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Wang X, Sin CF, Teo KC, Leung WCY, Wong YK, Liu RKC, Fok JW, Ip BY, Kwan HH, Lee TC, Sheng B, Yip EKK, Yap DYH, Luo H, Lau KK. Impact of renal function variability on long-term prognosis in ischemic stroke patients with atrial fibrillation. Front Neurol 2024; 15:1294022. [PMID: 38711560 PMCID: PMC11071668 DOI: 10.3389/fneur.2024.1294022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/25/2024] [Indexed: 05/08/2024] Open
Abstract
Background Although renal dysfunction is associated with adverse clinical outcomes in patients with atrial fibrillation (AF) following stroke, the impact of renal function variability is unclear. Aim This study aimed to assess the association between renal function variability and various adverse clinical outcomes in patients with transient ischemic attack (TIA)/ischemic stroke and atrial fibrillation (AF). Methods We conducted a population-based study and retrospectively identified patients hospitalized with a diagnosis of TIA/ischemic stroke and AF during 2016-2020 using the Clinical Data Analysis and Reporting System of Hong Kong. Serial serum creatinine tested upon the onset of TIA/ischemic stroke and during their subsequent follow-up was collected. Renal function variability was calculated using the coefficient of variation of the estimated glomerular filtration rate (eGFR). Clinical endpoints that occurred during the study period were captured and included ischemic stroke/systemic embolism, intracerebral hemorrhage (ICH), total bleeding, major adverse cardiovascular events (MACE), cardiovascular, non-cardiovascular, and all-cause mortality. Competing risk regression and Cox proportional hazard regression models were used to assess the associations of renal function variability with the outcomes of interest. Results A total of 3,809 patients (mean age 80 ± 10 years, 43% men) who satisfied the inclusion and exclusion criteria were followed up for a mean of 2.5 ± 1.5 years (9,523 patient-years). The mean eGFR was 66 ± 22 mL/min/1.73 m2 at baseline, and the median number of renal function tests per patient during the follow-up period was 20 (interquartile range 11-35). After accounting for potential confounders, a greater eGFR variability was associated with increased risks of recurrent ischemic stroke/systemic embolism [fully adjusted subdistribution hazard ratio 1.11, 95% confidence interval (CI) 1.03-1.20], ICH (1.17, 1.01-1.36), total bleeding (1.13, 1.06-1.21), MACE (1.22, 1.15-1.30), cardiovascular (1.49, 1.32-1.69), non-cardiovascular (1.43, 1.35-1.52), and all-cause mortality (fully adjusted hazard ratio 1.44, 1.39-1.50). Conclusion Visit-to-visit renal function variability is independently associated with adverse clinical outcomes in TIA/ischemic stroke patients with AF. Further large-scale studies are needed to validate our results.
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Affiliation(s)
- Xiao Wang
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chun-fung Sin
- Department of Pathology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kay-Cheong Teo
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - William C. Y. Leung
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yuen-Kwun Wong
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Roxanna K. C. Liu
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Joshua W. Fok
- Department of Medicine, Yan Chai Hospital, Hong Kong, Hong Kong SAR, China
| | - Bonaventure Y. Ip
- Department of Medicine and Therapeutics, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Hon Hang Kwan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong SAR, China
| | - Tsz Ching Lee
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Bun Sheng
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong SAR, China
| | - Edwin Kin-Keung Yip
- Department of Medicine and Geriatrics, Ruttonjee Hospital, Hong Kong, Hong Kong SAR, China
| | - Desmond Y. H. Yap
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Computer Science, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kui-Kai Lau
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Lee TC, Leung WC, Ho C, Chiu MW, Leung IY, Wong YK, Roxanna LK, Sum CH, Lui DT, Cheung RT, Leung GK, Chan KH, Teo KC, Lau KK. Association of LDL-cholesterol <1.8 mmol/L and statin use with the recurrence of intracerebral hemorrhage. Int J Stroke 2024:17474930241239523. [PMID: 38429252 DOI: 10.1177/17474930241239523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
BACKGROUND Recent intensive low-density lipoprotein cholesterol (LDL-C) lowering trials, including FOURIER, ODYSSEY OUTCOMES, and Treat Stroke to Target (TST) trials, have mostly refuted the concern surrounding statin use, LDL-C lowering, and intracerebral hemorrhage (ICH) risk. However, the results from these trials may not be fully applied to ICH survivors, as the populations studied were mainly patients without prior ICH, in whom the inherent ICH risk is more than 10 times lower than that of ICH survivors. Although available literature on statin use after ICH has demonstrated no excess risk of recurrent ICH, other potential factors that may modify ICH risk, especially hypertension control and ICH etiology, have not generally been considered. Notably, data on LDL-C levels following ICH are lacking. AIMS We aim to investigate the association between LDL-C levels and statin use with ICH risk among ICH survivors, and to determine whether the risk differed with patients' characteristics, especially ICH etiology. METHODS Follow-up data of consecutive spontaneous ICH survivors enrolled in the University of Hong Kong prospective stroke registry from 2011 to 2019 were retrospectively analyzed. ICH etiology was classified as cerebral amyloid angiopathy (CAA) using the modified Boston criteria or hypertensive arteriopathy, while the mean follow-up LDL-C value was categorized as <1.8 or ⩾1.8 mmol/L. The primary endpoint was recurrent ICH. The association of LDL-C level and statin use with recurrent ICH was determined using multivariable Cox regression. Pre-specified subgroup analyses were performed, including based on ICH etiology and statin prescription. Follow-up blood pressure was included in all the regression models. RESULTS In 502 ICH survivors (mean age = 64.2 ± 13.5 years, mean follow-up LDL-C = 2.2 ± 0.6 mmol/L, 28% with LDL-C <1.8 mmol/L), 44 had ICH recurrence during a mean follow-up of 5.9 ± 2.8 years. Statin use after ICH was not associated with recurrent ICH (adjusted hazard ratio (AHR) = 1.07, 95% confidence interval (CI) = 0.57-2.00). The risk of ICH recurrence was increased for follow-up LDL-C <1.8 mmol/L (AHR = 1.99, 95% CI = 1.06-3.73). This association was predominantly observed in ICH attributable to CAA (AHR = 2.52, 95% CI = 1.06-5.99) and non-statin users (AHR = 2.91, 95% CI = 1.08-7.86). CONCLUSION The association between post-ICH LDL-C <1.8 mmol/L and recurrent ICH was predominantly observed in CAA patients and those with intrinsically low LDL-C (non-statin users). While statins can be safely prescribed in ICH survivors, LDL-C targets should be individualized and caution must be exercised in CAA patients.
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Affiliation(s)
- Tsz-Ching Lee
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - William Cy Leung
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Chun Ho
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Megan Wl Chiu
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Ian Yh Leung
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Yuen-Kwun Wong
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Liu Kc Roxanna
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Christopher Hf Sum
- Division of Neurosurgery, Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - David Tw Lui
- Division of Endocrinology & Metabolism, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Raymond Tf Cheung
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Gilberto Kk Leung
- Division of Neurosurgery, Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Koon-Ho Chan
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kay-Cheong Teo
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kui-Kai Lau
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
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Ho I, Wong CK, Wong YK, Lam TH, Sze-Him Leung I, Lin M, Tak-Wai Lui D, Kwok WC, Tam CC, Chan YH, Chan EW, Tse HF. Aromatase Inhibitor Therapy Increases the Risk of New-Onset Atrial Fibrillation in Patients With Breast Cancer. JACC Asia 2024; 4:150-160. [PMID: 38371283 PMCID: PMC10866735 DOI: 10.1016/j.jacasi.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 02/20/2024]
Abstract
Background Previous studies suggest that aromatase inhibitors (AIs) increase the risk of adverse cardiovascular events and cardiac arrhythmias in patients with breast cancer, but it is unclear whether AIs also increase the risk of new-onset atrial fibrillation (AF). Objectives The purpose of this study was to investigate whether the use of AIs was associated with an increased risk of new-onset AF in patients with breast cancer. Methods We performed a retrospective analysis involving 5,707 patients with breast cancer (mean age 63.9 ± 11.2 years and 99.9% women) who received adjunctive hormone therapy with an AI (AI group, n = 4,878) or tamoxifen (tamoxifen group, n = 829) in Hong Kong between January 1, 1999, and December 31, 2020. After propensity score matching, there were 1,658 and 829 patients with balanced characteristics in the AI group and tamoxifen group, respectively. Results After 8,863 patient-years of follow-up, patients who were prescribed AI had a trend toward more new-onset arrhythmias compared with those prescribed tamoxifen (0.62 vs 0.30 per 100 patient-years; crude HR: 2.05; P = 0.053). The difference in arrhythmic risk was mainly driven by a higher incidence rate of new-onset AF in the AI group (0.59 vs 0.27 per 100 patient-years; crude HR: 2.18; P = 0.046). The use of AIs was confirmed to be an independent risk factor for new-onset AF on multivariate analysis (adjusted HR: 2.75; P = 0.01). Conclusions Among breast cancer patients prescribed adjunctive hormonal therapy, AI was associated with an increased risk of new-onset AF. Regular surveillance for new-onset AF should be considered in breast cancer patients treated with an AI.
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Affiliation(s)
- Isaac Ho
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR
| | - Chun-Ka Wong
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Yuen-Kwun Wong
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Tsun-Ho Lam
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | | | - Minqing Lin
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - David Tak-Wai Lui
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Wang Chun Kwok
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Chor-Cheung Tam
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Yap-Hang Chan
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Esther W.Y. Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Hung-Fat Tse
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
- Cardiac and Vascular Center, Hong Kong University Shenzhen Hospital, Shenzhen, China
- Center for Translational Stem Cell Biology, Hong Kong SAR, China
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Teo KC, Fong SM, Leung WCY, Leung IYH, Wong YK, Choi OMY, Yam KK, Lo RCN, Cheung RTF, Ho SL, Tsang ACO, Leung GKK, Chan KH, Lau KK. Location-Specific Hematoma Volume Cutoff and Clinical Outcomes in Intracerebral Hemorrhage. Stroke 2023; 54:1548-1557. [PMID: 37216445 DOI: 10.1161/strokeaha.122.041246] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/17/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Major intracerebral hemorrhage (ICH) trials have largely been unable to demonstrate therapeutic benefit in improving functional outcomes. This may be partly due to the heterogeneity of ICH outcomes based on their location, where a small strategic ICH could be debilitating, thus confounding therapeutic effects. We aimed to determine the ideal hematoma volume cutoff for different ICH locations in predicting ICH outcomes. METHODS We retrospectively analyzed consecutive ICH patients enrolled in the University of Hong Kong prospective stroke registry from January 2011 to December 2018. Patients with premorbid modified Rankin Scale score >2 or who underwent neurosurgical intervention were excluded. ICH volume cutoff, sensitivity, and specificity in predicting respective 6-month neurological outcomes (good [modified Rankin Scale score 0-2], poor [modified Rankin Scale score 4-6], and mortality) for specific ICH locations were determined using receiver operating characteristic curves. Separate multivariate logistic regression models were also conducted for each location-specific volume cutoff to determine whether these cutoffs were independently associated with respective outcomes. RESULTS Among 533 ICHs, the volume cutoff for good outcome according to ICH location was 40.5 mL for lobar, 32.5 mL for putamen/external capsule, 5.5 mL for internal capsule/globus pallidus, 6.5 mL for thalamus, 17 mL for cerebellum, and 3 mL for brainstem. ICH smaller than the cutoff for all supratentorial sites had higher odds of good outcomes (all P<0.05). Volumes exceeding 48 mL for lobar, 41 mL for putamen/external capsule, 6 mL for internal capsule/globus pallidus, 9.5 mL for thalamus, 22 mL for cerebellum, and 7.5 mL for brainstem were at greater risk of poor outcomes (all P<0.05). Mortality risks were significantly higher for volumes that exceeded 89.5 mL for lobar, 42 mL for putamen/external capsule, and 21 mL for internal capsule/globus pallidus (all P<0.001). All receiver operating characteristic models for location-specific cutoffs had good discriminant values (area under the curve >0.8), except in predicting good outcome for cerebellum. CONCLUSIONS ICH outcomes differed with location-specific hematoma size. Location-specific volume cutoff should be considered in patient selection for ICH trials.
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Affiliation(s)
- Kay-Cheong Teo
- Division of Neurology, Department of Medicine, Queen Mary Hospital (K.-C.T., S.-M.F., W.C.Y.L., I.Y.H.L., Y.-K.W., K.-K.Y., R.C.N.L., R.T.F.C., S.-L.H., K.-H.C., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Sze-Man Fong
- Division of Neurology, Department of Medicine, Queen Mary Hospital (K.-C.T., S.-M.F., W.C.Y.L., I.Y.H.L., Y.-K.W., K.-K.Y., R.C.N.L., R.T.F.C., S.-L.H., K.-H.C., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - William C Y Leung
- Division of Neurology, Department of Medicine, Queen Mary Hospital (K.-C.T., S.-M.F., W.C.Y.L., I.Y.H.L., Y.-K.W., K.-K.Y., R.C.N.L., R.T.F.C., S.-L.H., K.-H.C., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Ian Y H Leung
- Division of Neurology, Department of Medicine, Queen Mary Hospital (K.-C.T., S.-M.F., W.C.Y.L., I.Y.H.L., Y.-K.W., K.-K.Y., R.C.N.L., R.T.F.C., S.-L.H., K.-H.C., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Yuen-Kwun Wong
- Division of Neurology, Department of Medicine, Queen Mary Hospital (K.-C.T., S.-M.F., W.C.Y.L., I.Y.H.L., Y.-K.W., K.-K.Y., R.C.N.L., R.T.F.C., S.-L.H., K.-H.C., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Olivia M Y Choi
- Division of Neurosurgery, Department of Surgery, Queen Mary Hospital (O.M.Y.C., A.C.O.T., G.K.K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Ka-Keung Yam
- Division of Neurology, Department of Medicine, Queen Mary Hospital (K.-C.T., S.-M.F., W.C.Y.L., I.Y.H.L., Y.-K.W., K.-K.Y., R.C.N.L., R.T.F.C., S.-L.H., K.-H.C., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Rachel C N Lo
- Division of Neurology, Department of Medicine, Queen Mary Hospital (K.-C.T., S.-M.F., W.C.Y.L., I.Y.H.L., Y.-K.W., K.-K.Y., R.C.N.L., R.T.F.C., S.-L.H., K.-H.C., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Raymond T F Cheung
- Division of Neurology, Department of Medicine, Queen Mary Hospital (K.-C.T., S.-M.F., W.C.Y.L., I.Y.H.L., Y.-K.W., K.-K.Y., R.C.N.L., R.T.F.C., S.-L.H., K.-H.C., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
- Research Center of Heart, Brain, Hormone and Healthy Aging (R.T.F.C., S.-L.H., K.-H.C., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR (R.T.F.C., K.-H.C., K.-K.L.)
| | - Shu-Leong Ho
- Division of Neurology, Department of Medicine, Queen Mary Hospital (K.-C.T., S.-M.F., W.C.Y.L., I.Y.H.L., Y.-K.W., K.-K.Y., R.C.N.L., R.T.F.C., S.-L.H., K.-H.C., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
- Research Center of Heart, Brain, Hormone and Healthy Aging (R.T.F.C., S.-L.H., K.-H.C., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Anderson C O Tsang
- Division of Neurosurgery, Department of Surgery, Queen Mary Hospital (O.M.Y.C., A.C.O.T., G.K.K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Gilberto K K Leung
- Division of Neurosurgery, Department of Surgery, Queen Mary Hospital (O.M.Y.C., A.C.O.T., G.K.K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Koon-Ho Chan
- Division of Neurology, Department of Medicine, Queen Mary Hospital (K.-C.T., S.-M.F., W.C.Y.L., I.Y.H.L., Y.-K.W., K.-K.Y., R.C.N.L., R.T.F.C., S.-L.H., K.-H.C., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
- Research Center of Heart, Brain, Hormone and Healthy Aging (R.T.F.C., S.-L.H., K.-H.C., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR (R.T.F.C., K.-H.C., K.-K.L.)
| | - Kui-Kai Lau
- Division of Neurology, Department of Medicine, Queen Mary Hospital (K.-C.T., S.-M.F., W.C.Y.L., I.Y.H.L., Y.-K.W., K.-K.Y., R.C.N.L., R.T.F.C., S.-L.H., K.-H.C., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
- Research Center of Heart, Brain, Hormone and Healthy Aging (R.T.F.C., S.-L.H., K.-H.C., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR (R.T.F.C., K.-H.C., K.-K.L.)
