1,322 results on '"HS Lim"'
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2. POSTERS (1)59MULTIPOLAR CONTACT MAPPING GUIDED ABLATION OF TEMPORALLY STABLE HIGH FREQUENCY AND COMPLEX FRACTIONATED ATRIAL ELECTROGRAM SITES IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION60INTRA-CARDIAC AND PERIPHERAL LEVELS OF BIOCHEMICAL MARKERS OF FIBROSES IN PATIENTS UNDERGOING CATHETER ABLATION FOR ATRIAL FIBRILATION61THE DON'T WAIT TO ANTICOAGULATE PROJECT (DWAC) BY THE WEST OF ENGLAND ACADEMIC HEALTH SCIENCE NETWORK (AHSN) OPTIMISES STROKE PREVENTION FOR PATIENTS WITH ATRIAL FIBRILLATION (AF) WITHIN PRIMARY CARE IN LINE WITH NICE CG180 IN THE WEST OF ENGLAND62ILLNESS AND TREATMENT REPRESENTATIONS, COPING AND DISTRESS: VICIOUS CYCLES OF EVERYDAY EXPERIENCES IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION63THE NEEDS OF THE ADOLESCENT LIVING WITH AN INHERITED CARDIAC CONDITION: THE PATIENTS' PERSPECTIVE64SAFETY AND EFFICACY OF PARAMEDIC TREATMENT OF REGULAR SUPRAVENTRICULAR TACHYCARDIA (PARA-SVT)65NATURAL PROGRESSION OF QRS DURATION FOLLOWING IMPLATABLE CARDIOVERTER DEFIBRILLATORS (ICD) - IMPLANTATION66COMPARISON OF EFFICACY OF VOLTAGE DIRECTED CAVOTRICUSPID ISTHMUS ABLATION USING MINI VS CONVENTIONAL ELETRODES67CRYOBALLOON ABLATION (CRYO) FOR ATRIAL FIBRILLATION (AF) CANNOT BE GUIDED BY TEMPERATURE END-POINTS ALONE68MODERATOR BAND ECTOPY UNMASKED BY ADENOSINE AS A CAUSE OF ECTOPIC TRIGGERED IDIOPATHIC VF69EARLY CLINICAL EXPERIENCE WITH TARGETED SITE SELECTION FOR THE WiCS-LV ELECTRODE FOR CRT70DOES VECTOR MAPPING PRIOR TO IMPLANTABLE LOOP RECORDER INSERTION IMPROVE THE DETECTION OF ARRHYTHMIA?71THE ROLE OF SPECKLE TRACKING STRAIN IMAGING IN ASSESSING LEFT VENTRICULAR RESPONSE TO CARDIAC RESYNCHRONISATION THERAPY IN RESPONDERS AND NON-RESPONDERS72EVALUATING PATIENTS' EXPERIENCE AND SATISFACTION OF THE ATRIAL FIBRILLATION ABLATION PROCEDURE: A RETROSPECTIVE ANALYSIS73TROUBLESHOOTING LV LEAD IMPLANTATION - NOVEL 'UNIRAIL TECHNIQUE'74SUBCLINICAL ATHEROSCELEROSIS AND COGNITIVE IMPAIRMENT75EFFECT OF LOZARTANE ON DEVELOPMENT OF THE ELECTRICAL INSTABILITY OF THE MYOCARDIUM76THE INTERPLAY BETWEEN BODY COMPOSITION AND LEFT VENTRICULAR REMODELLING IN CARDIAC RESYNCHRONISATION THERAPY77FAMILY SCREENING IN IDIOPATHIC VENTRICULAR FIBRILLATION78MANAGEMENT OF ATRIAL FIBRILLATION IN A LARGE TEACHING HOSPITAL79THE EFFECT OF LEFT VENTRICULAR LEAD POSITION ON SURVIVAL IN PATIENTS WITH BINVENTRICULAR PACEMAKRS/DEFIBRILLATORS80ACUTE DEVICE IMPLANT-RELATED COMPLICATIONS DO NOT INCREASE LATE MORTALITY81ABORTED CARIDAC ARREST AS THE SENTINEL PRESENTATION IN A COHORT OF PATIENTS WITH THE CONCEALED BRUGADA PHENOTYPE82POST-CARDIAC DEVICE IMPLANTATION MOBILISATION ADVICE: A NATIONAL SURVEY83DO RISK SCORES DEVELOPED TO PROTECT ONE-YEAR MORTALITY ACTUALLY HELP IN ACCURATELY SELECTING PATIENTS RECEIVING PRIMARY PREVENTION ICD?84ATRIAL TACHYCARDIA ARISING FROM THE NON-CORONARY AORTIC CUSP85THE EFFECT OF DIFFERENT ATRIAL FIBRILLATION ABLATION STRATEGIES ON SURFACE ECG P WAVE DURATION86PRESCRIBING DRONEDARONE: HOW IS IT DONE ACROSS THE UK AND IS IT SAFE?87A CASE OF WIDE COMPLEX TACHYCARDIA88TRANSITION TO DEDICATED DAY CASE DEVICES - SAFETY AND EFFICACY IN A LARGE VOLUME CENTRE89SEQUENTIAL REGIONAL DOMINANT FREQUENCY MAPPING DURING ATRIAL FIBRILLATION: A NOVEL TEQUNIQUE90ELECTIVE CARDIOVERSION ENERGY PROTOCOLS: A RETROSPECTIVE COMPARISON OF ESCALATION STRATEGIES91THE INCIDENCE OF CLINCALLY RELEVANT HAEMATOMAS WITH PERIOPERATIVE USE OF NEWER P2Y12 INHIBITORS AND INTERRUPTED NOAC THERAPY IN CARDIAC IMPLANTABLE ELECTRONIC DEVICE INSERTION92AN AUDIT OF THE OUTCOMES FOR CHEMICAL AND DIRECT CURRENT CARDIOVERSION FOR ATRIAL FIBRILLATION AT OUR DGH OVER A 3 YEAR DURATION93REAL LIFE ACUTE MANAGEMET OF HAEMODYNAMICALLY TOLERATED MONOMORPHIC VENTRICULAR TACHYCARDIA. ARE WE MAKING EVIDENCE BASED ON DECISIONS?94A SERVICE EVALUATION TO ASSESS THE EFFICACY AND SAFETY OF NOVEL ORAL ANTICOAGULANTS VERSUS WARFARIN FOR ELECTIVE CARDIVERSION IN PATIENTS WITH NON VALVULAR AF IN A NURSE LED CARDIOVERSION SERVICE95PICK UP RATE OF IMPLANTED LOOP RECORDER AT A DISTRICT HOSPITAL
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K. Nizam ud Din, T.E. Edwards, R.J. Taylor, A.S. Sadiq, A.Y. Yeoh, A.S. Moss, Hassan Shariat, S.V. Saravu Vijayashankar, E. Yones, G.O. Furniss, A. Merghani, S.A. Akbar, G. Collins, Bode Ensam, K. Al-Lawati, M. Shah, S. Honarbakhsh, C.J. McAloon, N.V. Getman, Sevara Tairova, A.A. Khokhar, D. Thomas, K. Prakash, D.E. Thomas, A. Opel, Aaisha Opel, D.P. Redfearn, Wern Yew Ding, Shohreh Honarbakhsh, R.T. Buck, E.C. Taylor, J. Moore, G.A. Begg, D.T. Raine, P. Langley, E.J. Shepherd, S. Murray, S.W. Lord, J.P. Bourke, S. Plein, G.Y. Lip, M. H. Tayebjee, N. Owen, S. White, M. O'Neill, L.D. Hughes, S. Carroll, R. Moss-Morris, V. Baker, C. Kirkby, K. Patel, G. Robinson, S. Antoniou, L. Richmond, W. Ullah, R.J. Hunter, M. Finlay, M.J. Earley, M. Whitbread, R.J. Schilling, R. Cooper, S. Modi, R. Somani, A. Ng, N. Hobson, J.C. Caldwell, S. Hadjivassilev, R. Ang, M. Dhinoja, M. Earley, S. Sporton, R. Schilling, R. Hunter, P. Lambiase, A.J. Turley, N.M. Child, N.J. Linker, W.A. Owens, S.A. James, J. Milner, M. Tayebjee, J. Sibley, A. Griffiths, T. Meredith, Y. Basher, T.R. Betts, K. Rajappan, P.D. Lambiase, M.D. Lowe, Gulnara Rakhimbaeva, Nigora Akramova, T.V. Getman, T. Hamborg, J.P. O'Hare, H. Randeva, F. Osman, N. Srinivasan, E. Firman, L. Tobin, C. Murphy, M. Lowe, P. Mohan, G. Salahia, H.S. Lim, HS Lim, Velislav Batchvarov, Paul Brennan, Andrew Cox, Alison Muir, Elijah Behr, S. Hamill, C. Laventure, S. Newell, B. Gordon, K. Bashir, J. Chuen, W. Foster, S. Yusuf, S. Hayat, D. Panagopoulos, E.J. Davies, D.R. Tomlinson, G.A. Haywood, J. Mullan, N. Kelland, A. Horwood, N. Connell, S. Odams, J. Maloney, A. Shetty, A. Kyriacou, J. Sahu, J. Lee, O.U. Uzun, A.W. Wong, S.A. Ashtekar, Javad Hashemi, Saeed Gazor, Damian Redfearn, A. Song, J. Jenkins, J. Glancy, D.W. Wilson, E.S. Sammut, I.D. Diab, T.R.C. Cripps, A.G. Gill, S.A. Abbas, J.U. Enye, A.W. Wahab, S.E. Elshafie, K.L. Ling, P.C. Carey, D.C. Chatterjee, S.T. Timbrell, W.T. Tufail, H.W. Why, R.M. Martos, A.R. Thornley, S. James, M.G.D. Bates, E.H. Hassan, J.Q. Quick, R.P.W. Cowell, and E. Ho
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2016
3. DENGE ASSOCIADA À SÍNDROME DE GUILLAIN-BARRÉ
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HS Lima, LHL Bastos, LHB Carmona, and ARL Alves
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Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
Introdução: Os arbovírus, como a dengue, são transmitidos por artrópodes hematófagos, como os mosquitos do gênero Aedes. A dengue é uma doença infecciosa febril aguda, podendo se manifestar de forma leve ou grave. Entre as complicações graves, destaca-se a síndrome de Guillain-Barré, uma condição neurológica caracterizada por fraqueza muscular progressiva. Embora a associação entre dengue e síndrome de Guillain-Barré seja observada, a ocorrência de complicações neurológicas é rara. Objetivo: Este estudo tem como objetivo investigar a possível associação entre dengue e síndrome de Guillain-Barré. Materiais e métodos: Realizou-se uma revisão bibliográfica descritiva utilizando a plataforma Scientific Electronic Library Online (SCIELO). Utilizou-se o operador booleano “AND” e os descritores DeCS/MeSH: (dengue) and (Guillain-Barre Syndrome) and (Neurological). Foram considerados artigos publicados entre os anos de 2013 a 2023. Os critérios de inclusão foram a relevância para o tema e a associação clara entre a dengue e a síndrome de Guillain-Barré. Resultados e discussão: Foram identificados seis estudos relevantes, dos quais cinco foram selecionados para análise. A síndrome De Guillain-Barré é uma condição rara que afeta o sistema nervoso, causando danos na mielina, a bainha protetora dos nervos. Essa desmielinização compromete a transmissão correta dos sinais nervosos, resultando em fraqueza muscular, dormência e paralisia. Embora a associação entre dengue e seja descrita, é importante ressaltar que complicações neurológicas síndrome de Guillain-Barré decorrentes da dengue são pouco frequentes. Isso pode ser explicado pelo fato de que o vírus da dengue possui menor afinidade pelo sistema nervoso central em comparação com outros arbovírus, como o vírus da Chikungunya e Zika. O processo fisiopatológico da síndrome de Guillain-Barré envolve mecanismos imunológicos, nos quais a resposta imune contra o agente infeccioso resulta na produção de anticorpos que atacam os nervos periféricos, desencadeando uma resposta inflamatória e a subsequente desmielinização. Os anticorpos que fixam o complemento, macrófagos e células T desempenham papéis importantes nesse processo inflamatório. O diagnóstico das manifestações neurológicas associadas à dengue é realizado por meio de testes que detectam anticorpos específicos, aumento nos títulos de anticorpos, detecção de antígenos virais ou fragmentos de RNA em amostras de sangue ou líquor. Além disso, a síntese intratecal de anticorpos antiespecíficos pode ser analisada para auxiliar no diagnóstico da síndrome de Guillain-Barré. Conclusão: Embora existam evidências sugerindo uma associação entre dengue e síndrome de Guillain-Barré, é importante destacar que complicações neurológicas decorrentes da dengue são raras. Isso pode ser atribuído à menor tendência do vírus da dengue em atacar o sistema nervoso central em comparação com outros arbovírus. A compreensão dessa associação e o estudo de seus mecanismos fisiopatológicos são importantes para o avanço no conhecimento e manejo clínico dessas condições.
