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Yap CW, Yong C, Soon BKH. The different shapes of the fourth ventricle. Clin Radiol 2023; 78:875-884. [PMID: 37604738 DOI: 10.1016/j.crad.2023.07.012] [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] [Received: 01/02/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/23/2023]
Abstract
With a distinctive shape and surrounding anatomical structures, the fourth ventricle is located in the posterior cranial fossa. There are various pathologies, either developmental or acquired, that can present as a characteristic deformity of the fourth ventricle. Therefore, this paper will cover the anatomy of the fourth ventricle and correlate this to the various pathologies. The aim of this review is to improve the ability of the readers to recognise the change in shape and configuration of the fourth ventricle, enabling early detection of pathologies.
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Affiliation(s)
- C W Yap
- Department of Diagnostic Imaging, Level 2 Main Building, National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore.
| | - C Yong
- Department of Diagnostic Imaging, Level 2 Main Building, National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - B K H Soon
- Department of Diagnostic Imaging, Level 2 Main Building, National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
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2
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Bhogal S, Garcia-Garcia HM, Klein A, Benzuly K, Mangalmurti S, Moses J, Alaswad K, Jaffer F, Yong C, Nanjundappa A, Ben-Dor I, Mintz GS, Hashim H, Waksman R. Intravascular Lithotripsy for the Treatment of Severely Calcified Coronary Artery Disease: A DISRUPT CAD III Intravascular Ultrasound Substudy. Cardiovasc Revasc Med 2023; 53:22-27. [PMID: 36934007 DOI: 10.1016/j.carrev.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Coronary intravascular lithotripsy (IVL) has emerged as a novel technique for the treatment of severely calcified coronary lesions. We evaluated the mechanism and efficacy of IVL in facilitating optimal stent implantation in heavily calcified coronary lesions using intravascular ultrasound (IVUS). METHODS Forty-six patients were initially enrolled as a part of the Disrupt CAD III study. Of these, 33 had pre-IVL, 24 had post-IVL, and 44 had post-stent IVUS evaluation. The final analysis was performed on 18 patients who had IVUS images interpretable at all three intervals. The primary endpoint was increase in minimum lumen area (MLA) from pre-IVL to post-IVL treatment to post-stenting. RESULTS Pre-IVL, MLA was 2.75 ± 0.84 mm2, percent area stenosis was 67.22 % ± 20.95 % with maximum calcium angle of 266.90° ± 78.30°, confirming severely calcified lesions. After IVL, MLA increased to 4.06 ± 1.41 mm2 (p = 0.0003), percent area stenosis decreased to 54.80 % ± 25.71 % (p = 0.0009), and maximum calcium angle decreased to 239.40° ± 76.73° (p = 0.003). There was a further increase in MLA to 6.84 ± 2.18 mm2 (p < 0.0001) and decrease in percent area stenosis to 30.33 % ± 35.08 % (p < 0.0001) post-stenting with minimum stent area of 6.99 ± 2.14 mm2. The success rate of stent delivery, implantation, and post-stent dilation was 100 % post-IVL. CONCLUSION In this first study evaluating the mechanism of IVL using IVUS, the primary endpoint of increase in MLA from pre-IVL to post-IVL treatment to post-stenting was successfully achieved. Our study showed that the use of IVL-assisted percutaneous coronary intervention is associated with improved vessel compliance, facilitating optimal stent implantation in de novo severely calcified lesions.
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Affiliation(s)
- Sukhdeep Bhogal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
| | | | | | | | - Jeffrey Moses
- Columbia University Medical Center, New York, NY, USA
| | | | | | - Celina Yong
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | | | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Gary S Mintz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hayder Hashim
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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Bee SWL, Hoe RHM, Goh AGW, Goh Y, Chan VEY, Yong C, Lim MC, Kee CK, Kei PL. Cauda equina thickening: an approach to MRI findings. Clin Radiol 2023:S0009-9260(23)00141-1. [PMID: 37179144 DOI: 10.1016/j.crad.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/15/2023] [Accepted: 04/05/2023] [Indexed: 05/15/2023]
Abstract
There are many causes of cauda equina (CE) thickening on neuroimaging of the lumbar spine. The imaging features of CE thickening for the various conditions often overlap and are non-specific to clinch a definite diagnosis. Hence, the imaging findings have to be discerned in accordance with the patient's presenting history, clinical examination findings, and results from electrophysiology and laboratory studies. In this review, the authors aim to supplement the existing literature on imaging findings of CE thickening with a diagnostic framework for clinical workup. The authors also aim to familiarise readers with the interpretation of CE thickening on magnetic resonance imaging (MRI) and would like to illustrate the normal variants and pitfalls that could be mistaken for abnormal results.
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Affiliation(s)
- S W L Bee
- Department of Diagnostic Imaging, National University Hospital, Singapore.
| | - R H M Hoe
- Department of Neurology, National Neuroscience Institute, Singapore
| | - A G W Goh
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Y Goh
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - V E Y Chan
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | - C Yong
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - M C Lim
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - C K Kee
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - P L Kei
- Department of Diagnostic Imaging, Ng Teng Fong General Hospital, Singapore
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Brandt EJ, Tobb K, Cambron JC, Ferdinand K, Douglass P, Nguyen PK, Vijayaraghavan K, Islam S, Thamman R, Rahman S, Pendyal A, Sareen N, Yong C, Palaniappan L, Ibebuogu U, Tran A, Bacong AM, Lundberg G, Watson K. Assessing and Addressing Social Determinants of Cardiovascular Health: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:1368-1385. [PMID: 37019584 DOI: 10.1016/j.jacc.2023.01.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 04/07/2023]
Abstract
Social determinants of health (SDOH) are the social conditions in which people are born, live, and work. SDOH offers a more inclusive view of how environment, geographic location, neighborhoods, access to health care, nutrition, socioeconomics, and so on are critical in cardiovascular morbidity and mortality. SDOH will continue to increase in relevance and integration of patient management, thus, applying the information herein to clinical and health systems will become increasingly commonplace. This state-of-the-art review covers the 5 domains of SDOH, including economic stability, education, health care access and quality, social and community context, and neighborhood and built environment. Recognizing and addressing SDOH is an important step toward achieving equity in cardiovascular care. We discuss each SDOH within the context of cardiovascular disease, how they can be assessed by clinicians and within health care systems, and key strategies for clinicians and health care systems to address these SDOH. Summaries of these tools and key strategies are provided.