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5
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Teo KC, Keins S, Abramson JR, Leung WCY, Leung IYH, Wong YK, Yeung C, Kourkoulis C, Warren AD, Chan KH, Cheung RTF, Ho SL, Gurol ME, Viswanathan A, Greenberg SM, Anderson CD, Lau KK, Rosand J, Biffi A. Blood Pressure Control Targets and Risk of Cardiovascular and Cerebrovascular Events After Intracerebral Hemorrhage. Stroke 2023; 54:78-86. [PMID: 36321455 DOI: 10.1161/strokeaha.122.039709] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) survivors are at high risk for recurrent stroke and cardiovascular events. Blood pressure (BP) control represents the most potent intervention to lower these risks, but optimal treatment targets in this patient population remain unknown. We sought to determine whether survivors of ICH achieving more intensive BP control than current guideline recommendations (systolic BP <130 mmHg and diastolic BP <80 mmHg) were at lower risk of major adverse cardiovascular and cerebrovascular events and mortality. METHODS We analyzed data for 1828 survivors of spontaneous ICH from 2 cohort studies. Follow-up BP measurements were recorded 3 and 6 months after ICH, and every 6 months thereafter. Outcomes of interest were major adverse cardiovascular and cerebrovascular events (recurrent ICH, incident ischemic stroke, myocardial infarction), vascular mortality (defined as mortality attributed to recurrent ICH, ischemic stroke, or myocardial infarction), and all-cause mortality. RESULTS During a median follow-up of 46.2 months, we observed 166 recurrent ICH, 68 ischemic strokes, 69 myocardial infarction, and 429 deaths. Compared with survivors of ICH with systolic BP 120 to 129 mmHg, participants who achieved systolic BP <120 mmHg displayed reduced risk of recurrent ICH (adjusted hazard ratio [AHR], 0.74 [95% CI, 0.59-0.94]) and major adverse cardiovascular and cerebrovascular events (AHR, 0.69 [95% CI, 0.53-0.92]). All-cause mortality (AHR, 0.76 [95% CI, 0.57-1.03]) and vascular mortality (AHR, 0.68 [95% CI, 0.45-1.01]) did not differ significantly. Among participants aged >75 years or with modified Rankin Scale score 4 to 5, systolic BP <120 mmHg was associated with increased all-cause mortality (AHR, 1.38 [95% CI, 1.02-1.85] and AHR, 1.36 [95% CI, 1.03-1.78], respectively), but not vascular mortality. We found no differences in outcome rates between survivors of ICH with diastolic BP <70 versus 70 to 79 mmHg. CONCLUSIONS Targeting systolic BP <120 mmHg in select groups of survivors of ICH could result in decreased major adverse cardiovascular and cerebrovascular events risk without increasing mortality. Our findings warrant investigation in dedicated randomized controlled trials.
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Affiliation(s)
- Kay-Cheong Teo
- Department of Medicine, Queen Mary Hospital (K.-C.T., W.C.Y.L., I.Y.H.L., Y.-K.W., C.Y., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong
| | - Sophia Keins
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Henry and Allison McCance Center for Brain Health (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Jessica R Abramson
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Henry and Allison McCance Center for Brain Health (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - William C Y Leung
- Department of Medicine, Queen Mary Hospital (K.-C.T., W.C.Y.L., I.Y.H.L., Y.-K.W., C.Y., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong
| | - Ian Y H Leung
- Department of Medicine, Queen Mary Hospital (K.-C.T., W.C.Y.L., I.Y.H.L., Y.-K.W., C.Y., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong
| | - Yuen-Kwun Wong
- Department of Medicine, Queen Mary Hospital (K.-C.T., W.C.Y.L., I.Y.H.L., Y.-K.W., C.Y., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong
| | - Charming Yeung
- Department of Medicine, Queen Mary Hospital (K.-C.T., W.C.Y.L., I.Y.H.L., Y.-K.W., C.Y., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong
| | - Christina Kourkoulis
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Henry and Allison McCance Center for Brain Health (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Andrew D Warren
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Koon-Ho Chan
- Research Center of Heart, Brain, Hormone and Healthy Aging (K.-H.C., R.T.F.C., S.-L.H., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong (K.-H.C., R.T.F.C., K.-K.L.)
| | - Raymond T F Cheung
- Research Center of Heart, Brain, Hormone and Healthy Aging (K.-H.C., R.T.F.C., S.-L.H., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong (K.-H.C., R.T.F.C., K.-K.L.)
| | - Shu-Leong Ho
- Research Center of Heart, Brain, Hormone and Healthy Aging (K.-H.C., R.T.F.C., S.-L.H., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong
| | - M Edip Gurol
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Anand Viswanathan
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Steven M Greenberg
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Christopher D Anderson
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Henry and Allison McCance Center for Brain Health (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology, Brigham and Women's Hospital, Boston, MA (C.D.A.)
| | - Kui-Kai Lau
- Department of Medicine, Queen Mary Hospital (K.-C.T., W.C.Y.L., I.Y.H.L., Y.-K.W., C.Y., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong.,Research Center of Heart, Brain, Hormone and Healthy Aging (K.-H.C., R.T.F.C., S.-L.H., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong (K.-H.C., R.T.F.C., K.-K.L.)
| | - Jonathan Rosand
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Henry and Allison McCance Center for Brain Health (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Alessandro Biffi
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Henry and Allison McCance Center for Brain Health (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
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6
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Tse HF, Teo WS, Siu CW, Chao TF, Park HW, Shimizu W, Wong YK, Lip GYH. Prognosis and treatment of atrial fibrillation in Asian cities: 1-year review of the Asia-Pacific Heart Rhythm Society Atrial Fibrillation Registry. Europace 2022; 24:1889-1898. [PMID: 35025986 DOI: 10.1093/europace/euab327] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/24/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS The aim of this study is to describe the implementation of the current guidance for stroke prevention and treatment option in atrial fibrillation (AF) and to evaluate mortality and morbidity in relation to therapeutic decisions, including persistence with treatment at 1 year in Asia-Pacific regions. METHODS AND RESULTS We recruited 4664 patients consecutive in- and outpatients with AF who presented to cardiologists in five countries under the Asia-Pacific Heart Rhythm Society (APHRS) in whom 1-year follow-up was completed for 4003 (65.5% male; mean age 68.5 years). Oral anticoagulant (OAC) use remained high, 77% at follow-up, including 17% prescribed a vitamin K antagonist (VKA) and 60% a non-VKA oral anticoagulant (NOAC). At 1-year follow-up, 93% and 88% remained on a VKA or NOAC, respectively. With good adherence to OAC therapy, 1-year mortality was only 2.7%. Most deaths were non-cardiovascular (72.3%) and the 1-year incidence of stroke/transient ischaemic events (TIA) was low (<1%). Hospital readmissions were common for non-cardiovascular cases and atrial tachyarrhythmias. On multivariate analysis, independent baseline predictors of mortality and/or stroke/TIA/peripheral embolism were age, previous heart failure for >12 months, and malignancy. Independent predictors of mortality were age, chronic obstructive pulmonary disease, malignancy, and diuretic use. AF as a primary presentation was predictive of lower mortality and/or stroke/TIA/peripheral embolism as well as mortality. CONCLUSION In this 1-year analysis of the APHRS-AF registry, overall OAC use and persistence were high and were associated with low 1-year cardiovascular mortality and morbidity, but mortality and morbidity related to non-cardiovascular causes were high in AF patients, particularly from malignancy and pneumonia.
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Affiliation(s)
- Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Rm 1928, Block K, Hong Kong SAR L7 8TX, China
| | - Wee-Siong Teo
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Rm 1928, Block K, Hong Kong SAR L7 8TX, China
| | - Tze-Fan Chao
- Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hyung-Wook Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea.,Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuen-Kwun Wong
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Rm 1928, Block K, Hong Kong SAR L7 8TX, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
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7
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Lee MC, Wong YK, Lee ACW, Fung HS, Chiang JB, Kwok CH, Chiu LF. Single-centre Initial Experience of Transradial Access for Abdominal Interventional Radiology. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2217400] [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)
- MC Lee
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - YK Wong
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - ACW Lee
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - HS Fung
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - JB Chiang
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - CH Kwok
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - LF Chiu
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
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8
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Tam CCF, Chan YH, Wong YK, Li Z, Zhu X, Su KJ, Ganguly A, Hwa K, Ling XB, Tse HF. Multi-Omics Signatures Link to Ticagrelor Effects on Vascular Function in Patients With Acute Coronary Syndrome. Arterioscler Thromb Vasc Biol 2022; 42:789-798. [PMID: 35387483 DOI: 10.1161/atvbaha.121.317513] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Long-term antiplatelet agents including the potent P2Y12 antagonist ticagrelor are indicated in patients with a previous history of acute coronary syndrome. We sought to compare the effect of ticagrelor with that of aspirin monotherapy on vascular endothelial function in patients with prior acute coronary syndrome. METHODS This was a prospective, single center, parallel group, investigator-blinded randomized controlled trial. We randomized 200 patients on long-term aspirin monotherapy with prior acute coronary syndrome in a 1:1 fashion to receive ticagrelor 60 mg BD (n=100) or aspirin 100 mg OD (n=100). The primary end point was change from baseline in brachial artery flow-mediated dilation at 12 weeks. Secondary end points were changes to platelet activation marker (CD41_62p) and endothelial progenitor cell (CD34/133) count measured by flow cytometry, plasma level of adenosine, IL-6 (interleukin-6) and EGF (epidermal growth factor), and multi-omics profiling at 12 weeks. RESULTS After 12 weeks, brachial flow-mediated dilation was significantly increased in the ticagrelor group compared with the aspirin group (ticagrelor: 3.48±3.48% versus aspirin: -1.26±2.85%, treatment effect 4.73 [95% CI, 3.85-5.62], P<0.001). Nevertheless ticagrelor treatment for 12 weeks had no significant effect on platelet activation markers, circulating endothelial progenitor cell count or plasma level of adenosine, IL-6, and EGF (all P>0.05). Multi-omics pathway assessment revealed that changes in the metabolism and biosynthesis of amino acids (cysteine and methionine metabolism; phenylalanine, tyrosine, and tryptophan biosynthesis) and phospholipids (glycerophosphoethanolamines and glycerophosphoserines) were associated with improved brachial artery flow-mediated dilation in the ticagrelor group. CONCLUSIONS In patients with prior acute coronary syndrome, ticagrelor 60 mg BD monotherapy significantly improved brachial flow-mediated dilation compared with aspirin monotherapy and was associated with significant changes in metabolomic and lipidomic signatures. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03881943.
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Affiliation(s)
- Chor-Cheung Frankie Tam
- Division of Cardiology, Queen Mary Hospital, The University of Hong Kong, China (C.-C.F.T., Y.-H.C., Y.-K.W., H.-F.T.)
| | - Yap-Hang Chan
- Division of Cardiology, Queen Mary Hospital, The University of Hong Kong, China (C.-C.F.T., Y.-H.C., Y.-K.W., H.-F.T.)
| | - Yuen-Kwun Wong
- Division of Cardiology, Queen Mary Hospital, The University of Hong Kong, China (C.-C.F.T., Y.-H.C., Y.-K.W., H.-F.T.)
| | - Zhen Li
- mProbe Inc, Mountain View, CA (Z.L., X.Z.)
| | - Xiurui Zhu
- mProbe Inc, Mountain View, CA (Z.L., X.Z.)
| | | | - Anindita Ganguly
- Center for Biomedical Industry, Department of Molecular Science and Engineering National Taipei University of Technology, Taiwan (A.G., K.H.)
| | - Kuoyuan Hwa
- Center for Biomedical Industry, Department of Molecular Science and Engineering National Taipei University of Technology, Taiwan (A.G., K.H.)
| | | | - Hung-Fat Tse
- Division of Cardiology, Queen Mary Hospital, The University of Hong Kong, China (C.-C.F.T., Y.-H.C., Y.-K.W., H.-F.T.).,Cardiac and Vascular Center, Hong Kong University Shenzhen Hospital, China (H.-F.T.).,Hong Kong-Guangdong Joint Laboratory on Stem Cell and Regenerative Medicine, the University of Hong Kong, China (H.-F.T.).,Center for Translational Stem Cell Biology, Hong Kong SAR, China (H.-F.T.)
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9
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Wong YK, Tse HF. Circulating Biomarkers for Cardiovascular Disease Risk Prediction in Patients With Cardiovascular Disease. Front Cardiovasc Med 2021; 8:713191. [PMID: 34660715 PMCID: PMC8517145 DOI: 10.3389/fcvm.2021.713191] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 05/22/2021] [Accepted: 09/08/2021] [Indexed: 12/23/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death globally. Risk assessment is crucial for identifying at-risk individuals who require immediate attention as well as to guide the intensity of medical therapy to reduce subsequent risk of CVD. In the past decade, many risk prediction models have been proposed to estimate the risk of developing CVD. However, in patients with a history of CVD, the current models that based on traditional risk factors provide limited power in predicting recurrent cardiovascular events. Several biomarkers from different pathophysiological pathways have been identified to predict cardiovascular events, and the incorporation of biomarkers into risk assessment may contribute to enhance risk stratification in secondary prevention. This review focuses on biomarkers related to cardiovascular and metabolic diseases, including B-type natriuretic peptide, high-sensitivity cardiac troponin I, adiponectin, adipocyte fatty acid-binding protein, heart-type fatty acid-binding protein, lipocalin-2, fibroblast growth factor 19 and 21, retinol-binding protein 4, plasminogen activator inhibitor-1, 25-hydroxyvitamin D, and proprotein convertase subtilisin/kexin type 9, and discusses the potential utility of these biomarkers in cardiovascular risk prediction among patients with CVD. Many of these biomarkers have shown promise in improving risk prediction of CVD. Further research is needed to assess the validity of biomarker and whether the strategy for incorporating biomarker into clinical practice may help to optimize decision-making and therapeutic management.