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- 2023
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4. Quantitative analysis and biological efficacies regarding the neuroprotective and antineuroinflammatory actions of the herbal formula SCD-B-033
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HS Lim, SJ Jeong, CS Seo, Kim, and J Kim Yu
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business.industry ,Medicine ,Pharmacology ,business ,Quantitative analysis (chemistry) ,Neuroprotection - Published
- 2017
5. Quantitative analysis of the five marker compounds in Mori Cortex Radicis and its anti-inflammatory effects
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Chang-Seob Seo, HS Lim, SJ Jeong, and HK Shin
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Pharmacology ,medicine.drug_class ,Chemistry ,Organic Chemistry ,Pharmaceutical Science ,Anti-inflammatory ,Analytical Chemistry ,Complementary and alternative medicine ,Drug Discovery ,Botany ,Mori Cortex ,medicine ,Molecular Medicine ,Quantitative analysis (chemistry) - Published
- 2014
6. Clinical review of rhegmatogenous retinal detachment in Korea - Does seasonal variation exist in rhegmatogenous retinal detachment?
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Hs Lim, H Jin, and Kh Lee
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medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Retinal detachment ,Mean age ,Retinal ,General Medicine ,Seasonality ,University hospital ,medicine.disease ,Sclera buckling ,Ophthalmology ,chemistry.chemical_compound ,chemistry ,medicine ,business - Abstract
Purpose We investigated demographic and clinical features including seasonal variation of rhegmatogenous retinal detachment in Suwon, South Korea. Methods We reviewed medical records of 778 patients who were diagnosed with rhegmatogenous retinal detachment at Ajou university hospital located in Suwon City (Gyeuonggi-do, South Korea) from February 1995 to December 2013. Incidence of rhegmatogenous retinal detachment was counted by months and seasons. Demographic and clinical features were also analyzed. Results Total 778 eyes of 778 patients (778 patients; 418 men and 360 women; the mean age, 46.6 ± 17.3 years; range, 10-85 years) were included in the study. 86.1% (670 eyes) of eyes were phakic and high myopic eyes accounted for 11.6% (90 eyes) of the cases. The cases with single retinal break were 47.9% (373 eyes) and the average count of retinal break was 1.46. 65.8% (512 eyes) of the cases were treated successfully with sclera buckling. Incidence of retinal detachment was not different according to months (p=0.385) and seasons (p=0.090). Comparing the results of warm seasons (spring and summer) and cold seasons (autumn and winter), incidence of rhegmatogenous retinal detachment did not differ (p=0.071). Conclusion Unlike previous reports in Japan, Middle East and Europe, our study has no correlation with seasons. Previous studies suggested the higher incidence of rhegmatogenous retinal detachment in warm seasons is due to ambient temperature and increased outdoor activity, but summer in Korea is highly humid and hot. Also, it includes long rainy season, so it is not a good season for outdoor activity as other regions. These features may influence the result of our study.
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- 2014
7. Idiopathic parkinsonism with superimposed manganese exposure: utility of positron emission tomography
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Kim Y, Jw, Kim, Ito K, Hs, Lim, Hae-Kwan Cheong, Jy, Kim, Yc, Shin, Ks, Kim, and Moon Y
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Diagnosis, Differential ,Male ,Manganese Poisoning ,Occupational Exposure ,Putamen ,Humans ,Parkinson Disease ,Middle Aged ,Magnetic Resonance Imaging ,Dihydroxyphenylalanine ,Tomography, Emission-Computed - Abstract
It is difficult to distinguish manganism from idiopathic parkinsonism by clinical signs only. Case history and examination: A 48-year-old welder for over 10 years complained of masked face, right side (arm and leg) resting tremor, and bradykinesia for over one year. Magnetic resonance imaging (MRI) findings showed symmetrical high signal intensities in the globus pallidus on T1 weighted image. These intensities disappeared almost completely six months after cessation of exposure. 18F-6-fluorodopa (18F-dopa) positron emission tomography (PET) findings showed reduced 18F-dopa uptake in the left putamen, findings which appear in idiopathic parkinsonism. A PET study is necessary to distinguish manganism from idiopathic parkinsonism, especially in a working environment with elevated Mn concentrations, such as welding.
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- 1999
8. Plasma Vegf and Angiopoietin-2 are Elevated in Diabetes but May Not Mediate the Effects of Hyperglycaemia on Atherosclerosis
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HS Lim, Lip Gyh, and AD Blann
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medicine.medical_specialty ,Endocrinology ,biology ,business.industry ,Internal medicine ,Diabetes mellitus ,Angiopoietin 2 ,VEGF receptors ,medicine ,biology.protein ,General Medicine ,medicine.disease ,business - Published
- 2004
9. Relationship of Angiopoietin-1 and −2 (Ang-1 and −2), Vascular Endothelial Growth Factor (VEGF) and Von Willebrand Factor (vWf) to Endothelial Damage in Congestive Heart Failure (CHF)
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B Freestone, Lip Gyh, HS Lim, Ay Chong, Andrew D. Blann, and GJ Caine
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medicine.medical_specialty ,biology ,business.industry ,VEGF receptors ,General Medicine ,Vascular endothelial growth factor ,chemistry.chemical_compound ,Von Willebrand factor ,chemistry ,Angiopoietin-1 ,Internal medicine ,biology.protein ,Cardiology ,Medicine ,business ,Congestive heart failure chf - Published
- 2004
10. Tissue Inhibitor of Matrix Metalloproteinase-1 is a Marker of Left Ventricular Diastolic Dysfunction in Diabetic Heart Disease
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MH Tayebjee, Lip Gyh, and HS Lim
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,Left ventricular diastolic dysfunction ,General Medicine ,Disease ,Diabetic heart ,Matrix metalloproteinase ,business - Published
- 2004
11. The Impact OF Multiple Cardiovascular Risk Factors ON Coronary Artery Stenosis
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Lip Gyh, MH Tayebjee, K. T. Tan, RJ MacFadyen, and HS Lim
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medicine.medical_specialty ,Framingham Risk Score ,business.industry ,Internal medicine ,Cardiovascular risk factors ,Cardiology ,medicine ,General Medicine ,Coronary stenosis ,business - Published
- 2004
12. Endothelial Damage/Dysfunction is Independently Associated with Diastolic Dysfunction in Diabetes
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Ay Chong, B Freestone, Lip Gyh, HS Lim, and Andrew D. Blann
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medicine.medical_specialty ,business.industry ,Internal medicine ,Diabetes mellitus ,medicine ,Diastole ,Cardiology ,General Medicine ,business ,medicine.disease - Published
- 2004
13. [Untitled]
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Gavin M. Joynt, K S Tan, HS Lim, SJ Ramsay, S Lee, and Charles D. Gomersall
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medicine.medical_specialty ,business.industry ,Emergency medicine ,medicine ,Critical Care and Intensive Care Medicine ,business ,Intensive care medicine ,Surgical patients - Abstract
Preoperative optimization of 'high-risk' elective surgical patients has been demonstrated to result in improved outcomes. However, it has been argued that the mortality in the control groups was higher than expected, given the inclusion criteria. There have been no previous systematic studies of the outcome of patients who meet 'high-risk' criteria.
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- 2003
14. Increase in signal intensities on T1-weighted magnetic resonance images in asymptomatic manganese-exposed workers
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Kim Y, Ks, Kim, Js, Yang, Ij, Park, Kim E, Jin Y, Kr, Kwon, Kh, Chang, Jw, Kim, Sh, Park, Hs, Lim, Hae-Kwan Cheong, Yc, Shin, Park J, and Moon Y
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Adult ,Male ,Manganese ,Korea ,Manganese Poisoning ,Occupational Exposure ,Surveys and Questionnaires ,Brain ,Humans ,Magnetic Resonance Imaging ,Signal Transduction - Abstract
To clarify the clinical significance of increased signal intensities on T1 weighted magnetic resonance imaging (MRI) we performed a large-scale epidemiological study on asymptomatic manganese (Mn)-exposed workers with its focus on MRI.We randomly selected 121 male workers out of a total of 750 workers including Mn-exposed, non-exposed manual, and non-exposed clerical workers in the factories. We studied environmental and biological monitoring, neurological examination, and MRI.The proportion of workers with increased signal intensities among the exposed, the non-exposed manual workers, and the non-exposed clerical workers was 46.1%, 18.8%, and 0%, respectively. Especially, 73.5% of the welders showed increased signal intensities. In no subject, were clinical signs of manganism observed. The pallidal index correlated with blood Mn concentration.Increase in signal intensities on the T1-weighted image reflect recent exposure to Mn, but not necessarily manganism. At which increase of signal intensity, the progression of manganism from Mn exposure occurs, remains to be solved.
