1.Use of ADMS™ during sedation for dental treatment of an intellectually disabled patient: a case report.
Seong In CHI ; Hyun Jeong KIM ; Kwang Suk SEO ; Martin YANG ; Juhea CHANG
Journal of Dental Anesthesia and Pain Medicine 2016;16(3):217-222
Dental treatment is often performed under general anesthesia or sedation when an intellectually disabled patient has a heightened fear of treatment or has difficulty cooperating. When it is impossible to control the patient due to the severity of intellectual disability, conscious sedation is not a viable option, and only deep sedation should be performed. Deep sedation is usually achieved by propofol infusion using the target controlled infusion (TCI) system, with deep sedation being achieved at a slightly lower concentration of propofol in disabled patients. In such cases, anesthesia depth monitoring using EEG, as with a Bispectral Index (BIS) monitor, can enable dental treatment under appropriate sedation depth. In the present case, we performed deep sedation for dental treatment on a 27-year-old female patient with mental retardation and severe dental phobia. During sedation, we used BIS and a newly developed Anesthetic Depth Monitor for Sedation (ADMS™), in addition to electrocardiography, pulse oximetry, blood pressure monitoring, and capnometry for patient safety. Oxygen was administered via nasal prong to prevent hypoxemia during sedation. The BIS and ADMS™ values were maintained at approximately 70, and dental treatment was successfully performed in approximately 30 min..
Adult
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Anesthesia
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Anesthesia, General
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Anoxia
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Blood Pressure Monitors
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Conscious Sedation
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Deep Sedation
;
Dental Anxiety
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Electrocardiography
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Electroencephalography
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Female
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Humans
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Intellectual Disability
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Oximetry
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Oxygen
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Patient Safety
;
Propofol
2.An uncommon case of haemorrhagic enteric fever treated successfully with super-selective embolisation using polyvinyl alcohol particles and coils.
Wei Yang LIM ; Martin Weng Chin H'NG ; Sundeep PUNAMIYA
Singapore medical journal 2013;54(3):e53-5
Lower gastrointestinal haemorrhage due to enteric fever is uncommon and potentially fatal. The majority of patients recover with conservative treatment, with surgery reserved for life-threatening bleeding. Given the advances in radiologically guided procedures, there have been numerous reports of successful embolisation for gastrointestinal haemorrhage, although few of these involved enteric fever as the causative agent. We report an uncommon case of haemorrhagic enteric fever treated successfully with embolisation using polyvinyl alcohol particles and coils.
Adult
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Angiography
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Embolization, Therapeutic
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instrumentation
;
methods
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Female
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Gastrointestinal Hemorrhage
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therapy
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Humans
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Polyvinyl Alcohol
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chemistry
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Tomography, X-Ray Computed
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Treatment Outcome
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Typhoid Fever
;
therapy
3.Serum and Pleural Fluid Procalcitonin in Predicting Bacterial Infection in Patients with Parapneumonic Effusion.
Yang Ching KO ; Wen Pin WU ; Chi Sen HSU ; Mong Ping DAI ; Chien Chih OU ; Chih Hsiung KAO
Journal of Korean Medical Science 2009;24(3):398-402
This study evaluated the value of procalcitonin (PCT) levels in pleural effusion to differentiate the etiology of parapneumonic effusion (PPE). Forty-one consecutive PPE patients were enrolled and were divided into bacterial and non-bacterial PPE. Blood and pleural effusion samples were collected for PCT measurement on admission and analyzed for diagnostic evaluation. PCT of pleural fluid was significantly increased in the bacterial PPE group (0.24 ng/mL) compared to the non-bacterial PPE group (0.09 ng/mL), but there was no significant difference for serum PCT. A PCT concentration of pleural fluid >0.174 ng/mL (best cut-off value) was considered positive for a diagnosis of bacterial PPE (sensitivity, 80%; specificity, 76%; AUC, 0.84). Pleural effusion PCT in the bacterial PPE is significantly different from those of the non-bacterial PPE and control groups, so the diagnostic use of PCT still warrants further investigation.
Aged
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Bacterial Infections/*diagnosis
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Calcitonin/*analysis/blood
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Diagnosis, Differential
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Female
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Humans
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Male
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Middle Aged
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Pleural Effusion/*diagnosis
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Pneumonia/*diagnosis
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Predictive Value of Tests
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Protein Precursors/*analysis/blood
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ROC Curve
4.The experimental study of genetic engineering human neural stem cells mediated by lentivirus to express multigene.