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Affiliation(s)
- Eric J Brandt
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
| | - Kardie Tobb
- Cone Health Medical Group, Greensboro, North Carolina, USA
| | | | - Keith Ferdinand
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Paul Douglass
- Wellstar Health System Center for Cardiovascular Care, Marietta, Georgia, USA
| | - Patricia K Nguyen
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA; VA Palo Alto Healthcare System, Palo Alto, California, USA
| | | | - Sabrina Islam
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Ritu Thamman
- University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania, USA
| | - Shahid Rahman
- Memorial Hermann Heart and Vascular Institute, Houston, Texas, USA
| | - Akshay Pendyal
- University of North Carolina School of Medicine, Novant Health Charlotte Campus, Charlotte, North Carolina, USA
| | - Nishtha Sareen
- Ascension Medical Group, Ascension St Mary's Hospital, Saginaw, Michigan, USA
| | - Celina Yong
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA; VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Latha Palaniappan
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA
| | - Uzoma Ibebuogu
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Andrew Tran
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Adrian M Bacong
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA
| | - Gina Lundberg
- Emory Women's Heart Center, Emory Heart and Vascular Center, Marietta, Georgia, USA
| | - Karol Watson
- Division of Cardiology, University of California, Los Angeles, California, USA
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Corsi N, Pandolfo S, Eilender B, Bell S, Wang L, Tuderti G, Ghoreifi A, Tozzi M, Taylor J, Dhanji S, Yong C, Checcucci E, Derweesh I, Eun D, Porpiglia F, Gonzalgo M, Mehrazin R, Simone G, Ferro M, Margulis V, Sundaram C, Djaladat H, Wu Z, Autorino R, Abdollah F. Radical therapy for low-risk upper tract urothelial carcinoma (ROBUUST collaborative group). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00968-5] [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: 02/12/2023]
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Pandolfo S, Wu Z, Giuseppe S, Ferro M, Sundaram C, Yong C, Derweesh I, Dhanji S, Margulis V, Taylor J, Tozzi M, Davis M, Wood E, Mehrazin R, Gonzalgo M, Eilender B, Mendiola D, Wang L, Tuderti G, Checcucci E, Verze P, Djaladat H, Porpiglia F, Abdollah F, Autorino R. Predictive factors of complications in patients undergoing minimally invasive radical nephroureterectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00955-7] [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: 02/12/2023]
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Yong C, Suvarna A, Harrington R, Gummidipundi S, Krumholz HM, Mehran R, Heidenreich P. Temporal Trends in Gender of Principal Investigators and Patients in Cardiovascular Clinical Trials. J Am Coll Cardiol 2023; 81:428-430. [PMID: 36697143 DOI: 10.1016/j.jacc.2022.10.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/08/2022] [Accepted: 10/14/2022] [Indexed: 01/25/2023]
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Lin Y, Chidley P, Admojo L, Jassal S, Zantuck N, Foroudi F, Bevington E, Chew G, Hyett A, Loh S, Ng S, Leech T, Baker C, Law M, Ooi W, Yong C, Chao M. Pathological Complete Response and Oncological Outcomes in Locally Advanced Breast Cancers Treated with Neoadjuvant Radiotherapy: An Australian Perspective. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Bhogal S, Garcia-Garcia HM, Klein A, Benzuly K, Mangalmurti S, Moses J, Alaswad K, Jaffer F, Yong C, Nanjundappa A, Ben-Dor I, Mintz GS, Hashim H, Waksman R. Intravascular Lithotripsy for the Treatment of Severely Calcified Coronary Artery Disease: An IVUS Sub-Study. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.024] [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: 11/03/2022]
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Ducker G, Mills K, Yong C, Jones C, Mukhtyar C. POS0793 IMPROVED RELAPSE-FREE SURVIVAL WITH THE NORWICH PREDNISOLONE REGIMEN FOR GIANT CELL ARTERITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.847] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundGlucocorticoid therapy is the mainstay treatment for GCA. There is no consensus on the dose of prednisolone to be used. Prednisolone regimens used in clinical trials have reported relapse rates of 66 to 92%. The long-term follow-up of Tocilizumab and prednisolone for 1-year showed a relapse rate of 74% at 2 years. The Norwich Regimen is a bespoke prednisolone plan with an initial dose of 1mg/kg of lean body mass. It delivers 164.64 mg/kg of lean body mass in a logarithmic taper over 100 weeks. It was devised to reduce the risk of relapse and allow patients to be in control of their prednisolone reduction.ObjectivesTo document drug-free survival at 150 weeks of people with GCA treated with a bespoke prednisolone taperMethodsAll patients were diagnosed by biopsy, ultrasonography or PET scan and provided with a printed prednisolone plan at diagnosis. All individuals were assessed at approximately 3-6 monthly intervals in addition to suspected relapse, toxicity or other need for course correction. Relapses were confirmed objectively using a modification of the Kerr criteria. Relapse free survival was recorded at 100 weeks. Patients were given an open invite to contact us in the event of a suspected relapse after coming off prednisolone. A notes review was done to record events at 150 weeks.Results150 consecutive people with objectively diagnosed GCA (mean age 74) since 10/01/2012 have completed 150 weeks since starting prednisolone. Drug-free, relapse-free survival at 100 weeks was met by 133/150 (89%). 7 individuals died and 20 relapsed. A further 5 died and 15 relapsed by week 150; 103/150 (69%) survivors were in prednisolone-free remission. Of the 12 deaths – 6 died of cancer, 1 subdural haemorrhage, 1 ischaemic bowel, 1 septicaemia, 1 general decline (aged 93). The cause of death was not available for 2 individuals who died in the community. The median time to relapse for the 35 individuals was 80 weeks (IQR 64,109).ConclusionWe report the first results of a bespoke prednisolone taper to be used in real life. The Norwich Regimen for the treatment of GCA results in drug-free relapse-free survival of 89% at 100 weeks and 69% at 150 weeks, which is superior to all other reports published so far.References[1]Mukhtyar, C, Cate, H, Graham, C, Merry, P, Mills, K, and Misra, A, 2019, ‘Development of an evidence-based regimen of prednisolone to treat giant cell arteritis – the Norwich regimen’ Rheumatology Advances in Practice, Volume 3, Issue 1, 2019, rkz001, https://doi.org/10.1093/rap/rkz001[2]Hellmich B, Agueda A, Monti S, et al2018 Update of the EULAR recommendations for the management of large vessel vasculitis Annals of the Rheumatic Diseases 2020;79:19-30.Disclosure of InterestsNone declared
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Bhogal S, Garcia-Garcia HM, Klein A, Benzuly K, Mangalmurti S, Moses J, Alaswad K, Jaffer F, Yong C, Nanjundappa A, Ben-Dor I, Mintz GS, Hashim H, Waksman R. CRT-100.04 Intravascular Lithotripsy for the Treatment of Severely Calcified Coronary Artery Disease: An IVUS Sub-Study. JACC Cardiovasc Interv 2022. [DOI: 10.1016/j.jcin.2022.01.073] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gupta A, Liu T, Pounds C, Sharma RP, Yong C, Krumholz HM, Leon MB. Predictors of increased mortality in untreated moderate aortic stenosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1573] [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 natural history of native valvular moderate aortic stenosis (AS) is poorly understood.
Purpose
To examine the prognosis of patients with native valvular moderate AS, and identify high risk-features associated with increased mortality.
Methods
Natural language processing of electronic health records in the claims-linked Optum® database (2011–2018) from over 200 hospitals and 7000 clinics in the United States identified severity of AS (mild/moderate/severe) from echocardiograms and physician notes of patients more than 65 years old. Our cohort included 30,204 patients (3594 with mild, 9938 with moderate, and 16672 with severe AS). We used competing risk Kaplan-Meier analysis to compare 5-year mortality (obtained from the Social Security Death Masterfile) between the different AS severity groups adjusted for demographics and comorbidities, censoring for aortic valve replacement. The relationship between AS severity and survival was examined during median 1049 days (interquartile range: 597 to 1652 days) of follow-up. We performed Fine-Gray modeling to examine risk factors associated with long-term mortality in patients with moderate AS.
Results
A higher proportion of comorbidities like atrial fibrillation, diabetes, and coronary artery disease were observed with increasing severity of AS (Figure 1). After adjustment, compared with mild AS (5-year mortality: 31.6%), patients with untreated moderate (5-year mortality: 40.0%, HR 1.34, 95% CI 1.25 – 1.44) and untreated severe AS (5-year mortality: 51.1%, HR 1.88, 95% CI 1.75– 2.01) have increasing risk of long-term mortality (Figure 2). Significant predictors of 5-year mortality in patients with moderate AS include older age (HR 1.38, 95% CI 1.29 –1.47), male sex (HR 1.21, 95% CI 1.15 – 1.27), heart failure (HR 1.37, 95% CI 1.29 – 1.44), coronary artery disease (HR 1.20, 95% CI 1.13 – 1.27), and atrial fibrillation (HR 1.08, 95% CI 1.02 – 1.14). In a subcohort of 5189 patients for whom left ventricular ejection fraction (LVEF) information was available, reduced LVEF was associated with worse long-term mortality (LVEF<40%: HR 1.17, 95% CI 1.05 –1.31; LVEF 40–50%: HR 1.08, 95% CI 0.97 –1.20).