15. Low compliance and need for changes in national isolation guidelines for group 1 nationally notifiable communicable diseases in Korea
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YH Choi, J Gwack, ES Kim, HB Kim, K-H Song, and HS Lim
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Veterinary medicine ,Shigellosis ,Isolation (health care) ,business.industry ,Paratyphoid fever ,lcsh:R ,lcsh:Medicine ,General Medicine ,medicine.disease ,Cholera ,General Biochemistry, Genetics and Molecular Biology ,Typhoid fever ,Antibiotic therapy ,Environmental health ,Poster Presentation ,medicine ,lcsh:Q ,business ,lcsh:Science - Abstract
The national guidelines for group 1 nationally notifiable communicable diseases(cholera, typhoid fever, paratyphoid fever, shigellosis, and enterohemorrhagic Escherichia coli (EHEC) infection) recommend a universal isolation of the patients and screening for fecal shedding after finishing antibiotic therapy in Korea. This study was performed to evaluate the adequacy of the isolation guidelines.
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16. Prediction of early clinical response to neoadjuvant chemotherapy in Triple-negative breast cancer: Incorporating Radiomics through breast MRI.
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Lee HJ, Lee JH, Lee JE, Na YM, Park MH, Lee JS, and Lim HS
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- Humans, Female, Middle Aged, Retrospective Studies, Adult, Machine Learning, Treatment Outcome, Aged, ROC Curve, Breast diagnostic imaging, Breast pathology, Radiomics, Triple Negative Breast Neoplasms drug therapy, Triple Negative Breast Neoplasms diagnostic imaging, Triple Negative Breast Neoplasms pathology, Magnetic Resonance Imaging methods, Neoadjuvant Therapy
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This study assessed pretreatment breast MRI coupled with machine learning for predicting early clinical responses to neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC), focusing on identifying non-responders. A retrospective analysis of 135 TNBC patients (107 responders, 28 non-responders) treated with NAC from January 2015 to October 2022 was conducted. Non-responders were defined according to RECIST guidelines. Data included clinicopathologic factors and clinical MRI findings, with radiomics features from contrast-enhanced T1-weighted images, to train a stacking ensemble of 13 machine learning models. For subgroup analysis, propensity score matching was conducted to adjust for clinical disparities in NAC response. The efficacy of the models was evaluated using the area under the receiver-operating-characteristic curve (AUROC) before and after matching. The model combining clinicopathologic factors and clinical MRI findings achieved an AUROC of 0.752 (95% CI 0.644-0.860) for predicting non-responders, while radiomics-based models showed 0.749 (95% CI 0.614-0.884). An integrated model of radiomics, clinicopathologic factors, and clinical MRI findings reached an AUROC of 0.802 (95% CI 0.699-0.905). After propensity score matching, the hierarchical order of key radiomics features remained consistent. Our study demonstrated the potential of using machine learning models based on pretreatment MRI to non-invasively predict TNBC non-responders to NAC., (© 2024. The Author(s).)
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- 2024
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17. Severe early graft dysfunction post-heart transplantation: Two clinical trajectories and diastolic perfusion pressure as a predictor of mechanical circulatory support.
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Lim HS, Bhagra S, Berman M, Kwok CS, Chue C, Ranasinghe A, and Pettit S
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Background: Severe early graft dysfunction (EGD) is defined by mechanical circulatory support (MCS) <24 hours of heart transplantation (HT). We classified severe EGD based on timing of post-HT MCS: ''Immediate'' intra-operative vs ''Delayed'' post-operative MCS (after admission into intensive care unit (ICU) from operating theater). We hypothesized that (1) risk factors and clinical course differ between ''Immediate'' and ''Delayed'' MCS; and (2) diastolic perfusion pressure (DPP=diastolic blood pressure-central venous pressure) and Norepinephrine equivalents (NE=sum of vasopressor doses), as measures of vasoplegia are related to ''Delayed'' MCS., Methods: Two-center study of 216 consecutive patients who underwent HT. Recipient, donor, vasopressor doses and hemodynamic data at T0 and T6 (on admission and 6 hours after admission into ICU) were collected., Results: Of the 216 patients, 67 patients had severe EGD (''Immediate'' MCS: n = 43, ''Delayed'' MCS: n = 24). The likelihood of ''immediate'' MCS but not ''delayed'' MCS increased with increasing warm ischemic and cardiopulmonary bypass times on multinomial regression analysis with ''no MCS'' as the referent group. One-year mortality was highest in ''Immediate'' MCS vs ''no MCS'' and ''delayed'' MCS (34.9% vs 3.4% and 8% respectively, p < 0.001). Of the patients who had no immediate post-transplant MCS, DPP and NE at T6 were independently associated with subsequent ''delayed'' MCS. Sensitivity and specificity of NE≥ 0.2 mcg/kg/min for ''Delayed'' MCS were 71% and 81%. Sensitivity and specificity of DPP of ≥40 mmHg for No MCS were 83% and 74%. The discriminatory value of systemic vascular resistance for ''Delayed'' MCS was poor., Conclusion: Risk factors and 1-year survival differed significantly between ''Immediate'' and ''Delayed'' post-HT MCS. The latter is related to lower DPP and higher NE, which is consistent with vasoplegia as the dominant pathophysiology., (Copyright © 2024 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
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- 2024
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18. Advertising for Brands and Society: The Role of Perceived Authenticity in Corporate Transgender Advocacy Advertising Campaigns.
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Lim HS, Moon WK, and Ciszek E
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- Humans, Male, Female, Adult, Consumer Advocacy, Social Media, United States, Organizations, Transgender Persons, Advertising
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While organizations have increasingly engaged in corporate social advocacy (CSA) for sexual and gender diverse populations, transgender people have often been overlooked in LGBTQ advocacy campaigns. Among the different strategic communication tactics that can be used in CSA, advertising is an important channel for organizations to send their prosocial messages as well as to publicly demonstrate their support of particular causes and populations. Given the tension between growing social acceptance of gender diverse populations and anti-transgender political landscape in the USA, only a handful of organizations have recently shown transgender advocacy advertising campaigns. This study explores corporate transgender advocacy advertising campaigns as one contemporary CSA program, attending to the role of authenticity in CSA effectiveness. Findings show cisgender people perceive authenticity from transgender advocacy advertising campaigns regardless of their gender, which in turn, mitigates consumer skepticism and increases the willingness to engage with the campaign on social media and, further, to engage with other transgender advocacy campaigns. Theoretical and practical implications are discussed.
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- 2024
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19. Exploring the therapeutic potential of Potentilla fragarioides var. major (Rosaceae) extract in Alzheimer's disease using in vitro and in vivo models: A multi-faceted approach.
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Sohn E, Lim HS, Jin Kim Y, Kim BY, Yoon J, Kim JH, and Jeong SJ
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Alzheimer's disease (AD) is the most common cause of dementia and is caused by various factors including amyloid-beta (Aβ) aggregation. We investigated the pharmacological effects of the ethanol extract of Potentilla fragarioides var. major (Rosaceae) (EEPF) on AD-related pathogenesis, which remain elusive. We observed the effects of EEPF on Aβ disaggregation and free-radical scavenging activities for 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) using in vitro assays, evaluated the effects of EEPF on memory loss in two animal models, and examined the molecular regulatory mechanisms of EEPF using an antibody-protein microarray in EEPF-treated neuronal cell lines. EEPF inhibited Aβ aggregation in a concentration-dependent manner and enhanced free-radical scavenging activities for ABTS and DPPH. EEPF significantly inhibited memory impairment in the passive avoidance task, Y-maze test, and Morris water maze test in scopolamine-induced short-term memory loss mice and Aβ-injected AD-like mice. Nissl staining and immunohistochemistry for NeuN and Iba-1 confirmed the neuroprotective and anti-inflammatory effects of EEPF in both animal models. In H
2 O2 -treated HT22 hippocampal cells, EEPF significantly prevented cell damage, enhanced CaMK2, and reduced ferric reductase. In lipopolysaccharide (LPS)-stimulated BV-2 microglia, EEPF significantly inhibited LPS-induced production of inflammatory factors, such as nitric oxide, prostaglandin E2, tumor necrosis factor-α, and interleukin-6, and decreased the phosphorylation of Smad3 and cyclin D3. High-performance liquid chromatography confirmed that EEPF has five major components: neochlorogenic acid, chlorogenic acid, polydatin, isochlorogenic acid A, and buddleoside, with amounts ranging across 1.91-9.41 mg/g. EEPF may be a promising drug for treatment of AD and AD-related brain disorders., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 International Brain Research Organization (IBRO). Published by Elsevier Inc. All rights reserved.)- Published
- 2024
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20. Hemocompatibility-related Adverse Events in Patients With Temporary Mechanical Circulatory Support: The Scoring Haemostasis Events and Assessment for Risk (SHEAR) Score.
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Pappalardo F, Delmas C, Bertoldi L, Montisci A, Nap A, Ott S, Hunziker P, Lim HS, Panholzer B, Schwabenland I, Tycinska A, Stoppe C, and Vandenbriele C
- Abstract
Evaluation of treatment outcomes in patients supported by temporary mechanical circulatory support (tMCS) currently relies mainly on mortality, which may not sufficiently address other patient benefits or harms. Bleeding and thrombosis are major contributors to mortality. Still, current bleeding scores are not designed for critically ill patients undergoing tMCS, only consider selected populations, and do not account for the high heterogeneity among bleeding and thrombotic adverse events. To improve clinical management, a group of European experts has proposed a revised scoring system based on the MOMENTUM 3 Hemocompatibility Score and the Society of Cardiac Angiography and Interventions (SCAI)classification of cardiogenic shock. The new system termed the Scoring Haemostasis Events and Assessment for Risk (SHEAR) score, is divided into a baseline characterization stage and four escalating scoring stages encompassing all aspects of clinical relevance. This report summarizes the literature on hemocompatibility-related adverse events associated with tMCS, including bleeding, stroke, vascular access complications, hemolysis, thrombosis, and device failure. The SHEAR score provides a simple and rapid bedside scoring system aiming to provide a univocal tool to increase physician awareness of hemocompatibility complications at baseline and beyond, improve clinical research, and enable the capture of device-related complications that will inform relevant outcomes beyond mortality., Competing Interests: Declaration of competing interest The authors declare the following financial interests and/or personal relationships that may be considered potential competing interests: All authors received honoraria from Abiomed., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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21. Heat stress mediated structural and functional change of tetratricopeptide repeat-containing thioredoxin, OsTDX, in Oryza sativa.
