Can Elderly Patients with Severe Mitral Regurgitation Benefit from Trans-catheter Mitral Valve Repair?

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.

Comparisons of Moisturizing Function Between Rayon Fabric with Collagen Peptides from Fish Scales and Regular Rayon Fabric Under Various Relative Humidity

Chi‑Shih Huang,Erh‑Jen Hou,Ying‑Chou Lee,Tzong‑Huei Lee,Yi‑Jun Pan,Ta Yu,Wei‑Hsin Lin,Chun‑Han Shih,Wei‑Che Chang 한국섬유공학회 2023 Fibers and polymers Vol.24 No.12

The study was inspired by the specialized facial masks made of rayon non-woven fabrics which contained collagen peptides for improving moisturizing function. This study explored the moisturizing function of a rayon fabric containing collagen peptides extracted from tilapia fish scales under various conditions of relative humidity. This research had implications for the development of clothing that can prevent dry skin. A two-stage nested design experiment was adopted. The first-stage factor such as the fabric has two levels and the second-stage factor such as the relative humidity with three levels nested under each level of the first-stage factor. Preliminary results indicated that introducing a new variable (i.e., fabric moisturizing value, which combines the moisture regains of adsorption and desorption) would be useful. The moisturizing value of the novel rayon fabric and regular rayon fabric increased with the increase in relative humidity, and moisturizing effect of the novel rayon fabric with collagen peptides was better than that of the regular rayon fabric. Therefore, the novel rayon fabric may be suitable for preventing dry skin in winter.

Oral Presentations : Nutritional Assessment ; Evaluation of Parenteral Nutrition Utilization for Patients With Respiratoy Insufficiency

( Lie Jane Lin ),( Min Hua Shih ),( Yen Hui Chen ),( Ming Tsan Lin ),( Hong Shiee Lai ),( Fang Yue Lin ),( Wei Jao Chen ) 한국정맥경장영양학회 2005 The 11th PENSA Congress Vol.2005 No.-

The accuracy and clinical applicability of a sensor based electromagnetic nonfluoroscopic catheter tracking system

Shinya Yamada,Li-Wei Lo,Yenn-Jiang Lin,Shih-Lin Chang,Fa-Po Chung,Yu-Feng Hu,Ta-Chuan Tuan,Tze-Fan Chao,Jo-Nan Liao,Chin-Yu Lin,Shih-Ann Chen 대한심장학회 2019 Korean Circulation Journal Vol.49 No.1

Background and Objectives: The differences between electromagnetic-based mapping (EM) and impedance-based mapping (IM) in 3D anatomical reconstruction have not been fully clarified. We aimed to investigate the anatomical accuracy between EM (MediGuide™) and IM (EnSite Velocity™) systems. Methods: We investigated 15 consecutive patients (10 males, mean age 58±9 years) who underwent pulmonary veins (PVs) isolation for paroxysmal atrial fibrillation (PAF). Contrast-enhanced computed tomography (CT) image of the left atrium (LA) was acquired before ablation and the 3D geometry of the LA was constructed using EM during ablation procedure. We measured the 4 PV angles between the main trunk of each PV and the posterior LA after field scaling. Additionally, the posterior LA surface area was measured. The variables were compared to those of CT-based geometry. A control group of 40 patients who underwent conventional PVs isolation using IM were also evaluated. Results: The actual and relative changes of EM and CT-based geometry in all PV angles and posterior LA were significantly smaller compared to those of IM and CT-based geometry. Intraclass correlation coefficient (ICC) between EM and CT-based geometry were 0.871 (right superior pulmonary vein [RSPV]), 0.887 (right inferior pulmonary vein [RIPV]), 0.853 (left superior pulmonary vein [LSPV]), 0.911 (left inferior pulmonary vein [LIPV]), and 0.833 (posterior LA). On the other hand, ICC between IM and CT-based geometry were 0.548 (RSPV), 0.639 (RIPV), 0.691 (LSPV), 0.706 (LIPV), and 0.568 (posterior LA). Conclusions: Image integration with EM enables high accurate visualization of cardiac anatomy compared to IM in PAF ablation.