Conclusion
Our findings suggest that moderate AS is associated with poor long-term survival with higher risk associated with LVEF <40%, and comorbidities including heart failure, coronary artery disease and atrial fibrillation. Whether patients with moderate AS, particularly with high-risk features, benefit from treatment remains unknown.
Funding Acknowledgement
Type of funding sources: None. Baseline CharacteristicsAdjusted KM curves with Competing Risk
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Affiliation(s)
- A Gupta
- Columbia University Medical Center, Cardiology, New York, United States of America
| | - T Liu
- Edwards LifeSciences, Irvine, United States of America
| | - C Pounds
- Edwards LifeSciences, Irvine, United States of America
| | - R P Sharma
- Stanford University School of Medicine, Cardiology, Palo Alto, United States of America
| | - C Yong
- Stanford University School of Medicine, Cardiology, Palo Alto, United States of America
| | - H M Krumholz
- Yale New Haven Hospital, Cardiology, New Haven, United States of America
| | - M B Leon
- Columbia University Medical Center, Cardiology, New York, United States of America
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Batchelor WB, Damluji AA, Yong C, Fiuzat M, Barnett SD, Kandzari DE, Sherwood MW, Epps KC, Tehrani BN, Allocco DJ, Meredith IT, Lindenfeld J, O'Connor CM, Mehran R. Does study subject diversity influence cardiology research site performance?: Insights from 2 U.S. National Coronary Stent Registries. Am Heart J 2021; 236:37-48. [PMID: 33636137 PMCID: PMC8188231 DOI: 10.1016/j.ahj.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Minorities and women are underrepresented in cardiovascular research. Whether their higher enrollment can be predicted or influences research site performance is unclear. METHODS We evaluated 104 sites that enrolled 4,184 patients in the U.S. Platinum Diversity (PD) and Promus Element Plus (PE Plus) studies (2012 to 2016). Research sites were ranked from lowest to highest minority and female enrollment, respectively. United States Census Bureau division and core-based statistical area (CBSA) populations were determined for each site and the following study performance metrics compared across quartiles of minority and female enrollment, respectively: (1) study subject enrollment rate (SER), (2) time to first patient enrolled, (3) rate of follow-up visits not done, (4) rate of follow-up visits out of window, and (5) protocol deviation rate (PDR). Multivariable regression was used to predict SER and PDR. RESULTS Minority enrollment varied by region (P = .025) and population (P = .024) with highest recruitment noted in the Pacific, West South Central, South Atlantic, Mid-Atlantic and East North Central divisions. Female enrollment bore no relationship to region (P = .67) or population (P = .40). Median SER was similar in sites withi the highest vs lowest quartile of minority enrollment (SER of 4 vs 5 patients per month, respectively, P =0.78) and highest vs. lowest female enrollment (SER of 4 vs 4, respectively, P = .21). Median PDR was lower in sites within the highest vs lowest minority enrollment (0.23 vs 0.50 PDs per patient per month, respectively, P = .01) and highest vs. lowest female enrollment (0.28 vs. 0.37 PDs per patient per month, respectively, P = .04). However, this relationship did not persist after multivariable adjustment. All other site performance metrics were comparable across quartiles of minority and female enrollment. CONCLUSIONS Minority, but not female enrollment, correlated with research site geographic region and surrounding population. High enrollment of minorities and women did not influence study performance metrics. These findings help inform future strategies aimed at increasing clinical trial diversity. TRIAL REGISTRATION The PD and PE Plus studies are registered at www.clinicaltrials.gov under identifiers NCT02240810 and NCT01589978, respectively. KEY POINTS Question: Does the enrollment of more Blacks, Hispanics and women in US cardiovascular research studies influence the overall rate of study subject enrollment and/or other key study site performance metrics and can diverse enrollment be predicted? FINDINGS In this pooled analysis of 104 sites that enrolled 4,184 patients in the Platinum Diversity and Promus Element Plus Post-Approval Studies, we found that the enrollment of higher proportions of underrepresented minorities and women was univariately associated with lower protocol deviation rates while having no effect on other site performance metrics. A site's geographic location and surrounding population predicted minority, but not female enrollment. Meaning: These findings suggest that cardiovascular research subject diversity may be predicted from site characteristics and enhanced without compromising key study performance metrics. These insights help inform future strategies aimed at improving clinical trial diversity.
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Affiliation(s)
- Wayne B Batchelor
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA.
| | - Abdulla A Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA
| | - Celina Yong
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Mona Fiuzat
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Scott D Barnett
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA
| | | | - Matthew W Sherwood
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA
| | - Kelly C Epps
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA
| | - Behnam N Tehrani
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA
| | | | | | | | - Christopher M O'Connor
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA; Department of Medicine, Duke University School of Medicine, Durham, NC
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Chuah S, Yong C, Chew J, Cheow Y, Teo K, Zhang S, Lai R, Wong R, Lim A, Lim S, Tohu W. Mesenchymal stromal cell-derived small extracellular vesicles promote angio-osteogenesis and modulate macrophage polarization to enhance bone regeneration. Cytotherapy 2021. [DOI: 10.1016/s1465324921004473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chao M, Baker C, Jassal S, Law M, Bevington E, Stoney D, Zantuck N, Chew G, Loh S, Hyett A, Guerrieri M, Ng M, Cokelek M, Neoh D, Yong C, Ho H, Tacey M, Lim Joon D, Khor R, Foroudi F. The Pathological Response of Her2+ Breast Cancer with Neoadjuvant Chemotherapy and Radiation Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chao M, Jassal S, Baker C, Tacey M, Law M, Loh S, Cheng M, Yong C, Zantuck N, Bevington E, Hyett A, Guerrieri M, Cokelek M, Brown B, Chipman M, Chew G, Yeo B, Lippey J, Neoh D, Lamoury G, Spillane A, Foley C, Kechagioglou P, Rolfo M, Foroudi F. OC-0330: Neoadjuvant breast radiotherapy for one stage mastectomy and autologous breast reconstruction. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00354-6] [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: 11/16/2022]
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Gopinath D, Yong C, Mckenzie D, Harding-Forrester S, McIntyre K, Carey M. Laparoscopic and Robotic Mesh-Free Suture Hysteropexy Versus Mesh Sacral Hysteropexy: A Non-Randomised Comparison. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- Celina Yong
- VA Palo Alto Healthcare System, Palo Alto, California; Department of Medicine (Cardiovascular Medicine), Stanford University, Stanford, California; and the Stanford Cardiovascular Institute, Stanford, California.
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Goonawardena J, Yong C, Law M. P2 Is it time to switch to indocyanine green fluorescence for sentinel lymph node biopsy in early-stage breast cancer? Breast 2020. [DOI: 10.1016/j.breast.2020.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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20
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Yong C, Jaluba K, Heidenreich P. TCT-746 Differences in Transcatheter Aortic Valve Replacement (TAVR) Outcomes by Gender and Race Over Time. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.883] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Abnousi F, Kang G, Giacomini J, Yeung A, Zarafshar S, Vesom N, Ashley E, Harrington R, Yong C. A novel noninvasive method for remote heart failure monitoring: the EuleriAn video Magnification apPLications In heart Failure studY (AMPLIFY). NPJ Digit Med 2019; 2:80. [PMID: 31453375 PMCID: PMC6704101 DOI: 10.1038/s41746-019-0159-0] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 07/30/2019] [Indexed: 11/17/2022] Open
Abstract
Current remote monitoring devices for heart failure have been shown to reduce hospitalizations but are invasive and costly; accurate non-invasive options remain limited. The EuleriAn Video Magnification ApPLications In Heart Failure StudY (AMPLIFY) pilot aimed to evaluate the accuracy of a novel noninvasive method that uses Eulerian video magnification. Video recordings were performed on the neck veins of 50 patients who were scheduled for right heart catheterization at the Palo Alto VA Medical Center. The recorded jugular venous pulsations were then enhanced by applying Eulerian phase-based motion magnification. Assessment of jugular venous pressure was compared across three categories: (1) physicians who performed bedside exams, (2) physicians who reviewed both the amplified and unamplified videos, and (3) direct invasive measurement of right atrial pressure from right heart catheterization. Motion magnification reduced inaccuracy of the clinician assessment of central venous pressure compared to the gold standard of right heart catheterization (mean discrepancy of −0.80 cm H2O; 95% CI −2.189 to 0.612, p = 0.27) when compared to both unamplified video (−1.84 cm H2O; 95% CI −3.22 to −0.46, p = 0.0096) and the bedside exam (−2.90 cm H2O; 95% CI −4.33 to 1.40, p = 0.0002). Major categorical disagreements with right heart catheterization were significantly reduced with motion magnification (12%) when compared to unamplified video (25%) or the bedside exam (27%). This novel method of assessing jugular venous pressure improves the accuracy of the clinical exam and may enable accurate remote monitoring of heart failure patients with minimal patient risk.