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Jung YJ, Park JH, Lim HS, and Lee JR
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Heat stress due to global warming adversely affects plant physiology and metabolism, significantly reducing agricultural productivity. Plants have evolved various adaptive mechanisms to cope with such stresses, involving a range of heat stress-responsive proteins. This study investigates the molecular functions and structural changes of OsTDX (Oryza sativa TPR repeat-containing thioredoxin) in rice under heat stress, focusing on its roles as a disulfide reductase and molecular chaperone. OsTDX, sharing a 52 % overall amino acid identity with AtTDX, predominantly forms high molecular weight (HMW) complexes under heat stress conditions. Functional assays revealed that OsTDX exhibited increased disulfide reductase activity in a dose-dependent manner and significantly enhanced holdase chaperone activity, particularly under specific heat stress conditions (60 °C). The structural shift from low molecular weight (LMW) to HMW forms was accompanied by increased hydrophobicity, as indicated by bis-ANS fluorescence intensity measurements. In conclusion, OsTDX exhibits dual functions as a disulfide reductase and a holdase chaperone, with its chaperone activity significantly enhanced under heat stress through structural changes to HMW complexes. These findings contribute to understand the molecular mechanisms of heat tolerance in rice and highlight the potential role of OsTDX in the development of heat-tolerant crops to address crop yield declines due to global warming., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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22. Clinical and cost-effectiveness of left ventricular assist devices as destination therapy for advanced heart failure: systematic review and economic evaluation.
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Beese S, Avşar TS, Price M, Quinn D, Lim HS, Dretzke J, Ogwulu CO, Barton P, Jackson L, and Moore D
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- Humans, State Medicine, United Kingdom, Heart Failure economics, Heart Failure therapy, Heart-Assist Devices economics, Quality-Adjusted Life Years, Technology Assessment, Biomedical, Cost-Effectiveness Analysis
- Abstract
Background: Selected patients with advanced heart failure ineligible for heart transplantation could benefit from left ventricular assist device therapy as 'destination therapy'. There is evidence of the efficacy of destination therapy; however, it is not currently commissioned within the United Kingdom National Health Service due to the lack of economic evidence., Objective: What is the clinical and cost-effectiveness of a left ventricular assist device compared to medical management for patients with advanced heart failure ineligible for heart transplantation (destination therapy)?, Methods: A systematic review of evidence on the clinical and cost-effectiveness of left ventricular assist devices as destination therapy was undertaken including, where feasible, a network meta-analysis to provide an indirect estimate of the relative effectiveness of currently available left ventricular assist devices compared to medical management. For the systematic reviews, data sources searched (up to 11 January 2022) were Cochrane CENTRAL, MEDLINE and EMBASE via Ovid for primary studies, and Epistemonikos and Cochrane Database of Systematic Reviews for relevant systematic reviews. Trial registers were also searched, along with data and reports from intervention-specific registries. Economic studies were identified in EconLit, CEA registry and the NHS Economic Evaluation Database (NHS EED). The searches were supplemented by checking reference lists of included studies. An economic model (Markov) was developed to estimate the cost-effectiveness of left ventricular assist devices compared to medical management from the United Kingdom National Health Service/personal social service perspective. Deterministic and probabilistic sensitivity analyses were conducted to explore uncertainties. Where possible, all analyses focused on the only currently available left ventricular assist device (HeartMate 3
TM , Abbott, Chicago, IL, USA) in the United Kingdom., Results: The clinical effectiveness review included 134 studies (240 articles). There were no studies directly comparing HeartMate 3 and medical management (a randomised trial is ongoing). The currently available left ventricular assist device improves patient survival and reduces stroke rates and complications compared to earlier devices and relative to medical management. For example, survival at 24 months is 77% with the HeartMate 3 device compared to 59% with the HeartMate II (MOMENTUM 3 trial). An indirect comparison demonstrated a reduction in mortality compared to medical management [relative risk of death 0.25 (95% confidence interval 0.13 to 0.47); 24 months; this study]. The cost-effectiveness review included 5 cost analyses and 14 economic evaluations covering different generations of devices and with different perspectives. The reported incremental costs per quality-adjusted life-year gained compared to medical management were lower for later generations of devices [as low as £46,207 (2019 prices; United Kingdom perspective; time horizon at least 5 years)]. The economic evaluation used different approaches to obtain the relative effects of current left ventricular assist devices compared to medical management from the United Kingdom National Health Service/personal social service perspective. All gave similar incremental cost-effectiveness ratios of £53,496-58,244 per quality-adjusted life-year gained - lifetime horizon. Model outputs were sensitive to parameter estimates relating to medical management. The findings did not materially differ on exploratory subgroup analyses based on the severity of heart failure., Limitations: There was no direct evidence comparing the clinical effectiveness of HeartMate 3 to medical management. Indirect comparisons made were based on limited data from heterogeneous studies regarding the severity of heart failure (Interagency Registry for Mechanically Assisted Circulatory Support score distribution) and possible for survival only. Furthermore, the cost of medical management of advanced heart failure in the United Kingdom is not clear., Conclusions: Using cost-effectiveness criteria applied in the United Kingdom, left ventricular assist devices compared to medical management for patients with advanced heart failure ineligible for heart transplant may not be cost-effective. When available, data from the ongoing evaluation of HeartMate 3 compared to medical management can be used to update cost-effectiveness estimates. An audit of the costs of medical management in the United Kingdom is required to further decrease uncertainty in the economic evaluation., Study Registration: This study is registered as PROSPERO CRD42020158987., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128996) and is published in full in Health Technology Assessment ; Vol. 28, No. 38. See the NIHR Funding and Awards website for further award information.- Published
- 2024
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23. Cardiogenic shock trajectories: is the Society for Cardiovascular Angiography and Interventions definition the right one?
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Dorian D, Thomson RJ, Lim HS, and Proudfoot AG
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- Humans, Prognosis, Hemodynamics physiology, Societies, Medical, Shock, Cardiogenic physiopathology, Shock, Cardiogenic diagnostic imaging
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Purpose of Review: We review the current Society for Cardiovascular Angiography and Interventions (SCAI) cardiogenic shock classification system and consider alternatives or iterations that may enhance our current descriptions of cardiogenic shock trajectory., Recent Findings: Several studies have identified the potential prognostic value of serial SCAI stage re-assessment, usually within the first 24 h of shock onset, to predict deterioration and clinical outcomes across shock causes. In parallel, numerous registry-based analyses support the utility of a more precise assessment of the macrocirculation and microcirculation, leveraging invasive haemodynamics, imaging and additional laboratory and clinical markers. The emergence of machine learning and artificial intelligence capabilities offers the opportunity to integrate multimodal data into high fidelity, real-time metrics to more precisely define trajectory and inform our therapeutic decision making., Summary: Whilst the SCAI staging system remains a pivotal tool in cardiogenic shock assessment, communication and reassessment, it is vital that the sophistication with which we measure and assess shock trajectory evolves in parallel our understanding of the complexity and variability of clinical course and clinical outcomes., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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24. Translating the 'shunt fraction' method to derive native cardiac output during VA ECMO support.
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Lim HS
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- Humans, Heart Failure therapy, Heart Failure physiopathology, Extracorporeal Membrane Oxygenation methods, Cardiac Output physiology
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- 2024
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25. Treatment Response With Potassium-competitive Acid Blockers Based on Clinical Phenotypes of Gastroesophageal Reflux Disease: A Systematic Literature Review and Meta-analysis.
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Seo S, Jung HK, Gyawali CP, Lee HA, Lim HS, Jeong ES, Kim SE, and Moon CM
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Background/aims: Gastroesophageal reflux disease (GERD) is typically managed based on the clinical phenotype. We evaluated the efficacy and safety of potassium-competitive acid blockers (PCABs) in patients with various clinical GERD phenotypes., Methods: Core databases were searched for studies comparing PCABs and proton pump inhibitors (PPIs) in clinical GERD phenotypes of erosive reflux disease (ERD), non-erosive reflux disease (NERD), PPI-resistant GERD and night-time heartburn. Additional analysis was performed based on disease severity and drug dosage, and pooled efficacy was calculated., Results: In 9 randomized controlled trials (RCTs) evaluating the initial treatment of ERD, the risk ratio for healing with PCABs versus PPIs was 1.09 (95% CI, 1.04-1.13) at 2 weeks and 1.03 (95% CI, 1.00-1.07) at 8 weeks, respectively. PCABs exhibited a significant increase in both initial and sustained healing of ERD compared to PPIs in RCTs, driven particularly in severe ERD (Los Angeles grade C/D). In 3 NERD RCTs, PCAB was superior to placebo in proportion of days without heartburn. Observational studies on PPI-resistant symptomatic GERD reported symptom frequency improvement in 86.3% of patients, while 90.7% showed improvement in PPIresistant ERD across 5 observational studies. Two RCTs for night-time heartburn had different endpoints, limiting meta-analysis. Pronounced hypergastrinemia was observed in patients treated with PCABs., Conclusions: Compared to PPIs, PCABs have superior efficacy and faster therapeutic effect in the initial and maintenance therapy of ERD, particularly severe ERD. While PCABs may be an alternative treatment option in NERD and PPI-resistant GERD, findings were inconclusive in patients with night-time heartburn.
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- 2024
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26. Luminescent Cs 8 PbBr 6 4+ Quantum Dots Centered on the Octahedral PbBr 6 4- Cluster within Zeolite LTA: Exploring the Edge of Three-Dimensional Crystal Structure and Its Stability.
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Lim HS, Jeong SG, Park GB, Kim JY, Heo NH, and Lim WT
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The perovskite quantum dots (QDs) of CsPbX
3 (X = Cl, Br, I) exhibit exceptional photoluminescent properties, but their sensitivity to moisture and heat poses a challenge. This study presents a solvent-free synthesis approach for incorporating CsPbBr3 perovskite QDs into zeolite A. The introduction of [Cs8 PbBr6 ]4+ perovskite QDs into the zeolite framework resulted in a highly stable configuration, maintaining its initial luminescence properties even after being underwater or exposed to heat. The structure is determined by 3-dimensional single-crystal crystallography. Each octahedral PbBr6 4- ion is surrounded by Cs+ ions and [Cs8 PbBr6 ]4+ perovskite QDs being formed at the 32% of the center of a large cavity. Further, [Na12 CsBr8 ]5+ QDs are formed at the very center of another 46% large cavities by combining Cs+ , Na+ , and Br- ions. The peak in the emission spectrum of Pb,Br,Cs,Na-A is similar to those of the CsPbBr3 nanocrystal, Cs4 PbBr6 0-dimensional perovskite QDs, and Pb,Br,H,Cs,Na-FAU(X and Y). This work demonstrates that Pb,Br,Cs,Na-A can be produced using a simplified solvent-free synthesis procedure, which exhibits excellent stability against moisture and heat. Moreover, through a straightforward process, various quantum dots (QDs) can be incorporated into zeolite cavities to develop materials with variety photoluminescent properties.- Published
- 2024
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27. Management of Acute Coronary Syndromes in Older People: Comprehensive Review and Multidisciplinary Practice-Based Recommendations.
