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Qiu L, Chen Y, Williams TM, Amini A, Sampath S, Glaser SM, Chen YJ, Liu L, Leung D, Liu A, McGee HM. Evaluation of 68Ga-Fibroblast Activation Protein Inhibitor vs. 18F-FDG as a Novel Radiotracer for Biologically Guided Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:e251. [PMID: 37784976 DOI: 10.1016/j.ijrobp.2023.06.1193] [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) Real-time biology guided radiation therapy (BgRT) uses real-time positron emissions from a PET tracer during treatment to guide targeted radiation to cancerous lesions. Fibroblast activation protein alpha (FAP) is highly expressed on cancer-associated fibroblasts in tumors with low expression in normal tissues. While 18F-FDG-PET requires fasting and has background in the liver and brain, 68-Gallium labeled FAP inhibitor (FAPI) does not require fasting and has less background uptake. The goal of this study was to investigate the utility of FAPI as a potential universal fiducial for BgRT. We hypothesized that 68Ga-FAPI would be a better radiotracer than 18F-FDG, as assessed by the Normalized Minimal kBq/mL and the Normal Target Signal (NTS), two parameters used to gauge the suitability of BgRT. MATERIALS/METHODS PET-CTs were obtained for 50 patients with pancreatic, liver, lung, head & neck, and cervical cancer using 18F-FDG and 68Ga-FAPI (n = 10 for each). Four DICOM images were obtained per patient (FDG PET + CT, FAPI PET + CT). Radiation oncologists delineated the gross tumor volume (GTV) on PET images. A separate set of auto-contours were generated from the PET using an auto-threshold of 40% maximum SUV for all tumors. A 1 cm expansion was added to the GTV to create a ring around the physician-generated contours and auto-contours. The following parameters were measured: GTV volume, SUV max of GTV, SUV mean of GTV, Normalized Minimal kBq/mL within the GTV, and NTS (= SUV max/Ring SUV mean). Values were compared using paired t-test. For the BgRT product with similar calculations, the required Normalized Minimal kBq/mL is > 5 kBq/mL; the required NTS is > 2.7 for treatment planning and > 2.0 for BgRT delivery. RESULTS The Normalized Minimal kBq/mL for FAPI was > 5 kBq/mL for all tumors and greater for auto-contoured GTVs compared to physician-contoured GTVs. The mean NTS for the auto-contours for all tumor sites was > 2.0. In addition, there was a statistically significant increase in the NTS for FAPI compared to FDG in pancreatic, liver and head & neck cancers. In pancreatic cancer, there was a statistically significant increase in Normalized Minimal kBq/mL for FAPI compared to FDG (26.0 vs 14.2) (p = 0.01) and the SUVmax of FAPI was almost double that of FDG (15.9 vs 8.2) (p = 0.01). FAPI had no background in the liver, but had high background in the uterus, suggesting it may have a role in liver cancer but not cervical cancer. CONCLUSION This is the first study demonstrating the potential superiority of 68Ga-FAPI compared to 18F-FDG as a biologic fiducial for BgRT when treating pancreatic, liver and head & neck cancers, with a similar efficacy for lung cancer. Our results indicate that auto-contoured GTVs generate a higher NTS than physician-contoured GTVs but all are > 2.0. In addition, the Normalized Minimal kBq/mL for auto-contours is > 5 kBq/mL for all tumors. As hypothesized, FAPI-based BgRT is most likely to be successful when treating tumors with significant desmoplastic stroma, such as pancreatic cancer.
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Affiliation(s)
- L Qiu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Y Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - T M Williams
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - A Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - S Sampath
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - S M Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - Y J Chen
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - L Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - D Leung
- RefleXion Medical, Inc., Hayward, CA
| | - A Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - H M McGee
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
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Wong JYC, Liu B, Dandapani SV, Li YR, Glaser SM, Liu J, Chen Q, Qing K, Chen HK, Simpson J, Da Silva A, Leung D, Feghali K, Dorff TB, Liu A, Williams TM. Pilot Study of a Novel Ring Gantry-Based PET/CT Linear Accelerator in Patients with Prostate Cancer Receiving [18F]-DCFPyL for PSMA PET Imaging. Int J Radiat Oncol Biol Phys 2023; 117:e451. [PMID: 37785452 DOI: 10.1016/j.ijrobp.2023.06.1636] [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 RefleXion X1® system is a hybrid PET imaging-radiotherapy system that uses real-time positron emissions from a PET tracer to deliver biologically guided radiotherapy (BgRT). This study (NCT05470699) evaluated the hypothesis that the X1 PET imaging subsystem would be able to detect [18F]-DCFPyL PSMA PET signal sufficient to generate a deliverable BgRT plan in patients with prostate cancer. MATERIALS/METHODS Patients with prostate cancer scheduled for a diagnostic [18F]-DCFPyL PSMA PET scan as part of standard of care were eligible. Upon completion of the diagnostic PSMA PET scan, images were transferred to the radiotherapy planning system for target identification and contouring. If at least one PET avid tumor lesion was identified, the patient was then scanned on the X1 unit. BgRT planning was performed on each X1 scanned patient. The target lesion volume, activity concentration (AC) and normalized target signal (NTS) were acquired. Successful and deliverable BgRT plans required that the target AC was ≥ 5 kBq/ml and NTS ≥ 2.7. RESULTS Twenty-six patients underwent [18F]-DCFPyL PET scans (13 with rising PSA after surgery or radiotherapy, 6 with known metastases and 7 with newly diagnosed high-risk prostate cancer). Median (range) PSA was 3.40 (0.04-122). In 16 patients a PET avid tumor was identified and contoured for planning (4 lymph nodes, 5 bone, 6 prostate gland, and 1 prostate bed). In 13 patients the target lesion was visualized on the X1 PET scan, while in 3 patients the target lesion was too close to the bladder to be clearly visualized. BgRT planning was feasible and met standard of care published SBRT organ dose constraints in 8 patients (3 prostate gland, 3 bone, 2 lymph nodes). BgRT planning was not feasible in 8 patients due to insufficient AC, low NTS or proximity of the target lesion to the PET avid bladder. The accompanying table compares median (range) target volume, AC and NTS for feasible versus not feasible plans. CONCLUSION This is the first study to investigate the feasibility of using [18F]-DCFPyL PET imaging for BgRT plan generation on the X1 system in patients with prostate cancer. Lesions that are relevant to radiotherapy of prostate cancer can be visualized including lymph node and bone metastases. A dedicated BgRT workflow with PSMA PET imaging on the X1 at 60 minutes post injection will result in higher target AC and will optimize BgRT planning. PET avid lesions < 1 cm or close to the bladder may make BgRT planning challenging. [18F]-DCFPyL-guided BgRT is technically feasible using the RefleXion X1. BgRT using targeted PET radiopharmaceuticals to biologically guide external beam radiotherapy represents a promising new dimension in radiation oncology and warrants further investigation.