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Affiliation(s)
- Freddy Abnousi
- 1Division of Cardiovascular Medicine, Department of Medicine, Stanford University Medical Center, Palo Alto, CA USA.,2Yale School of Medicine, Palo Alto, CA USA.,3Yale School of Medicine, New Haven, CT USA
| | - Guson Kang
- 1Division of Cardiovascular Medicine, Department of Medicine, Stanford University Medical Center, Palo Alto, CA USA
| | - John Giacomini
- 1Division of Cardiovascular Medicine, Department of Medicine, Stanford University Medical Center, Palo Alto, CA USA.,Veterans Affairs Palo Alto Medical Center, Palo Alto, CA USA
| | - Alan Yeung
- 1Division of Cardiovascular Medicine, Department of Medicine, Stanford University Medical Center, Palo Alto, CA USA
| | - Shirin Zarafshar
- 1Division of Cardiovascular Medicine, Department of Medicine, Stanford University Medical Center, Palo Alto, CA USA.,Veterans Affairs Palo Alto Medical Center, Palo Alto, CA USA
| | - Nicholas Vesom
- 1Division of Cardiovascular Medicine, Department of Medicine, Stanford University Medical Center, Palo Alto, CA USA
| | - Euan Ashley
- 1Division of Cardiovascular Medicine, Department of Medicine, Stanford University Medical Center, Palo Alto, CA USA
| | - Robert Harrington
- 1Division of Cardiovascular Medicine, Department of Medicine, Stanford University Medical Center, Palo Alto, CA USA
| | - Celina Yong
- 1Division of Cardiovascular Medicine, Department of Medicine, Stanford University Medical Center, Palo Alto, CA USA.,Veterans Affairs Palo Alto Medical Center, Palo Alto, CA USA
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Liu L, Huang H, Li W, Wen L, Zhou F, Yong C, Yin X, Zhang X. 389 Chromatin accessibility signatures in human blood CD4+ T and CD19+ B cells. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- C Yong
- Department of Interdisciplinary Studies of Life Education, Graduate School, Hallym University
| | - J Lyu
- Institute of Aging, Hallym University
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Nicholson ML, Yong C, Trotter PB, Grant L, Hosgood SA. Risk factors for transplant renal artery stenosis after live donor transplantation. Br J Surg 2018; 106:199-205. [DOI: 10.1002/bjs.10997] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/07/2018] [Accepted: 08/09/2018] [Indexed: 11/05/2022]
Abstract
Abstract
Background
Renal transplant surgeons are making increasing use of live donor kidneys with multiple renal arteries. This study aimed to identify independent risk factors for the development of transplant renal artery stenosis (TRAS) in the modern era of complex arterial reconstruction for multiple vessels.
Methods
Multivariable logistic regression analysis with a stepwise variable deletion model was used to identify risk factors for the development of TRAS in a consecutive series of live donor kidney transplants.
Results
Of 506 kidney transplants, 19 (3·8 per cent) had evidence of significant TRAS on CT angiography. Functional TRAS, defined by improvement in BP control or renal function after correction of a stenosis by angioplasty, occurred in 13 of 506 patients (2·6 per cent). Independent risk factors for TRAS were: use of an explanted internal iliac artery graft from the recipient (odds ratio (OR) 4·95; P = 0·020) and total ischaemia time (OR 1·82; P = 0·010). TRAS was associated with a lower 5-year allograft survival rate (79 versus 88·7 per cent; P = 0·020) but only one graft loss was attributed directly to TRAS. The 5-year allograft survival rate after internal iliac artery grafting was 86 per cent.
Conclusion
Although use of an internal iliac artery graft is an independent risk factor for TRAS after live donor kidney transplantation, this technique is still a useful option for complex arterial reconstruction.
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Affiliation(s)
- M L Nicholson
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - C Yong
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - P B Trotter
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - L Grant
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - S A Hosgood
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
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Ye L, Gui-Hua Z, Kun Y, Hong-Fa W, Ting X, Gong-Zhen L, Wei-Xia Z, Yong C. [Primary culture of cat intestinal epithelial cell and construction of its cDNA library]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2018; 29:464-467. [PMID: 29508581 DOI: 10.16250/j.32.1374.2016271] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective To establish the primary cat intestinal epithelial cells (IECs) culture methods and construct the cDNA library for the following yeast two-hybrid experiment, so as to screen the virulence interaction factors among the final host. Methods The primary cat IECs were cultured by the tissue cultivation and combined digestion with collagenase XI and dispase I separately. Then the cat IECs cultured was identified with the morphological observation and cyto-keratin detection, by using goat anti-cyto-keratin monoclonal antibodies. The mRNA of cat IECs was isolated and used as the template to synthesize the first strand cDNA by SMART™ technology, and then the double-strand cDNAs were acquired by LD-PCR, which were subsequently cloned into the plasmid PGADT7-Rec to construct yeast two-hybrid cDNA library in the yeast strain Y187 by homologous recombination. Matchmaker™ Insert Check PCR was used to detect the size distribution of cDNA fragments after the capacity calculation of the cDNA library. Results The comparison of the two cultivation methods indicated that the combined digestion of collagenase XI and dispase I was more effective than the tissue cultivation. The cat IECs system of continuous culture was established and the cat IECs with high purity were harvested for constructing the yeast two-hybrid cDNA library. The library contained 1.1×106 independent clones. The titer was 2.8×109 cfu/ml. The size of inserted fragments was among 0.5-2.0 kb. Conclusion The yeast two-hybrid cDNA library of cat IECs meets the requirements of further screen research, and this study lays the foundation of screening the Toxoplasma gondii virulence interaction factors among the cDNA libraries of its final hosts.