Pei-qiang CAI ; Xun TANG ; Yue-qiu LIN ; Oudega MARTIN ; Guang-yun SUN ; Lin XU ; Yun-kang YANG ; Tian-hua ZHOU
Chinese Journal of Traumatology 2006;9(1):43-49
OBJECTIVETo explore the feasibility to construct genetic engineering human neural stem cells (hNSCs) mediated by lentivirus to express multigene in order to provide a graft source for further studies of spinal cord injury (SCI).
METHODSHuman neural stem cells from the brain cortex of human abortus were isolated and cultured, then gene was modified by lentivirus to express both green fluorescence protein (GFP) and rat neurotrophin-3 (NT-3); the transgenic expression was detected by the methods of fluorescence microscope, dorsal root ganglion of fetal rats and slot blot.
RESULTSGenetic engineering hNSCs were successfully constructed. All of the genetic engineering hNSCs which expressed bright green fluorescence were observed under the fluorescence microscope. The conditioned medium of transgenic hNSCs could induce neurite flourishing outgrowth from dorsal root ganglion (DRG). The genetic engineering hNSCs expressed high level NT-3 which could be detected by using slot blot.
CONCLUSIONSGenetic engineering hNSCs mediated by lentivirus can be constructed to express multigene successfully.
Animals ; Cell Differentiation ; Cells, Cultured ; Feasibility Studies ; Gene Expression ; Genetic Engineering ; methods ; Genetic Therapy ; methods ; Genetic Vectors ; genetics ; Green Fluorescent Proteins ; Humans ; Immunohistochemistry ; Lentivirus ; genetics ; Microscopy, Fluorescence ; Neurons ; metabolism ; Rats ; Stem Cell Transplantation ; Stem Cells ; metabolism ; Transgenes
5.Genetic engineering neural stem cell modified by lentivirus for repair of spinal cord injury in rats.
Xun TANG ; Pei-Qiang CAI ; Yue-Qiu LIN ; Martin OUDEGA ; Bas BLITS ; Ling XU ; Yun-Kang YANG ; Tian-Hua ZHOU
Chinese Medical Sciences Journal 2006;21(2):120-124
OBJECTIVETo explore the feasibility for therapy of spinal cord injury (SCI) by genetic engineering neural stem cell (NSC) modified by lentiviral vector.
METHODSFollowing the construction of the genetic engineering NSC modified by lentivirus to secrete both neurotrophic factor-3 (NT-3) and green fluorescence protein (GFP), hemisection of spinal cord at the level of T10 was performed in 56 adult Wistar rats that were randomly divided into 4 groups (n = 14), namely 3 therapeutic groups and 1 control group. The therapeutic groups were dealed with NSC, genetic engineering NSC, and concentrated lentiviral supernatant which carries both GFP and NT-3, respectively. Then used fluorescence microscope to detect the transgenic expression in vitro and in vivo, migration of the grafted cells in vivo, and used the Basso, Beattie, and Bresnahan (BBB) open-field locomotor test to assess the recovery of function.
RESULTSThe transplanted cells could survive for long time in vivo and migrate for long distance. The stable transgenic expression could be detected in vivo. The hindlimb function of the injured rats in 3 therapeutic groups, especially those dealed with genetic engineering NSC, improved obviously.
CONCLUSIONIt is feasible to combine NSC with lentivirus for the repair of SCI. NSC modified by lentivirus to deliver NT-3, acting as a source of neurotrophic factors and function cell in vivo, has the potential to participate in spinal cord repair.
Animals ; Cell Line ; Embryonic Stem Cells ; transplantation ; Female ; Genetic Engineering ; methods ; Genetic Vectors ; Green Fluorescent Proteins ; genetics ; Lentivirus ; genetics ; Neurons ; transplantation ; Neurotrophin 3 ; genetics ; Rats ; Rats, Wistar ; Spinal Cord Injuries ; therapy
6.Spatial analysis on the distribution of hemorrhagic fever with renal syndrome by geographic information system in Haidian district, Beijing.
Li-qun FANG ; Wu-chun CAO ; Zhe DUN ; Xiao-ming WU ; Pei-yuan SUN ; Martin KULLDORFF ; Bing-cai WANG ; Hong YANG ; Xiao-wen LI
Chinese Journal of Epidemiology 2003;24(11):1020-1023
OBJECTIVETo analyze the spatial distribution of hemorrhagic fever with renal syndrome (HFRS) in Haidian district, Beijing and to explore the geographical characteristics of HFRS in highly endemic areas.
METHODSAdministration boundary layer was established under the background of 1:100,000 map in the ArcInfo 8.1 software. The HFRS cases from 1997 to 2002 were positioned on the map. Highly endemic areas were identified by spatial cluster analysis using SaTScan 3.0 software. Distribution of HFRS cases was shown in different colors and contours by spatial analysis of geographic information system (GIS).