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Affiliation(s)
- J Y C Wong
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - B Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - S V Dandapani
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - Y R Li
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - S M Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - J Liu
- Clinical Trials Office, City of Hope National Medical Center, Duarte, CA
| | - Q Chen
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - K Qing
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - H K Chen
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - J Simpson
- Clinical Trials Office, City of Hope National Medical Center, Duarte, CA
| | | | - D Leung
- RefleXion Medical, Inc., Hayward, CA
| | - K Feghali
- RefleXion Medical, Inc., Hayward, CA
| | - T B Dorff
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, Duarte, CA
| | - A Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - T M Williams
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
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Liu B, Chen Q, Qing K, Dandapani SV, Li YR, Glaser SM, Chen HK, Da Silva A, Leung D, Feghali KAA, Simpson J, Liu J, Dorff TB, Liu A, Williams TM, Wong JYC. Dosimetric Plan Evaluation of Biology Guided Radiotherapy Using [18F]-DCFPyL PSMA Radiotracer in Patients with Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e688. [PMID: 37786022 DOI: 10.1016/j.ijrobp.2023.06.2158] [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 X1 system represents a cutting-edge solution in radiotherapy delivery, with its capability to perform Biology Guided Radiotherapy (BgRT). The system utilizes real-time positron emission tomography (PET) signal as biological fiducials to provide tracked dose delivery and is initially available for use with [18F]-Fluorodeoxyglucose (FDG). The aim of this research study is to assess the quality of BgRT treatment plans for prostate cancer using patients' PSMA PET images obtained on the X1 system. MATERIALS/METHODS Sixteen patients with at least one PET-avid tumor identified on their whole-body diagnostic PSMA PET scan were selected. These patients were scanned on X1 following their diagnostic scan without additional radiotracer administration. Based on the X1 PET images, a BgRT plan was created for each patient, with the prescription dose determined by the location of treatment sites. The planning objectives of organs-at-risk (OARs) were established in accordance with the 2018 Timmerman guidelines. Target coverage objective was the dose covering 95% (D95%) of the planning target volume (PTV) to be higher than 100%. The following parameters were analyzed: PTV D95%, the minimal dose (Dmin) of gross tumor volume (GTV), plan maximum dose (Dmax), conformity index (CI), gradient index (GI), and maximum point dose (D0.03cc) to the nearest OARs. The X1 BgRT planning system also generated dose volume histogram (DVH) bounds, which model variations in BgRT delivery. The low boundary of GTV Dmin, representing the minimum GTV dose in the worst-case scenario, was recorded. RESULTS BgRT plans were created for all patients, except for one where the target signal was indistinguishable from the bladder. The prescription dose was 2700 cGy or 3000 cGy in 3 fractions for lymph node lesions, 2400 cGy to 3000 cGy in 3 fractions for bone metastasis, and 4500 cGy in 5 fractions for lesions in prostate. All plans met the dose constraints for OARs as per the Timmerman guidelines. The Dmax of all plans was 129.9% ± 6.9% (mean ± standard deviation). The PTV D95% and GTV Dmin were 101.7% ± 1.0% and 111.0% ± 7.6%, respectively. The low boundary of GTV Dmin was 95.9% ± 5.8%. The CI and GI were 1.22 ± 0.11 and 9.40 ± 2.12, respectively. The D0.03cc to nearest OARs was 84.6% ± 25.4%. The estimated treatment time was 699 ± 228 seconds. CONCLUSION This study is a pioneering effort to evaluate the quality of BgRT plans for prostate cancer patients using the [18F]-DCFPyL PSMA radiotracer. Our results showed that all BgRT plans met the planning objectives defined in the Timmerman protocol. BgRT with [18F]-DCFPyL represents a promising treatment modality for patients with prostate cancer. Further research is needed to validate this approach, including a comprehensive assessment of the dosimetric and tracking accuracy through physical measurements.
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Affiliation(s)
- B Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - Q Chen
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - K Qing
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - S V Dandapani
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - Y R Li
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - S M Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - H K Chen
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | | | - D Leung
- RefleXion Medical, Inc., Hayward, CA
| | | | - J Simpson
- Clinical Trials Office, City of Hope National Medical Center, Duarte, CA
| | - J Liu
- Clinical Trials Office, City of Hope National Medical Center, Duarte, CA
| | - T B Dorff
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, Duarte, CA
| | - A Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - T M Williams
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - J Y C Wong
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
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Szeto H, Graif A, Patel A, Vance A, Molavi S, Grilli C, Kimbiris G, Leung D. Abstract No. 37 The Perigraft Approach for Type II Endoleak Embolization. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.079] [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: 02/27/2023] Open
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Ryan W, Laughlin B, Leung D, Grilli C, Molavi S, Graif A. Abstract No. 85 Comparison of Percutaneous Cryoablation and Microwave Ablation for Treatment of Renal Masses. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.132] [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: 02/27/2023] Open
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Jamal J, Idris H, Faour A, Yang W, McLean A, Burgess S, Shugman I, Oloughlin A, Leung D, Mussap CJ, Juergens CP, Lo S, French JK. Reperfusion strategy and late clinical outcomes of patients with ST-elevation myocardial infarction (STEMI) in the absence of standard modifiable risk factors (SMuRFs). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2034] [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
Introduction
There is growing evidence that patients presenting with STEMI in the absence of standard modifiable cardiovascular risk factors (SMuRFs; smoking, hypertension, hypercholesterolemia, diabetes) have poorer outcomes compared to those with atleast one SMuRF. It has been hypothesised that this may be in part due to decreased administration of pharmacotherapies in the post-infarct period due to perceived low risk. Long term outcomes of patients without SMuRFs based on reperfusion strategy received during the index admission have not been investigated.