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Affiliation(s)
- Yuen-Kwun Wong
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hung-Fat Tse
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.,Department of Medicine, Shenzhen Hong Kong University Hospital, Shenzhen, China.,Hong Kong-Guangdong Joint Laboratory on Stem Cell and Regenerative Medicine, The University of Hong Kong, Hong Kong, China.,Shenzhen Institutes of Research and Innovation, The University of Hong Kong, Hong Kong, China
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10
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Chan YH, Schooling CM, Zhao J, Au Yeung SL, Hai JJ, Thomas GN, Cheng KK, Jiang CQ, Wong YK, Au KW, Tang CS, Cheung CYY, Xu A, Sham PC, Lam TH, Lam KSL, Tse HF. Mendelian Randomization Focused Analysis of Vitamin D on the Secondary Prevention of Ischemic Stroke. Stroke 2021; 52:3926-3937. [PMID: 34565175 DOI: 10.1161/strokeaha.120.032634] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Experimental studies showed vitamin D (Vit-D) could promote vascular regeneration and repair. Prior randomized studies had focused mainly on primary prevention. Whether Vit-D protects against ischemic stroke and myocardial infarction recurrence among subjects with prior ischemic insults was unknown. Here, we dissected through Mendelian randomization any effect of Vit-D on the secondary prevention of recurrent ischemic stroke and myocardial infarction. METHODS Based on a genetic risk score for Vit-D constructed from a derivation cohort sample (n=5331, 45% Vit-D deficient, 89% genotyped) via high-throughput exome-chip screening of 12 prior genome-wide association study-identified genetic variants of Vit-D mechanistic pathways (rs2060793, rs4588, and rs7041; F statistic, 73; P<0.001), we performed a focused analysis on prospective recurrence of myocardial infarction (MI) and ischemic stroke in an independent subsample with established ischemic disease (n=441, all with prior first ischemic event; follow-up duration, 41.6±14.3 years) under a 2-sample, individual-data, prospective Mendelian randomization approach. RESULTS In the ischemic disease subsample, 11.1% (n=49/441) had developed recurrent ischemic stroke or MI and 13.3% (n=58/441) had developed recurrent or de novo ischemic stroke/MI. Kaplan-Meier analyses showed that genetic risk score predicted improved event-free survival from recurrent ischemic stroke or MI (log-rank, 13.0; P=0.001). Cox regression revealed that genetic risk score independently predicted reduced risk of recurrent ischemic stroke or MI combined (hazards ratio, 0.62 [95% CI, 0.48-0.81]; P<0.001), after adjusted for potential confounders. Mendelian randomization supported that Vit-D is causally protective against the primary end points of recurrent ischemic stroke or MI (Wald estimate: odds ratio, 0.55 [95% CI, 0.35-0.81]) and any recurrent or de novo ischemic stroke/MI (odds ratio, 0.64 [95% CI, 0.42-0.91]) and recurrent MI alone (odds ratio, 0.52 [95% CI, 0.30-0.81]). CONCLUSIONS Genetically predicted lowering in Vit-D level is causal for the recurrence of ischemic vascular events in persons with prior ischemic stroke or MI.
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Affiliation(s)
- Yap-Hang Chan
- Division of Cardiology, Queen Mary Hospital (Y.-H.C., J.J.H., Y.-K.W., K.-W.A., H.-F.T.), The University of Hong Kong, Hong Kong SAR, China
| | - C Mary Schooling
- School of Public Health (C.M.S., J.Z., S.-L.A.Y., T.-H.L.), The University of Hong Kong, Hong Kong SAR, China
| | - Jie Zhao
- School of Public Health (C.M.S., J.Z., S.-L.A.Y., T.-H.L.), The University of Hong Kong, Hong Kong SAR, China
| | - Shiu-Lun Au Yeung
- School of Public Health (C.M.S., J.Z., S.-L.A.Y., T.-H.L.), The University of Hong Kong, Hong Kong SAR, China
| | - Jo Jo Hai
- Division of Cardiology, Queen Mary Hospital (Y.-H.C., J.J.H., Y.-K.W., K.-W.A., H.-F.T.), The University of Hong Kong, Hong Kong SAR, China.,Department of Medicine, Shenzhen Hong Kong University Hospital, China (J.J.H., H.-F.T.)
| | - G Neil Thomas
- Department of Public Health and Epidemiology, University of Birmingham, United Kingdom (G.N.T., K.-K.C.)
| | - Kar-Keung Cheng
- Department of Public Health and Epidemiology, University of Birmingham, United Kingdom (G.N.T., K.-K.C.)
| | | | - Yuen-Kwun Wong
- Division of Cardiology, Queen Mary Hospital (Y.-H.C., J.J.H., Y.-K.W., K.-W.A., H.-F.T.), The University of Hong Kong, Hong Kong SAR, China
| | - Ka-Wing Au
- Division of Cardiology, Queen Mary Hospital (Y.-H.C., J.J.H., Y.-K.W., K.-W.A., H.-F.T.), The University of Hong Kong, Hong Kong SAR, China
| | - Clara S Tang
- Department of Psychiatry and Centre for Genomic Sciences (C.S.T., P.-C.S.), The University of Hong Kong, Hong Kong SAR, China
| | - Chloe Y Y Cheung
- Division of Endocrinology, Queen Mary Hospital (C.Y.Y.C., A.X., K.S.-L.L.), The University of Hong Kong, Hong Kong SAR, China
| | - Aimin Xu
- Division of Endocrinology, Queen Mary Hospital (C.Y.Y.C., A.X., K.S.-L.L.), The University of Hong Kong, Hong Kong SAR, China
| | - Pak-Chung Sham
- Department of Psychiatry and Centre for Genomic Sciences (C.S.T., P.-C.S.), The University of Hong Kong, Hong Kong SAR, China
| | - Tai-Hing Lam
- School of Public Health (C.M.S., J.Z., S.-L.A.Y., T.-H.L.), The University of Hong Kong, Hong Kong SAR, China
| | - Karen Siu-Ling Lam
- Division of Endocrinology, Queen Mary Hospital (C.Y.Y.C., A.X., K.S.-L.L.), The University of Hong Kong, Hong Kong SAR, China
| | - Hung-Fat Tse
- Division of Cardiology, Queen Mary Hospital (Y.-H.C., J.J.H., Y.-K.W., K.-W.A., H.-F.T.), The University of Hong Kong, Hong Kong SAR, China.,Hong Kong-Guangdong Joint Laboratory on Stem Cell and Regenerative Medicine (H.-F.T.), The University of Hong Kong, Hong Kong SAR, China.,Shenzhen Institutes of Research and Innovation (H.-F.T.), The University of Hong Kong, Hong Kong SAR, China.,Department of Medicine, Shenzhen Hong Kong University Hospital, China (J.J.H., H.-F.T.)
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11
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Lau KK, Chua BJ, Ng A, Leung IYH, Wong YK, Chan AHY, Chiu YK, Chu AXW, Leung WCY, Tsang ACO, Teo KC, Mak HKF. Low-Density Lipoprotein Cholesterol and Risk of Recurrent Vascular Events in Chinese Patients With Ischemic Stroke With and Without Significant Atherosclerosis. J Am Heart Assoc 2021; 10:e021855. [PMID: 34369170 PMCID: PMC8475056 DOI: 10.1161/jaha.121.021855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Recent trials have shown that low‐density lipoprotein cholesterol (LDL‐C) <1.80 mmol/L (<70 mg/dL) is associated with a reduced risk of major adverse cardiovascular events in White patients with ischemic stroke with atherosclerosis. However, it remains uncertain whether the findings can be generalized to Asian patients, or that similar LDL‐C targets should be adopted in patients with stroke without significant atherosclerosis. Methods and Results We performed a prospective cohort study and recruited consecutive Chinese patients with ischemic stroke with magnetic resonance angiography of the intra‐ and cervicocranial arteries performed at the University of Hong Kong between 2008 and 2014. Serial postevent LDL‐C measurements were obtained. Risk of major adverse cardiovascular events in patients with mean postevent LDL‐C <1.80 versus ≥1.80 mmol/L, stratified by presence or absence of significant (≥50%) large‐artery disease (LAD) and by ischemic stroke subtypes, were compared. Nine hundred four patients (mean age, 69±12 years; 60% men) were followed up for a mean 6.5±2.4 years (mean, 9±5 LDL‐C readings per patient). Regardless of LAD status, patients with a mean postevent LDL‐C <1.80 mmol/L were associated with a lower risk of major adverse cardiovascular events (with significant LAD: multivariable‐adjusted subdistribution hazard ratio, 0.65; 95% CI, 0.42–0.99; without significant LAD: subdistribution hazard ratio, 0.53; 95% CI, 0.32–0.88) (both P<0.05). Similar findings were noted in patients with ischemic stroke attributable to large‐artery atherosclerosis (subdistribution hazard ratio, 0.48; 95% CI, 0.28–0.84) and in patients with other ischemic stroke subtypes (subdistribution hazard ratio, 0.64; 95% CI, 0.43–0.95) (both P<0.05). Conclusions A mean LDL‐C <1.80 mmol/L was associated with a lower risk of major adverse cardiovascular events in Chinese patients with ischemic stroke with and without significant LAD. Further randomized trials to determine the optimal LDL‐C cutoff in stroke patients without significant atherosclerosis are warranted.
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Affiliation(s)
- Kui-Kai Lau
- Division of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences University of Hong Kong Hong Kong
| | - Bryan J Chua
- Division of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong Kong
| | - Alexander Ng
- Division of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong Kong
| | - Ian Yu-Hin Leung
- Division of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong Kong
| | - Yuen-Kwun Wong
- Division of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong Kong
| | - Anna Ho-Yin Chan
- Division of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong Kong
| | - Yuen-Kei Chiu
- Division of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong Kong
| | - Ariane Xia-Wei Chu
- Division of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong Kong
| | - William C Y Leung
- Division of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong Kong
| | - Anderson Chun-On Tsang
- Division of Neurosurgery Department of Surgery Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong Kong
| | - Kay-Cheong Teo
- Division of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong Kong
| | - Henry Ka-Fung Mak
- The State Key Laboratory of Brain and Cognitive Sciences University of Hong Kong Hong Kong.,Department of Diagnostic Radiology Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong Kong
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12
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Wong YK, Chan YH, Hai JSH, Lau KK, Tse HF. Predictive value of visit-to-visit blood pressure variability for cardiovascular events in patients with coronary artery disease with and without diabetes mellitus. Cardiovasc Diabetol 2021; 20:88. [PMID: 33894788 PMCID: PMC8070286 DOI: 10.1186/s12933-021-01280-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/15/2021] [Indexed: 12/26/2022] Open
Abstract
Background High blood pressure is a major risk factor for cardiovascular disease. Visit-to-visit blood pressure variability (BPV) has recently been shown to predict cardiovascular outcomes. We investigated the predictive value of BPV for major adverse cardiovascular events (MACE) among patients with coronary artery disease (CAD), with and without type 2 diabetes mellitus (T2DM). Methods Patients with stable CAD were enrolled and monitored for new MACE. Visit-to-visit BPV was defined as the coefficient of variation (CV) of systolic and diastolic BP across clinic visits. Multivariable logistic regression analysis was performed to evaluate the association of BPV with MACE. Area under the receiver operating characteristic curve (AUC) was used to assess its predictive ability. Results Among 1140 Chinese patients with stable CAD, 192 (17%) experienced a new MACE. In multivariable analyses, the risk of MACE was significantly associated with CV of systolic BP (odds ratio [OR] for highest versus lowest quartile, 3.30; 95% CI 1.97–5.54), and diastolic BP (OR for highest versus lowest quartile, 2.39; 95% CI 1.39–4.11), after adjustment for variables of the risk factor model (age, gender, T2DM, hypertension, antihypertensive agents, number of BP measurements) and mean BP. The risk factor model had an AUC of 0.70 for prediction of MACE. Adding systolic/diastolic CV into the risk factor model with mean BP significantly increased the AUC to 0.73/0.72 (P = 0.002/0.007). In subgroup analyses, higher CV of systolic BP remained significantly associated with an increased risk for MACE in patients with and without T2DM, whereas the association of CV of diastolic BP with MACE was observed only in those without T2DM. Conclusions Visit-to-visit variability of systolic BP and of diastolic BP was an independent predictor of new MACE and provided incremental prognostic value beyond mean BP and conventional risk factors in patients with stable CAD. The association of BPV in CAD patients without T2DM with subsequent risk for MACE was stronger than in those with T2DM. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01280-z.
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Affiliation(s)
- Yuen-Kwun Wong
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yap-Hang Chan
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - JoJo S H Hai
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Kui-Kai Lau
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hung-Fat Tse
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China. .,Department of Medicine, Shenzhen Hong Kong University Hospital, Shenzhen, China. .,Hong Kong-Guangdong Joint Laboratory On Stem Cell and Regenerative Medicine, The University of Hong Kong, Hong Kong, China. .,Shenzhen Institutes of Research and Innovation, The University of Hong Kong, Hong Kong SAR, China.
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Kuo MCC, Au KT, Li YS, Siu KC, Wong YK, Chiu ATS, Yeung K. Validation of the Chinese Version of Dementia Quality of Life Measure - Proxy in Care Home Residents with Dementia. East Asian Arch Psychiatry 2021; 31:9-12. [PMID: 33753571 DOI: 10.12809/eaap2019] [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] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate psychometric properties of the Chinese version of Dementia Quality of Life Measure - Proxy (C-DEMQoL-Proxy). METHODS Care home residents aged ≥60 years who were diagnosed with dementia or demonstrated impairment in cognition were recruited from four care facilities in Hong Kong. Caregivers of these participants were also invited to participate. The original DEMQoL-Proxy was translated into Chinese (Cantonese) by a trained translator. The forward-translated version was reviewed by an expert panel of six experienced healthcare professionals. Revisions were made based on comments. The instrument was back-translated to English to check whether further changes were necessary. Demographic data (age, sex, type and severity of dementia, and Mini-Mental State Examination [MMSE] score) were collected from medical records of participants with dementia. Caregivers were interviewed by an occupational therapist or personnel supervised by the occupational therapist using the C-DEMQoL-Proxy and the Chinese version of Quality of Life-Alzheimer's Disease-Proxy (C-QoL-AD-Proxy). Acceptability, reliability, and validity of the C-DEMQoL-Proxy were evaluated using standard psychometric methods. RESULTS 90 individuals (82.2% women) with dementia aged 72 to 102 years were included. Their diagnosis included Alzheimer's disease (23.3%), vascular dementia (15.6%), mixed and other types of dementias (51.1%), and missing (10%). Severity was mild in 12.2%, moderate in 62.2%, and severe in 25.6%. The mean MMSE score was 12.0 ± 4.9. 20% of the caregivers were family members and the rest were professional carers. The C-DEMQoL-Proxy had good acceptability, with no floor or ceiling effects or missing data. It had good internal consistency (Cronbach alpha = 0.91) and test-retest reliability (intraclass correlation coefficients = 0.83). It was mildly correlated with C-QoL-AD-Proxy (r = 0.29, p < 0.01). Age and sex were not correlated with C-DEMQoL-Proxy scores. C-DEMQoL-Proxy scores were not significantly different between dementia types, severity levels, or between those with higher or lower MMSE scores. CONCLUSION The C-DEMQoL-Proxy is a valid and reliable instrument to assess health-related quality of life in individuals with dementia.