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Narendren A, Whitehead N, Burrell LM, Yudi MB, Yeoh J, Jones N, Weinberg L, Miles LF, Lim HS, Clark DJ, Al-Fiadh A, Farouque O, and Koshy AN
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Managing health care for older adults aged 75 years and older can pose unique challenges stemming from age-related physiological differences and comorbidities, along with elevated risk of delirium, frailty, disability, and polypharmacy. This review is aimed at providing a comprehensive analysis of the management of acute coronary syndromes (ACS) in older patients, a demographic substantially underrepresented in major clinical trials. Because older patients often exhibit atypical ACS symptoms, a nuanced diagnostic and risk stratification approach is necessary. We aim to address diagnostic challenges for older populations and highlight the diminished sensitivity of traditional symptoms with age, and the importance of biomarkers and imaging techniques tailored for older patients. Additionally, we review the efficacy and safety of pharmacological agents for ACS management in older people, emphasizing the need for a personalized and shared decision-making approach to treatment. This review also explores revascularization strategies, considering the implications of invasive procedures in older people, and weighing the potential benefits against the heightened procedural risks, particularly with surgical revascularization techniques. We explore the perioperative management of older patients experiencing myocardial infarction in the setting of noncardiac surgeries, including preoperative risk stratification and postoperative care considerations. Furthermore, we highlight the critical role of a multidisciplinary approach involving cardiologists, geriatricians, general and internal medicine physicians, primary care physicians, and allied health, to ensure a holistic care pathway in this patient cohort.
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- 2024
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28. Arrhythmogenic Mitral Valve Prolapse: Can We Risk Stratify and Prevent Sudden Cardiac Death?
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Cameron JN, Kadhim KI, Kamsani SH, Han HC, Farouque O, Sanders P, and Lim HS
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Ventricular arrhythmias associated with mitral valve prolapse (MVP) and the capacity to cause sudden cardiac death (SCD), referred to as 'malignant MVP', are an increasingly recognised, albeit rare, phenomenon. SCD can occur without significant mitral regurgitation, implying an interaction between mechanical derangements affecting the mitral valve apparatus and left ventricle. Risk stratification of these arrhythmias is an important clinical and public health issue to provide precise and targeted management. Evaluation requires patient and family history, physical examination and electrophysiological and imaging-based modalities. We provide a review of arrhythmogenic MVP, exploring its epidemiology, demographics, clinical presentation, mechanisms linking MVP to SCD, markers of disease severity, testing modalities and management, and discuss the importance of risk stratification. Even with recently improved understanding, it remains challenging how best to weight the prognostic importance of clinical, imaging and electrophysiological data to determine a clear high-risk arrhythmogenic profile in which an ICD should be used for the primary prevention of SCD., Competing Interests: Disclosure: SHBK has received travel expenses from Abbott and Medtronic. PS has received funding from Boston Scientific, Medtronic, Abbott Medical and Becton Dickenson, speaker fees from Pfizer, and a fellowship from the National Health and Medical Research Council of Australia; and has served on the advisory boards of Medtronic, Abbott Medical, Boston Scientific, CathRx and Pacemate. HSL has received funding from the Australian Government’s Medical Research Future Fund; travel expenses from the Asia Pacific Heart Rhythm Society Conference; and research support from Abbott and Medtronic; and is the Australian Representative for the AsiaPacific Heart Rhythm Society. All other authors have no conflicts of interest to declare., (Copyright © The Author(s), 2024. Published by Radcliffe Group Ltd.)
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- 2024
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29. Prevalence, Implications, and Risk Factors of Traumatic Dural Tears in Thoracic and Lumbar Fractures: A Retrospective Study.
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Mohamad NH, Salim AA, Yusof MI, Khoh PS, Lim HS, Bahrin Z, and Sadagatullah AN
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Introduction Spine fracture in association with traumatic dural tear is a serious injury. A traumatic dural tear is difficult to determine based on initial clinical presentation and radiological imaging even with magnetic resonance imaging (MRI). However, during decompression surgery, cerebrospinal fluid leaks surrounding the injured segments are usually confirmed by directly visualizing them. For preoperative planning and intraoperatively limiting further damage to the dural and neurological structures, early detection of traumatic dural tears before surgery is important. This study aims to determine the prevalence, implication, risk factors, and complications of traumatic dural tears in patients who have undergone surgical treatment for thoracic and lumbar fractures. We believe our retrospective study would identify more accurate risk factors for traumatic dural tears and aid us with preoperative planning and operative precaution. Methods This study retrospectively included all patients who had thoracic and lumbar fractures and had posterior instrumentation and decompression surgery at three hospitals in the Northern region of Malaysia from January 2018 to December 2020. Fractures associated with pathological spine including metastatic, severe osteoporosis, ankylosing spondylitis, metabolic bone disease, those with missing data, and iatrogenic dural tears were excluded from this study. Preoperative and postoperative neurological assessments based on the American Spinal Injury Association (ASIA) impairment scale, blood loss volume, duration of the surgery, and post-surgery complications were gathered from medical records. Interpedicular distance, ratio of central canal diameter, laminar fracture gap, and pedicle fractures were identified and measured. The obtained data was analyzed using Pearson's chi-square and Fisher's exact test for categorical variables, and independent t-test/Mann-Whitney test for numerical variables. Result This study comprised a total of 93 patients who had fractures in their thoracic and lumbar regions. The mean age of the patients was 38 years. The number of patients with traumatic dural tears was 20 (21.5%). There was an association between the presence of dural tears and preoperative neurological deficits (P<0.001). Wider mean interpedicular distance (P=0.004), increased central canal diameter ratio (P<0.001), and displaced laminar fracture (P<0.001) were significantly higher in patients with traumatic dural tears. Multiple logistic regression analysis showed both incomplete (P=0.002) and complete (P=0.037) preoperative neurological deficit, increase of central diameter ratio of encroachment (P=0.011), and presence of >2mm laminar fracture gap (P=0.015) had a significant association with a traumatic dural tear. This study found that patients with traumatic dural tears had longer surgical times and statistically larger mean blood loss volumes when compared to patients without dural tears (P<0.001). There is no significant association between the complications following the surgery and the presence of a dural tear (P>0.05). Conclusion This study shows that the presence of preoperative neurological deficits, wider interpedicular distance, severe canal encroachment, and wide separation of laminar fracture may indicate the likelihood of traumatic dural tear in spine fracture. These factors will enable surgeons to enhance their operational planning and make early preparations for the management of dural tears., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Human Research Ethics Committee Universiti Sains Malaysia issued approval USM/JEPeM/21070500. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mohamad et al.)
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- 2024
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30. Safety and efficacy of selumetinib in pediatric and adult patients with neurofibromatosis type 1 and plexiform neurofibroma.
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Kim H, Yoon HM, Kim EK, Ra YS, Kim HW, Yum MS, Kim MJ, Baek JS, Sung YS, Lee SM, Lim HS, Lee BJ, Lim HT, Kim D, Yoon J, Bae H, Hwang S, Choi YH, Kim KA, Choi IH, Lee SW, Park SJ, and Lee BH
- Abstract
Background: The MEK inhibitor, selumetinib, reduces plexiform neurofibroma (PN) in pediatric patients with neurofibromatosis type 1 (NF1). Its safety and efficacy in adults with PN and effectiveness in other NF1manifestations (e.g., neurocognitive function, growth reduction, and café-au-lait spots) are unknown., Methods: This open-label, phase 2 trial enrolled 90 pediatric or adult NF1 patients with inoperable, symptomatic, or potentially morbid, measurable PN (≥ 3 cm). Selumetinib was administered at doses of 20 or 25 mg/m2 or 50 mg q 12 hrs for 2 years. Pharmacokinetics, PN volume, growth parameters, neurocognitive function, café-au-lait spots, and quality of life (QoL) were evaluated., Results: Fifty-nine children and 30 adults (median age, 16 years; range, 3-47) received an average of 22±5 (4-26) cycles of selumetinib. Eighty-eight (98.9%) out of 89 per-protocol patients showed volume reduction in the target PN (median, 40.8%; 4.2%-92.2%), and 81 (91%) patients showed partial response (≥ 20% volume reduction). The response lasted until cycle 26. Scores of neurocognitive functions (verbal comprehension, perceptual reasoning, processing speed, and full-scale IQ) significantly improved in both pediatric and adult patients (P <0.05). Prepubertal patients showed increases in height score and growth velocity (P <0.05). Café-au-lait spot intensity decreased significantly (P <0.05). Improvements in QoL and pain scores were observed in both children and adults. All adverse events were CTCAE grade 1 or 2 and were successfully managed without drug discontinuation., Conclusion: Selumetinib decrease PN volume in the majority of pediatric and adult NF1 patients while also showing efficacy in non-malignant diverse NF1 manifestations., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology.)
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- 2024
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31. Multimodality imaging for the evaluation and management of patients with long-term (durable) left ventricular assist devices A Clinical Consensus Statement of the European Association of Cardiovascular Imaging (EACVI) of the ESC.
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Cameli M, Aboumarie HS, Pastore MC, Caliskan K, Cikes M, Garbi M, Lim HS, Muraru D, Mandoli GE, Pergola V, Plein S, Pontone G, Soliman OI, Maurovich-Horvat P, Donal E, Cosyns B, and Petersen SE
- Abstract
Left ventricular assist devices (LVADs) are gaining increasing importance as therapeutic strategy in advanced heart failure (HF), not only as bridge to recovery or to transplant, but also as destination therapy. Even though long-term LVADs are considered a precious resource to expand the treatment options and improve clinical outcome these patients, these are limited by peri-operative and post-operative complications, such as device-related infections, haemocompatibility-related events, device mispositioning and right ventricular failure. For this reason, a precise pre-operative, peri-operative and post-operative evaluation of these patients is crucial for the selection of LVADs candidates and the management LVADs recipients. The use of different imaging modalities offers important information to complete the study of patients with LVADs in each phase of their assessment, with peculiar advantages/disadvantages, ideal application and reference parameters for each modality. This clinical consensus statement sought to guide the use of multimodality imaging for the evaluation of patients with advanced HF undergoing LVADs implantation., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
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- 2024
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32. Antifungal prophylaxis against invasive Candida and Aspergillus infection in adult heart transplant recipients: protocol for a systematic review and meta-analysis.