Purpose
We sought to analyse late clinical outcomes of STEMI patients with and without SMuRFs based on reperfusion strategy received during the index admission.
Methods
All patients who underwent PCI between 2003 and 2014 were identified from a PCI centre STEMI database. Late clinical outcomes of patients with and without SMuRFs were analysed overall and based on reperfusion strategy [primary PCI (pPCI) vs pharmaco-invasive PCI (PI-PCI)]. Propensity matching was used to account for differences in baseline characteristics between the groups.
Results
Amongst 2,091 STEMI patients, 531 (25%) had no SMuRFs (51% pPCI, 49% PI-PCI) and 1560 (75%) had ≥1 SMuRF (52% pPCI, 48% PI-PCI). Unadjusted late mortality in SMuRF-less patients was 13.4% (18.8% pPCI, 7.7% PI-PCI) and for those with ≥1 SMuRF was 9.7% (11.0% pPCI, 8.4% PI-PCI). After propensity-matching clinical and angiographic characteristics, 5 year mortality rates were significantly higher for patients without SMuRFs compared to those with SMuRFs [HR 1.36, CI: 1.03–1.81, p=0.031]. This difference was attenuated for patients who underwent pPCI [HR 1.72, CI: 1.22–2.43, p=0.002]. Interestingly, this discrepancy was not observed amongst individuals who underwent pharmaco-invasive PCI [HR 1.13, CI: 0.53–1.48, p=0.638], as SMuRF-less patients had similar mortality rates to their counterparts. Long term rates of reinfarction, stent thrombosis and target vessel revascularisation were similar between the groups. Additionally, there was no significant difference in rates of stroke and major bleeding amongst all 4 subgroups.
Conclusion
Patients presenting with STEMI in the absence of SMuRFs have increased overall late mortality compared to those with at least one SMuRF. However, this difference was not observed in patients who underwent a pharmaco-invasive strategy, whereby patients without SMuRFs had similar outcomes to those with SMuRFs after adjusting for confounders. Our findings suggest the use of a pharmaco-invasive strategy in appropriate SMuRF-less patients presenting with STEMI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Jamal
- Liverpool Hospital , Sydney , Australia
| | - H Idris
- Liverpool Hospital , Sydney , Australia
| | - A Faour
- Liverpool Hospital , Sydney , Australia
| | - W Yang
- Liverpool Hospital , Sydney , Australia
| | - A McLean
- Liverpool Hospital , Sydney , Australia
| | - S Burgess
- Liverpool Hospital , Sydney , Australia
| | - I Shugman
- Liverpool Hospital , Sydney , Australia
| | | | - D Leung
- Liverpool Hospital , Sydney , Australia
| | | | | | - S Lo
- Liverpool Hospital , Sydney , Australia
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Ota Y, Leung D, Lin E, Liao E, Kurokawa R, Kurokawa M, Baba A, Yokota H, Bathla G, Moritani T, Srinivasan A, Capizzano A. Prognostic Factors of Stroke-Like Migraine Attacks after Radiation Therapy (SMART) Syndrome. AJNR Am J Neuroradiol 2022; 43:396-401. [PMID: 35177545 PMCID: PMC8910816 DOI: 10.3174/ajnr.a7424] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/10/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Prognostic factors of stroke-like migraine attacks after radiation therapy (SMART) syndrome have not been fully explored. This study aimed to assess clinical and imaging features to predict the clinical outcome of SMART syndrome. MATERIALS AND METHODS We retrospectively reviewed the clinical manifestations and imaging findings of 20 patients with SMART syndrome (median age, 48 years; 5 women) from January 2016 to January 2020 at 4 medical centers. Patient demographics and MR imaging features at the time of diagnosis were reviewed. This cohort was divided into 2 groups based on the degree of clinical improvement (completely versus incompletely recovered). The numeric and categoric variables were compared as appropriate. RESULTS There were statistically significant differences between the completely recovered group (n = 11; median age, 44 years; 2 women) and the incompletely recovered group (n = 9; median age, 55 years; 3 women) in age, months of follow-up, and the presence of steroid treatment at diagnosis (P = .028, .002, and .01, respectively). Regarding MR imaging features, there were statistically significant differences in the presence of linear subcortical WM susceptibility abnormality, restricted diffusion, and subcortical WM edematous changes in the acute SMART region (3/11 versus 8/9, P = .01; 0/11 versus 4/9, P = .026; and 2/11 versus 7/9, P = .022, respectively). Follow-up MRIs showed persistent susceptibility abnormality (11/11) and subcortical WM edematous changes (9/9), with resolution of restricted diffusion (4/4). CONCLUSIONS Age, use of steroid treatment at the diagnosis of SMART syndrome, and MR imaging findings of abnormal susceptibility signal, restricted diffusion, and subcortical WM change in the acute SMART region can be prognostic factors in SMART syndrome.