Harm Avoidance is Correlated with the Reward System in Adult Patients with Attention Deficit Hyperactivity Disorder: A Functional Magnetic Resonance Imaging Study

Tsung-Hua Lu(Tsung-Hua Lu),Shih-Hsien Lin(Shih-Hsien Lin),Mei Hung Chi(Mei Hung Chi),Ching-Lin Chu(Ching-Lin Chu),Dong-Yu Yang(Dong-Yu Yang),Wei Hung Chang(Wei Hung Chang),Po See Chen(Po See Chen),Yen 대한정신약물학회 2023 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.21 No.1

Objective: Hypoactivity in the reward system among patients with attention deficit hyperactivity disorder (ADHD) is a well-known phenomenon. Whether the activity in the reward pathway is related to harm avoidance, such as in sensitivity to punishment, is unclear. Evidence regarding the potential difference between ADHD patients and controls in terms of this association is scarce. Methods: Event-related functional magnetic resonance imaging was conducted on subjects performing the Iowa gambling test. Fourteen adults with ADHD and 14 controls were enrolled in the study. Results: Harm avoidance was found to be positively correlated with the activities of the bilateral orbitofrontal cortex and right insula in individuals with ADHD. A group difference was also confirmed. Conclusion: Understanding the roles of harm avoidance and brain activation during risk tasks is important.

Catheter Ablation of Ventricular Tachycardia in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy

Fa-Po Chung,Chin-Yu Lin,Yenn-Jiang Lin,Shih-Lin Chang,Li-Wei Lo,Yu-Feng Hu,Ta-Chuan Tuan,Tze-Fan Chao,Jo-Nan Liao,Ting-Yung Chang,Shih-Ann Chen 대한심장학회 2018 Korean Circulation Journal Vol.48 No.10

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is predominantly an inherited cardiomyopathy with typical histopathological characteristics of fibro-fatty infiltration mainly involving the right ventricular (RV) inflow tract, RV outflow tract, and RV apex in the majority of patients. The above pathologic evolution frequently brings patients with ARVD/C to medical attention owing to the manifestation of syncope, sudden cardiac death (SCD), ventricular arrhythmogenesis, or heart failure. To prevent future or recurrent SCD, an implantable cardiac defibrillator (ICD) is highly desirable in patients with ARVD/C who had experienced unexplained syncope, hemodynamically intolerable ventricular tachycardia (VT), ventricular fibrillation, and/or aborted SCD. Notably, the management of frequent ventricular tachyarrhythmias in ARVD/C is challenging, and the use of antiarrhythmic drugs could be unsatisfactory or limited by the unfavorable side effects. Therefore, radiofrequency catheter ablation (RFCA) has been implemented to treat the drug-refractory VT in ARVD/C for decades. However, the initial understanding of the link between fibro-fatty pathogenesis and ventricular arrhythmogenesis in ARVD/C is scarce, the efficacy and prognosis of endocardial RFCA alone were limited and disappointing. The electrophysiologists had broken through this frontier after better illustration of epicardial substrates and broadly application of epicardial approaches in ARVD/C. In recent works of literature, the application of epicardial ablation also successfully results in higher procedural success and decreases VT recurrences in patients with ARVD/C who are refractory to the endocardial approach during long-term follow-up. In this article, we review the important evolution on the delineation of arrhythmogenic substrates, ablation strategies, and ablation outcome of VT in patients with ARVD/C.

Delay of Surgery for Spinal Metastasis due to the COVID-19 Outbreak Affected Patient Outcomes

Chia-Jung Hsieh,Chun-Yu Wu,Yen-Heng Lin,Yu-Cheng Huang,Wen-Chi Yang,Tom Wei-Wu Chen,Wei-Li Ma,Wei-Hsin Lin,Feng-Ming Hsu,Furen Xiao,Shih-Hung Yang,Dar-Ming Lai,Chang-Mu Chen,Shin-Yi Chao,Fon-Yih Tsuan 대한척추신경외과학회 2023 Neurospine Vol.20 No.4

Objective: The present study is to analyze the effects of the coronavirus disease 2019 (COVID 2019) outbreak and the subsequent lockdown on the outcomes of spinal metastasis patients. Methods: The study was a retrospective analysis of data from a prospective cohort study. All patients underwent surgical intervention for spinal metastases between January 2019 and December 2021 and had at least 3 months of postoperative follow-up. The primary outcome was overall mortality during the 4 different stages (pre-COVID-19 era, COVID-19 pandemic except in Taiwan, national lockdown, lifting of the lockdown). The secondary outcomes were the oncological severity scores, medical/surgical accessibility, and patient functional outcome during the 4 periods as well as survival/mortality. Results: A total of 233 patients were included. The overall mortality rate was 41.20%. During the Taiwan lockdown, more patients received palliative surgery than other surgical methods, and no total en bloc spondylectomy was performed. The time from surgeon visit to operation was approximately doubled after the COVID-19 outbreak in Taiwan (75.97, 86.63, 168.79, and 166.91 hours in the 4 periods, respectively). The estimated survival probability was highest after the national lockdown was lifted and lowest during the lockdown. In the multivariate analysis, increased risk of mortality was observed with delay of surgery, with emergency surgery having a higher risk with delays above 33 hours, urgent surgery (below 59 and above 111 hours), and elective surgery (above 332 hours). Conclusion: The COVID-19 pandemic and related policies have altered daily clinical practice and negatively impacted the survival of patients with spinal metastases.