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Affiliation(s)
- M C C Kuo
- School of Medical and Health Sciences, Tung Wah College, Hong Kong SAR, China
| | - K T Au
- Department of Occupational Therapy, The Society for the Relief of Disabled Children, Hong Kong SAR, China
| | - Y S Li
- Elderly Service, The Salvation Army, Hong Kong SAR, China
| | - K C Siu
- Department of Occupational Therapy, United Christian Hospital, Hong Kong SAR, China
| | - Y K Wong
- Department of Occupational Therapy, Kowloon Hospital, Hong Kong SAR, China
| | - A T S Chiu
- Hong Kong Society for the Blind, Hong Kong SAR, China
| | - K Yeung
- Hong Kong Society for the Blind, Hong Kong SAR, China
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14
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Teo KC, Leung WCY, Wong YK, Liu RKC, Chan AHY, Choi OMY, Kwok WM, Leung KK, Tse MY, Cheung RTF, Tsang ACO, Lau KK. Delays in Stroke Onset to Hospital Arrival Time During COVID-19. Stroke 2020; 51:2228-2231. [PMID: 32432998 PMCID: PMC7258759 DOI: 10.1161/strokeaha.120.030105] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [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] [Indexed: 12/16/2022]
Abstract
Background and Purpose: The current coronavirus disease 2019 (COVID-19) pandemic represents a global public health crisis, disrupting emergency healthcare services. We determined whether COVID-19 has resulted in delays in stroke presentation and affected the delivery of acute stroke services in a comprehensive stroke center in Hong Kong. Methods: We retrospectively reviewed all patients with transient ischemic attack and stroke admitted via the acute stroke pathway of Queen Mary Hospital, Hong Kong, during the first 60 days since the first diagnosed COVID-19 case in Hong Kong (COVID-19: January 23, 2020–March 24, 2020). We compared the stroke onset to hospital arrival (onset-to-door) time and timings of inpatient stroke pathways with patients admitted during the same period in 2019 (pre–COVID-19: January 23, 2019–March 24, 2019). Results: Seventy-three patients in COVID-19 were compared with 89 patients in pre–COVID-19. There were no significant differences in age, sex, vascular risk factors, nor stroke severity between the 2 groups (P>0.05). The median stroke onset-to-door time was ≈1-hour longer in COVID-19 compared with pre–COVID-19 (154 versus 95 minutes, P=0.12), and the proportion of individuals with onset-to-door time within 4.5 hours was significantly lower (55% versus 72%, P=0.024). Significantly fewer cases of transient ischemic attack presented to the hospital during COVID-19 (4% versus 16%, P=0.016), despite no increase in referrals to the transient ischemic attack clinic. Inpatient stroke pathways and treatment time metrics nevertheless did not differ between the 2 groups (P>0.05 for all comparisons). Conclusions: During the early containment phase of COVID-19, we noted a prolongation in stroke onset to hospital arrival time and a significant reduction in individuals arriving at the hospital within 4.5 hours and presenting with transient ischemic attack. Public education about stroke should continue to be reinforced during the COVID-19 pandemic.
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Affiliation(s)
- Kay-Cheong Teo
- Division of Neurology, Department of Medicine (K.-C.T., W.C.Y.L., Y.-K.W., R.K.C.L., A.H.Y.C., K.-K.L., M.-Y.T., R.T.F.C., K.K.L.), Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong
| | - William C Y Leung
- Division of Neurology, Department of Medicine (K.-C.T., W.C.Y.L., Y.-K.W., R.K.C.L., A.H.Y.C., K.-K.L., M.-Y.T., R.T.F.C., K.K.L.), Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong
| | - Yuen-Kwun Wong
- Division of Neurology, Department of Medicine (K.-C.T., W.C.Y.L., Y.-K.W., R.K.C.L., A.H.Y.C., K.-K.L., M.-Y.T., R.T.F.C., K.K.L.), Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong
| | - Roxanna K C Liu
- Division of Neurology, Department of Medicine (K.-C.T., W.C.Y.L., Y.-K.W., R.K.C.L., A.H.Y.C., K.-K.L., M.-Y.T., R.T.F.C., K.K.L.), Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong
| | - Anna H Y Chan
- Division of Neurology, Department of Medicine (K.-C.T., W.C.Y.L., Y.-K.W., R.K.C.L., A.H.Y.C., K.-K.L., M.-Y.T., R.T.F.C., K.K.L.), Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong
| | - Olivia M Y Choi
- Division of Neurosurgery, Department of Surgery (O.N.Y.C., A.C.-O.T.), Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong
| | - Wing-Man Kwok
- Department of Accident and Emergency, Queen Mary Hospital, Hong Kong (W.-M.K.)
| | - Kung-Ki Leung
- Division of Neurology, Department of Medicine (K.-C.T., W.C.Y.L., Y.-K.W., R.K.C.L., A.H.Y.C., K.-K.L., M.-Y.T., R.T.F.C., K.K.L.), Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong
| | - Man-Yu Tse
- Division of Neurology, Department of Medicine (K.-C.T., W.C.Y.L., Y.-K.W., R.K.C.L., A.H.Y.C., K.-K.L., M.-Y.T., R.T.F.C., K.K.L.), Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong
| | - Raymond T F Cheung
- Division of Neurology, Department of Medicine (K.-C.T., W.C.Y.L., Y.-K.W., R.K.C.L., A.H.Y.C., K.-K.L., M.-Y.T., R.T.F.C., K.K.L.), Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong
| | - Anderson Chun-On Tsang
- Division of Neurosurgery, Department of Surgery (O.N.Y.C., A.C.-O.T.), Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine (K.-C.T., W.C.Y.L., Y.-K.W., R.K.C.L., A.H.Y.C., K.-K.L., M.-Y.T., R.T.F.C., K.K.L.), Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong
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15
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Wong YK, Cheung CYY, Tang CS, Hai JSH, Lee CH, Lau KK, Au KW, Cheung BMY, Sham PC, Xu A, Lam KSL, Tse HF. High-sensitivity troponin I and B-type natriuretic peptide biomarkers for prediction of cardiovascular events in patients with coronary artery disease with and without diabetes mellitus. Cardiovasc Diabetol 2019; 18:171. [PMID: 31847896 PMCID: PMC6918569 DOI: 10.1186/s12933-019-0974-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/03/2019] [Indexed: 12/16/2022] Open
Abstract
Background High-sensitivity troponin I (hs-Tnl) and B-type natriuretic peptide (BNP) are promising prognostic markers for coronary artery disease (CAD). This prospective cohort study investigated whether a combination of these cardiac biomarkers with conventional risk factors would add incremental value for the prediction of secondary major adverse cardiovascular events (MACEs) in patients with CAD, with and without type 2 diabetes mellitus (T2DM). Methods Baseline plasma level of hs-Tnl and BNP was measured in 2275 Chinese patients with stable CAD. Patients were monitored for new-onset of MACE over a median of 51 months. Cox proportional hazard model and area under the receiver operating characteristic curve (AUC) were used to assess the association of cardiac biomarkers with MACE and their predictive values in relationship with or without T2DM. Results During the follow up period 402 (18%) patients experienced a new-onset MACE with hs-Tnl and BNP level significantly higher than in those without MACE. In multivariable analyses, patients with elevated hs-Tnl (hazard ratio, 1.75 [95% CI 1.41–2.17]; P < 0.001) and BNP (hazard ratio, 1.42 [95% CI 1.15–1.75]; P = 0.001) were significantly associated with an increased risk of MACE after adjustment for variables of a risk factor model of age, sex, T2DM and hypertension. The risk factor model had an AUC of 0.64 for MACE prediction. The AUC significantly increased to 0.68 by the addition of hs-Tnl to the risk factor model. Subgroup analyses showed that hs-Tnl and BNP remained significant predictors of MACE in both patients with and without T2DM in multivariable models with higher risk of MACE evident in those without T2DM. Among patients without T2DM, addition of each biomarker yielded greater predictive accuracy than in T2DM patients, with AUC further increased to 0.75 when a combination of hs-Tnl and BNP was added to the risk factor model (age, sex and hypertension). Conclusions Elevated hs-Tnl and BNP level are independent predictors of new-onset MACE in CAD patients, irrespective of diabetes status. Among CAD patients without T2DM, a combination of cardiac biomarkers hs-Tnl and BNP yield the greatest predictive value beyond conventional risk factors.
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Affiliation(s)
- Yuen-Kwun Wong
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Chloe Y Y Cheung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Clara S Tang
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - JoJo S H Hai
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Chi-Ho Lee
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Kui-Kai Lau
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Ka-Wing Au
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Bernard M Y Cheung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Pak-Chung Sham
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China.,Centre for Genomic Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,State Key Laboratory in Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Aimin Xu
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.,State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, China.,Department of Pharmacology & Pharmacy, The University of Hong Kong, Hong Kong, China
| | - Karen S L Lam
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China. .,State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, China. .,Department of Medicine, Shenzhen Hong Kong University Hospital, Shenzhen, China.
| | - Hung-Fat Tse
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China. .,Department of Medicine, Shenzhen Hong Kong University Hospital, Shenzhen, China. .,Hong Kong-Guangdong Joint Laboratory on Stem Cell and Regenerative Medicine, The University of Hong Kong, Hong Kong, China. .,Shenzhen Institutes of Research and Innovation, The University of Hong Kong, Hong Kong, China.
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Wong YK, Cheung CYY, Tang CS, Au KW, Hai JSH, Lee CH, Lau KK, Cheung BMY, Sham PC, Xu A, Lam KSL, Tse HF. Age-Biomarkers-Clinical Risk Factors for Prediction of Cardiovascular Events in Patients With Coronary Artery Disease. Arterioscler Thromb Vasc Biol 2019; 38:2519-2527. [PMID: 30354221 DOI: 10.1161/atvbaha.118.311726] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective- In patients with stable coronary artery disease, conventional risk factors provide limited incremental predictive value for cardiovascular events. We sought to investigate whether a panel of cardiometabolic biomarkers alone or combined with conventional risk factors would exhibit incremental value in the prediction of cardiovascular events. Approach and Results- In the discovery cohort, we measured serum adiponectin, A-FABP (adipocyte fatty acid-binding protein), lipocalin-2, FGF (fibroblast growth factor)-19 and 21, plasminogen activator inhibitor-1, and retinol-binding protein-4 in 1166 Chinese coronary artery disease patients. After a median follow-up of 35 months, 170 patients developed new-onset major adverse cardiovascular events (MACE). In the model with age ≥65 years and conventional risk factors, area under the curve for predicting MACE was 0.68. Addition of lipocalin-2 to the age-clinical risk factor model improved predictive accuracy (area under the curve=0.73). Area under the curve further increased to 0.75 when a combination of lipocalin-2, A-FABP, and FGF-19 was added to yield age-biomarkers-clinical risk factor model. The adjusted hazard ratio on MACEs for lipocalin-2, A-FABP, and FGF-19 levels above optimal cutoffs were 2.23 (95% CI, 1.62-3.08), 1.99 (95% CI, 1.43-2.76), and 1.65 (95% CI, 1.15-2.35), respectively. In the validation cohort of 1262 coronary artery disease patients with type 2 diabetes mellitus, the age-biomarkers-clinical risk factor model was confirmed to provide good discrimination and calibration over the conventional risk factor alone for prediction of MACE. Conclusions- A combination of the 3 biomarkers, lipocalin-2, A-FABP, and FGF-19, with clinical risk factors to yield the age-biomarkers-clinical risk factor model provides an optimal and validated prediction of new-onset MACE in patients with stable coronary artery disease.
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Affiliation(s)
- Yuen-Kwun Wong
- From the Department of Medicine (Y.-K.W., C.Y.Y.C., K.-W.A., J.S.H.H., C.-H.L., K.-K.L., B.M.Y.C., A.X., K.S.L.L., H.-F.T.), the University of Hong Kong, China
| | - Chloe Y Y Cheung
- From the Department of Medicine (Y.-K.W., C.Y.Y.C., K.-W.A., J.S.H.H., C.-H.L., K.-K.L., B.M.Y.C., A.X., K.S.L.L., H.-F.T.), the University of Hong Kong, China
| | - Clara S Tang
- Department of Surgery (C.S.T.), the University of Hong Kong, China
| | - Ka-Wing Au
- From the Department of Medicine (Y.-K.W., C.Y.Y.C., K.-W.A., J.S.H.H., C.-H.L., K.-K.L., B.M.Y.C., A.X., K.S.L.L., H.-F.T.), the University of Hong Kong, China
| | - JoJo S H Hai
- From the Department of Medicine (Y.-K.W., C.Y.Y.C., K.-W.A., J.S.H.H., C.-H.L., K.-K.L., B.M.Y.C., A.X., K.S.L.L., H.-F.T.), the University of Hong Kong, China
| | - Chi-Ho Lee
- From the Department of Medicine (Y.-K.W., C.Y.Y.C., K.-W.A., J.S.H.H., C.-H.L., K.-K.L., B.M.Y.C., A.X., K.S.L.L., H.-F.T.), the University of Hong Kong, China
| | - Kui-Kai Lau
- From the Department of Medicine (Y.-K.W., C.Y.Y.C., K.-W.A., J.S.H.H., C.-H.L., K.-K.L., B.M.Y.C., A.X., K.S.L.L., H.-F.T.), the University of Hong Kong, China
| | - Bernard M Y Cheung
- From the Department of Medicine (Y.-K.W., C.Y.Y.C., K.-W.A., J.S.H.H., C.-H.L., K.-K.L., B.M.Y.C., A.X., K.S.L.L., H.-F.T.), the University of Hong Kong, China
| | - Pak-Chung Sham
- Department of Psychiatry (P.-C.S.), the University of Hong Kong, China.,Centre for Genomic Sciences, Li Ka Shing Faculty of Medicine (P.-C.S.), the University of Hong Kong, China.,State Key Laboratory in Brain and Cognitive Sciences (P.-C.S.), the University of Hong Kong, China
| | - Aimin Xu
- From the Department of Medicine (Y.-K.W., C.Y.Y.C., K.-W.A., J.S.H.H., C.-H.L., K.-K.L., B.M.Y.C., A.X., K.S.L.L., H.-F.T.), the University of Hong Kong, China.,State Key Laboratory of Pharmaceutical Biotechnology (A.X., K.S.L.L.), the University of Hong Kong, China.,Department of Pharmacology & Pharmacy (A.X.), the University of Hong Kong, China
| | - Karen S L Lam
- From the Department of Medicine (Y.-K.W., C.Y.Y.C., K.-W.A., J.S.H.H., C.-H.L., K.-K.L., B.M.Y.C., A.X., K.S.L.L., H.-F.T.), the University of Hong Kong, China.,State Key Laboratory of Pharmaceutical Biotechnology (A.X., K.S.L.L.), the University of Hong Kong, China
| | - Hung-Fat Tse
- From the Department of Medicine (Y.-K.W., C.Y.Y.C., K.-W.A., J.S.H.H., C.-H.L., K.-K.L., B.M.Y.C., A.X., K.S.L.L., H.-F.T.), the University of Hong Kong, China.,Hong Kong-Guangdong Joint Laboratory on Stem Cell and Regenerative Medicine (H.-F.T.), the University of Hong Kong, China.,Shenzhen Institutes of Research and Innovation (H.-F.T.), the University of Hong Kong, China.,Department of Medicine, Shenzhen Hong Kong University Hospital, China (H.-F.T.)