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Affiliation(s)
- Y. Ota
- From the Division of Neuroradiology (Y.O., E. Liao, R.K., M.K., A.B., T.M., A.S., A.A.C.)
| | - D. Leung
- Department of Radiology and Division of Neuro-Oncology (D.L.), Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - E. Lin
- Division of Neuroradiology (E. Lin), Department of Radiology, University of Rochester Medical Center, Rochester, New York
| | - E. Liao
- From the Division of Neuroradiology (Y.O., E. Liao, R.K., M.K., A.B., T.M., A.S., A.A.C.)
| | - R. Kurokawa
- From the Division of Neuroradiology (Y.O., E. Liao, R.K., M.K., A.B., T.M., A.S., A.A.C.)
| | - M. Kurokawa
- From the Division of Neuroradiology (Y.O., E. Liao, R.K., M.K., A.B., T.M., A.S., A.A.C.)
| | - A. Baba
- From the Division of Neuroradiology (Y.O., E. Liao, R.K., M.K., A.B., T.M., A.S., A.A.C.)
| | - H. Yokota
- Department of Diagnostic Radiology and Radiation Oncology (H.Y.), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - G. Bathla
- Division of Neuroradiology (G.B.), Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - T. Moritani
- From the Division of Neuroradiology (Y.O., E. Liao, R.K., M.K., A.B., T.M., A.S., A.A.C.)
| | - A. Srinivasan
- From the Division of Neuroradiology (Y.O., E. Liao, R.K., M.K., A.B., T.M., A.S., A.A.C.)
| | - A.A. Capizzano
- From the Division of Neuroradiology (Y.O., E. Liao, R.K., M.K., A.B., T.M., A.S., A.A.C.)
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Ramachandran J, Pender P, Assad J, Wang A, Faour A, Leung D, Rajaratnam R, Mussap C, Juergens C, Lo S. Pericardiocentesis over 3 years at a tertiary referral Australian hospital. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.112] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Pericardiocentesis is a lifesaving intervention performed both percutaneously or surgically. We analysed 3 years of experience in a major tertiary hospital in Sydney Australia.
Purpose
To examine the indications, safety and delivery of a pericardiocentesis service at a major teaching hospital.
Methods
We retrospectively audited consecutive patients who underwent pericardiocentesis for pericardial effusion[PE] at a major teaching hospital from February 2018 to December 2020. Eligible patients were identified from the electronic medical records with this coding diagnosis.
Results
89 patients identified with mean age 60.8 ± 18.9years and 58.4%(51/89) male. Follow-up to August 2021 showed 41.5% had died, with an index hospitalisation mortality of 19%(17/89). Malignancy was the most common aetiology 30.3%(27/89) and attributable cause of hospitalisation death in 29.4%. Alternate causes included pericarditis 14.6%, idiopathic 13.4%, percutaneous-coronary-intervention(PCI) 5.6%(6/89) and electrophysiology 4.5%(4/89) complications. Three patients had aortic dissection (3.3%) and two were fatal. Clinical tamponade was present in 66.2%(55/89), PE identification occurred via echocardiography(TTE) in 55% cases (49/89) and incidental CT-diagnosis in 20.2%. TTE findings: right atrial collapse 54%(47/87), right ventricular collapse 60.9%(53/87), fixed and dilated inferior vena cava 64.7%. Pericardiocentesis was performed by cardiology trainees in 90.5% cases, 64.5% with consultant supervision and during working hours in 57.3% of cases. Percutaneous drainage was successful in 96%(72/75) of cases and was performed in the coronary care unit (30.3%), catheterisation laboratory (23.5%), emergency department (19.1%) and ICU (11.2%). Subxiphoid approach in 70%(62/89) was the most common then trans-apical 15%(13/89), parasternal 3%(3/89) and surgical 16%(14/89). TTE confirmed drain position in 76%(54/71), fluoroscopy in 28.5%(6/21) and agitated saline in 38.9%(30/77). Haemo-serous fluid noted in 77%(67/87) with average initial fluid drainage 480 ± 326mls and mean drain removal time 54 ± 33hrs. 17%(15/89) required re-drainage with adenocarcinoma found in 33.3%(5/15). Background antiplatelet treatment in 30.6%(27/88) and of these 67%(18/27) were on dual antiplatelets. 33%(29/89) patients were anticoagulated and 31.3%(9/29) required reversal prior to drainage. Complications were rare, 4%(3/75) had right heart chamber perforation needing emergency surgery. Two were post complex PCI (one died during admission from multiorgan failure) and one with pericarditis .
Conclusions
Pericardiocentesis is a safe and effective procedure for tamponade treatment and largely guided by echocardiography in our experience. Complications are rare and prognosis depends on aetiology with malignancy the most common. Drainage is often successfully performed emergently where the patient is located. Tamponade resulting from procedural complications are rare in our cohort.
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Affiliation(s)
| | - P Pender
- Liverpool Hospital, Sydney, Australia
| | - J Assad
- Liverpool Hospital, Sydney, Australia
| | - A Wang
- Liverpool Hospital, Sydney, Australia
| | - A Faour
- Liverpool Hospital, Sydney, Australia
| | - D Leung
- Liverpool Hospital, Sydney, Australia
| | | | - C Mussap
- Liverpool Hospital, Sydney, Australia
| | | | - S Lo
- Liverpool Hospital, Sydney, Australia
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Leung J, Pender P, French J, Leung D, Mussap C, Asrress K, Taylor D, Naguib Badie T, Kadappu K, Gibbs O, Kachwalla K, Nguyen P, Hopkins A, Lo S. Intravascular lithotripsy during percutaneous coronary intervention for calcified coronary lesions: analysis of patient and procedural characteristics and clinical outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.130] [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
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
Coronary artery calcification is frequently encountered during percutaneous coronary intervention (PCI). It can reduce PCI success and increase intra-procedural and post-procedural complications, including stent embolization, under-expansion and mal-apposition. Intravascular lithotripsy (IVL) is a new tool developed to treat calcified coronary lesions.
Purpose
Retrospective analysis of all cases of intravascular lithotripsy performed within our local health district to examine patient and procedural characteristics and clinical outcomes.
Methods
All patients undergoing PCI with intravascular lithotripsy between September 2019-August 2021 within our local health district were analysed. Patient and procedural characteristics and clinical outcomes were recorded.