Development of Novel Tool Center Point Velocity Planning Algorithm for Five Axis Machine Tool

Shih-Kai Wu,Meng-Shiun Tsai,Ming-Tzong Lin,Hong-Wei Huang 한국정밀공학회 2018 International Journal of Precision Engineering and Vol.19 No.8

In this paper, a tool center point (TCP) feedrate scheduling algorithm for 5-axis machine tool is developed to generate the axes interpolation commands. The proposed algorithm considers not only the constraints of TCP velocity, acceleration and jerk, but also the velocity differences of each axes at the junction of each block. First, the proposed method determines the maximum speed for each block segment at the TCP coordinate based on the computed length. Then the kinematics of the five axis machine tool is employed to derive the five-axis corner velocity difference (FCVD) formulation. The FCVD utilizes the axis velocity difference at the junction of blocks as the designed variable. As the starting and end velocities of each block are determined, the S-shape acceleration/ deceleration (Acc/Dec) method is adopted to generate both smooth TCP and rotary axis profile based on the given interpolation parameters. The servo dynamics of the five axis machine tool are utilized to evaluate the performances of the FCVD. Simulation results demonstrate that the FCVD can achieve better contour accuracy with less machining time as compared to the five-axis feedrate regulation formulation (FFRF) algorithm. Furthermore, the FCVD are compared with Heidenhain CNC controller and the results show that the FCVD has similar behaviors as the Heidenhain controller, but it can achieve less machining time.

Electroencephalographic spectrogram–guided total intravenous anesthesia using dexmedetomidine and propofol prevents unnecessary anesthetic dosing during craniotomy: a propensity score–matched analysis

Lin Feng-Sheng,Shih Po-Yuan,Sung Chao-Hsien,Chou Wei-Han,Wu Chun-Yu 대한마취통증의학회 2024 Korean Journal of Anesthesiology Vol.77 No.1

Background: The bispectral index (BIS) may be unreliable to gauge anesthetic depth when dexmedetomidine is administered. By comparison, the electroencephalogram (EEG) spectrogram enables the visualization of the brain response during anesthesia and may prevent unnecessary anesthetic consumption. Methods: This retrospective study included 140 adult patients undergoing elective craniotomy who received total intravenous anesthesia using a combination of propofol and dexmedetomidine infusions. Patients were equally matched to the spectrogram group (maintaining the robust EEG alpha power during surgery) or the index group (maintaining the BIS score between 40 and 60 during surgery) based on the propensity score of age and surgical type. The primary outcome was the propofol dose. Secondary outcome was the postoperative neurological profile.Results: Patients in the spectrogram group received significantly less propofol (1585 ± 581 vs. 2314 ± 810 mg, P < 0.001). Fewer patients in the spectrogram group exhibited delayed emergence (1.4% vs. 11.4%, P = 0.033). The postoperative delirium profile was similar between the groups (profile P = 0.227). Patients in the spectrogram group exhibited better in-hospital Barthel’s index scores changes (admission state: 83.6 ± 27.6 vs. 91.6 ± 17.1; discharge state: 86.4 ± 24.3 vs. 85.1 ± 21.5; group–time interaction P = 0.008). However, the incidence of postoperative neurological complications was similar between the groups.Conclusions: EEG spectrogram–guided anesthesia prevents unnecessary anesthetic consumption during elective craniotomy. This may also prevent delayed emergence and improve postoperative Barthel index scores.

Novel Patched 1 Mutations in Patients with Gorlin-Goltz Syndrome Strategic Treated by Smoothened Inhibitor

( Shih-wen Hsu ),( Chien-yio Lin ),( Chuang-wei Wang ),( Wen-hung Chung ),( Chih-hsun Yang ),( Yao-yu Chang ) 대한피부과학회 2018 Annals of Dermatology Vol.30 No.5

We studied a family with Gorlin-Goltz syndrome. The novel mutations of our cases were located on the 21st exon of the PTCH1 gene (c.3450C>G). The father, who received a strategic 56-day vismodegib treatment for disease control, was the first patient with Gorlin syndrome treated with the hedgehog inhibitor in Taiwan. The lesions regressed gradually, with scar formation, and were subsequently removed via a wide excision. Further details are provided below. (Ann Dermatol 30(5) 597∼601, 2018)