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Hai JJ, Wong YK, Wong CK, Un KC, Chan PH, Siu CW, Yiu KH, Lau CP, Tse HF. Prognostic implications of statin intolerance in stable coronary artery disease patients with different levels of high-sensitive troponin. BMC Cardiovasc Disord 2019; 19:168. [PMID: 31307391 PMCID: PMC6633694 DOI: 10.1186/s12872-019-1152-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/08/2019] [Indexed: 12/27/2022] Open
Abstract
Background The prognostic implication of statin in tolerance (SI) in those with stable CAD remains unclear. We hypothesized that SI is of higher prognostic significance in stable CAD patients with elevated high-sensitive cardiac troponin I (hs-cTnI). Methods A total of 952 stable CAD patients from the prospective Hong Kong CAD study who had complete clinical data, biomarker measurements and who were prescribed statin therapy were studied. Results We identified 13 (1.4%) and 125 (13.1%) patients with complete and partial SI, respectively. At baseline, patients with SI were more likely to have diabetes mellitus and a higher hs-cTnI level, but no difference in LDL-C level compared with those without SI. After 51 months of follow-up, patients with SI had a higher mean LDL-C level than those without SI. A total of 148 (15.5%) patients developed major adverse cardiovascular events (MACEs). Both SI (HR 1.52, 95% CI 1.06–2.19, P = 0.02) and elevated hs-cTnI (HR 3.18, 95% CI 2.07–4.89, P < 0.01) were independent predictors of a MACE in patients with stable CAD. When stratified by hs-cTnI level, SI independently predicted MACE-free survival only in those with elevated hs-cTnI (HR 1.51, 95% CI 1.01–2.24, P = 0.04). Conclusions SI independently predicted MACE in patients with stable CAD and high hs-cTnI, but not in those with low hs-cTnI. Hs-cTnI may be used to stratify stable CAD patients who have SI for intensive lipid-lowering therapy using non-statin agents. Electronic supplementary material The online version of this article (10.1186/s12872-019-1152-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jo-Jo Hai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yuen-Kwun Wong
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Chun-Ka Wong
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Ka-Chun Un
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Pak-Hei Chan
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Chu-Pak Lau
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. .,Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China. .,The University of Hong Kong-Shenzhen Institute of Research and Innovation, Shenzhen, China. .,Hong Kong-Guangdong Joint Laboratory on Stem Cell and Regenerative Medicine, the University of Hong Kong, Hong Kong, China.
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So CW, Lui CT, Tsui KL, Chan KL, Law AKK, Wong YK, Li T, Wong CL, Leung SC. Questionnaire survey on medical futility and termination of resuscitation in cardiac arrest patients among emergency physicians in Hong Kong. Hong Kong Med J 2019; 25:183-191. [PMID: 31178438 DOI: 10.12809/hkmj187755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The perceptions of medical futility and decisions about termination of resuscitation (TOR) for out-of-hospital cardiac arrest (OHCA) are highly heterogeneous and dependent on the practice of the attending emergency physicians. The objective of this study was to report and investigate the knowledge, attitudes, and practices regarding medical futility and TOR during management of OHCA in Hong Kong. METHODS A cross-sectional survey was conducted among emergency medicine physicians in Hong Kong. The questionnaire assessed participants' background, knowledge, attitudes, and behaviours concerning medical futility and TOR in management of OHCA. Composite scores were calculated to reflect knowledge, attitudes, and practices of OHCA treatment. Subgroup analysis and multiple regression analysis were used to explore the relationship between participants' background, knowledge, attitudes, and behaviours. RESULTS The response rate to this survey was 57% (140/247). Independent predictors of less aggressive resuscitation in OHCA patients included status as a Fellow of the Hong Kong College of Emergency Medicine (β= -0.314, P=0.028) and being an Advanced Cardiac Life Support instructor (β= -0.217, P=0.032). There was no difference in aggressiveness of resuscitation in terms of years of clinical experience (β=0.015, P=0.921), knowledge of TOR (β=0.057, P=0.509), or attitudes about TOR (β= -0.103, P=0.214). The correlation between knowledge and attitudes was low (Spearman's coefficient=0.02, P=0.795). CONCLUSION Clinical practice and behaviour of TOR was not demonstrated to have associations with knowledge or attitude. Status as a Fellow of the Hong Kong College of Emergency Medicine or Advanced Cardiac Life Support instructor were the only two parameters identified that had significant relationships with earlier TOR in medically futile patients with OHCA.
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Affiliation(s)
- C W So
- Department of Accident and Emergency, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - C T Lui
- Department of Accident and Emergency, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - K L Tsui
- Department of Accident and Emergency, Pok Oi Hospital, Yuen Long, Hong Kong
| | - K L Chan
- Department of Accident and Emergency, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - A K K Law
- Department of Accident and Emergency, Prince of Wales Hospital, Shatin, Hong Kong
| | - Y K Wong
- Department of Accident and Emergency, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - T Li
- Department of Accident and Emergency, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - C L Wong
- Department of Accident and Emergency, Princess Margaret Hospital, Laichikok, Hong Kong
| | - S C Leung
- Accident and Emergency Department, Queen Mary Hospital, Pokfulam, Hong Kong
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Abstract
Objective The classical radiographic signs in acute epiglottitis are qualitative. The purpose of our study was to identify objective radiographic parameters to aid diagnosis of acute epiglottitis in Chinese adults. Methods A case-control study of Chinese adult patients attending the accident and emergency department (AED) who were subsequently diagnosed to have acute epiglottitis from 1st January 2009 to 31st December 2013 in a public hospital in Hong Kong. Controls were one-to-one age- and sex-matched patients who attended the AED during the study period for orthopaedic problems with cervical spine radiographs taken. Cases and controls were retrieved from the hospital computer system and their radiographs were interpreted by two specialist radiologists with various pharyngeal and laryngeal parameters, including the dimensions of the third cervical vertebral body, epiglottis, aryepiglottic fold, hypopharynx, retropharyngeal soft tissue and retrotracheal soft tissue, measured and analysed. Sensitivity, specificity, positive and negative likelihood ratios were calculated for each of the parameters. Results Twenty-six patients and 26 age- and sex-matched controls were included in the study. Epiglottis width of 5.5 mm or more was found to be 96.2% sensitive and 100% specific in diagnosing acute epiglottitis. Positive and negative likelihood ratios were infinity and 0.04 respectively. Aryepiglottic fold width of 5.9 mm or more was 92.3% sensitive and 80.8% specific. Positive and negative likelihood ratios were 4.80 and 0.10 respectively. Conclusion The identified objective radiographic parameters should aid in the diagnosis of acute epiglottitis in Chinese adults. (Hong Kong j. emerg.med. 2016;23:168-175)
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Affiliation(s)
| | - NY Pan
- Princess Margaret Hospital, Department of Radiology, 2-10 Princess Margaret Hospital Road, Kwai Chung, N.T., Hong Kong
| | - CY Chu
- Pamela Youde Nethersole Eastern Hospital, Department of Radiology, 3 Lok Man Road, Chai Wan, Hong Kong
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21
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Wong YK, Ho YH, Leung HM, Ho KC, Yau YH, Yung KKL. Enhancement of Chlorella vulgaris harvesting via the electro-coagulation-flotation (ECF) method. Environ Sci Pollut Res Int 2017; 24:9102-9110. [PMID: 28039627 DOI: 10.1007/s11356-016-7856-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 10/06/2016] [Indexed: 06/06/2023]
Abstract
This article explores the potential of using an electro-coagulation-flotation (ECF) harvester to allow flotation of microalgae cells for surface harvesting. A response surface methodology (RSM) model was used to optimize ECF harvesting by adjusting electrode plate material, electrode plate number, charge of the electrodes, electrolyte concentration, and pH value of the culture solution. The result revealed that three aluminum electrode plates (one anode and two cathodes), brine solution (8 g/L), and acidity (pH = 4) of culture solution (optimized ECF harvester) The highest flocculant concentration was measured at 2966 mg/L after 60 min and showed a 79.8 % increase of flocculation concentration. Such results can provide a basis for designing a large-scale microalgae harvester for commercial use in the future.
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Affiliation(s)
- Y K Wong
- Department of Biology, Hong Kong Baptist University, Hong Kong, SAR, China
- Center for Research in Environmental Science, The Open University of Hong Kong, Hong Kong, China
| | - Y H Ho
- Center for Research in Environmental Science, The Open University of Hong Kong, Hong Kong, China
| | - H M Leung
- Department of Biology, Hong Kong Baptist University, Hong Kong, SAR, China
| | - K C Ho
- Center for Research in Environmental Science, The Open University of Hong Kong, Hong Kong, China
| | - Y H Yau
- Center for Research in Environmental Science, The Open University of Hong Kong, Hong Kong, China
| | - K K L Yung
- Department of Biology, Hong Kong Baptist University, Hong Kong, SAR, China.
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22
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Leung HM, Duzgoren-Aydin NS, Au CK, Krupanidhi S, Fung KY, Cheung KC, Wong YK, Peng XL, Ye ZH, Yung KKL, Tsui MTK. Monitoring and assessment of heavy metal contamination in a constructed wetland in Shaoguan (Guangdong Province, China): bioaccumulation of Pb, Zn, Cu and Cd in aquatic and terrestrial components. Environ Sci Pollut Res Int 2017; 24:9079-9088. [PMID: 27164879 DOI: 10.1007/s11356-016-6756-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 04/25/2016] [Indexed: 06/05/2023]
Abstract
The objective of this study is to evaluate the current status of heavy metal concentrations in constructed wetland, Shaoguan (Guangdong, China). Sediments, three wetland plants (Typha latifolia, Phragmites australis, and Cyperus malaccensis), and six freshwater fish species [Carassius auratus (Goldfish), Cirrhinus molitorella (Mud carp), Ctenopharyngodon idellus (Grass carp), Cyprinus carpio (Wild common carp), Nicholsicypris normalis (Mandarin fish), Sarcocheilichthys kiangsiensis (Minnows)] in a constructed wetland in Shaoguan were collected and analyzed for their heavy metal compositions. Levels of Pb, Zn, Cu, and Cd in sediments exceeded approximately 532, 285, 11, and 66 times of the Dutch Intervention value. From the current study, the concentrations of Pb and Zn in three plants were generally high, especially in root tissues. For fish, concentrations of all studied metals in whole body of N. mormalis were the highest among all the fishes investigated (Pb 113.4 mg/kg, dw; Zn 183.1 mg/kg, dw; Cu 19.41 mg/kg, dw; 0.846 mg/kg, dw). Heavy metal accumulation in different ecological compartments was analyzed by principle component analysis (PCA), and there is one majority of grouped heavy metals concentration as similar in composition of ecological compartment, with the Cd concentration quite dissimilar. In relation to future prospect, phytoremediation technology for enhanced heavy metal accumulation by constructed wetland is still in early stage and needs more attention in gene manipulation area.
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Affiliation(s)
- H M Leung
- Department of Biology, Hong Kong Baptist University, Hong Kong, SAR, China
- Department of History, Hong Kong Shue Yan University, Hong Kong, SAR, China
- Upper Iowa University, 605 Washington St, Fayette, IA, 52142, USA
| | - N S Duzgoren-Aydin
- Department of Geoscience & Geography, New Jersey City University, Jersey City, NJ, 07305, USA
| | - C K Au
- Department of History, Hong Kong Shue Yan University, Hong Kong, SAR, China
| | - S Krupanidhi
- Department of Biotechnology, Vignan's University (VFSTRU), Vadlamudi, 522213, India
| | - K Y Fung
- Department of Biology, Hong Kong Baptist University, Hong Kong, SAR, China
| | - K C Cheung
- Institute of Vocational Education, Hong Kong Vocational Training Council, Hong Kong, SAR, China
| | - Y K Wong
- School of Science and Technology, The Open University of Hong Kong, Hong Kong, SAR, China
| | - X L Peng
- Division of Science and Technology, United International College, Beijing Normal University-Hong Kong Baptist University, E-407A, 28 Jinfeng Road, Tangjiawan, Zhuhai, GD, 519085, China
| | - Z H Ye
- State Key Lab of Biocontrol, Sun Yat-sen University, Guangzhou, Guangdong Province, People's Republic of China.
- School of Life Science, Sun Yat-sen University, Guangzhou, Guangdong Province, People's Republic of China.
| | - K K L Yung
- Department of Biology, Hong Kong Baptist University, Hong Kong, SAR, China.
| | - M T K Tsui
- Department of Biology, University of North Carolina, Greensboro, NC, 27402, USA.
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Wong YK, Ho YH, Ho KC, Leung HM, Yung KKL. Maximization of cell growth and lipid production of freshwater microalga Chlorella vulgaris by enrichment technique for biodiesel production. Environ Sci Pollut Res Int 2017; 24:9089-9101. [PMID: 27975198 DOI: 10.1007/s11356-016-7792-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 09/28/2016] [Indexed: 06/06/2023]
Abstract
Chlorella vulgaris was cultivated under limitation and starvation and under controlled conditions using different concentrations of nitrate (NaNO3) and phosphate (K2HPO4 and KH2PO4) chemicals in modified Bold basal medium (BBM). The biomass and lipid production responses to different media were examined in terms of optical density, cell density, dry biomass, and lipid productivity. In the 12-day batch culture period, the highest biomass productivity obtained was 72.083 mg L-1 day-1 under BBM - NcontrolPlimited condition. The highest lipid content, lipid concentration, and lipid productivity obtained were 53.202 %, 287.291 mg/L, and 23.449 mg L-1 day-1 under BBM - NControlPDeprivation condition, respectively. Nitrogen had a major effect in the biomass concentration of C. vulgaris, while no significant effect was found for phosphorus. Nitrogen and phosphorus starvation was found to be the strategy affecting the lipid accumulation and affected the lipid composition of C. vulgaris cultures.