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Irshad Z, Jenkins A, Lim HS, and Maidment ID
- Abstract
Introduction: Invasive fungal infections (IFI) can contribute to increased mortality and morbidity rates after heart transplant in adults. The most common causes are Aspergillus and Candida species. There is uncertainty on how effective antifungal prophylaxis is against Candida spp infections and limited guidance on the prevention of Aspergillus spp infections. This systematic review and meta-analysis will assess the literature to see if antifungal prophylaxis reduces the incidence of IFI after heart transplant in adults., Methods and Analysis: This systematic review protocol follows the Preferred Reporting Items for Systematic reviews and Meta Analysis guidelines. A systematic search of the Cochrane Library, Web of Science, Scopus, Embase, MEDLINE, and Proquest databases will be undertaken. Reference lists of retrieved publications and conference abstracts will also be searched. Title, abstract and full-text screening will be undertaken by two reviewers. Discrepancies will be resolved by a third reviewer. Studies with paediatric patients, multi-organ transplants, or patients with a second heart transplant will be excluded, along with those who do not have clear definitions and diagnostic criteria for IFI. Risk of bias will be assessed using the Cochrane Risk of Bias 2 tool and the Risk of Bias in Non-randomised Studies of Interventions tool. A meta-analysis will be carried out, but if studies are not deemed to be sufficiently similar, only a narrative synthesis will be undertaken., Ethics and Dissemination: Ethical approval is not required for this systematic review as primary data will not be collected. The results of the review will be disseminated through publication in an academic journal and scientific conferences., Prospero Registration Number: CRD42024516588., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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33. Childhood adversity and suicidal ideation in older Korean adults: unraveling the mediating mechanisms of mental health, physical health, and social relationships.
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Lee JK, Lee J, Chung MK, Shin T, Park JY, Lee KJ, Lim HS, Hwang S, Urtnasan E, Jo Y, and Kim MH
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- Humans, Male, Female, Republic of Korea epidemiology, Aged, Mental Health, Middle Aged, Depression psychology, Depression epidemiology, Aged, 80 and over, Suicidal Ideation, Adverse Childhood Experiences psychology, Adverse Childhood Experiences statistics & numerical data, Social Support, Health Status
- Abstract
Background: Suicide rates in older adults are much higher than those in younger age groups. Given the rapid increase in the proportion of older adults in Korea and the high suicide rate of this age group, it is worth investigating the mechanism of suicidal ideation for older adults. Generally, adverse childhood experiences are positively associated with suicidal ideation; however, it is not fully understood what mediating relationships are linked to the association between these experiences and current suicidal ideation., Methods: The data from 685 older Korean adults were analyzed utilizing logistic regression, path analyses, and structural equation modeling. Based on our theoretical background and the empirical findings of previous research, we examined three separate models with mental health, physical health, and social relationship mediators. After that, we tested a combined model including all mediators. We also tested another combined model with mediation via mental health moderated by physical health and social relationships., Results: The univariate logistic regression results indicated that childhood adversity was positively associated with suicidal ideation in older adults. However, multivariate logistic regression results demonstrated that the direct effect of childhood adversity became nonsignificant after accounting all variables. Three path models presented significant mediation by depression and social support in the association between childhood adversity and suicidal ideation. However, combined structural equation models demonstrated that only mediation by a latent variable of mental health problems was statistically significant. Social relationships moderated the path from mental health problems to suicidal ideation., Conclusions: Despite several limitations, this study has clinical implications for the development of effective strategies to mitigate suicidal ideation. In particular, effectively screening the exposure to adverse childhood experiences, early identification and treatment of depressive symptoms can play a crucial role in weakening the association between childhood adversity and suicidal ideation in older adults., (© 2024. The Author(s).)
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- 2024
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34. Hemodynamic management of cardiogenic shock in the intensive care unit.
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Lim HS, González-Costello J, Belohlavek J, Zweck E, Blumer V, Schrage B, and Hanff TC
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- Humans, Heart-Assist Devices, Shock, Cardiogenic therapy, Shock, Cardiogenic physiopathology, Hemodynamics physiology, Intensive Care Units
- Abstract
Hemodynamic derangements are defining features of cardiogenic shock. Randomized clinical trials have examined the efficacy of various therapeutic interventions, from percutaneous coronary intervention to inotropes and mechanical circulatory support (MCS). However, hemodynamic management in cardiogenic shock has not been well-studied. This State-of-the-Art review will provide a framework for hemodynamic management in cardiogenic shock, including a description of the 4 therapeutic phases from initial 'Rescue' to 'Optimization', 'Stabilization' and 'de-Escalation or Exit therapy' (R-O-S-E), phenotyping and phenotype-guided tailoring of pharmacological and MCS support, to achieve hemodynamic and therapeutic goals. Finally, the premises that form the basis for clinical management and the hypotheses for randomized controlled trials will be discussed, with a view to the future direction of cardiogenic shock., Competing Interests: Conflicts of interest SL has received honoraria from Abiomed. JGC reports having received fees for educational presentations from Abbott and Orion and consultancies and travel grants from Abbott. JB has received honoraria from Abiomed, Getinge, Resuscitec and Xenios. EZ reports no relevant conflict of interest with respect to the content of this manuscript. VB has reported no conflict of interest. BS has received research support from the German Research Foundation, the Else Kröner-Fresenius-Stiftung and Abiomed as well as speaker fees from Abbott, Abiomed and AstraZeneca, outside of the submitted work. TH has received a research grant through the ISHLT funded by Abiomed., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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35. Pharmacokinetic and Pharmacodynamic Modeling Analysis of Delpazolid (LCB01-0371) in Adult Patients with Pulmonary Tuberculosis.
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Lee SM, Choi SC, Mun KR, Seo JY, Cho YL, Shim TS, and Lim HS
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- Humans, Male, Female, Adult, Middle Aged, Aged, Antitubercular Agents pharmacokinetics, Antitubercular Agents therapeutic use, Antitubercular Agents administration & dosage, Young Adult, Dose-Response Relationship, Drug, Administration, Oral, Oxazolidinones pharmacokinetics, Oxazolidinones administration & dosage, Oxazolidinones therapeutic use, Tuberculosis, Pulmonary drug therapy, Models, Biological
- Abstract
Delpazolid (LCB01-0371) is a novel oxazolidinone derivative with a good safety profile for treating gram-positive pathogenic infections such as Mycobacterium abscessus, a highly pathogenic drug-resistant Mycobacterium. In this study, we evaluated the pharmacokinetics (PK) and pharmacodynamics (PD) of delpazolid after 14 days of multiple oral administration, using data from adult patients with pulmonary tuberculosis. 800 mg once a day, 400 mg twice a day, 800 mg twice a day, and 1200 mg once a day delpazolid for 14 days were tested in 63 patients with pulmonary tuberculosis. For PK blood collection, inpatient and outpatient scheduling were separately implemented. Plasma concentrations of delpazolid were measured at visits 2, 4, 6, and 8 in outpatients, and four sparse blood samples were measured in inpatients. PD models were sequentially fitted using individual PK parameter estimates obtained from PK compartmental models. For PK modeling, 180 plasma concentrations of delpazolid from 56 patients were included. A two-compartment mixed first- and zero-order absorption model best described the time course of plasma concentration. For the PD model, 448 bacterial titer data from 60 patients were used. The time course of bacterial titers (log
10 CFU/mL) was described by a model that consists of the growth and killing rate of bacteria with the sigmoid Emax model. The PK-PD simulation suggested that the bacterial titers are the lowest on the 800 mg bid regimen among the four, consistent with observed data, as all regimens substantially decrease. In the dose-response relationship, the effectiveness of delpazolid was suggested., (© 2024, The American College of Clinical Pharmacology.)- Published
- 2024
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36. Reduced frequency and severity of radiation esophagitis without marginal failure risk by contralateral esophagus sparing IMRT in stage III non-small cell lung cancer patients undergoing definitive concurrent chemoradiotherapy.
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Lim HS, Yang K, Noh JM, Pyo H, Kim JM, Kwon D, Ju SG, and Ahn YC
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- Humans, Male, Female, Middle Aged, Aged, Adult, Neoplasm Staging, Esophagus radiation effects, Esophagus pathology, Organ Sparing Treatments methods, Aged, 80 and over, Retrospective Studies, Severity of Illness Index, Esophagitis etiology, Carcinoma, Non-Small-Cell Lung pathology, Carcinoma, Non-Small-Cell Lung therapy, Carcinoma, Non-Small-Cell Lung radiotherapy, Chemoradiotherapy adverse effects, Chemoradiotherapy methods, Radiotherapy, Intensity-Modulated adverse effects, Radiotherapy, Intensity-Modulated methods, Lung Neoplasms pathology, Lung Neoplasms therapy, Lung Neoplasms radiotherapy, Radiation Injuries etiology
- Abstract
Purpose: Radiation esophagitis is frequent and annoying toxicity in high dose thoracic radiation therapy. Contalateral esophagus sparing intensity modulated radiation therapy (CES-IMRT) has been proposed to mitigate this problem, and this is to report the impact of CES-IMRT in definitive concurrent chemoradiotherapy (dCCRT) for lung cancer patients., Materials and Methods: From January 2021 till May 2023, 183 stage III non-small cell lung cancer patients underwent dCCRT. Esophagus was located within 1 cm from internal target volume in 159 patients. We comparatively evaluated the frequency and severity of esophagitis by pain-killer usage, analgesic quantification algorithm (AQA) score, and failure patterns in 159 CES-necessary patients., Results: All patients underwent dCCRT (66 Gy in 30 fractions with concurrent chemotherapy). Actual CES-IMRT application was determined based on the discretion of responsible radiation oncologists: CES-applied in 41 patients; and CES-unapplied in 118. CES-applied patients experienced pain events less frequently (pain-killer usage: 53.7 % vs. 77.1 %, p = 0.008) and less severely (AQA score of 2-3: 39.0 % vs. 68.6 %, p = 0.002). On multivariate analyses, overlapping volume of esophagus and planning target (HR = 1.32, 95 % CI 1.12-1.55, p = 0.001) and CES-IMRT application (HR = 0.31, 95 % CI 0.13-0.76, p = 0.010) were associated with AQA score of 2-3 less frequently. There were no differences in failure pattern, progression-free survival, and overall survival., Conclusions: CES-IMRT application resulted in less frequent and less severe pain events without compromising oncologic outcomes. Further studies, preferably in a randomized fashion, would be desired., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
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- 2024
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37. Pre-treatment radiological factors associated with poor functional outcome in an Asian cohort of large vessel occlusion acute ischemic stroke patients undergoing mechanical thrombectomy.