RESULTSSpatial Cluster Analysis of confirmed cases of HFRS identified in 1997 - 2002 in Haidian district showed that HFRS patients were not randomly distributed. The highly endemic areas were founded in Sujiatuo township, Yongfeng township, Shangzhuang township, Wenquan town and Bei'anhe township (relative risk = 4.43, P = 0.001). A thematic map of HFRS in haidian district was set up.
CONCLUSIONHFRS infections were not randomly distributed, since the distribution was related to geographic-environmental factors.
China ; epidemiology ; Hemorrhagic Fever with Renal Syndrome ; epidemiology ; Humans ; Urban Health ; statistics & numerical data ; Urbanization
7.Dynamic condylar screw or hip joint (spanning) external fixator for treatment of pathological fractures of femoral neck and trochanter secondary to benign lesions.
Chun-lin ZHANG ; Bing-fang ZENG ; Yang DONG ; Daria brooks TERRELL ; Martin M MALAWER
Chinese Medical Journal 2008;121(2):178-180
Adolescent
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Adult
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Bone Screws
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Child
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External Fixators
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Female
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Femoral Neck Fractures
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surgery
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Femoral Neoplasms
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complications
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surgery
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Hip Fractures
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surgery
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Humans
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Male
8.First report of a novel abluminal groove filled biodegradable polymer rapamycin-eluting stent in de novo coronary artery disease: results of the first in man FIREHAWK trial.
Jie QIAN ; Bo XU ; Alexandra J LANSKY ; Yue-jin YANG ; Shu-bin QIAO ; Yong-jian WU ; Jue CHEN ; Feng-huan HU ; Wei-xian YANG ; Gary S MINTZ ; Martin B LEON ; Run-lin GAO
Chinese Medical Journal 2012;125(6):970-976
BACKGROUNDDurable polymers used for first-generation drug-eluting stents (DES) potentially contribute to persistent inflammation and late DES thrombosis. We report the first in human experience with the rapamycin-eluting biodegradable polymer coated cobalt-chromium FIREHAWK stent with abluminal groove.
METHODSA total of 21 patients with stable or unstable angina, or prior myocardial infarction, with single de novo native coronary stenoses < 30 mm in length in vessel sizes ranging from 2.25 to 4.0 mm were enrolled. The primary endpoint was major adverse cardiac events (MACE) at 30 days defined as the composite of cardiac death, myocardial infarction (Q and non-Q), or ischemia-driven target lesion revascularization. Secondary endpoints include device, lesion, and clinical success rates, 4-month in-stent late lumen loss by quantitative coronary angiography (QCA), proportion of uncovered or malapposed stent struts by optical coherence tomograpphy (OCT) at 4 months, and MACE at 4, 12, 24 and 36-month follow-up.
RESULTSDevice success was 95.7%, lesion and clinical success was 100.0%. There were no MACE events at 30 days. One patient died of non-cardiac hemorrhagic stroke 5 days after index procedure. At 4 months, in-stent late loss was (0.13 ± 0.18) mm, and complete strut coverage was 96.2% by OCT with 0.1% strut malapposition. At 4-month follow-up there was no additional MACE events, and a single target vessel (non-target lesion) revascularization.
CONCLUSIONSThe FIREHAWK abluminal groove biodegradable polymer rapamycin-eluting stent demonstrated feasibility, safety and efficacy in this first in human experience. OCT findings indicated excellent stent strut coverage 4 months after implantation. Larger studies are required to confirm whether the early FIREHAWK stent results translate into longer term restenosis and thrombosis benefits.
Aged ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Artery Disease ; therapy ; Drug-Eluting Stents ; adverse effects ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Polymers ; administration & dosage ; Sirolimus ; administration & dosage ; Tomography, Optical Coherence
9.Efficacy and safety of FIREHAWK® abluminal groove filled biodegradable polymer sirolimus-eluting stents for the treatment of long coronary lesions: nine-month angiographic and one-year clinical results from TARGET I trial long cohort.
Bo XU ; Run-Lin GAO ; Rui-Yan ZHANG ; Hai-Chang WANG ; Zhan-Quan LI ; Yue-Jin YANG ; Chang-Sheng MA ; Ya-Ling HAN ; Alexandra J LANSKY ; Yong HUO ; Wei LI ; Martin B LEON
Chinese Medical Journal 2013;126(6):1026-1032
BACKGROUNDPrevious studies indicated that long coronary lesions are one of the key predictors of drug-eluting stent (DES) failure. The purpose of this study was to evaluate the efficacy and the safety of the long length FIREHAWK(®) stent in long coronary artery disease.