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Affiliation(s)
- Y K Wong
- Biology Department, The Hong Kong Baptist University, Kowloon, Hong Kong
- Center for Research in Environmental Science, The Open University of Hong Kong, Hong Kong, China
| | - Y H Ho
- Center for Research in Environmental Science, The Open University of Hong Kong, Hong Kong, China
| | - K C Ho
- Center for Research in Environmental Science, The Open University of Hong Kong, Hong Kong, China
| | - H M Leung
- Biology Department, The Hong Kong Baptist University, Kowloon, Hong Kong
| | - K K L Yung
- Biology Department, The Hong Kong Baptist University, Kowloon, Hong Kong.
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Chan JTK, Leung HM, Yue PYK, Au CK, Wong YK, Cheung KC, Li WC, Yung KKL. Combined effects of land reclamation, channel dredging upon the bioavailable concentration of polycyclic aromatic hydrocarbons (PAHs) in Victoria Harbour sediment, Hong Kong. Mar Pollut Bull 2017; 114:587-591. [PMID: 27634738 DOI: 10.1016/j.marpolbul.2016.09.017] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 09/07/2016] [Accepted: 09/10/2016] [Indexed: 06/06/2023]
Abstract
The up-to-date concentration of polycyclic aromatic hydrocarbons (PAHs) in sediment materials of Victoria Harbour was investigated so as to evaluate the pollution potential associated with the reclamation projects in Hong Kong. A total of 100 sediment samples were collected at 20 locations. Except the control point in reservoir, the PAHs concentrations were detectable levels all sites (131-628.3ng/g, dw) and such values were higher than Dutch Target and Intervention Values (the New Dutch standard in 2016). The PAHs concentration indicating that construction waste and wastewater discharges were the main pollutant sources. Results of correlation in single cell gel electrophoresis assay (comet assay) studies also revealed that the PAHs concentration was highly correlated (<0.01) with DNA migration (i.e. the length of tail moment of fish cells) in 5mg/ml of PAHs. The above observation indicates that the PAHs present in the sediment may substantially effect the marine ecosystem. Although the dredged sediment can be a useful sea-filling material for land reclamation; however, the continuing leaching of PAHs and its impact on the aquatic environment need to be studied further.
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Affiliation(s)
- J T K Chan
- Department of Biology, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
| | - H M Leung
- Department of Biology, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China; Department of History, Shue Yan University, Hong Kong, China; Upper Iowa University, 605 Washington St, Fayette, IA 52142, USA
| | - P Y K Yue
- Department of Biology, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
| | - C K Au
- Department of History, Shue Yan University, Hong Kong, China
| | - Y K Wong
- School of Science and Technology, The Open University of Hong Kong, Hong Kong, China
| | - K C Cheung
- Department of Applied Sciences, Institute of Vocational Education (Kwai Chung), Hong Kong, China
| | - W C Li
- Department of Science and Environmental Studies, The Education University of Hong Kong, Hong Kong, China
| | - K K L Yung
- Department of Biology, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China.
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Lam SK, Yip SF, Crow P, Fung HT, Cheng JM, Tan KS, Wong OF, Yeung DY, Wong YK, Poon KM, Ades G. Comparison of green pit viper and Agkistrodon halys antivenom in inhibition of coagulopathy due to Trimeresurus albolabris venom: an in-vitro study using human plasma. Hong Kong Med J 2016; 23:13-8. [PMID: 27909267 DOI: 10.12809/hkmj154617] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION There are two antivenoms that may be administered in Hong Kong following a bite by Trimeresurus albolabris: the green pit viper antivenom from the Thai Red Cross Society in Thailand and the Agkistrodon halys antivenom from the Shanghai Institute of Biological Products in China. Both are recommended by the Central Coordinating Committee of Accident and Emergency Services of the Hospital Authority for treating patients with a bite by Trimeresurus albolabris. The choice of which antivenom to use is based on physician preference. This study aimed to compare the relative efficacy of the two antivenoms. METHODS This in-vitro experimental study was carried out by a wildlife conservation organisation and a regional hospital in Hong Kong. Human plasma from 40 adult health care worker volunteers was collected. The Trimeresurus albolabris venom was added to human plasma and the mixture was assayed after incubation with each antivenom (green pit viper and Agkistrodon halys) using saline as a control. Fibrinogen level and clotting time in both antivenom groups were studied. RESULTS The mean fibrinogen level was elevated from 0 g/L to 2.86 g/L and 1.11 g/L after the addition of green pit viper antivenom and Agkistrodon halys antivenom, respectively. When mean clotting time was measured, the value was 6.70 minutes in the control, prolonged to more than 360 minutes by green pit viper antivenom and to 19.06 minutes by Agkistrodon halys antivenom. CONCLUSIONS Green pit viper antivenom was superior to Agkistrodon halys antivenom in neutralisation of the thrombin-like and hypofibrinogenaemic activities of Trimeresurus albolabris venom.
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Affiliation(s)
- S K Lam
- Department of Accident and Emergency, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - S F Yip
- Department of Pathology and Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - P Crow
- Fauna Conservation Department, Kadoorie Farm and Botanic Garden, Tai Po, Hong Kong
| | - H T Fung
- Department of Accident and Emergency, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - J Mh Cheng
- Department of Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - K S Tan
- Fauna Conservation Department, Kadoorie Farm and Botanic Garden, Tai Po, Hong Kong
| | - O F Wong
- Department of Accident and Emergency, North Lantau Hospital, Lantau, Hong Kong
| | - D Yt Yeung
- Department of Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Y K Wong
- Fauna Conservation Department, Kadoorie Farm and Botanic Garden, Tai Po, Hong Kong
| | - K M Poon
- Department of Accident and Emergency, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - G Ades
- Fauna Conservation Department, Kadoorie Farm and Botanic Garden, Tai Po, Hong Kong
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Wong YK, Lui CT, Li KK, Wong CY, Lee MM, Tong WL, Ong KL, Tang SYH. Prediction of en-route complications during interfacility transport by outcome predictive scores in ED. Am J Emerg Med 2016; 34:877-82. [PMID: 26947612 DOI: 10.1016/j.ajem.2016.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/06/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective was to determine the accuracy of the outcome predictive scores (Modified Early Warning Score [MEWS]; Hypotension, Low Oxygen Saturation, Low Temperature, Abnormal ECG, Loss of Independence [HOTEL] score; and Simple Clinical Score [SCS]) in predicting en-route complications during interfacility transport (IFT) in emergency department. DESIGN This was a retrospective cohort study. METHODS All IFT cases by ambulances with either nurse-led or physician-led escort, occurring between 1 January 2011 and 31 December 2012, were included. Obstetric and pediatric cases (age < 18 years) were excluded. The condition of patients was quantified by using the predictive scores (MEWS, HOTEL, and SCS) at triage station and on ambulance departure. The accuracy of predictive scores was compared by the receiver operating characteristic (ROC) curves. RESULTS A total of 659 cases were included. Seventeen cases had en-route complications (2.6%). The complication rate in physician-escorted transport (2.2%) was similar to that in nurse-escorted transport (2.6%). None of the 57 intubated cases had en-route complications. The area under the ROC curve for MEWS was 0.662 (triage) and 0.479 (departure). The accuracy of MEWS at triage was better than that at departure (P = .049). The area under the ROC curve for HOTEL was 0.613 (triage) and 0.597 (departure), and that for SCS was 0.6 (triage) and 0.568 (departure). In general, the predictive scores at triage were better than those on departure. CONCLUSION None of the scores had good accuracy in prediction of en-route complications during IFT. MEWS at triage was among the best one already but was not ideal.
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Affiliation(s)
- Y K Wong
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - C T Lui
- Department of Accident and Emergency Medicine, Tuen Mun Hospital.
| | - K K Li
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - C Y Wong
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - M M Lee
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - W L Tong
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - K L Ong
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - S Y H Tang
- Department of Accident and Emergency Medicine, Tuen Mun Hospital
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Wong YK, Ho KC, Tsang YF, Wang L, Yung KKL. Cultivation of Chlorella vulgaris in Column Photobioreactor for Biomass Production and Lipid Accumulation. Water Environ Res 2016; 88:40-46. [PMID: 26803025 DOI: 10.2175/106143015x14362865227553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Microalgae have been used as energy resources in recent decades to mitigate the global energy crisis. As the demand for pure microalgae strains for commercial use increases, designing an effective photobioreactor (PBR) for mass cultivation is important. Chlorella vulgaris, a local freshwater microalga, was used to study the algal biomass cultivation and lipid production using various PBR configurations (bubbling, air-lift, porous air-lift). The results show that a bubbling column design is a better choice for the cultivation of Chlorella vulgaris than an air-lift one. The highest biomass concentration in the bubbling PBR was 0.78 g/L while the air-lift PBR had a value of 0.09 g/L. Key operating parameters, including draft-tube length and bubbling flowrate, were then optimized based on biomass production and lipid yield. The highest lipid content was in the porous air-lift PBR and the air-lift PBR with shorter draft tube (35 cm) was also better than a longer one (50 cm) for algal cultivation, but the microalgae attachment on the inner tube of PBR always occurred. The highest biomass concentration could be produced under the highest gas flowrate of 2.7 L/min, whereas the lowest dry cell mass was under the lowest gas flowrate of 0.2 L/min.
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Affiliation(s)
- Y K Wong
- Department of Biology, Hong Kong Baptist University, Hong Kong
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Wong YK, Yung KKL, Tsang YF, Xia Y, Wang L, Ho KC. Scenedesmus quadricauda for Nutrient Removal and Lipid Production in Wastewater. Water Environ Res 2015; 87:2037-2044. [PMID: 26652116 DOI: 10.2175/106143015x14362865227193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Scenedesmus quadricauda, a local freshwater microalga, was used to treat primary settled and filtrate wastewater and to produce algal lipid. For the primary settled wastewater, the maximum biomass concentrations of acclimated and unacclimated microalgae were 0.995 g/L and 0.940 g/L, respectively. Over 90% orthophosphate and 95% ammonia nitrogen in the acclimated and unacclimated cultures, respectively, were removed after five days. The lipid contents of the microalgae were higher than 13% in all cultures. The highest growth rate occurred in the 25% filtrate culture. Over 80% phosphate was removed under the 25% and 50% filtrate cultures within six days, while over 90% ammonia nitrogen was removed within five days under both conditions. The lipid content was the highest (18.1%) under the 50% filtrate condition. C16:0, C18:2n6, and C18:3n3 were dominant fatty acids. In conclusion, S. quadricauda is a viable candidate for wastewater treatment and lipid production.
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Affiliation(s)
- Y K Wong
- Department of Biology, Hong Kong Baptist University, Hong Kong SAR, China
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Leung HM, Leung SKS, Au CK, Cheung KC, Wong YK, Leung AOW, Yung KKL. Comparative assessment of water quality parameters of mariculture for fish production in Hong Kong Waters. Mar Pollut Bull 2015; 94:318-322. [PMID: 25697818 DOI: 10.1016/j.marpolbul.2015.01.028] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 01/27/2015] [Accepted: 01/29/2015] [Indexed: 06/04/2023]
Abstract
The objective of the study is to evaluate the effect of fish cultivation on water quality in fish culture zone (FCZ) and analysed by Principle Component Analysis (PCA). 120 surface water samples were collected from Hong Kong Waters (60 samples in Victoria Harbour and another 60 in Ma Wan FCZ). Significant difference was found in dissolved oxygen (MW: 59.6%; VH: 81.3%), and Escherichia coli (MW: 465 CFU/100 ml; VH: 162.5 CFU/100 ml). Three principle components are responsible for water quality variations in the studying sites. The first component included E. coli (0.625) and dissolved oxygen (0.701). The second included E. coli (0.387) and ammonical-nitrogen (0.571). The third included E. coli (0.194) and ammonical-nitrogen (0.287). This framework provides information to assess the relative contribution of eco-aquaculture to nutrient loads and the subsequent risk of eutrophication. To conclude, a rigorous monitoring of water quality is necessary to assess point and nonpoint source pollution. Besides, appropriate remediation techniques should be used to combat water pollution and achieve sustainability.
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Affiliation(s)
- H M Leung
- Department of Biology, Hong Kong Baptist University, Hong Kong Special Administrative Region
| | - S K S Leung
- Institute of Vocational Education, Hong Kong Vocational Training Council, Hong Kong Special Administrative Region
| | - C K Au
- Department of History, Hong Kong Shue Yan University, Hong Kong Special Administrative Region
| | - K C Cheung
- Institute of Vocational Education, Hong Kong Vocational Training Council, Hong Kong Special Administrative Region
| | - Y K Wong
- School of Science and Technology, The Open University of Hong Kong, Hong Kong Special Administrative Region
| | - A O W Leung
- Department of Biology, Hong Kong Baptist University, Hong Kong Special Administrative Region
| | - K K L Yung
- Department of Biology, Hong Kong Baptist University, Hong Kong Special Administrative Region.
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Lau KK, Wong YK, Chan YH, Li OY, Lee PYS, Yuen GG, Wong YK, Tong S, Wong D, Chan KH, Cheung RTF, Siu CW, Ho SL, Tse HF. Mediterranean-style diet is associated with reduced blood pressure variability and subsequent stroke risk in patients with coronary artery disease. Am J Hypertens 2015; 28:501-7. [PMID: 25352231 DOI: 10.1093/ajh/hpu195] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The Mediterranean-style diet is widely advocated for the prevention of cardiovascular diseases (CVD). Meanwhile, blood pressure variability (BPV) is a novel risk factor for CVD. It is unknown whether dietary pattern plays a role in modulating BPV. METHODS We prospectively followed-up 274 consecutive patients with stable coronary artery disease (CAD). The Mediterranean diet score (MDS) was derived for all individuals upon recruitment, blood pressure (BP) was measured during each subsequent clinic visit and the visit-to-visit BPV was calculated. The occurrence of major adverse cardiovascular events (MACEs) and all-cause mortality was monitored. RESULTS After a mean follow-up of 77±12 months, 16.1% of the study population developed MACEs. About 11.3% died from all causes. Patients who developed MACEs or all-cause mortality had a greater systolic BPV compared to those who did not develop an adverse event. Patients who developed a MACE had a lower MDS and further analysis revealed those who developed a stroke had a lower MDS compared with those who did not develop a stroke, but there were no significant differences in MDS between CAD patients with or without subsequent acute coronary syndrome, cardiovascular, or all-cause mortality. After adjusting for confounding variables, a high MDS was an independent predictor for low systolic BPV (B -0.74, 95% confidence interval -1.27 to -0.21, P < 0.01) and was noted to be protective against subsequent development of stroke (hazards ratio 0.48, 95% confidence interval 0.24 to 0.94, P = 0.03). CONCLUSIONS Among patients with CAD, a higher MDS is associated with a lower visit-to-visit BPV and with lower stroke risk.
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Affiliation(s)
- Kui-Kai Lau
- Neurology Division, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Yuen-Kwun Wong
- Neurology Division, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Yap-Hang Chan
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Oi-Yi Li
- Neurology Division, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Philip Yat-Sing Lee
- Neurology Division, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Gabrielle G Yuen
- Neurology Division, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Yee-Kiu Wong
- Neurology Division, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Samuel Tong
- Neurology Division, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Dicken Wong
- Neurology Division, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Koon-Ho Chan
- Neurology Division, Department of Medicine, The University of Hong Kong, Hong Kong
| | | | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Shu-Leong Ho
- Neurology Division, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong.