Results
67 patients (50 men) were included with mean age 71.4 ± 8.7years. Risk factors prevalence included smoking (34%), hypertension (82%), dyslipidaemia (69%) and diabetes (46%). Trans-radial artery access was used in 38 patients (57%). IVL was performed most commonly in the left anterior descending artery (52%),[Figure 1]. IVL was utilised in 9 chronic total occlusions and 12 bifurcation lesions. Intracoronary (IC) imaging was performed in 59 patients (88%), intravascular ultrasound in 41(61%) and optical coherence tomography in 18 (27%). 41 (69%) patients had imaging performed pre and post IVL and post PCI. IC imaging identified 14 cases with 270º calcification arc and 45 cases with 360º arc. Nine cases (13.4%) required rotational atherectomy prior to IVL (most commonly 1.75mm burr). Mean reference vessel diameter was 3.2 ± 0.3mm. Mean lesion length was 36.3 ± 16.5mm. Mean pre-PCI stenosis was 85.5 ± 10.8%. Drug eluting stents were successfully deployed in 57 cases (85%), 10 had balloon angioplasty alone. Mean stent length was 39.2 ± 17.8mm. Mean post-PCI stenosis was 4.5 ± 13.3% (median 0%). Figure 2 shows a statistically significant increase in minimum lumen diameter and minimum lumen area post-IVL and minimal-stent-area (MSA) post-PCI. Mean stent expansion was 83%. Mean screening time 35.8 ± 17.8 minutes with mean contrast used 207.3 ± 78.7mL. No sustained arrhythmias or side-branch loss occurred. Vessel rupture was recorded in one patient necessitating urgent cardiac surgery (due to oversized balloon) and in 4 cases the IVL balloon could not cross the lesion.
Conclusion
Our experience shows that IVL is safe and effective and facilitates stent delivery and expansion. Intracoronary imaging is important to determine the need for calcium modification and evaluate its success prior to stent delivery and to confirm optimised stent expansion. Abstract Figure. Breakdown of PCI Artery Abstract Figure. IC Dimensions Pre/Post IVL/Post PCI
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Affiliation(s)
- J Leung
- Liverpool Hospital, Liverpool, Australia
| | - P Pender
- Liverpool Hospital, Liverpool, Australia
| | - J French
- Liverpool Hospital, Liverpool, Australia
| | - D Leung
- Liverpool Hospital, Liverpool, Australia
| | - C Mussap
- Liverpool Hospital, Liverpool, Australia
| | - K Asrress
- Liverpool Hospital, Liverpool, Australia
| | - D Taylor
- Liverpool Hospital, Liverpool, Australia
| | | | - K Kadappu
- Liverpool Hospital, Liverpool, Australia
| | - O Gibbs
- Liverpool Hospital, Liverpool, Australia
| | | | - P Nguyen
- Liverpool Hospital, Liverpool, Australia
| | - A Hopkins
- Liverpool Hospital, Liverpool, Australia
| | - S Lo
- Liverpool Hospital, Liverpool, Australia
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Leung J, Pender P, French J, Leung D, Mussap C, Asrress K, Taylor D, Naguib Badie T, Kaddapu K, Xu J, Kachwalla H, Hopkins A, Gibbs O, Lo S. Intravascular Lithotripsy versus Rotational Atherectomy Cutting Balloon on Stent Expansion for Heavily Calcified Coronary Lesions. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.599] [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: 11/15/2022]
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11
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Jayanti S, Juergens C, Makris A, Hennessy A, Lo S, Badie T, Xu J, Kadappu K, Kachwalla H, Gibbs O, Faour A, Rajaratnam R, French J, Leung D, Nguyen P. Ultrasound Guidance Facilitates Ideal Femoral Puncture for Coronary Angiography. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.640] [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: 11/17/2022]
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12
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Wong W, Leung D, Chua G, Duque J, Peare S, So H, Chan S, Kwan M, Ip P, Lau Y. Adolescents’ attitudes to the COVID-19 vaccination. Vaccine 2022; 40:967-969. [PMID: 35063284 PMCID: PMC8752287 DOI: 10.1016/j.vaccine.2022.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/06/2021] [Accepted: 01/07/2022] [Indexed: 12/24/2022]
Abstract
Vaccines against COVID-19 are now available for adolescents in Hong Kong but vaccine hesitancy is a major barrier to herd immunity. This survey study explores Hong Kong adolescents’ attitudes towards the COVID-19 vaccination. 2609 adolescents from across Hong Kong completed an online survey focused on the intent to vaccinate and the reasons for their choice. 39% of adolescents intended to take the COVID-19 vaccination and significant factors for this decision include: having at least one parent vaccinated, knowing somebody diagnosed with COVID-19 and receiving the influenza vaccine. Adolescents’ major concerns were either the safety and efficacy of the vaccine or the risk of infection. This study has proved that even in adolescents the vaccine hesitancy model is prominent with adolescents’ intentions highly related to confidence in the vaccine and perception of disease risk. Future interventions should target these specific concerns to ensure adolescents are well educated to overcome vaccine hesitancy.