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Yeo JYP, Teo KSH, Tan EY, Yaow C, Hariz H, Lim HS, Ng BJM, Wong YHL, Subramaniam C, Makmur A, Han W, Chan MYY, Sia CH, Jing M, Tan BYQ, Tang DKK, and Yeo LLL
- Abstract
Background and Aims: Endovascular thrombectomy (EVT) is the current standard of care for large vessel occlusion (LVO) acute ischemic stroke (AIS); however, up to two-thirds of EVT patients have poor functional outcomes despite successful reperfusion. Many radiological markers have been studied as predictive biomarkers for patient outcomes in AIS. This study seeks to determine which clinico-radiological factors are associated with outcomes of interest to aid selection of patients for EVT for LVO AIS., Methods: A retrospective study of patients who underwent EVT from 2016 to 2020 was performed. Data on various radiological variables, such as anatomical parameters, clot characteristics, collateral status, and infarct size, were collected alongside traditional demographic and clinical variables. Univariate and multivariate analysis was performed for the primary outcomes of functional independence at 3 months post-stroke (modified Rankin Scale 0-2) and secondary outcomes of in-hospital mortality and symptomatic intracranial hemorrhage., Results: The study cohort comprised 325 consecutive patients with anterior circulation LVO AIS (54.5% male) with a median age of 68 years (interquartile range 57-76). The median NIHSS was 19. Age, hypertension, hyperlipidaemia, National Institutes of Health Stroke Scale (NIHSS), Alberta mCTA score, ASPECTS, clot length, thrombus HU and mTICI score and the angle between ICA and CCA were associated with functional outcomes at 3 months on univariate analysis. On multivariate analysis, age, Alberta mCTA collaterals and NIHSS were significantly associated with functional outcomes, while ASPECTS approached significance., Conclusion: Among the many proposed radiological markers for patients in the hyperacute setting undergoing EVT, the existing well-validated clinico-radiological measures remain strongly associated with functional status., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Yeo, Teo, Tan, Yaow, Hariz, Lim, Ng, Wong, Subramaniam, Makmur, Han, Chan, Sia, Jing, Tan, Tang and Yeo.)
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- 2024
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38. Development of a quality of life measure for left ventricular assist device recipients using a mixed methods approach.
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Slade AL, McMullan C, Haque MS, Griffith S, Marley L, Quinn D, O'Hara ME, Horton M, Calvert MJ, Lim HS, and Lane DA
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Background: Left ventricular assist device (LVAD) recipients report symptom improvement but find adjusting to life with the LVAD challenging. These challenges are unique, and existing patient-reported outcome measures (PROMs) do not reflect their experiences. This study aimed to develop a culturally relevant quality of life PROM for use with LVAD recipients in future research, design evolutions and clinical practice., Methods: A three-stage mixed-methods approach was used to develop a PROM: stage 1 included group concept mapping (GCM); stage 2 semi-structured qualitative interviews were conducted with 11 LVAD recipients and 10 clinicians, and a questionnaire was developed using a conceptual framework; and stage 3 used exploratory psychometric analysis of the PROM data using Rasch measurement theory. This paper presents stages 2 and 3., Results: The conceptual framework consisted of four key concepts, including general health, life with the LVAD, equipment and clothing and emotional impact. Statements from interviews and GCM were used to create items for the LVAD quality of life (LVAD-QoL). Cognitive interviews tested face validity and participant comprehension. Forty-nine participants were recruited from three UK transplant centres. PROM data were collected and analysed using Rasch analysis. Four items displayed misfit; dependency between item sets was the biggest issue (57/485 pairwise differences). After restructuring and dealing with item misfit, the LVAD-QoL conformed to the Rasch model, supporting the psychometric properties and quality of the LVAD-QoL., Conclusions: Using a mixed-methods approach ensured the development of a robust and psychometrically sound tool for research, design evolution and clinical practice with LVAD recipients., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
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- 2024
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39. Developing prediction algorithms for late-life depression using wearable devices: a cohort study protocol.
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Lee JK, Kim MH, Hwang S, Lee KJ, Park JY, Shin T, Lim HS, Urtnasan E, Chung MK, and Lee J
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- Humans, Aged, Republic of Korea epidemiology, Male, Female, Cohort Studies, Research Design, Machine Learning, Aged, 80 and over, Wearable Electronic Devices, Depressive Disorder, Major diagnosis, Depressive Disorder, Major epidemiology, Algorithms
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Introduction: Despite the high prevalence of major depressive disorder (MDD) among the elderly population, the rate of treatment is low due to stigmas and barriers to medical access. Wearable devices such as smartphones and smartwatches can help to screen MDD symptoms earlier in a natural setting while forgoing these concerns. However, previous research using wearable devices has mostly targeted the younger population. By collecting longitudinal data using wearable devices from the elderly population, this research aims to produce prediction algorithms for late-life depression and to develop strategies that strengthen medical access in community care systems., Methods and Analysis: The current cohort study recruited a subsample of 685 elderly people from the Korean Genome and Epidemiology Study-Cardiovascular Disease Association Study, a national large cohort established in 2004. The current study has been conducted over a 3-year period to explore the development patterns of late-life depression. Participants have completed three annual face-to-face interviews (baseline, the first follow-up and the second follow-up) and 2 years of app-based surveys and passive sensing data collection. All the data collection will end at the second follow-up interview. The collected self-report, observational and passive sensing data will be primarily analysed by machine learning., Ethics and Dissemination: This study protocol has been reviewed and approved by the Yonsei University Mirae Campus Institutional Review Board (1041849-2 02 111 SB-180-06) in South Korea. All participants provided written informed consent. The findings of this research will be disseminated by academic publications and conference presentations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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40. Society for Cardiovascular Magnetic Resonance 2022 Cases of SCMR case series.
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Johnson JN, Pouraliakbar H, Mahdavi M, Ranjbar A, Pfirman K, Mehra V, Ahmed S, Ba-Atiyah W, Galal MO, Zahr RA, Hussain N, Tadikamalla RR, Farah V, Dzelebdzic S, Muniz JC, Lee M, Williams J, Lee S, Aggarwal SK, Clark DE, Hughes SG, Ganigara M, Nagiub M, Hussain T, Kwok C, Lim HS, Nolan M, Kikuchi DS, Goulbourne CA, Sahu A, Sievers B, Sievers B, Sievers B, Garg R, Armas CR, Paleru V, Agarwal R, Rajagopal R, Bhagirath P, Kozor R, Aneja A, Tunks R, and Chen SSM
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- Humans, Middle Aged, Female, Male, Aged, Magnetic Resonance Imaging, Adult, Prognosis, Young Adult, Predictive Value of Tests, Cardiovascular Diseases diagnostic imaging, Cardiovascular Diseases therapy
- Abstract
"Cases of SCMR" is a case series on the SCMR website (https://www.scmr.org) for the purpose of education. The cases reflect the clinical presentation, and the use of cardiovascular magnetic resonance (CMR) in the diagnosis and management of cardiovascular disease. The 2022 digital collection of cases are presented in this manuscript., Competing Interests: Competing interests There are no competing interests. Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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41. 2023 Cardiac Society of Australia and New Zealand Expert Position Statement on Catheter and Surgical Ablation for Atrial Fibrillation.
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Kistler PM, Sanders P, Amarena JV, Bain CR, Chia KM, Choo WK, Eslick AT, Hall T, Hopper IK, Kotschet E, Lim HS, Ling LH, Mahajan R, Marasco SF, McGuire MA, McLellan AJ, Pathak RK, Phillips KP, Prabhu S, Stiles MK, Sy RW, Thomas SP, Toy T, Watts TW, Weerasooriya R, Wilsmore BR, Wilson L, and Kalman JM
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- Humans, Australia, Cardiology standards, New Zealand, Societies, Medical, Atrial Fibrillation surgery, Catheter Ablation methods, Catheter Ablation standards
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Catheter ablation for atrial fibrillation (AF) has increased exponentially in many developed countries, including Australia and New Zealand. This Expert Position Statement on Catheter and Surgical Ablation for Atrial Fibrillation from the Cardiac Society of Australia and New Zealand (CSANZ) recognises healthcare factors, expertise and expenditure relevant to the Australian and New Zealand healthcare environments including considerations of potential implications for First Nations Peoples. The statement is cognisant of international advice but tailored to local conditions and populations, and is intended to be used by electrophysiologists, cardiologists and general physicians across all disciplines caring for patients with AF. They are also intended to provide guidance to healthcare facilities seeking to establish or maintain catheter ablation for AF., (Copyright © 2024 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)
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- 2024
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42. Derivation of Stroke Volume from Pulmonary Artery Pressures.
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Yim IHW, Drury NE, and Lim HS
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Introduction: Intermittent cardiac output (CO) studies using thermodilution are considered the gold standard. We have developed a stroke volume (SV) calculator from pulmonary pulse pressure (PP) to allow continuous monitoring of SV and CO from PP., Methods: Hemodynamic data on 169 patients following orthotopic heart transplantation were used to compare our calculator-derived SV (and SV index, or SVi) against thermodilution-derived SV on admission into intensive care unit immediately following heart transplantation (T0) and 6 h after admission (T6)., Results: The calculated SV correlated with thermodilution-derived SV T0 (r = 0.920, p < 0.001, coefficient of 0.539 and the constant of 2.06). The median calculator SV, adjusted for coefficient and constant, was 48.4 ml (37.7, 60.7), comparable to the median thermodilution-derived SV 47.9 ml (37.5, 61.0), p = 0.737 with acceptable agreement on Bland-Altman plots. The thermodilution-derived SVi was 28.1 ml (19.7, 38.7) and adjusted calculator-derived SVi 28.9 ml (19.7, 39.9), p = 0.781. At T6, median thermodilution-derived SVi was 27.7 ml (19.5, 35.9) compared to the calculator-derived SVi median of 26.1 ml (17.7, 37.7), p = 0.203., Conclusions: Changes in PP can be used to track changes in SV using this calculator. Changes in PP may be used to assess response to treatment in the early post-operative period., (© 2024. The Author(s).)
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- 2024
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43. Incidence and progression of atrial fibrillation in patients with and without heart failure using mineralocorticoid receptor antagonists: a meta-analysis.
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Sampaio Rodrigues T, Garcia Quarto LJ, Nogueira SC, Koshy AN, Mahajan R, Sanders P, Ekinci EI, Burrell LM, Farouque O, and Lim HS
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- Humans, Incidence, Randomized Controlled Trials as Topic, Global Health, Mineralocorticoid Receptor Antagonists therapeutic use, Atrial Fibrillation drug therapy, Atrial Fibrillation complications, Heart Failure epidemiology, Disease Progression
- Abstract
Background: Mineralocorticoid receptor antagonists (MRAs) have emerged as potential therapy to target the underlying arrhythmogenic substrate in atrial fibrillation (AF). Nevertheless, there have been inconsistent results on the impact of MRAs on AF., Objective: We sought to evaluate the effect of MRAs on AF incidence and progression in patients with and without heart failure., Methods: Electronic databases were searched up to September, 2022 for randomized controlled trials (RCTs) that evaluated MRA use and reported AF outcomes. Primary outcome was a composite of new-onset or recurrent AF. Safety outcomes included hyperkalemia and gynecomastia risks. A random-effects meta-analysis estimated pooled odds ratios (OR) and 95% confidence intervals (CI)., Results: 12 RCTs, comprising 11,419 patients treated with various MRAs were included [5960 (52%) on MRA]. On follow-up (6-39 months), 714 (5.5%) patients developed AF. MRA therapy was associated with a 32% reduction in the risk of new-onset or recurrent AF [OR 0.68 (95% CI 0.51-0.92), I
2 = 40%]. On subgroup analysis, the greatest benefit magnitude was demonstrated in reducing AF recurrence [OR 0.50 (95% CI 0.30-0.83)] and among patients with left ventricular dysfunction [OR 0.59 (95% CI 0.40-0.85)]. Gynecomastia, but not hyperkalemia, was associated with MRA use. Meta-regression analysis demonstrated that therapy duration was a significant interaction factor driving the effect size (Pinteraction = 0.013)., Conclusion: MRA use is associated with a reduction in AF risk, especially AF progression. A prominent effect is seen in patients with heart failure, further augmented by therapy duration. Prospective trials are warranted to evaluate MRA use as upstream therapy for preventing this common arrhythmia., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)- Published
- 2024
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44. Mitral valve prolapse: arrhythmic risk during pregnancy and postpartum.