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Lau KK, Wong YK, Teo KC, Chang RSK, Chan KH, Hon SFK, Wat KL, Cheung RTF, Li LSW, Siu CW, Tse HF. Long-term prognostic implications of visit-to-visit blood pressure variability in patients with ischemic stroke. Am J Hypertens 2014; 27:1486-94. [PMID: 24842389 DOI: 10.1093/ajh/hpu070] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Blood pressure (BP) variability (BPV) is a novel risk factor for the development of atherosclerotic diseases. High BPV has recently been shown to predict all-cause and cardiovascular mortality in patients with lacunar infarct. Whether BPV has prognostic implications in patients with ischemic stroke subtypes, other than those due to small-vessel occlusion, remains uncertain. METHODS We prospectively followed up the clinical outcome of 632 consecutive ischemic stroke patients without atrial fibrillation. The average BP and BPV, as determined by the coefficient of variation of the systolic and diastolic BP, were recorded during a mean 12 ± 6 outpatient clinic visits. RESULTS The average age of the population was 71 ± 11 years. After a mean of 76 ± 18 months of follow-up, 161 patients died (26%); 35% (n = 56 of 161) of these deaths were due to cardiovascular causes. Sixteen percent and 5% developed recurrent stroke and acute coronary syndrome (ACS), respectively. After adjusting for mean systolic BP and confounding variables, patients with high systolic BPV were at significantly greater risk of cardiovascular mortality (hazards ratio (HR) = 2.36; 95% confidence interval (CI) = 1.02-5.49; P < 0.05). High systolic BPV also predicted all-cause mortality after adjusting for mean systolic BP (HR = 1.79; 95% CI = 1.16-2.75; P < 0.05). There was no association between systolic BPV and nonfatal recurrent stroke or nonfatal ACS. Raised diastolic BPV did not predict recurrent nonfatal stroke, nonfatal ACS, or mortality. CONCLUSIONS Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality in patients with ischemic stroke without atrial fibrillation, independent of other conventional risk factors, including average BP control.
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Affiliation(s)
- Kui-Kai Lau
- Division of Neurology, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Yuen-Kwun Wong
- Division of Neurology, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Kay-Cheong Teo
- Division of Neurology, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Richard S K Chang
- Division of Neurology, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Koon-Ho Chan
- Division of Neurology, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Sonny F K Hon
- Division of Neurology, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Ka-Lung Wat
- Division of Cardiology, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Raymond T F Cheung
- Division of Neurology, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Leonard S W Li
- Division of Rehabilitation Medicine, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Chung-Wah Siu
- Division of Cardiology, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, University of Hong Kong, Hong Kong, China;
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Lau KK, Wong YK, Teo KC, Chang RSK, Hon SFK, Chan KH, Cheung RTF, Li LSW, Tse HF, Ho SL, Siu CW. Stroke patients with a past history of cancer are at increased risk of recurrent stroke and cardiovascular mortality. PLoS One 2014; 9:e88283. [PMID: 24523883 PMCID: PMC3921146 DOI: 10.1371/journal.pone.0088283] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 01/07/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Cancer patients are at increased risk of cardiovascular and cerebrovascular events. It is unclear whether cancer confers any additional risk for recurrent stroke or cardiovascular mortality after stroke. METHODS This was a single center, observational study of 1,105 consecutive Chinese ischemic stroke patients recruited from a large stroke rehabilitation unit based in Hong Kong. We sought to determine whether patients with cancer are at higher risk of recurrent stroke and cardiovascular mortality. RESULTS Amongst 1,105 patients, 58 patients (5.2%) had cancer, of whom 74% were in remission. After a mean follow-up of 76 ± 18 months, 241 patients developed a recurrent stroke: 22 in patients with cancer (38%, annual incidence 13.94%/year), substantially more than those without cancer (21%, 4.65%/year) (p<0.01). In a Cox regression model, cancer, age and atrial fibrillation were the 3 independent predictors of recurrent stroke with a hazard ratio (HR) of 2.42 (95% confidence interval (CI): 1.54-3.80), 1.01 (1.00-1.03) and 1.35 (1.01-1.82) respectively. Likewise, patients with cancer had a higher cardiovascular mortality compared with those without cancer (4.30%/year vs. 2.35%/year, p = 0.08). In Cox regression analysis, cancer (HR: 2.08, 95% CI: 1.08-4.02), age (HR: 1.04, 95% CI 1.02-1.06), heart failure (HR: 3.06, 95% CI 1.72-5.47) and significant carotid atherosclerosis (HR: 1.55, 95% CI 1.02-2.36) were independent predictors for cardiovascular mortality. CONCLUSIONS Stroke patients with a past history of cancer are at increased risk of recurrent stroke and cardiovascular mortality.
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Affiliation(s)
- Kui-Kai Lau
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yuen-Kwun Wong
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Kay-Cheong Teo
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Richard Shek-Kwan Chang
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Sonny Fong-Kwong Hon
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Koon-Ho Chan
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Raymond Tak-Fai Cheung
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Leonard Sheung-Wai Li
- Division of Rehabilitation Medicine, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Hung-Fat Tse
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Shu-Leong Ho
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- * E-mail: (CWS); (SLH)
| | - Chung-Wah Siu
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- * E-mail: (CWS); (SLH)
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Lau KK, Wong YK, Chang RSK, Teo KC, Hon SFK, Chan KH, Wat KL, Cheung RTF, Li LSW, Siu CW, Ho SL, Tse HF. Visit-to-visit systolic blood pressure variability predicts all-cause and cardiovascular mortality after lacunar infarct. Eur J Neurol 2013; 21:319-25. [PMID: 24267182 DOI: 10.1111/ene.12310] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 10/21/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Both blood pressure (BP) and its variability (BPV) are established risk factors for development of atherosclerotic disease and are associated with an increased risk for cardiovascular and all-cause mortality. The prognostic implications of outpatient clinic visit-to-visit BPV amongst patients with lacunar infarction are nevertheless unknown. METHODS The clinical outcome of 281 patients with lacunar infarction was prospectively followed up. The average BP and BPV, as determined by the standard deviation of the systolic and diastolic BP, were recorded during a mean 13 ± 6 outpatient clinic visits. RESULTS The mean age of the population was 70 ± 10 years. After a mean 78 ± 18 months follow-up, 65 patients died (23%), 31% (20/65) due to cardiovascular causes; 14% and 7% developed recurrent stroke and acute coronary syndrome. After adjusting for age, sex, mean systolic and diastolic BP, cardiovascular risk factors and comorbidities, patients with a systolic BPV of the third tertile had significantly higher risk of all-cause mortality [hazard ratio (HR) 1.97, 95% confidence interval (CI) 1.02-3.80, P = 0.04) and cardiovascular mortality (HR 7.64, 95% CI 1.65-35.41, P < 0.01) than those with systolic BPV of the first tertile. Nevertheless, systolic BPV did not predict recurrent stroke or acute coronary syndrome. Diastolic BPV did not predict various adverse clinical outcomes. CONCLUSIONS Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality after lacunar infarct, independent of conventional risk factors including average BP control.
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Affiliation(s)
- K K Lau
- Neurology Division, Department of Medicine, University of Hong Kong, Hong Kong, China
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Diamond T, Wong YK, Golombick T. Effect of oral cholecalciferol 2,000 versus 5,000 IU on serum vitamin D, PTH, bone and muscle strength in patients with vitamin D deficiency. Osteoporos Int 2013; 24:1101-5. [PMID: 22422304 DOI: 10.1007/s00198-012-1944-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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: 09/18/2011] [Accepted: 02/06/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED Treatment of vitamin D deficiency for 3 months with oral cholecalciferol 5,000 IU daily was more effective than 2,000 IU daily in achieving optimal serum 25-hydroxyvitamin D (25OHD) concentrations. Optimal 25OHD serum level calculated to be 63.8 nmol/L. All parameters of muscle strength improved following administration of cholecalciferol for 3 months. INTRODUCTION The aim of this study was to determine the optimal dose of cholecalciferol required to achieve target serum 25OHD level ≥ 75 nmol/L and its relationship to both bone turnover and muscle strength. METHODS Thirty deficient patients (serum 25OHD ≤ 50 nmol/L) were randomly assigned into two groups-i.e. 2,000 and 5,000 IU/day. Data were collected at baseline, at 2 and 3 months post-therapy: (a) clinical demographics, (b) dietary calcium recall, (c) physical tests of muscle function and (d) biochemistry. Statistical analysis used paired student t test and analysis of variance. Regression analysis was used to determine relationship between serum 25OHD and parathyroid hormone (PTH). RESULTS Twenty-six (87%) patients completed 3 months of therapy. The percent increase in serum 25OHD (compared to baseline) was 82.7% in 2,000-IU group and 219.5% in 5,000-IU group. All participants (100%) achieved a serum 25OHD concentration >50 nmol/L; only 5 subjects (45.4%) in 2,000-IU group compared to 14 subjects (93.3%) in 5,000-IU group achieved final 25OHD concentration ≥ 75 nmol/L (p < 0.01). In the regression analysis, the reflexion point at which the PTH level increased above the normal range was calculated to be 63.8 nmol/L 25OHD. All parameters of muscle strength showed trends in improvements following the administration of both the 2,000 and 5,000 IU doses. No patient reported untoward side effects and no patient developed hypercalcaemia. CONCLUSION Treatment for 3 months with oral cholecalciferol 5,000 IU daily may be more effective than 2,000 IU daily in achieving optimal serum 25OHD concentrations in vitamin D-deficient patients.
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Affiliation(s)
- T Diamond
- Department Endocrinology, St George Hospital, Level 3 Prichard Wing, Gray street, Kogarah, NSW 2211, Australia.
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Lau KK, Wong YK, Chan YH, Yiu KH, Teo KC, Li LSW, Ho SL, Chan KH, Siu CW, Tse HF. Prognostic implications of surrogate markers of atherosclerosis in low to intermediate risk patients with type 2 diabetes. Cardiovasc Diabetol 2012; 11:101. [PMID: 22900680 PMCID: PMC3444371 DOI: 10.1186/1475-2840-11-101] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 08/11/2012] [Indexed: 11/24/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) patients are at increased risk of developing cardiovascular events. Unfortunately traditional risk assessment scores, including the Framingham Risk Score (FRS), have only modest accuracy in cardiovascular risk prediction in these patients. Methods We sought to determine the prognostic values of different non-invasive markers of atherosclerosis, including brachial artery endothelial function, carotid artery atheroma burden, ankle-brachial index, arterial stiffness and computed tomography coronary artery calcium score (CACS) in 151 T2DM Chinese patients that were identified low-intermediate risk from the FRS recalibrated for Chinese (<20% risk in 10 years). Patients were prospectively followed-up and presence of atherosclerotic events documented for a mean duration of 61 ± 16 months. Results A total of 17 atherosclerotic events in 16 patients (11%) occurred during the follow-up period. The mean FRS of the study population was 5.0 ± 4.6% and area under curve (AUC) from receiver operating characteristic curve analysis for prediction of atherosclerotic events was 0.59 ± 0.07 (P = 0.21). Among different vascular assessments, CACS > 40 had the best prognostic value (AUC 0.81 ± 0.06, P < 0.01) and offered significantly better accuracy in prediction compared with FRS (P = 0.038 for AUC comparisons). Combination of FRS with CACS or other surrogate vascular markers did not further improve the prognostic values over CACS alone. Multivariate Cox regression analysis identified CACS > 40 as an independent predictor of atherosclerotic events in T2DM patients (Hazards Ratio 27.11, 95% Confidence Interval 3.36-218.81, P = 0.002). Conclusions In T2DM patients identified as low-intermediate risk by the FRS, a raised CACS > 40 was an independent predictor for atherosclerotic events.
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Affiliation(s)
- Kui-Kai Lau
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
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Yu H, Wang J, Deng B, Wei X, Wong YK, Chan WL, Tsang KM, Yu Z. Chaotic phase synchronization in small-world networks of bursting neurons. Chaos 2011; 21:013127. [PMID: 21456841 DOI: 10.1063/1.3565027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We investigate the chaotic phase synchronization in a system of coupled bursting neurons in small-world networks. A transition to mutual phase synchronization takes place on the bursting time scale of coupled oscillators, while on the spiking time scale, they behave asynchronously. It is shown that phase synchronization is largely facilitated by a large fraction of shortcuts, but saturates when it exceeds a critical value. We also study the external chaotic phase synchronization of bursting oscillators in the small-world network by a periodic driving signal applied to a single neuron. It is demonstrated that there exists an optimal small-world topology, resulting in the largest peak value of frequency locking interval in the parameter plane, where bursting synchronization is maintained, even with the external driving. The width of this interval increases with the driving amplitude, but decrease rapidly with the network size. We infer that the externally applied driving parameters outside the frequency locking region can effectively suppress pathologically synchronized rhythms of bursting neurons in the brain.
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Affiliation(s)
- Haitao Yu
- School of Electrical Engineering and Automation, Tianjin University, Tianjin 300072, People's Republic of China
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Ho HF, Wong YK, Rad AB. Adaptive fuzzy approach for a class of uncertain nonlinear systems in strict-feedback form. ISA Trans 2008; 47:286-299. [PMID: 18482726 DOI: 10.1016/j.isatra.2008.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 01/07/2008] [Accepted: 03/17/2008] [Indexed: 05/26/2023]
Abstract
Adaptive fuzzy control is proposed for a class of affine nonlinear systems in strict-feedback form with unknown nonlinearities. The unknown nonlinearities include two types of nonlinear functions: one satisfies the "triangularity condition" and can be directly approximated by fuzzy logic system, while the other is assumed to be partially known and consists of parametric uncertainties. Takagi-Sugeno type fuzzy approximators are used to approximate unknown system nonlinearities and the design procedure is a combination of adaptive backstepping and generalized small gain design techniques. It is proved that the proposed adaptive control scheme can guarantee the uniformly ultimately bounded (UBB) stability of the closed-loop systems. Simulation studies are shown to illustrate the effectiveness of the proposed approach.
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Affiliation(s)
- H F Ho
- The Hong Kong Polytechnic University, Department of Electrical Engineering, Hung Hom, Kowloon, Hong Kong.
