022]
Abstract
This longitudinal study aimed to investigate the associations between the polymorphisms of guanine nucleotide-binding protein subunit β-3 (GNB3) C825T and metabolic disturbance in bipolar II disorder (BP-II) patients being treated with valproate (VPA). A 100 BP-II patients received a 12-week course of VPA treatment, and their body weight and metabolic indices were measured. At baseline, the GNB3 C825T polymorphisms were associated with the triglyceride level (P=0.032) in BP-II patients. During the VPA treatment course, the polymorphisms were not only associated with body mass index (BMI) and waist circumference (P-values=0.009 and 0.001, respectively), but also with total cholesterol, triglyceride, low-density lipoprotein and leptin levels (P-values=0.004, 0.002, 0.031 and 0.015, respectively). Patients with the TT genotype had a lower BMI, smaller waist circumference, and lower levels of lipids and leptin than those with the CT or CC genotypes undergoing the VPA treatment course.
Collapse
Affiliation(s)
- P S Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - H H Chang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - C-C Huang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - C C Lee
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - S-Y Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - S-L Chen
- Department of Neurology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - S-Y Huang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Y K Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - R-B Lu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
50
|
Abstract
Cancer and cardiovascular disease (CVD) are two major causes of mortality in older adults. With improved survival and outcomes from cancer and CVD, the role of the geriatrician is evolving. Geriatricians provide key skills to facilitate patient-centered and value-based care in the growing older population of cancer patients (and survivors). Cancer treatment in older adults is particularly injurious with respect to complications stemming from cancer therapy and as well as to CVD related to cancer therapy in the context of physiologic aging. To best meet their natural potential as caregiving leaders, geriatricians must hone skills and insights pertaining to oncologic and cardiovascular care, insights that can inform and enhance key management expertise. In this paper, we will review common chemotherapy and radiation-induced cardiovascular complications, screening recommendations, and advance the concept of a geriatric, cardiology, and oncology collaboration. We assert that geriatricians are well suited to a leadership role in the care of older cardio-oncology patients and in the education of primary care physicians and subspecialists on geriatric principles.
Collapse
Affiliation(s)
- Kim-Lien Nguyen
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA 90073 USA ; Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073 USA
| | - Rami Alrezk
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA 90073 USA ; Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA USA ; GRECC, VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Pejman G Mansourian
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073 USA
| | - Arash Naeim
- Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA USA ; Division of Hematology-Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Matthew B Rettig
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA 90073 USA ; Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA USA ; Division of Hematology-Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Cathy C Lee
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA 90073 USA ; Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA USA ; GRECC, VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| |
Collapse
|