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Sabbag A, Aabel EW, Castrini AI, Siontis KC, Laredo M, Nizard J, Duthoit G, Asirvatham S, Sehrawat O, Kirkels FP, van Rosendael PJ, Beinart R, Acha MR, Peichl P, Lim HS, Sohns C, Martins R, Font J, Truong NNK, Estensen M, and Haugaa KH
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- Humans, Female, Pregnancy, Retrospective Studies, Adult, Risk Factors, Arrhythmias, Cardiac epidemiology, Arrhythmias, Cardiac etiology, Tachycardia, Ventricular epidemiology, Tachycardia, Ventricular etiology, Puerperal Disorders epidemiology, Puerperal Disorders etiology, Defibrillators, Implantable, Incidence, Ventricular Fibrillation epidemiology, Ventricular Fibrillation etiology, Postpartum Period, Mitral Valve Prolapse complications, Mitral Valve Prolapse epidemiology, Pregnancy Complications, Cardiovascular epidemiology
- Abstract
Background and Aims: Arrhythmic mitral valve prolapse (AMVP) is linked to life-threatening ventricular arrhythmias (VAs), and young women are considered at high risk. Cases of AMVP in women with malignant VA during pregnancy have emerged, but the arrhythmic risk during pregnancy is unknown. The authors aimed to describe features of women with high-risk AMVP who developed malignant VA during the perinatal period and to assess if pregnancy and the postpartum period were associated with a higher risk of malignant VA., Methods: This retrospective international multi-centre case series included high-risk women with AMVP who experienced malignant VA and at least one pregnancy. Malignant VA included ventricular fibrillation, sustained ventricular tachycardia, or appropriate shock from an implantable cardioverter defibrillator. The authors compared the incidence of malignant VA in non-pregnant periods and perinatal period; the latter defined as occurring during pregnancy and within 6 months after delivery., Results: The authors included 18 women with AMVP from 11 centres. During 7.5 (interquartile range 5.8-16.6) years of follow-up, 37 malignant VAs occurred, of which 18 were pregnancy related occurring in 13 (72%) unique patients. Pregnancy and 6 months after delivery showed increased incidence rate of malignant VA compared to the non-pregnancy period (univariate incidence rate ratio 2.66, 95% confidence interval 1.23-5.76)., Conclusions: The perinatal period could impose increased risk of malignant VA in women with high-risk AMVP. The data may provide general guidance for pre-conception counselling and for nuanced shared decision-making between patients and clinicians., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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45. Temporal association between atrial fibrillation and ischemic stroke: Systematic review and meta-analysis.
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D'lima J, Thijs V, Lim HS, Rodrigues TS, and Beaudoin AM
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Background: Paroxysmal atrial fibrillation (PAF) is strongly associated with ischemic stroke. Continuous cardiac implantable electronic devices (CIEDs) can assess PAF episodes over prolonged periods. Studies that attempted to find a temporal association between PAF and ischemic stroke were inconclusive. Thus, we performed a systematic review and meta-analysis to assess this relationship., Aims: This study aimed to assess the temporal association between AF episodes and stroke within 30 days of the arrhythmic episode. The secondary outcome is a temporal association within a 90-day period., Summary of Review: A total of 2804 studies that discussed the temporal relationship between PAF and ischemic stroke were screened, and 7 studies were included in the meta-analysis. Among the 4041 patients included in these studies, there were 138 patients with device detected PAF episodes and stroke. Four studies used a 30-day window for temporality and the pooled odds ratio (OR) showed a significant association (OR 4.11 (95% CI 1.03-16.40)). The three studies reporting on AF and stroke within a 90-day window did not find a significant temporal relationship (OR 0.43 (95% CI 0.13-1.41)). Finally, the pooled result of those seven studies did not show a significant association (OR 1.51 (95% CI 0.44-5.17))., Conclusion: This meta-analysis supports a temporal relationship between PAF and ischemic stroke within a 30-day window. Establishing this relationship is important for individualized risk prediction and targeted anticoagulation treatment., Data Access Statement: The data will be made available upon reasonable request., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: V.T. receives consulting fees from Medtronic and lecture, and consulting fees from Boehringer Ingelheim and Bayer. H.S.L. reports having received research support from St Jude Medical (now Abbott).
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- 2024
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46. Anti-Oxidative Bioactivities of Medicinal Herbs in the Treatment of Aging-Related Diseases.
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Lim HS, Park G, and Kim YU
- Abstract
Over the last 20 years, significant progress has been made in understanding the biology of aging and lifespans [...].
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- 2024
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47. Finite Element Analysis of a Rib Cage Model: Influence of Four Variables on Fatigue Life during Simulated Manual CPR.
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Jeon JH, Sul JH, Ko DH, Seo MJ, Kim SM, and Lim HS
- Abstract
Cardiopulmonary resuscitation (CPR) is a life-saving technique used in emergencies when the heart stops beating, typically involving chest compressions and ventilation. Current adult CPR guidelines do not differentiate based on age beyond infancy and childhood. This oversight increases the risk of fatigue fractures in the elderly due to decreased bone density and changes in thoracic structure. Therefore, this study aimed to investigate the correlation and impact of factors influencing rib fatigue fractures for safer out-of-hospital manual cardiopulmonary resuscitation (OHMCPR) application. Using the finite element analysis (FEA) method, we performed fatigue analysis on rib cage models incorporating chest compression conditions and age-specific trabecular bone properties. Fatigue life analyses were conducted on three age-specific rib cage models, each differentiated by trabecular bone properties, to determine the influence of four explanatory variables (the properties of the trabecular bone (a surrogate for the age of the subject), the site of application of the compression force on the breastbone, the magnitude of applied compression force, and the rate of application of the compression force) on the fatigue life of the model. Additionally, considering the complex interaction of chest compression conditions during actual CPR, we aimed to predict rib fatigue fractures under conditions simulating real-life scenarios by analyzing the sensitivity and interrelation of chest compression conditions on the model's fatigue life. Time constraints led to the selection of optimal analysis conditions through the use of design of experiments (DOE), specifically orthogonal array testing, followed by the construction of a deep learning-based metamodel. The predicted fatigue life values of the rib cage model, obtained from the metamodel, showed the influence of the four explanatory variables on fatigue life. These results may be used to devise safer CPR guidelines, particularly for the elderly at a high risk of acute cardiac arrest, safeguarding against potential complications like fatigue fractures.
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- 2024
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48. Health Outcome Comparison Based on Dietary Inflammatory Levels among Sample of Korean Elderly.
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Koo SK and Lim HS
- Abstract
The aim of this study was to investigate the effect of a senior-friendly diet based on the dietary inflammatory index (DII) on the nutritional status and health indicators of older people. A total of 256 participants were classified into tertiles based on their DII values and split into intervention (n = 201) and control ( n = 55) groups. The intervention group was provided with a senior-friendly diet, and the control group was allowed to eat their usual diet. Before and after the trial, anthropometric measurements, blood analyses, and questionnaires were completed for both groups. The mean age of the participants was 82.49 years, and 66.4% were female. On average, participants had 2.5 medical conditions, with a notable prevalence of cardiovascular disease. Following the intervention, the energy, carbohydrate, protein, and fat intakes significantly increased in the intervention group compared to pre-intervention levels. Tertile 3 exhibited substantial improvements in total nutrition score, NQ-E balance, and DII total score, as well as in triglycerides and blood glucose, attributed to this dietary intervention compared to other groups. In comparison with Tertile 1, nutrient intake and nutritional status in Tertile 3 were closely associated with significant influencing factors of the dietary intervention. For the group with the worst DII (Tertile 3), this dietary intervention greatly improved nutritional status, nutrient intake, and clinical indicators; thus, this senior-friendly diet appears to be beneficial for elderly people with nutritional vulnerabilities., Competing Interests: The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.
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- 2024
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49. Important Role of Ion Flux Regulated by Separators in Lithium Metal Batteries.
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Jia H, Zeng C, Lim HS, Simmons A, Zhang Y, Weber MH, Engelhard MH, Gao P, Niu C, Xu Z, Zhang JG, and Xu W
- Abstract
Polyolefin separators are the most common separators used in rechargeable lithium (Li)-ion batteries. However, the influence of different polyolefin separators on the performance of Li metal batteries (LMBs) has not been well studied. By performing particle injection simulations on the reconstructed three-dimensional pores of different polyethylene separators, it is revealed that the pore structure of the separator has a significant impact on the ion flux distribution, the Li deposition behavior, and consequently, the cycle life of LMBs. It is also discovered that the homogeneity factor of Li-ion toward Li metal electrode is positively correlated to the longevity and reproducibility of LMBs. This work not only emphasizes the importance of the pore structure of polyolefin separators but also provides an economic and effective method to screen favorable separators for LMBs., (© 2024 UChicago Argonne, LLC. Battelle Memorial Institute and The Authors. Advanced Materials published by Wiley‐VCH GmbH.)
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- 2024
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50. A study on the estimation of area of origin of swing cast-off pattern.
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Lee SY, Lim HS, Yie HY, Rhee KJ, Kim SM, and Seo YI
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In bloodstain pattern analysis (BPA), a field of forensic science, there has been active discussion on the estimation of the area of origin of impact spatter. However, there is no established methodology to quantitatively analyze the area of origin of a swing cast-off pattern. To quantitatively analyze the methodology of previous research on estimation of area of origin, a device for generating uniform swing cast-off patterns was produced. Using artificial blood, 10 swing cast-off patterns were generated on porous paper; in each, 10 blood drops were selected for the calculation of the impact angle. Hemospat software was used for individual bloodstain analysis, and an open source code was used for estimation of area of origin. Under the same conditions, an additional 10 swing cast-off patterns were generated, and quantitative analysis was performed using trigonometric functions and an adjustment formula that minimized errors in calculating the impact angle. The adjustment formula was corrected to calculate the impact angle for the bloodstains on the porous surface. As uncertainty decreases, the error increases, and the point at which both uncertainty and error can be minimized is calculated as 75%. The existing formula included the trajectory in the estimated likelihood range in 75% of samples. When the adjustment formula was applied, the accuracy was improved, with the trajectory included in the area with a 90% likelihood., (© 2024 The Authors. Journal of Forensic Sciences published by Wiley Periodicals LLC on behalf of American Academy of Forensic Sciences.)
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- 2024
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