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13
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Dang V, Pender P, Hopkins A, Rajaratnam R, Leung D, Lo S. Percutaneous Coronary Intervention (PCI) for Spontaneous Coronary Artery Dissection (SCAD) Induced Acute Coronary Syndrome (ACS): 21 Year Experience in a Single Australian Centre. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.610] [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: 11/27/2022]
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14
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Takayesu J, Sapir E, Xie J, Sun Y, Morikawa A, Junck L, Leung D, Umemura Y, Heth J, Al-Holou W, Wahl D, Lawrence T, Mayo C, Hayman J, Kim M. Survival Outcomes and Symptom Benefit From Palliative Radiotherapy in Breast Cancer Patients With Leptomeningeal Disease. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1561] [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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15
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Narkewicz M, Ye W, Leung D, Siegel M, Molleston J, Masand P, Karmazyn B, Harned R, Stoll J, Ling S, Navarro O, Magee J. 211: Heterogeneous ultrasound predicts high risk for the development of advanced liver disease in CF children: Final results of PUSH study. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01636-2] [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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16
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Ho GWK, Chan ACY, Shevlin M, Karatzias T, Chan PS, Leung D. Childhood Adversity, Resilience, and Mental Health: A Sequential Mixed-Methods Study of Chinese Young Adults. J Interpers Violence 2021; 36:NP10345-NP10370. [PMID: 31524036 DOI: 10.1177/0886260519876034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Resilience is a key health protective factor for those with adverse childhood experiences (ACEs), but little research has explored how it manifests in early adulthood or across cultures. The purpose of this study was to generate a fuller understanding of resilience and its contribution to the relationships between mental health problems and ACEs among Chinese young adults in Hong Kong. Using a sequential explanatory mixed-methods design, 433 Chinese young adults aged 18 to 24 years were surveyed online to examine the relationships between ACEs, resilience, and mental health problems (depression, anxiety, maladjustment, and posttraumatic stress symptoms). Among them, 34 participants with ACEs were purposively selected and interviewed to explore cultural factors that influenced their resilience. Quantitative data were analyzed using multiple hierarchical regression analyses; qualitative data were analyzed using a qualitative descriptive approach. Higher cumulative ACE exposure was associated with higher severity of adjustment disorder and odds for screening positive for posttraumatic stress disorders, but not for symptoms of depression or anxiety. Resilience significantly contributed to explaining variances across all mental health outcomes over and beyond ACEs and in a protective fashion. Four themes emerged from qualitative interviews: (a) Privacy, emotional restraint, and "saving face"; (b) Conforming to preserve harmony; (c) A will to excel; and (d) Viewing adversity as a matter of luck. These findings suggest Chinese young adults' resilience was influenced by cultural norms of restraint, conformity, competition, and superstition. The present study provides a model for future studies using a mixed-methods design to deeply examine resilience among younger people exposed to early adversities within sociocultural, historical, or geographical contexts.
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Affiliation(s)
- G W K Ho
- The Hong Kong Polytechnic University, Hong Kong
| | - A C Y Chan
- The Hong Kong Polytechnic University, Hong Kong
| | - M Shevlin
- Ulster University, Derry, Northern Ireland
| | - T Karatzias
- Edinburgh Napier University, UK
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - P S Chan
- The Hong Kong Polytechnic University, Hong Kong
| | - D Leung
- The Hong Kong Polytechnic University, Hong Kong
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17
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Iammarino M, Alfano L, James M, Mozaffar T, Mathews K, Weihl C, Leung D, Statland J, Kang P, Wicklund M, Lowes L, Vissing J, Manera JD, Ganesh V, Holmberg B, DeSpain E, Bates K, Sproule D, Johnson N, GRASP Consortium. LGMD. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.218] [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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18
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Lo KL, Leung D, Lai Z, Li C, Ma SF, Wong J, Yuen KK, Li J, Chiu P, Mak SK, Wong J, Ng CF. Picture-in-picture video demonstration of systematic transperineal prostate biopsy. Hong Kong Med J 2021; 27:304-305. [PMID: 34413262 DOI: 10.12809/hkmj208864] [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: 11/05/2022] Open
Affiliation(s)
- K L Lo
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - D Leung
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Z Lai
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - C Li
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - S F Ma
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - J Wong
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - K K Yuen
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - J Li
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - P Chiu
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - S K Mak
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - J Wong
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - C F Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
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Wei J, Kim H, Spencer C, Brennan-Crispi D, Zheng Y, Leung D, Cotsarelis G, Leung T. 608 Neuroimmune control of adult mammalian scarless skin regeneration. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.637] [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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20
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Forman J, Yoshida T, Lillis J, Gill A, Corbett A, Cahill M, Lockhart A, Simpson E, Boguniewicz M, Hanifin J, De Benedetto A, David G, Leung D, Schlievert P, Gill S, Beck L. 189 Microbial expression of lantibiotics may explain discrepancies between S. aureus culturability and metagenomics in atopic dermatitis subjects and healthy controls. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.210] [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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21
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Beck L, Boguniewicz M, Hatta T, Chiesa Fuxench Z, Simpson E, De Benedetto A, Ko J, Ong P, Yoshida T, Gallo R, Schlievert P, Gill S, Mosmann T, Berdyshev E, David G, Lussier S, Rudman Spergel A, Leung D. 666 Effect of dupilumab on the host-microbe interface in atopic dermatitis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.696] [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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22
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Graif A, Grilli C, Seigo M, Benninghoff M, Kimbiris G, Abid W, Patel A, Leung D. Abstract No. 116 Effect of endovascular therapy on oxygen requirements at discharge in patients with acute pulmonary embolism. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.122] [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] Open
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23
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Woo J, Leung D, Yu R, Lee R, Wong H. Factors Affecting Trends in Societal Indicators of Ageing Well in Hong Kong: Policies, Politics and Pandemics. J Nutr Health Aging 2021; 25:325-329. [PMID: 33575723 PMCID: PMC7552947 DOI: 10.1007/s12603-020-1488-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To document the trend in a quality of life indicator for the older Hong Kong population as an assessment of the impact of age friendly city policies, political conflicts and the covid-19 pandemic. DESIGN Random telephone survey and collection of government data over four years (2017-2020). SETTING Community living older people. PARTICIPANTS People aged 50 years and over. MEASUREMENTS The Hong Kong Quality of Life Index covering four domains of in income security, health status, capability and enabling environment. RESULTS From 2017-9, improvements were seen in various domains in parallel with the adoption of the World Health Organization's Age Friendly City concept by government policy together with a territory wide initiative supported by a major philanthropic organization. However scores of all domains dropped markedly as a result of political conflicts as well as the onset of the pandemic. CONCLUSION The documentation of the trend in HKEQOL shows that while it may be used as a macro indicator that is able to reflect policies affecting the well-being of older people, it is also able to reflect the impact of societal unrest and pandemics, and that the latter may override the effect of existing ageing policies. It also follows that during social unrest and pandemics, specific policies targeting older people may be needed to maintain well-being.