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Yu IH, Wong YK. Evaluation of mandibular anatomy related to sagittal split ramus osteotomy using 3-dimensional computed tomography scan images. Int J Oral Maxillofac Surg 2008; 37:521-8. [PMID: 18450425 DOI: 10.1016/j.ijom.2008.03.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 01/07/2008] [Accepted: 03/07/2008] [Indexed: 12/01/2022]
Affiliation(s)
- I H Yu
- Department of Dentistry, Taichung Veterans General Hospital College of Dentistry, Yang Ming Medical University, Taichung, Taiwan
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Abstract
We explored the feasibility and efficacy of an exercise programme for elderly people with knee pain conducted via videoconferencing. Twenty-two community-dwelling subjects aged 60 years or above with knee pain were recruited from two community centres in Hong Kong. A 12-week exercise programme, including strengthening and balance training, was given via videoconferencing to subjects at both centres, in conjunction with a home-based exercise programme. The outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), quadriceps muscle strength, Berg's Balance Scale (BBS) and subjects' degree of acceptance of videoconferencing. Twenty subjects completed the 12-week programme and significant improvements occurred in all domains of the WOMAC score (P <0.003). There was a 44% and a 13% increase in quadriceps muscle strength (P <0.001) and BBS (P <0.001), respectively. Over 80% of the elderly subjects who joined the programme agreed or strongly agreed about all aspects of using videoconferencing. Most of them felt that the system was user-friendly and convenient. Videoconferencing appears to be a useful method of delivering a resistance-training programme for community-dwelling elderly persons with knee pain.
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Affiliation(s)
- Y K Wong
- Division of Geriatrics, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin Hospital, 33-A Kung Kok Street, Shatin NT, Hong Kong, China
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Abstract
Traditional fault detection and isolation methods are based on quantitative models which are sometimes difficult and costly to obtain. In this paper, qualitative bond graph (QBG) reasoning is adopted as the modeling scheme to generate a set of qualitative equations. The QBG method provides a unified approach for modeling engineering systems, in particular, mechatronic systems. An input-output qualitative equation derived from QBG formalism performs continuous system monitoring. Fault diagnosis is activated when a discrepancy is observed between measured abnormal behavior and predicted system behavior. Genetic algorithms (GA's) are then used to search for possible faulty components among a system of qualitative equations. In order to demonstrate the performance of the proposed algorithm, we have tested it on a laboratory scale servo-tank liquid process rig. Results of the proposed model-based fault detection and diagnosis algorithm for the process rig are presented and discussed.
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Affiliation(s)
- C H Lo
- Dept. of Electrical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
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Abstract
OBJECTIVE To identify exercise test variables that can improve the positive predictive value of exercise testing in women. DESIGN Cohort study. SETTING Regional cardiothoracic centre. SUBJECTS 1286 women and 1801 men referred by primary care physicians to a rapid access chest pain clinic, of whom 160 women and 406 men had ST depression of at least 1 mm during exercise testing. The results for 136 women and 124 men with positive exercise tests were analysed. MAIN OUTCOME MEASURES The proportion of women with a positive exercise test who could be identified as being at low risk for prognostic coronary heart disease and the resulting improvement in the positive predictive value. RESULTS Independently of age, an exercise time of more than six minutes, a maximum heart rate of more than 150 beats/min, and an ST recovery time of less than one minute were the variables that best identified women at low risk. One to three of these variables identified between 11.8% and 41.2% of women as being at low risk, with a risk for prognostic disease of between 0-11.5%. The positive predictive value for the remaining women was improved from 47.8% up to 61.5%, and the number of normal angiograms was potentially reducible by between 21.1-54.9%. By the same criteria, men had higher risks for prognostic disease. CONCLUSIONS A strategy of discriminating true from false positive exercise tests is worthwhile in women but less successful in men.
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Affiliation(s)
- Y K Wong
- Wessex Cardiac Unit, Southampton University Hospital, Tremona Road, Southampton, Hampshire, UK.
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Cheng KY, Cheng PG, Mak KT, Wong SH, Wong YK, Yeung EW. Relationships of perceived benefits and barriers to physical activity, physical activity participation and physical fitness in Hong Kong female adolescents. J Sports Med Phys Fitness 2003; 43:523-9. [PMID: 14767415] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
AIM Previous studies that examined participation in physical activity suggested that female adolescents were less active compared with males. However, the relationship between physical fitness, physical activity participation, and perceived benefits and barriers for physical activity to adolescents, irrespective of gender, has not been made clear. This study examines the association of these factors in female adolescents. METHODS Physical activity participation and perceived benefits and barriers to physical activity were determined in 206 secondary school female subjects (aged 11 to 18) using a validated questionnaire. RESULTS Subjects with a correct concept about optimal physical activity participation to maintain health engaged in an activity level higher than the group without a correct concept (t=2.37, p=0.02). A significant correlation was established between the physical activity participation with "health" (r=0.22, p<0.001) and "body image" (r=0.17, p=0.02) in the perceived benefit category. The individual factor, "make me feel better in general" in the "health" category (p=0.04) and the intention to participate (p<0.001) were shown to be significant predictors for physical activity participation. The combined effects of the regression model explained 35.9% of the variance in participation in physical activity. CONCLUSION Policies to support regular physical activity participation at school and out-of-school should be strategically developed and promoted, highlighting the promotion of health benefits in exercise and the reinforcement of initial intent towards exercise.
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Affiliation(s)
- K Y Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
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Abstract
This paper presents a novel method to determine the parameters of a first-order plus dead-time model using neural networks. The outputs of the neural networks are the gain, dominant time constant, and apparent time delay. By combining this algorithm with a conventional PI or PID controller, we also present an adaptive controller which requires very little a priori knowledge about the plant under control. The simplicity of the scheme for real-time control provides a new approach for implementing neural network applications for a variety of on-line industrial control problems. Simulation and experimental results demonstrate the feasibility and adaptive property of the proposed scheme.
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Affiliation(s)
- H F Ho
- The Hong Kong Polytechnic University, Department of Electrical Engineering, Hung Hom, Kowloon, Hong Kong
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Abstract
In this paper, the problem of fault diagnosis via integration of genetic algorithms (GA's) and qualitative bond graphs (QBG's) is addressed. We suggest that GA's can be used to search for possible fault components among a system of qualitative equations. The QBG is adopted as the modeling scheme to generate a set of qualitative equations. The qualitative bond graph provides a unified approach for modeling engineering systems, in particular, mechatronic systems. In order to demonstrate the performance of the proposed algorithm, we have tested the proposed algorithm on an in-house designed and built floating disc experimental setup. Results from fault diagnosis in the floating disc system are presented and discussed. Additional measurements will be required to localize the fault when more than one fault candidate is inferred. Fault diagnosis is activated by a fault detection mechanism when a discrepancy between measured abnormal behavior and predicted system behavior is observed. The fault detection mechanism is not presented here.
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Affiliation(s)
- C H Lo
- The Hong Kong Polytechnic University, Department of Electrical Engineering, Hung Hom, Kowloon
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Abstract
BACKGROUND Chronic infection with organisms such as Chlamydia pneumoniae is thought to cause coronary heart disease. We investigated whether myocardial infarction deaths are associated with large household size and overcrowding, as these are factors that may facilitate the transmission of infection. DESIGN Ecological study of England and Wales. METHODS Population data were obtained from the 1991 National Census and mortality data were obtained from the Office of National Statistics. For various categories of household size and overcrowding, we calculated mortality rates standardized for age, sex and deprivation. RESULTS Standardized mortality rates for acute respiratory infections were associated with household size and overcrowding, while rates for myocardial infarction and gastric carcinoma, both putatively associated with chronic infection, were associated with household size. For combined deaths from causes other than myocardial infarction, there were small associations with household size and overcrowding. In the case of myocardial infarction, the association was generally strongest in the age group 45-54.9 years. For this age group, the standardized mortality rate ratio for the category of largest size household was 2.7 in the year 1991. CONCLUSIONS There is an association between household size and mortality from myocardial infarction. Chronic infection is a possible cause.
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Affiliation(s)
- Y K Wong
- Wessex Cardiac Unit, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
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Wong YK, Tang KT, Wu JC, Hwang JJ, Wang HS. Stimulation of hyaluronan synthesis by interleukin-1beta involves activation of protein kinase C betaII in fibroblasts from patients with Graves' ophthalmopathy. J Cell Biochem 2001; 82:58-67. [PMID: 11400163 DOI: 10.1002/jcb.1118] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [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: 11/12/2022]
Abstract
Hyaluronan accumulation in the retroorbital connective tissue is one of the pathological features of Graves' ophthalmopathy. Interleukin-1beta (IL-1beta) is known to stimulate hyaluronan synthesis in orbital fibroblasts. In the present study, the intracellular signal transduction pathways involved in this stimulatory effect were investigated in cultured human retroorbital fibroblasts from patients with Graves' ophthalmopathy. IL-1beta-induced hyaluronan synthesis was significantly inhibited by pretreatment of the cells with two protein kinase C (PKC) inhibitors, chlerythrine chloride and H-7. In addition, treatment with phorbol 12-myristate 13-acetate (PMA), a direct PKC activator, also resulted in increased hyaluronan production. IL-1beta- or PMA-stimulated hyaluronan synthesis was blocked by the protein synthesis inhibitor, cycloheximide. Moreover, the intracellular Ca(2+) concentration of the orbital fibroblasts was also involved in the IL-1beta induced transduction pathway, the effect being completely inhibited by BAPTA, an internal calcium chelator. In addition, A23187, a calcium ionophore, increased hyaluronan synthesis in unstimulated cells. These results suggest that the Ca(2+)-dependent PKC signal transduction pathway plays an important role in the IL-1beta-induced hyaluronan synthesis. Moreover, IL-1beta treatment resulted in increased PKC activity and the rapid translocation of PKC betaII from the cytoplasm to the plasma membrane. These results indicate that cytosolic Ca(2+) and PKC betaII are involved in IL-1beta-induced hyaluronan synthesis in cultured orbital fibroblasts from patients with Graves' ophthalmopathy.
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Affiliation(s)
- Y K Wong
- Department of Anatomy, School of Life Science/Medicine, National Yang Ming University, Taipei, Taiwan
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47
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Abstract
A new cell line, ME, has been established from a melanoma of the palatal mucosa. The cultured monolayer of cells was fusiform and melanin-producing. The cells were highly tumorigenic and metastatic in nude mice. The xenographic tumors resembled the original tumor in morphology, melanin production, and the expression of S-100 and HMB-45 antigens. The metaphase karyotype of ME indicated multiple aberrations of chromosomes 2, 3, 5, 7-11, 13, 19, 21 and X. A homozygous loss of the p16/MTS1 gene during the establishment of ME correlated with karyotypic evidence of chromosome 9 abnormalities. Absence of nm23 protein expression and elevated expression of CD44 protein (indicative of metastatic phenotypes) were demonstrated in primary and xenographic tumors. ME cells could be valuable in developing novel therapeutic strategies for oral melanoma.
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Affiliation(s)
- K W Chang
- Institute of Oral Biology and Faculty of Dentistry National Yang-Ming University, 112, Taipei, Taiwan
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48
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Lin SC, Chang KW, Chang CS, Yu SY, Chao SY, Wong YK. Establishment and characterization of a cell line (HCDB-1) derived from a hamster buccal pouch carcinoma induced by DMBA and Taiwanese betel quid extract. Proc Natl Sci Counc Repub China B 2000; 24:129-35. [PMID: 10943946] [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: 02/17/2023]
Abstract
This study identified that the carcinogenesis of hamster buccal pouch (HBP) induced by 7,12-dimethylbenz[a]anthracene (DMBA) was greatly enhanced (18 folds) by a combination treatment with Taiwanese betel quid (BQ) extract. A new cell line, HCDB-1, has been established from induced carcinomas. The cultured monolayer cells were epithelioid in shape with irregular nuclei. They demonstrated abundant cytokeratin and tonofilaments; however, ultrastructural well-organized desmosomes were lacking. The HCDB-1 cell exhibited population doubling in 19 h and was highly tumorigenic in nude mice. A C-->T transition at codon 141 (Ala to Val) of the p53 gene was detected in this cell. This mutation is equivalent to a specific temperature-sensitive mouse p53Ala135Val mutant that causes transformation by shifting to 37.5 degrees C. HCDB-1 is the first cell line established from the HBP model of oral carcinogenesis induced by DMBA/Taiwanese BQ extract. It might be valuable for exploring the molecular pathogenesis of oral cancer.
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MESH Headings
- 9,10-Dimethyl-1,2-benzanthracene
- Animals
- Areca
- Carcinoma, Papillary/chemically induced
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/ultrastructure
- Cell Division
- Cricetinae
- Genes, p53
- Mice
- Mouth Neoplasms/chemically induced
- Mouth Neoplasms/genetics
- Mouth Neoplasms/pathology
- Mouth Neoplasms/ultrastructure
- Plant Extracts/toxicity
- Plants, Medicinal
- Polymerase Chain Reaction
- Polymorphism, Single-Stranded Conformational
- Taiwan
- Tumor Cells, Cultured
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Affiliation(s)
- S C Lin
- Institute of Oral Biology and Department of Dentistry, National Yang-Ming University, Taipei, Taiwan, ROC
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49
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Abstract
To determine the alterations of the p16/MTS1 gene in oral squamous cell carcinoma (OSCC), we examined in Taiwanese patients the mutation, deletion and methylation of p16/MTS1 in primary OSCCs associated mostly with betel quid (BQ)/tobacco use. Among 110 tumors undergoing mutational analyses, seven (6%) showed mutations in exon 2 or the intron 1/exon 2 splice site. All but one mutation disrupted the encoded proteins. Base transitions represented the vast majority (6/7) of the mutations identified in BQ/tobacco consuming subjects. It was noted that 15/56 (27%) tumors examined by restriction fragment methylation analysis revealed a significant level of methylation in different loci of exon 1 as compared with the respective non-cancerous tissue. Mutation of p16/MTS1 was exclusively identified in carcinomas of buccal mucosa, whereas methylation of the p16/MTS1 promoter region occurred preferentially in carcinomas of the tongue (54%) rather than at other sites (22%). Homozygous deletion was not found in 56 paired samples examined, nor was hemizygous deletion indicated in 12 informative cases. The results indicated aberrant methylation and mutation as the molecular abnormality of p16/MTS1 in the OSCC from Taiwanese.
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Affiliation(s)
- S C Lin
- Institute of Oral Biology and Faculty of Dentistry, National Yang-Ming University, Taiwan, ROC
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50
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Abstract
The expression of p53 and p21WAF1 in 53 oral verrucous leukoplakias (OVLs), mostly non-dysplastic lesions, was investigated to ascertain the role of such events in malignant conversion. Immunohistochemical analysis revealed aberrant p53 and p21WAF1 immunoreactivity in 51% (27 cases) and 75% (40 cases), respectively. After an average follow-up period of three and a half years, histopathological examination revealed that 22 (42%) cases had developed oral squamous cell carcinoma (OSCC), 14 (26%) cases had undergone recurrence, and 17 (32%) cases were free of disease. The oncogenic potential of this subset of premalignant lesions warrants attention. A significant difference in the frequency of OSCC progression/recurrence was noted in lesions bearing aberrant immunoreactivity of either p53 (93% vs 42%; P=0.00008) or p21WAF1 (80% vs 32%; P=0.002) in comparison with lesions without immunoreactivity. This study suggested that the aberrant immunoreactivity of p53 and p21WAF1 may represent important alterations of OVL and could affect the outcome of this lesion.
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Affiliation(s)
- K W Chang
- The Faculty of Dentistry and Institute of Oral Biology, National Yang-Ming University, Taipei, Taiwan, ROC
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