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Affiliation(s)
- L Ye
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Jining 272033, China; First people's Hospital of Jining City, China
| | - Z Gui-Hua
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Jining 272033, China
| | - Y Kun
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Jining 272033, China
| | - W Hong-Fa
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Jining 272033, China
| | - X Ting
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Jining 272033, China
| | - L Gong-Zhen
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Jining 272033, China
| | - Z Wei-Xia
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Jining 272033, China
| | - C Yong
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Jining 272033, China
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Yong C, Reynaud E, Dargent-Molina P, Heude B, Charles M, Plancoulaine S. 0843 Blood Cord Vitamin D Levels And Persistent Short Night Sleep Duration Among Preschoolers In The French Eden Birth Cohort. Sleep 2018. [DOI: 10.1093/sleep/zsy061.842] [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: 11/13/2022] Open
Affiliation(s)
- C Yong
- INSERM, Villejuif, FRANCE
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Hellyer JA, Azarbal F, Than CT, Fan J, Schmitt SK, Yang F, Frayne SM, Phibbs CS, Yong C, Heidenreich PA, Turakhia MP. Impact of Baseline Stroke Risk and Bleeding Risk on Warfarin International Normalized Ratio Control in Atrial Fibrillation (from the TREAT-AF Study). Am J Cardiol 2017; 119:268-274. [PMID: 27836133 DOI: 10.1016/j.amjcard.2016.09.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
Warfarin prevents stroke and prolongs survival in patients with atrial fibrillation and flutter (AF, collectively) but can cause hemorrhage. The time in international normalized ratio (INR) therapeutic range (TTR) mediates stroke reduction and bleeding risk. This study sought to determine the relation between baseline stroke, bleeding risk, and TTR. Using data from The Retrospective Evaluation and Assessment of Therapies in Atrial Fibrillation (TREAT-AF) retrospective cohort study, national Veterans Health Administration records were used to identify patients with newly diagnosed AF from 2003 to 2012 and subsequent initiation of warfarin. Baseline stroke and bleeding risk was determined by calculating CHA2DS2-VASc and HAS-BLED scores, respectively. Main outcomes were first-year and long-term TTR and INR monitoring rate. In 167,190 patients, the proportion of patients with TTR (>65%) decreased across increasing strata of CHA2DS2-VASc and HAS-BLED. After covariate adjustment, odds of achieving TTR >65% were significantly associated with high CHA2DS2-VASc or HAS-BLED score. INR monitoring rate was similar across risk strata. In conclusion, increased baseline stroke and bleeding risk is associated with poor INR control, despite similar rates of INR monitoring. These findings may paradoxically limit warfarin's efficacy and safety in high-risk patients and may explain observed increased bleeding and stroke rates in this cohort.
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Yong C, Abnousi F, Asch S, Heidenreich P. TCT-100 Asians suffer the highest in-hospital mortality rates after acute coronary syndrome despite high use of early invasive procedures. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.344] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yong C, Teo YM, Jeevesh K. Diagnostic performance of contrast-enhanced ultrasound in the evaluation of renal masses in patients with renal impairment. Med J Malaysia 2016; 71:193-198. [PMID: 27770118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the performance of contrastenhanced ultrasound (CEUS) in the risk stratification of indeterminate renal lesions picked up incidentally on abdominal imaging, in patients with renal impairment. METHODS A retrospective study was performed of nonconsecutive patients who underwent CEUS at our tertiary care centre for indeterminate renal lesions between March 2010 and September 2014. A total of 63 patients with 74 nodules were assessed with CEUS and stratified into either benign (Bosniak I, II, IIF) or suspicious for malignancy (Bosniak III, IV or hypervascular solid lesions). Diagnostic accuracy was determined by comparing these findings to subsequent histological diagnoses, temporal change after at least 20 months follow-up or after a diagnostic computer tomography / magnetic resonance imaging study. RESULTS CEUS correctly identified 49/52 (94.2%) of benign lesions and 21/22 (95.5%) of malignant lesions, resulting in a sensitivity of 95.5% (95% CI 77.2-99.9%), specificity of 94.2% (95% CI 84.1-98.8%), positive predictive value (PPV) 87.5% (95% CI 67.6-97.3) and negative predictive value (NPV) 98.0% (95% CI 89.4-100%). CONCLUSION CEUS has high diagnostic performance in predicting the benignity of a renal lesion in patients with renal impairment, showing sensitivity and NPV approaching 100%.
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Affiliation(s)
- C Yong
- National University Hospital, Department of Diagnostic Imaging, Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, Singapore 119074.
| | - Y M Teo
- National University Hospital, Department of Diagnostic Imaging, Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, Singapore 119074
| | - K Jeevesh
- National University Hospital, Department of Diagnostic Imaging, Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, Singapore 119074
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Yong C, Azarbal F, Abnousi F, Heidenreich PA, Schmitt S, Fan J, Than CT, Ullal AJ, Yang F, Phibbs CS, Frayne SM, Ho PM, Shore S, Mahaffey KW, Turakhia MP. Racial Differences in Quality of Anticoagulation Therapy for Atrial Fibrillation (from the TREAT-AF Study). Am J Cardiol 2016; 117:61-8. [PMID: 26552504 DOI: 10.1016/j.amjcard.2015.09.047] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/25/2015] [Accepted: 09/25/2015] [Indexed: 11/19/2022]
Abstract
The influence of race on quality of anticoagulation control is not well described. We examined the association between race, international normalized ratio (INR) monitoring intensity, and INR control in warfarin-treated patients with atrial fibrillation (AF). Using data from the Veterans Health Administration (VHA), we performed a retrospective cohort study of 184,161 patients with a new diagnosis of AF/flutter from 2004 to 2012 who received any VHA prescription within 90 days of diagnosis. The primary predictor was race, ascertained from multiple VHA and linked Medicare demographic files. The primary outcome was first-year and long-term time in therapeutic range (TTR) of INR 2.0 to 3.0. Secondary outcomes were INR monitoring intensity and warfarin persistence. Of the 116,021 patients who received warfarin in the cohort, INR monitoring intensity was similar across racial groups. However, TTR was lowest in blacks and highest in whites (first year 0.49 ± 0.23 vs 0.57 ± 0.21, p <0.001; long term 0.52 ± 0.20 vs 0.59 ± 0.18, p <0.001); 64% of whites and 49% of blacks had long-term TTR >55% (p <0.001). After adjusting for site and patient-level covariates, black race was associated with lower first-year and long-term TTRs (4.2% and 4.1% below the conditional mean, relative to whites; p <0.0001 for both). One-year warfarin persistence was slightly lower in blacks compared to whites (58% vs 60%, p <0.0001). In conclusion, in patients with AF anticoagulated with warfarin, differences in INR control are most evident among blacks, underscoring the need to determine if other types of intensive management or warfarin alternatives may be necessary to improve anticoagulation among vulnerable AF populations.