METHODSThe long cohort of TARGET I was a prospective, multicenter, single arm trial. It was planned to enroll 50 patients undergoing percutaneous coronary intervention (PCI) for the treatment of de novo long lesions in a native coronary artery. The major inclusion criteria of the trial was that patients were intended to undergo the treatment of a long target lesion(s) with diameter stenosis ≥ 70% and reference vessel diameter 2.5 mm to 4.0 mm by visual estimate, that needed to be covered by at least one 33 mm or 38 mm stent or multiple long stents overlapped. The angiographic follow-up was planned at 9-month and the clinical follow-up will be up to 5 years. The primary end point was in-stent late lumen loss at 9-month.
RESULTSFifty patients (mean age (57.6 ± 10.2) years) with 59 de novo long lesions (reference vessel diameter (2.85 ± 0.44) mm, lesion length (35.2 ± 9.4) mm, and stent length (41.8 ± 11.3) mm) were enrolled. The angiographic follow-up rate was 92% at 9-month. The in-stent late loss was (0.16 ± 0.16) mm. Proximal edge, distal edge and in-segment late loss (mm) were 0.21 ± 0.35, 0.03 ± 0.33, and 0.07 ± 0.26, respectively. No in-segment binary restenosis was observed. At 1-year no death, Q wave myocardial infarction (MI), or stent thrombosis occurred. Non-Q-wave MI occurred in two patients (4%) due to procedural complications.
CONCLUSIONSTreatment of long coronary lesions with the FIREHAWK(®) stent is able to produce similar results as observed in the FIREHAWK(®) FIM clinical trial. Based on this result, we are confident in the treatment prospect of the FIREHAWK(®) for long coronary lesions.
Aged ; Coronary Artery Disease ; drug therapy ; therapy ; Drug-Eluting Stents ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Sirolimus ; adverse effects ; therapeutic use ; Treatment Outcome
10.Machine Learning-Based Prediction of COVID-19 Severity and Progression to Critical Illness Using CT Imaging and Clinical Data
Subhanik PURKAYASTHA ; Yanhe XIAO ; Zhicheng JIAO ; Rujapa THEPUMNOEYSUK ; Kasey HALSEY ; Jing WU ; Thi My Linh TRAN ; Ben HSIEH ; Ji Whae CHOI ; Dongcui WANG ; Martin VALLIÈRES ; Robin WANG ; Scott COLLINS ; Xue FENG ; Michael FELDMAN ; Paul J. ZHANG ; Michael ATALAY ; Ronnie SEBRO ; Li YANG ; Yong FAN ; Wei-hua LIAO ; Harrison X. BAI
Korean Journal of Radiology 2021;22(7):1213-1224
Objective:
To develop a machine learning (ML) pipeline based on radiomics to predict Coronavirus Disease 2019 (COVID-19) severity and the future deterioration to critical illness using CT and clinical variables.
Materials and Methods:
Clinical data were collected from 981 patients from a multi-institutional international cohort with real-time polymerase chain reaction-confirmed COVID-19. Radiomics features were extracted from chest CT of the patients. The data of the cohort were randomly divided into training, validation, and test sets using a 7:1:2 ratio. A ML pipeline consisting of a model to predict severity and time-to-event model to predict progression to critical illness were trained on radiomics features and clinical variables. The receiver operating characteristic area under the curve (ROC-AUC), concordance index (C-index), and time-dependent ROC-AUC were calculated to determine model performance, which was compared with consensus CT severity scores obtained by visual interpretation by radiologists.
Results:
Among 981 patients with confirmed COVID-19, 274 patients developed critical illness. Radiomics features and clinical variables resulted in the best performance for the prediction of disease severity with a highest test ROC-AUC of 0.76 compared with 0.70 (0.76 vs. 0.70, p = 0.023) for visual CT severity score and clinical variables. The progression prediction model achieved a test C-index of 0.868 when it was based on the combination of CT radiomics and clinical variables compared with 0.767 when based on CT radiomics features alone (p < 0.001), 0.847 when based on clinical variables alone (p = 0.110), and 0.860 when based on the combination of visual CT severity scores and clinical variables (p = 0.549). Furthermore, the model based on the combination of CT radiomics and clinical variables achieved time-dependent ROC-AUCs of 0.897, 0.933, and 0.927 for the prediction of progression risks at 3, 5 and 7 days, respectively.
Conclusion
CT radiomics features combined with clinical variables were predictive of COVID-19 severity and progression to critical illness with fairly high accuracy.