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Ching-Wei Lee,Shih-Hsien Sung,Wei-Ming Huang,Yi-Lin Tsai,Hsiang-Yao Chen,Chiao-Po Hsu,Chun-Che Shih,Kuo-Piao Chung 대한심장학회 2019 Korean Circulation Journal Vol.49 No.6
Background and ObjectivesAge is a traditional risk factor for open-heart surgery. The efficacy and safety of transcatheter edge-to-edge mitral valve repair, using MitraClip (Abbott Vascular), has been demonstrated in patients with severe mitral regurgitation (MR). Since octogenarians or older patients are usually deferred to receive open-heart surgery, the main interest of this study is to elucidate the procedural safety and long-term clinical impact of MitraClip in elderly patients. MethodsPatients with symptomatic severe MR were evaluated by the heart team. For those with high or prohibitive surgical risks, transcatheter mitral valve repair was performed in hybrid operation room. Transthoracic echocardiography (TTE), blood tests, and six-minute walk test (6MWT) were performed before, 1-month, 6-months, and 1 year after index procedure. ResultsA total of 46 consecutive patients receiving MitraClip procedure were enrolled. Nineteen patients (84.2±4.0 years) were over 80-year-old and 27 (73.4±11.1 years) were younger than 80. Compare to baseline, the significant reduction in MR severity was achieved after the procedure and sustained. All the patients benefited from significant improvement in New York Heart Association functional class. The 6-minute walk test (6MWT) increased from 259±114 to 319±92 meters (p=0.03) at 1 year. The overall 1-year survival rate was 80% in the elderly and 88% in those <80 years, p=0.590. Baseline 6MWT was a predictor for all-cause mortality (odds ratio, 0.99; 95% confidence interval, 0.982–0.999; p=0.026) after the MitraClip procedure. ConclusionsTrans-catheter edge-to-edge mitral valve repairs are safe and have positive clinical impact in subjects with severe MR, even in advanced age.
Pulmonary Arterial Thrombosis in a Patient With an Atrial Septal Defect and Eisenmenger Syndrome
Ching-Wei Lee,Shao-Sung Huang,Po-Hsun Huang 대한심장학회 2012 Korean Circulation Journal Vol.42 No.11
Pulmonary hypertension is characterized by elevated pulmonary arterial pressure and secondary right ventricular failure. A thromboembolic occlusion of the proximal or distal pulmonary vasculature results in chronic thromboembolic pulmonary hypertension. We report an uncommon case that presented to our hospital with symptoms of dyspnea on exertion over 2 years. The patient had been treated for profound pulmonary thrombosis and right ventricular failure with adequate anticoagulation and sildenafil. Our echocardiography disclosed a large atrial septal defect with severe pulmonary hypertension and right ventricular failure. A diagnosis of Eisenmenger syndrome with pulmonary artery thrombosis was made. Although Eisenmenger syndrome with pulmonary thrombosis is well described in western societies,a huge pulmonary thrombosis is seldom reported in eastern countries. Profound pulmonary thrombosis may obfuscate the actual diagnosis of pulmonary artery hypertension with underlying congenital heart disease. A physical examination and echocardiography are essential in patients with pulmonary hypertension.
Wei Ching Lee,Victor Der-Thanq Chen,Li-Yi Wang 서울대학교 교육연구소 2017 Asia Pacific Education Review Vol.18 No.4
Accompanying the trend of schools moving from teacher-centred to learner-centred pedagogy (LCP) practices, researchers have argued that teachers switching from the one to the other may as a result make changes in their personal judgement of their own teaching competency. This review aims to provide a comprehensive overview of recent studies of teacher efficacy beliefs (TEB) in relation to the LCP context. We have adopted a grounded approach to review 34 published papers between January 2009 and April 2016. Six themes were identified from our analysis of the findings of these studies to delineate how TEB has been studied in the LCP context. By a comparison with other two influential reviews on TEB research, we have also identified three trends and five issues in TEB research in LCP context. Future research directions are proposed with the intent to engage researchers sharing the same interest in this field.
A sequence of physical processes quantified in LAOS by continuous local measures
Ching-Wei Lee,Simon A. Rogers 한국유변학회 2017 Korea-Australia rheology journal Vol.29 No.4
The response to large amplitude oscillatory shear of a soft colloidal glass formed by a suspension of multiarm star polymers is investigated by means of well-defined continuous local measures. The local measures provide information regarding the transient elastic and viscous response of the material, as well as elastic extension via a shifting equilibrium position. It is shown that even when the amplitude of the strain is very large, cages reform and break twice per period and exhibit maximum elasticity around the point of zero stress. It is also shown that around the point of zero stress, the cages are extended by a nearly constant amount of approximately 5% at 1 rad/s and 7% at 10 rad/s, even when the total strain is as large as 420%. The results of this study provide a blueprint for a generic approach to elucidating the complex dynamics exhibited by soft materials under flow.
Lee, Wei Ching,Yusof, Mastura Md.,Lau, Fen Nee,Ee Phua, Vincent Chee Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.6
Background: The use of preoperative chemoirradiation is the commonest treatment strategy employed in Malaysia for locally advanced rectal cancer. We need to determine the local control and survival rates for comparison with established rates in the literature. Materials and Methods: This retrospective study analyzed all newly diagnosed patients with rectal adenocarcinoma who underwent long course preoperative radiotherapy (RT) at the Department of Radiotherapy and Oncology, Kuala Lumpur Hospital (HKL) between $1^{st}$ January 2004 and $31^{st}$ December 2010. The aim of the study was to determine the radiological response post radiotherapy, pathological response including circumferential resection margin (CRM) status, 3 years local control, 3 years overall survival (OS) and 3 years disease free survival (DFS). Statistical analysis was performed using the SPSS software. Kaplan-Meier and log rank analysis were used to determine survival outcomes. Results: A total of 507 patients with rectal cancer underwent RT at HKL. Sixty seven who underwent long course preoperative RT were eligible for this study. The median age at diagnosis was 60 years old with a range of 26-78 years. The median tumour location was 6 cm from the anal verge. Most patients had suspicion of mesorectum involvement (95.5%) while 28.4% of patients had enlarged pelvic nodes on staging CT scan. All patients underwent preoperative chemo-irradiation except for five who had preoperative RT alone. Only 38 patients underwent definitive surgery (56.7%). Five patients were deemed to be inoperable radiologically and 3 patients were found to have unresectable disease intraoperatively. The remaining 21 patients defaulted surgery (31.3%). The median time from completion of RT to surgery was 8 weeks (range 5.6 to 29.4 weeks). Fifteen patients (39.5%) had surgery more than 8 weeks after completion of RT. Complete pathological response was noted in 4 patients (10.5%). The pathological CRM positive rate after RT was 18.4%. With a median follow-up of 38.8 months, the 3 year local control rate was 67%. The 3 years rate for CRM positive (<2 mm), CRM clear (>2 mm) and pCR groups were 0%, 88.1% and 100% respectively (p-value of 0.007). The 3 year OS and DFS were 57.3% and 44.8% respectively. Conclusions: In conclusion, the approach of long course preoperative chemoirradiation for rectal cancer needs to be re-examined in our local setting. The high rate of local recurrence is worrying and is mainly due to patient defaulting post-preoperative chemoirradiation or delayed definitive surgery.