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Affiliation(s)
- Celina Yong
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University; Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Farnaz Azarbal
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University
| | - Freddy Abnousi
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University; Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University; Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Susan Schmitt
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Jun Fan
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Claire T Than
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Aditya J Ullal
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Felix Yang
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Ciaran S Phibbs
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University
| | - Susan M Frayne
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University; Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - P Michael Ho
- Department of Medicine, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
| | - Supriya Shore
- Department of Medicine, Emory University, Atlanta, Georgia
| | - Kenneth W Mahaffey
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University
| | - Mintu P Turakhia
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University; Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
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Abnousi F, Yong C, Fearon W. Cost–effectiveness of fractional flow reserve-guided percutaneous coronary intervention. Interv Cardiol 2015. [DOI: 10.2217/ica.15.22] [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] Open
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Yu B, Zhao S, Hu D, Ambegaonakr BM, DYSIS-China Study Investigators, Jia Er BA, Guiwen C, Buxing C, Hong C, Jin C, Jing C, Liefeng C, Min C, Qiong C, Shaoliang C, Tielong C, Xiaofei C, Xiaohong C, You C, Guoli C, Mei C, Hongliang C, Qin C, Shiwei C, Yong C, Shudong D, Henghua D, Xiaomei D, Yirong D, Xiaoyan D, Birong D, Yumei D, Yugang D, Ping D, Lei D, Limei F, Ningyuan F, Lixia F, Lie F, Jun G, GeWeihong, Hongmin G, Minxia G, Qinghua H, Fengchang H, Dayi H, Lingzhi H, Xueqiang H, Yaojun H, Yiming H, Zhiping H, Fei H, Qi H, Dejia H, Gewen H, Hongman H, Liming H, Qiong H, Ruowen H, Taifu H, Bin J, Kai J, Hui J, Huigen J, Jinsong K, Bao L, Chengjiang L, Hongjuan L, Jun(Xinjiang) L, Jun(Jiangsu) L, Nanfang L, Qifu L, Qiang L, Xin L, Xueyou L, Yanbing L, Yanping L, Yansheng L, Yong L, Yuling L, Zhanquan L, Zhengfang L, Li L, Yongxue L, Zerong L, Yuhua L, Fan L, Hong L, Hui L, Minling L, Qiang L, Qingsong L, Shaokui L, Weidong L, Xueping L, Xinjian L, Benyan L, Shaonian L, Suxin L, Hong L, LvYun, Aiqun M, Jianhua M, Qiang M, Yan M, Changsheng M, Yide M, Yiming M, NieXiaoli, NiuXiaoyuan, Hongtao P, Mingkang P, Qiaoqing P, Huifen Q, Qiumin Q, Lijie Q, Liqun R, Jingshan S, Qiang S, Jing H, Xiuyun S, Yongquan S, Liangyi S, Zhi S, Zhiyuan S, Yufeng S, Chunyan T, TengXiaochun, Haoming T, Wenhua T, Qinwei T, TuQiuyun, Keying W, Aihong W, Chaohui W, Chunning W, Dezhao W, Guixia W, Hanqiao W, Jianan W, Jianjun W, Lan W, Xiaoming W, Yaping W, Yangwei W, Yongjun W, Meifang W, Yidong W, Hongyun W, Chun W, Dongmei W, Jiang W, Jun W, Xiaolin W, Zonggui W, XiGuangxia, Yi X, Qian X, Xiaoping X, Yulong X, Anding X, XueYuanming, Chuanzhu Y, Tao Y, Xiaowei Y, Gangyi Y, Jian Y, Wangpingm Y, Xiaosu Y, Xinchun Y, Yifang Y, Yu Y, Mingyu Y, Min Y, Ping Y, Bo Y, Jiangyi Y, Jinming Y, Yan Y, Ling Z, Longyi Z, Xiaoyun Z, Baorong Z, Bei Z, Chaoxin Z, Xuelian Z, Dadong Z, Dongping Z, Fuchun Z, Hong Z, Huifang Z, Liping Z, Liyang Z, Rufu Z, Saidan Z, Weijuan Z, Dong Z, Gang Z, Shuiping Z, Xiuxin Z, Qiangsun Z, Yang Z, Xiaohui Z, Yali Z, Yujie Z, Yi Z, Yulan Z, Xiangping Z. Gender differences in lipid goal attainment among Chinese patients with coronary heart disease: insights from the DYSlipidemia International Study of China. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv018] [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: 11/12/2022]
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Soofi M, Yong C, Froelicher V. Justification of an introductory electrocardiogram teaching mnemonic by demonstration of its prognostic value. Am J Med 2014; 127:1202-7. [PMID: 25065339 DOI: 10.1016/j.amjmed.2014.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/12/2014] [Accepted: 07/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES With diminishing time afforded to electrocardiography in the medical curriculum, we have found Sibbitt's simple mnemonic, the Diagonal Line Lead Rule, for a pattern recognition approach to 12-lead electrocardiogram (ECG) interpretation to be appreciated by students. However, it still lacks universal acceptance because its clinical utility has not been documented. The study objective was to demonstrate the clinical utility of the Diagonal Line Lead ECG Teaching Rule. METHODS After excluding ECGs of high-risk patients with Wolff-Parkinson-White syndrome and QRS durations greater than 120 ms, the initial ECGs of the remaining 43,798 patients were scored according to the Diagonal Line Lead Rule. A total of 45,497 patients from the Veterans Affairs Palo Alto Healthcare System were referred for a routine initial resting ECG from 1987 to 1999. We determined cardiovascular mortality with 8 years of follow-up. RESULTS In patients with normal QRS duration, diagnostic Q-wave or T-wave inversions isolated to the diagonal line leads showed no increased risk of cardiovascular death. Q-wave or T-wave inversion in any other lead was significantly associated with cardiovascular death with an age-adjusted Cox hazard of 2.6 (confidence interval, 2.4-2.8; P < .0001) and an annual cardiovascular mortality rate of 3.0%. Leads V4-V6, I, and aVL were especially significant predictors of cardiovascular death, with a Cox hazard greater than 3. CONCLUSIONS Our analysis demonstrates the prognostic power and clinical utility of a simple mnemonic for 12-lead ECG interpretation that can facilitate ECG teaching and interpretation.
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Affiliation(s)
| | - Celina Yong
- Stanford Cardiovascular Institute/The Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Victor Froelicher
- Stanford Cardiovascular Institute/The Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif; Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif.
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Onukwugha E, Kwok Y, Yong C, Mullins C, Seal B, Hussain A. Variation in the Length of Radiation Therapy Among Men Diagnosed With Incident Metastatic Prostate Cancer. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Callister R, Giles A, Dascombe B, Baker A, Nasstasia Y, Halpin S, Hides L, Yong C, Kelly B. Healthy Body Healthy Mind: Development of an exercise intervention for the management of youth depression. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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37
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Qingle Z, Yong C, Xiaofeng H, Yanhao L. A Case of Primitive Trigeminal Artery-Cavernous Fistula: Embolization, Complications and Strategy. Neuroradiol J 2011; 24:810-2. [PMID: 24059781 DOI: 10.1177/197140091102400523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 01/03/2011] [Indexed: 11/17/2022] Open
Abstract
A 22-year-old man with primitive trigeminal artery-cavernous fistula was admitted to our hospital. Embolization with Guglielmi detachable coils and microcoils was attempted on the fistula from the internal carotid artery. The last microcoil was incorrectly released to the basilar artery through the primitive trigeminal artery. The misplaced microcoil was eventually retrieved by goose-neck snare. There was no related complication in the follow-up period.
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Affiliation(s)
- Z. Qingle
- Department of Interventional Therapy, Nanfang Hospital, Southern Medical University; Guangzhou, China
| | - C. Yong
- Department of Interventional Therapy, Nanfang Hospital, Southern Medical University; Guangzhou, China
| | - H. Xiaofeng
- Department of Interventional Therapy, Nanfang Hospital, Southern Medical University; Guangzhou, China
| | - L. Yanhao
- Department of Interventional Therapy, Nanfang Hospital, Southern Medical University; Guangzhou, China
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38
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Sharma M, Yong C, Majure D, Zellner C, Roberts JP, Bass NM, Ports TA, Yeghiazarians Y, Gregoratos G, Boyle AJ. Safety of cardiac catheterization in patients with end-stage liver disease awaiting liver transplantation. Am J Cardiol 2009; 103:742-6. [PMID: 19231345 DOI: 10.1016/j.amjcard.2008.10.037] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 10/31/2008] [Accepted: 10/31/2008] [Indexed: 12/13/2022]
Abstract
Patients with end-stage liver disease (ESLD) are predisposed to bleeding complications due to thrombocytopenia, reduced synthesis of coagulation factors, and increased fibrinolytic activity. The exact incidence of vascular access site and bleeding complications related to cardiac catheterization in this group remains unknown. Eighty-eight consecutive patients with ESLD who underwent left-sided cardiac catheterization from August 2004 to February 2007 were identified. Eighty-one patients without known liver disease matched for age, gender, and body mass index who underwent left-sided cardiac catheterization during the same period were chosen as the control group. Vascular complications were defined as hematoma >5 cm, pseudoaneurysm, arteriovenous fistula, or retroperitoneal bleeding. Patients with ESLD had lower baseline mean hematocrit (32.3 +/- 6.0% vs 39.2 +/- 6.2%, p <0.001) and mean platelet count (90.1 +/- 66.3 vs 236.1 +/- 77.1 x 10(9)/L, p <0.001) compared with controls. They also had higher mean serum creatinine (1.9 +/- 1.7 vs 1.2 +/- 0.8 mg/dl, p = 0.002) and mean international normalized ratio (1.6 +/- 0.7 vs 1.1 +/- 0.2, p <0.001). There were more complicated pseudoaneurysms in the patients with liver failure (5.7% [5 of 88]), compared with 0% in controls (p = 0.029). Patients with ESLD had lower starting hemoglobin levels and greater reductions in hemoglobin after cardiac catheterization, resulting in greater need for packed red blood cell transfusion (16% vs 4%, p = 0.008), fresh frozen plasma (51.7% vs 1.2%, p <0.001), and platelet transfusions (48.3% vs 1.2%, p <0.001). Major bleeding was higher in the ESLD group (14.8% vs 3.7%, p = 0.014), driven mainly by the need for blood transfusion. In conclusion, despite severe coagulopathy, left-sided cardiac catheterization may be performed safely in this patient population, with correction of coagulopathy and meticulous attention to procedural technique.
