Long-Term Anticoagulation in the Extreme Elderly with the Newer Antithrombotics: Safe or Sorry?

Jun R Chiong,Rebecca J Cheung 대한심장학회 2013 Korean Circulation Journal Vol.43 No.5

Background and Objectives: The prevalence of atrial fibrillation (AF) doubles in the extreme elderly and is higher than in the rest of the po-pulation. Warfarin therapy to prevent thromboembolic events secondary to AF is often underutilized and under-prescribed in this sub-group, due to the fear of bleeding and other complications. Newer oral anticoagulants such as rivaroxaban and dabigatran offer alterna-tive therapeutic options for the extreme elderly. We review the clinical trial data of these newer agents in the extreme elderly population. Subjects and Methods: The primary literature was identified through PubMed, using the following search terms: anticoagulation, rivar-oxaban, dabigatran, warfarin, elderly, AF, bleeding, stroke, and aging. Additional references were identified through the review of references from the articles obtained. We included clinical studies evaluating anticoagulation therapies in AF. Selection emphasis was placed on th-ose evaluating anticoagulation in the elderly population. Results: Dabigatran and rivaroxaban have predictable, dose-proportional pharmacokinetic and pharmacodynamic properties, which make them favorable options for the elderly. Fewer monitoring parameters and drug interactions allow for the greater ease of use. A landmark trial shows that the rate of intracranial hemorrhage with dabigatran is lower in this population compared to warfarin. However, the data is based on a small number of subjects enrolled in the clinical trials. As such, the real-world use of these agents may not replicate the publish-ed rates of bleeding and thrombosis in the study populations. Conclusion: More research is needed in this area, specifically in this population, before newer agents such as rivaroxaban and dabigatran are widely recommended for use in the extreme elderly patients.

EFFECT OF TURBINE UPSTREAM GEOMETRY ON PULSATING FLOW AND TURBOCHARGED SI-ENGINE PERFORMANCE

김제영,Chiong Meng Soon,Rajoo Srithar 한국자동차공학회 2023 International journal of automotive technology Vol.24 No.2

The pulsating exhaust flow propagates through the exhaust line upon opening of exhaust valves while carrying a high amount of energy (high pressure and temperature). The amount of energy delivered to the turbine could be affected by turbine upstream geometry along with the propagation. Therefore, in this study, the impact of the turbine upstream geometry (diameter, length of exhaust runner, and exhaust manifold volume) on pulsating flow and engine & turbocharger has been investigated using 1D engine simulation packages, AVL-BOOST. A validated 1-liter 3-cylinder SI-engine model was utilized as a base engine model. The simulation captured how different geometry influences the pulsating pressure profile and the impact on system-level performance and behavior. The current research highlighted that the exhaust manifold volume is strongly associated with exhaust resistance, scavenging, pulsation, knocking, and fuel economy. By minimizing unnecessary volume in the exhaust manifold, it presents high potentials to improve low-speed torque (~15 %), fuel consumption (~2.4 %), brake thermal efficiency (~1.4 %), scavenging and knock resistance against the baseline model.

Poster Session : PS 0049 ; Cardiology : Association of The Neutrophil-Lymphocyte Ratio (NLR) with Outcomes in Patients Admitted for an Acute Coronary Syndrome

( Jaime Aherrera ),( Lowe Chiong ),( Paul Reganit ),( Felix Punzalan ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Patients with documented acute coronary syndromes (ACS) exhibit a wide spectrum of early risk of death. An elevated neutrophil count predicts a worse outcome in ACS. In contrast, a low lymphocyte count is related to high risks of adverse outcomes. The neutrophil-lymphocyte ratio (NLR), therefore, integrates for two WBC subtypes with opposite actions in terms of vascular infl ammation. Objectives: Among patients diagnosed with ACS, we aim to determine if an elevated NLR taken within 24 hours of admission is associated with higher rates of adverse outcomes. Methods: A prospective cohort of adult patients admitted with a diagnosis of ACS was conducted. The participants were stratifi ed into two: low to intermediate NLR (NLR < 6.5) and high NLR (NLR > 6.50). Primary outcome was in-hospital mortality. Secondary outcomes include development or worsening of congestive heart failure (CHF) and the development of cardiogenic shock, re-infarction, renal failure, pneumonia, and arrhythmias. Results: 117 patients with a mean age of 60 +/- 13 were included. Diagnosis on admission was unstable angina (28%), NSTEMI (40%), and STEMI (37%). Analysis of data showed that the odds of in-hospital deaths among those with a high NLR is 5.71 times higher compared to those with low-intermediate NLR [OR 5.71 (1.53-21.23, p 0.009)]. Using linear regression, the NLR of patients who were non-survivors was computed at 9.91, while the NLR of those who survived was 5.47. A high NLR was also predictive of the development or worsening of CHF, shock, re-infarction, arrhythmias, and development of any adverse outcome. Conclusion: Among patients with ACS, an elevated NLR (>6.5) taken within 24 hours of presentation is a useful marker to predict in-hospital mortality, development or worsening or CHF, and development of shock, re-infarction, and arrhythmias.