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Affiliation(s)
- J Woo
- Prof Jean Woo, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T. Hong Kong, Tel: 852-3505-3493, Fax: 852-2637-3852,
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Xu J, Juergens C, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Leung D, Lo S. Ticagrelor is Superior to Clopidogrel in Preserving Vasodilatory Capacity of the Coronary Microcirculation After Non-ST Elevation Acute Coronary Syndrome. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.510] [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: 11/15/2022]
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25
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Huynh Q, Whitmore K, Negishi K, DePasquale C, Hare J, Leung D, Stanton T, Marwick T. Reducing Readmission in Heart Failure: The Role of Patients’ Cognitive Function. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.100] [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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26
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Leung J, Pender P, French J, Leung D, Mussap C, Asrress K, Taylor D, Naguib BT, Kaddapu K, Gibbs O, Kachwalla H, Nguyen P, Hopkins A, Lo S. Initial Experience with Intravascular Lithotripsy with Shockwave Balloon for Calcified Coronary Lesions During Percutaneous Coronary Intervention (PCI). Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.485] [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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Xu J, Lo S, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Juergens C, Leung D. Brachial Artery Flow-Mediated Vasodilation is Related to the Coronary Index of Microcirculatory Resistance in Non-ST Elevation Acute Coronary Syndrome. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.262] [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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28
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Femia G, Ramachandran J, Poon J, Hopkins A, Mussap C, Rajaratnam R, French J, Leung D, Lo S, Juergens C. The Impact of COVID-19 on ST Elevation Myocardial Infarction. Heart Lung Circ 2021. [PMCID: PMC8324111 DOI: 10.1016/j.hlc.2021.06.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Szafron V, Pereira M, Vogel T, Leung D, Forbes-Satter L. M412 A BALANCING ACT: TREATMENT OF COVID-19 AND CYTOMEGALOVIRUS IN A PATIENT WITH PRIMARY IMMUNODEFICIENCY. Ann Allergy Asthma Immunol 2020. [PMCID: PMC7661922 DOI: 10.1016/j.anai.2020.08.359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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30
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Kim M, Sun Y, Aryal M, Parmar H, Piert M, Rosen B, Mayo C, Balter J, Schipper M, Gabel N, Briceño E, You D, Heth J, Al-Holou W, Umemura Y, Leung D, Junck L, Wahl D, Lawrence T, Cao Y. A Phase II Study of Dose-Intensified Chemoradiation Using Biologically-Based Target Volume Definition in Patients with Newly Diagnosed Glioblastoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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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31
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Nakatsuji T, Hata T, Tong L, Cheng J, Shafiq F, Butcher A, Spergel A, Johnson K, Jepson B, Calatroni A, Taylor P, Leung D, Gallo R. 860 Microbiome therapy of atopic dermatitis by application of rationally selected human commensal skin bacteria. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.876] [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]
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32
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Graif A, Scott A, Zimmermann T, Kimbiris G, Grilli C, Putnam S, Paik H, Nwosu U, Leung D. 4:12 PM Abstract No. 263 Temporal analysis of heart rate during catheter-directed thrombolysis for acute pulmonary embolism. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.310] [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: 10/25/2022] Open
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Graif A, Kornblum J, McNinch J, Putnam S, Paik H, Grilli C, Kimbiris G, Agriantonis D, Leung D. 3:09 PM Abstract No. 256 Comparison of endovascular and noninvasive therapies in acute pulmonary embolism: a PERT experience. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.303] [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] Open
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Xu J, Lo S, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Juergens C, Leung D. 805 Clopidogrel Versus Ticagrelor on Coronary Microvascular and Peripheral Endothelial Function After Non-ST Elevation Acute Coronary Syndromes (NSTE-ACS): Results of a Randomised Trial. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.812] [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: 11/26/2022]
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Nayyar D, Leung D, Aty W, Premawardhana U, Kadappu K. 422 Transoesophageal Echocardiography in Diagnosing Acute Aortic Dissection not Evident on CT Aortogram. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.429] [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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Xu J, Lo S, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Juergens C, Leung D. P2708Clopidogrel versus ticagrelor on coronary microvascular and peripheral endothelial function after non-ST elevation acute coronary syndrome: a randomised trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1025] [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
Ticagrelor has been shown to reduce microvascular injury and improve peripheral endothelial function compared to clopidogrel in ST-elevation myocardial infarction and stable patients. However, comparable data is lacking in non-ST elevation acute coronary syndromes (NSTE-ACS).
Purpose
To investigate the effects of clopidogrel versus ticagrelor on coronary microvascular function and peripheral endothelial function in NSTE-ACS patients.
Methods
Patients hospitalised for NSTE-ACS were prospectively randomised 1:1 to clopidogrel (300mg loading then 75mg daily) or ticagrelor (180mg loading then 90mg twice-daily). Coronary microvascular function was assessed with index of microcirculatory resistance (IMR) in the infarct related artery (IRA) and non-IRA before and after percutaneous coronary intervention (PCI) using a standard pressure-temperature coronary wire. Peripheral endothelial function was assessed with flow-mediated vasodilation (FMD) of the brachial artery, performed on admission prior to antiplatelet loading and again before discharge, using a pneumatic cuff and 10MHz linear ultrasound transducer.
Results
A total of 40 patients were included for analysis (Figure 1). Median age was 53.5 (IQR 49.0–61.5) years, 35 (87.5%) were male, 11 (27.5%) had diabetes, 19 (47.5%) were smokers. Median peak troponin T was 527 (175–1006.5) ng/L, median GRACE score 91.5 (78.3–103.3) and median SYNTAX score 13 (6–20). Baseline characteristics were similar between both groups. There was no significant difference in the median baseline IMR between the 2 groups in both the IRA (clopidogrel 14.4 [IQR 12.2–18.6] vs ticagrelor 20.8 [11.3–27.4], p=0.22) and non-IRA (14.0 [11.0–22.0] vs 14.0 [10.0–29.5] respectively, p=0.74). 28 patients underwent PCI to the IRA (12 clopidogrel, 16 ticagrelor). There was no significant difference in the median post-PCI IMR between the 2 groups (19.5 [14.5–24.5] vs 29.0 [19.0–35.6] respectively, p=0.11). However, there was significant worsening of post-PCI compared with pre-PCI IMR (19.5 vs 15.0, p=0.049) in the clopidogrel group but not in the ticagrelor group (29.0 vs 25.4, p=0.47). FMD was performed in 23 patients (9 clopidogrel, 14 ticagrelor). Admission median %FMD (change in post-stimulus diameter as a percentage of the baseline diameter) was similar between the 2 groups (13.2% [10.1–17.6] vs 12.2% [10.2–15.8] respectively, p=0.41). There was a trend towards higher median pre-discharge %FMD in the ticagrelor group (12.8% [12.2–18.0]) compared to the clopidogrel group (10.4% [9.5–11.2], p=0.09). There was a trend towards lower pre-discharge %FMD compared to admission in the clopidogrel group (10.4% vs 13.2%, p=0.05) but not the ticagrelor group (12.8% vs 12.2%, p=0.43).