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Affiliation(s)
- Madan Sharma
- Division of Cardiology, University of California, San Francisco, San Francisco, California, USA [corrected]
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39
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Sharma M, Yong C, Zellner C, Boyle A. Vascular complications in patients with end-stage liver disease undergoing left ventricular catheterization before orthotopic liver transplantation. Cardiovascular Revascularization Medicine 2008. [DOI: 10.1016/j.carrev.2008.02.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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40
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Yong C, Bridenbaugh E, Zawieja D, Swartz M. Shear stress-induced gene response in human microvascular lymphatic endothelial cells. J Biomech 2006. [DOI: 10.1016/s0021-9290(06)84340-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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41
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Yong C, Halekoh U, Jørgensen H, Lauridsen C. Dependent on dietary treatments of mothers, rats
showed individual preference of diets containing
ingredients produced with different cultivation
strategies. J Anim Feed Sci 2005. [DOI: 10.22358/jafs/67163/2005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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42
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Kobayashi N, Ando M, Kosaka Y, Yong C, Okitsu T, Arata T, Ikeda H, Kobayashi K, Ueda T, Kurabayashi Y, Tanaka N. Partial hepatectomy and subsequent radiation facilitates engraftment of mouse embryonic stem cells in the liver. Transplant Proc 2004; 36:2352-4. [PMID: 15561246 DOI: 10.1016/j.transproceed.2004.08.141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 10/26/2022]
Abstract
For liver-targeted regenerative medicine, embryonic stem (ES) cell-derived hepatocyte-like cells proffer great expectation. In vitro exposure to a combination of various growth factors, such as hepatocyte growth factor and fibroblast growth factor-4, as well as cytokines, leads to differentiation of ES cells into hepatocyte-like cells. We sought to determine the in vivo environment that allowed engraftment of ES cells transplanted to the liver. Thus, we examined the effect of partial hepatectomy (50%) (PHT) and subsequent radiation (RT) of the male Balb/c mouse host liver on ES cell engraftment. ES cells (5 x 10(6)) derived from 129Sv mice were transplanted into the residual liver. The controls were ES cells transplanted into a normal liver. Bromo-deoxy-residine (BrdU)-uptake was performed to evaluate the effect of hepatectomy and RT on hepatocyte regeneration. Mouse ES cells engrafted, forming teratomas in the normal liver without showing any mononuclear infiltration. A liver modified by PHT and RT facilitated engraftment of mouse ES cells compared with a normal liver. Hepatic RT significantly suppressed hepatocytic uptake of BrdU.
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Affiliation(s)
- N Kobayashi
- Department of Surgery, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
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43
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Yong C, Yinghai W, Kongqing Y. Macroscopic dynamics in separable neural networks. Phys Rev E Stat Nonlin Soft Matter Phys 2001; 63:041901. [PMID: 11308871 DOI: 10.1103/physreve.63.041901] [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] [Subscribe] [Scholar Register] [Received: 09/18/2000] [Indexed: 05/23/2023]
Abstract
Parallel dynamics of neural networks with separable coupling is given starting from Coolen-Sherrington theory. Away from saturation, it is shown that this parallel retrieve dynamics is equivalent to the sequential dynamics for finite temperature. But the finite-size effects were found to be governed by a homogeneous Markov process, not by a time-dependent Ornstein-Uhlenbeck process in sequential dynamics.
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Affiliation(s)
- C Yong
- Department of Physics, Lanzhou University, Lanzhou Gansu 730000, China
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44
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McCormick-Davis C, Dalton SB, Hout DR, Singh DK, Berman NE, Yong C, Pinson DM, Foresman L, Stephens EB. A molecular clone of simian-human immunodeficiency virus (DeltavpuSHIV(KU-1bMC33)) with a truncated, non-membrane-bound vpu results in rapid CD4(+) T cell loss and neuro-AIDS in pig-tailed macaques. Virology 2000; 272:112-26. [PMID: 10873754 DOI: 10.1006/viro.2000.0333] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report on the role of vpu in the pathogenesis of a molecularly cloned simian-human immunodeficiency virus (SHIV(KU-1bMC33)), in which the tat, rev, vpu, env, and nef genes derived from the uncloned SHIV(KU-1b) virus were inserted into the genetic background of parental nonpathogenic SHIV-4. A mutant was constructed (DeltavpuSHIV(KU-1bMC33)) in which 42 of 82 amino acids of Vpu were deleted. Phase partitioning studies revealed that the truncated Vpu was not an integral membrane protein, and pulse-chase culture studies revealed that cells inoculated with DeltavpuSHIV(KU-1bMC33) released viral p27 into the culture medium with slightly reduced kinetics compared with cultures inoculated with SHIV(KU-1bMC33). Inoculation of DeltavpuSHIV(KU-1bMC33) into two pig-tailed macaques resulted in a severe decline of CD4(+) T cells and neurological disease in one macaque and a more moderate decline of CD4(+) T cells in the other macaque. These results indicate that a membrane-bound Vpu is not required for the CD4(+) T cell loss and neurological disease in SHIV-inoculated pig-tailed macaques. Furthermore, because the amino acid substitutions in the Tat and Rev were identical to those previously reported for the nonpathogenic SHIV(PPc), our results indicate that amino acid substitutions in the Env and/or Nef were responsible for the observed CD4(+) T cell loss and neurological disease after inoculation with this molecular clone.
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Affiliation(s)
- C McCormick-Davis
- Departments of Microbiology, Molecular Genetics and Immunology, University of Kansas Medical Center, Kansas City, Kansas 66160, USA
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Abstract
The terfenadine-pseudoephedrine dosage form discussed here is the sustained-release core tablet composed of outer (fast-release) and inner (sustained-release) layers. To develop the double-layer tablet dissolution-equivalent to a core tablet, the fast-release and sustained-release layers were prepared using various disintegrants and polymers, respectively. The layer composed of terfenadine/pseudoephedrine/lactose/cornstarch/sodium bicarbonate/hydroxypropylcellulose (HPC)/sodium lauryl sulfate/microcrystalline cellulose (60/10/90/30/20/1/40/1/293 mg), which gave the fast disintegration time and high dissolved amounts of drugs, was selected as the fast-release layer. The dissolved amounts of pseudoephedrine from sustained-release layers increased more with a smaller ratio of ethylcellulose and hydroxypropylmethylcellulose (HPMC). Dissolution mechanism analysis showed the release of pseudoephedrine was proportional to the square root of time, indicating that drug might be released from the layers by Fickian diffusion. The layer composed of pseudoephedrine/ethylcellulose/HPMC (110/30/155 mg), which had similar dissolution amounts of pseudoephedrine as the inner layer of a core tablet, was selected as the sustained-release layer. Furthermore, the dissolved amounts of drugs from the core and double-layer tablets had deviations of less than 5% against the average dissolved amounts of drugs at each time. There was no significant difference between the dissolved amounts of drugs from these tablets at each time in pH 1.2, 4.0, and 6.8 (P > .05). Our results suggest that this double-layer tablet was a dissolution equivalent to the core tablet.