The Safe Conduct of Echocardiographic Studies During the COVID-19 Pandemic: Perspectives and Experience from a Tertiary Echocardiography Laboratory in Singapore

Choong Hou Koh,Siau Chien Chiong,Phong Teck Lee,Zee Pin Ding,See Hooi Ewe 아시아심장혈관영상의학회 2020 Cardiovascular Imaging Asia Vol.4 No.2

Comparative investigation into the anti-ulcer activity of virgin coconut oil and coconut oil in pylorous ligated animal model

Malarvili Selvarajah,Zuraini Ahmad,Zainul Amiruddin Zakaria,Hoe Siong Chiong,Yoke Kin Yong,Kamariah Long,Muhammad Nazrul Hakim 셀메드 세포교정의약학회 2015 TANG Vol.5 No.4

This current study investigated the anti-ulcer activity of 2 types of virgin coconut oil (VCO-A and VCO-B) and coconut oil (CO). Sprague-Dawley of male rats divided into 6 groups and each group consisted of ten rats. Rats were then treated with either VCO or CO and then were then anaesthetized and pyloric ligation was performed. The anaesthesia was discontinued and the animal usually recovered consciousness within less than an hour. Three hours later, the animal was then again anaesthetized and sacrificed with chloroform. Stomach removed and its content subjected to measurement of volume and pH. The results revealed VCO-B and VCO-A (100%) significantly inhibited (p < 0.001) the volume of gastric juice secreted by the control rats by 66.81% and 51.53%, respectively. Followed by CO 42.80%. While the inhibition of gastric juice for positive control rats which treated with ranitidine (100 mg/kg) was only 22.38%. The total acid output was reduced by the oils to 70.80%, 74.16% and 40.45% for VCO-A, VCO-B and CO respectively compared to control group. Ranitidine reduced the total acid output by 34.83%. In conclusion, prevention of gastric lesions in rats by VCO was found to increase the mucous and decrease the acid volume, total acid contents and ulcer scoring. The treatment of VCO affects the all parameters that influence the initiation and perpetuation of ulceration.

Strengthening of bolted shear joints in industrialized ferrocement construction

M. Ismail,M. Shariati,A.S.M. Abdul Awal,C.E. Chiong,E. Sadeghipour Chahnasir,A. Porbar,A. Heydari,M. Khorami 국제구조공학회 2018 Steel and Composite Structures, An International J Vol.28 No.6

This paper highlights results of some experimental work that deals with strengthening of bolted shear joints in thin-walled ferrocement structure where steel wires, bent into U-shape are considered as simple inserts around the bolt hole. The parameters investigated include the number of layers of wire mesh, edge distance of bolt hole, size and location of the inserts. Test results have shown that for small edge distance, failure occurred either in cleavage or shearing mode, and the strength of the joint increased with an increase in the edge distance. This continued up to an upper limit set by either tension or bearing failure. The experimental study further revealed that for a given edge distance the strength of a joint can significantly be enhanced by using U-inserts. The equations developed for predicting joint strength in ferrocement composites can also be modified to include the effects of the inserts with a good level of accuracy.

Report of the Second Asian Prostate Cancer (A-CaP) Study Meeting

Kim, Choung-Soo,Lee, Ji Youl,Chung, Byung Ha,Kim, Wun-Jae,Fai, Ng Chi,Hakim, Lukman,Umbas, Rainy,Ong, Teng Aik,Lim, Jasmine,Letran, Jason L.,Chiong, Edmund,Wu, Tong-lin,Lojanapiwat, Bannakij,Tü,rk Asian Pacific Prostate Society 2017 Prostate international Vol.5 No.3

<P>The Asian Prostate Cancer (A-CaP) Study is an Asia-wide initiative that has been developed over the course of 2 years. The study was launched in December 2015 in Tokyo, Japan, and the participating countries and regions engaged in preparations for the study during the course of 2016, including patient registration and creation of databases for the purpose of the study. The Second A-CaP Meeting was held on September 8, 2016 in Seoul, Korea, with the participation of members and collaborators from 12 countries and regions. Under the study, each participating country or region will begin registration of newly diagnosed prostate cancer patients and conduct prognostic investigations. From the data gathered, common research themes will be identified, such as comparisons among Asian countries of background factors in newly diagnosed prostate cancer patients. This is the first Asia-wide study of prostate cancer and has developed from single country research efforts in this field, including in Japan and Korea. At the Second Meeting, participating countries and regions discussed the status of preparations and discussed various issues that are being faced. These issues include technical challenges in creating databases, promoting participation in each country or region, clarifying issues relating to data input, addressing institutional issues such as institutional review board requirements, and the need for dedicated data managers. The meeting was positioned as an opportunity to share information and address outstanding issues prior to the initiation of the study. In addition to A-CaP-specific discussions, a series of special lectures was also delivered as a means of providing international perspectives on the latest developments in prostate cancer and the use of databases and registration studies around the world.</P>