Figure 1
Conclusions
In our NSTE-ACS patients undergoing PCI, ticagrelor resulted in less disruption of coronary microvascular function and may also have beneficial effects on peripheral endothelial function compared to clopidogrel.
Acknowledgement/Funding
Dr. James Xu is funded by a post-graduate scholarship from the Australian Government Research Training Program (RTP)
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Affiliation(s)
- J Xu
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - S Lo
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - C Mussap
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - J French
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - R Rajaratnam
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - K Kadappu
- Campbelltown Hospital, Department of Cardiology, Sydney, Australia
| | - U Premawardhana
- Campbelltown Hospital, Department of Cardiology, Sydney, Australia
| | - P Nguyen
- Campbelltown Hospital, Department of Cardiology, Sydney, Australia
| | - C Juergens
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - D Leung
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
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Vance A, Chohan O, Chedrawy C, Graif A, McKenna G, Garcia M, Kimbiris G, Grilli C, Leung D. 03:18 PM Abstract No. 95 May-Thurner and beyond: subclassification of iliac vein compression related to overlying arterial vasculature. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.140] [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: 12/01/2022] Open
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Xu J, Hopkins A, Leung D, Mussap C, French J, Juergens C, Lo S. Intravascular Ultrasound (IVUS) Analysis of Intensive Plaque Modification with Rotational Atherectomy with or without Adjunctive Cutting Balloon for Extremely Calcified Coronary Lesions. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.641] [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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39
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Nguyen P, Makris A, Hennessy A, Jayanti S, Wang A, Park K, Chen V, Nguyen T, Lo S, Xuan W, Leung M, Badie T, Xu J, Kadappu K, Kachwalla H, Gibbs O, Faour A, Kee A, Rajaratnam R, Leung D, French J, Juergens C. Standard Versus Ultrasound-Guided Radial and Femoral Access (SURF) - A Randomised Controlled Trial. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pender P, Faour A, Gibbs O, Dang V, Hopkins A, Leung D, Mussap C, French J, Juergens C, Lo S. Use of Mechanical Cardiac Support (MCS) for ST-elevated Myocardial Infarction with Cardiogenic Shock(STEMI-CS) in a Non-transplant Centre. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.710] [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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41
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Huynh Q, Negishi K, De Pasquale C, Hare J, Leung D, Stanton T, Marwick T. Cognitive Domains and Post-Discharge Outcomes in Hospitalised Patients With Heart Failure. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.025] [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: 11/25/2022]
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42
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Xu J, Lo S, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Juergens C, Leung D. Clopidogrel Versus Ticagrelor on Coronary Microvascular Function After Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS): A Randomised Trial. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.594] [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: 11/26/2022]
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Assad J, Pender P, Faour A, Leung D, Rajaratnam R, Mussap C, Juergens C, Lo S. Pericardiocentesis for Pericardial Effusion – a Single Centre Experience. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pender P, Gibbs O, Faour A, Dang V, Hopkins A, Leung D, Mussap C, French J, Juergens C, Lo S. Mechanical Circulatory Support for Semi – elective PCI in High-risk Patients with Extracorporeal Membranous Oxygenation (ECMO) Compared to Impella Heart Pump Device. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.656] [Citation(s) in RCA: 1] [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: 10/26/2022]
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45
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Leung D, Wong G. AWARENESS AND ANXIETY IN HELP-SEEKERS FOR DEMENTIA ASSESSMENT SERVICE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.518] [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)
| | - G Wong
- The University of Hong Kong
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Leung D, Cheung P, Cheuk M, Dorsch M, Jones A. P1489Sustained long term benefits after alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy: a single centre experience. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1489] [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: 11/13/2022] Open
Affiliation(s)
- D Leung
- C.K Hui Heart Centre, Edmonton, Canada
| | - P Cheung
- C.K Hui Heart Centre, Edmonton, Canada
| | - M Cheuk
- C.K Hui Heart Centre, Edmonton, Canada
| | - M Dorsch
- C.K Hui Heart Centre, Edmonton, Canada
| | - A Jones
- C.K Hui Heart Centre, Edmonton, Canada
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Chedrawy C, Graif A, Leung D, Agriantonis D, Nwosu U, Vance A, Kimbiris G, Garcia M, Putnam S, Lie K, Grilli C. 3:18 PM Abstract No. 353 Nitinol self-expanding stents for the treatment of chronic iliofemoral veno-occlusive disease. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.392] [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] Open
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Graif A, Chedrawy C, Vance A, Kimbiris G, Grilli C, Agriantonis D, Leung D. 3:18 PM Abstract No. 223 Catheter-directed thrombolysis for acute pulmonary embolism in 132 patients: a single-center experience. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.250] [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] Open
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Vance A, Graif A, Grilli C, Nwosu U, Liao M, Agriantonis D, Kimbiris G, Garcia M, Leung D. Abstract No. 639 Outcome of iliocaval stent-assisted reconstruction in patients with chronic obstruction of the inferior vena cava. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.684] [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: 10/17/2022] Open
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Tran J, Ng A, Chan O, Leung D, Leung M. The Long-Term Prognostic Values of Left Ventricular Function and Dyssynchrony After a Non-ST Elevation Myocardial Infarction. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.529] [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: 10/28/2022]
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