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Affiliation(s)
- H G Choi
- College of Pharmacy, Seoul National University, Shinlim-Dong, Kwanak-Ku, South Korea
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46
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Olson KA, Nelson C, Tai G, Hung W, Yong C, Astell C, Sadowski I. Two regulators of Ste12p inhibit pheromone-responsive transcription by separate mechanisms. Mol Cell Biol 2000; 20:4199-209. [PMID: 10825185 PMCID: PMC85789 DOI: 10.1128/mcb.20.12.4199-4209.2000] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [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: 11/20/2022] Open
Abstract
The yeast Saccharomyces cerevisiae transcription factor Ste12p is responsible for activating genes in response to MAP kinase cascades controlling mating and filamentous growth. Ste12p is negatively regulated by two inhibitor proteins, Dig1p (also called Rst1p) and Dig2p (also called Rst2p). The expression of a C-terminal Ste12p fragment (residues 216 to 688) [Ste12p(216-688)] from a GAL promoter causes FUS1 induction in a strain expressing wild-type STE12, suggesting that this region can cause the activation of endogenous Ste12p. Residues 262 to 594 are sufficient to cause STE12-dependent FUS1 induction when overexpressed, and this region of Ste12p was found to bind Dig1p but not Dig2p in yeast extracts. In contrast, recombinant glutathione S-transferase-Dig2p binds to the Ste12p DNA-binding domain (DBD). Expression of DIG2, but not DIG1, from a GAL promoter inhibits transcriptional activation by an Ste12p DBD-VP16 fusion. Furthermore, disruption of dig1, but not dig2, causes elevated transcriptional activation by a LexA-Ste12p(216-688) fusion. Ste12p has multiple regions within the C terminus (flanking residue 474) that can promote multimerization in vitro, and we demonstrate that these interactions can contribute to the activation of endogenous Ste12p by overproduced C-terminal fragments. These results demonstrate that Dig1p and Dig2p do not function by redundant mechanisms but rather inhibit pheromone-responsive transcription through interactions with separate regions of Ste12p.
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Affiliation(s)
- K A Olson
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, Canada
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47
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Ikematsu H, Nabeshima A, Yong C, Li W, Kajiyama W, Hara H, Hayashi J, Kashiwagi S. [Amantadine usage for influenza A during an influenza outbreak in a nursing home]. Kansenshogaku Zasshi 2000; 74:476-80. [PMID: 10860361 DOI: 10.11150/kansenshogakuzasshi1970.74.476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
An outbreak of an influenza like illness was found in a nursing home in Fukuoka in January, 1999. Results of hemagglutinin inhibition tests with paired sera of patients and rapid diagnosis kit for influenza A indicated that an influenza A (H3N2) outbreak had occurred. A total of 15 patients with influenza like illness from one residential area of the nursing home were administered amantadine, 100 mg per day for five days. Clinical records of 264 residents were surveyed retrospectively from the tenth to the thirty-first of January, 1999. Influenza like illness was found in 112 residents (42.4%). The incidence of influenza like illness differed by residential area, ranging from 27.6% to 54.0%. The mean duration of fever was 3.6 days among patients administered amantadine. The mean duration was 4.4 days for patients not administered amantadine. The incidence of influenza like illness decreased rapidly after amantadine administration in the residential area where amantadine administration was done. These results suggest that amantadine is effective in mitigating influenza symptoms in the elderly. Amantadine may be useful for diminishing the influence of influenza A outbreaks in nursing homes.
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Affiliation(s)
- H Ikematsu
- Department of Clinical Research, Hara-Doi Hospital
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48
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Ikematsu H, Nabeshima A, Yong C, Hayashi J, Goto S, Oka T, Hara H, Kashiwagi S. [The efficacy of influenza vaccine among geriatric inpatients]. Kansenshogaku Zasshi 2000; 74:17-23. [PMID: 10695290 DOI: 10.11150/kansenshogakuzasshi1970.74.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To investigate the efficacy of influenza vaccine in the elderly, hemagglutination inhibition (HI) antibody titer for the three types of influenza viruses were measured and the influenza infection rate was determined serologically in geriatric inpatients. Influenza vaccination was done for inpatients. For patients who had influenza vaccination in the year prior to the study, influenza vaccine was administered once or twice, and the number of injections were determined randomly. Influenza vaccine was injected twice to those had not received influenza vaccine in the previous year. Serum samples were collected from 166 vaccinated and 104 unvaccinated patients before and after 1996/1997 influenza season. In the vaccinees who had been vaccinated the previous year, 56 patients were injected once and 58 patient were injected twice. Fifty-two patients had not been vaccinated the previous year. Serologically diagnosed influenza infection rate in the 104 unvaccinated patients was 16.3% for influenza A/H3N2 and 8.7% for influenza B. The infection rate was 3.0% for influenza A/H3N2 and 0.6% for influenza B in the 166 vaccinated patients. The infection rates were significantly lower in the vaccinees than in the unvaccinated patients (p < 0.001 with A/H3N2 and p < 0.01 with B). There was no significant difference in the infection rate among the three vaccinated groups. These results suggest that the influenza vaccination had significant protective efficacy for influenza infection in the elderly. Prior vaccination did not diminish the efficacy of the influenza vaccine. The efficacy of a single influenza vaccine injection was equivalent to that of two injection.
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Affiliation(s)
- H Ikematsu
- Department of Clinical Research, Hara-Doi Hospital
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49
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Berman NE, Marcario JK, Yong C, Raghavan R, Raymond LA, Joag SV, Narayan O, Cheney PD. Microglial activation and neurological symptoms in the SIV model of NeuroAIDS: association of MHC-II and MMP-9 expression with behavioral deficits and evoked potential changes. Neurobiol Dis 1999; 6:486-98. [PMID: 10600404 DOI: 10.1006/nbdi.1999.0261] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
HIV-1 causes cognitive and motor deficits and HIV encephalitis (HIVE) in a significant proportion of AIDS patients. Neurological impairment and HIVE are thought to result from release of cytokines and other harmful substances from infected, activated microglia. In this study, the quantitative relationship between microglial activation and neurological impairment was examined in the simian immunodeficiency model of HIVE. Macaque monkeys were infected with a passaged, neurovirulent strain of simian immunodeficiency virus, SIV(mac)239(R71/17E). In concurrent studies, functional impairment was assessed by motor and auditory brainstem evoked potentials and by measurements of cognitive and motor behavioral deficits. Brain tissue was examined by immunohistochemistry using two markers of microglia activation, MHC-II and matrix metalloproteinase-9 (MMP-9). The inoculated animals formed two groups: rapid progressors, which survived 6-14 weeks postinoculation, and slow progressors, which survived 87-109 weeks. In the rapid progressors, two patterns of MHC-II expression were present: (1) a widely disseminated pattern of MHC-II expressing microglia and microglial nodules in cortical gray matter and subcortical white matter, and (2) a more focal pattern in which MHC-II expressing microglia were concentrated into white matter. Animals exhibiting both patterns of microglial activation showed mild to severe changes in cognitive and motor behavior and evoked potentials. All rapid progressors showed expression of MMP-9 in microglia located in subcortical white matter. In the slow progressors MHC-II and MMP-9 staining was similar to uninoculated control macaques, and there was little or no evidence of HIVE. These animals showed behavioral deficits at the end of the disease course, but little changes in evoked potentials. Thus, increases in MHC-II and MMP-9 expression are associated with development of cognitive and motor deficits, alterations in evoked potentials, and rapid disease progression.
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Affiliation(s)
- N E Berman
- Department of Anatomy and Cell Biology, Marion Merrell Dow Laboratories, Kansas City, KS 66160-7400, USA
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50
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Affiliation(s)
- Y Yi-rong
- Department of Urology, First Affiliated Hospital, Wenzhou Medical College, Zhejiang, China
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