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      • KCI등재

        Comparison of Serum Ketone Levels and Cardiometabolic Efficacy of Dapagliflozin versus Sitagliptin among Insulin-Treated Chinese Patients with Type 2 Diabetes Mellitus

        Chi-Ho Lee,Mei-Zhen Wu,David Tak-Wai Lui,Darren Shing-Hei Chan,Carol Ho-Yi Fong,Sammy Wing-Ming Shiu,Ying Wong,Alan Chun-Hong Lee,Joanne King-Yan Lam,Yu-Cho Woo,Karen Siu-Ling Lam,Kelvin Kai-Hang Yiu 대한당뇨병학회 2022 Diabetes and Metabolism Journal Vol.46 No.6

        Background: Insulin-treated patients with long duration of type 2 diabetes mellitus (T2DM) are at increased risk of ketoacidosis related to sodium-glucose co-transporter 2 inhibitor (SGLT2i). The extent of circulating ketone elevation in these patients remains unknown. We conducted this study to compare the serum ketone response between dapagliflozin, an SGLT2i, and sitagliptin, a dipeptidyl peptidase-4 inhibitor, among insulin-treated T2DM patients.Methods: This was a randomized, open-label, active comparator-controlled study involving 60 insulin-treated T2DM patients. Participants were randomized 1:1 for 24-week of dapagliflozin 10 mg daily or sitagliptin 100 mg daily. Serum β-hydroxybutyrate (BHB) levels were measured at baseline, 12 and 24 weeks after intervention. Comprehensive cardiometabolic assessments were performed with measurements of high-density lipoprotein cholesterol (HDL-C) cholesterol efflux capacity (CEC), vibration-controlled transient elastography and echocardiography.Results: Among these 60 insulin-treated participants (mean age 58.8 years, diabetes duration 18.2 years, glycosylated hemoglobin 8.87%), as compared with sitagliptin, serum BHB levels increased significantly after 24 weeks of dapagliflozin (P=0.045), with a median of 27% increase from baseline. Change in serum BHB levels correlated significantly with change in free fatty acid levels. Despite similar glucose lowering, dapagliflozin led to significant improvements in body weight (P=0.006), waist circumference (P=0.028), HDL-C (P=0.041), CEC (P=0.045), controlled attenuation parameter (P=0.007), and liver stiffness (P=0.022). Average E/e’, an echocardiographic index of left ventricular diastolic dysfunction, was also significantly lower at 24 weeks in participants treated with dapagliflozin (P=0.037).Conclusion: Among insulin-treated T2DM patients with long diabetes duration, compared to sitagliptin, dapagliflozin modestly increased ketone levels and was associated with cardiometabolic benefits.

      • KCI등재

        Study on Treatment Planning for the Prostate in Proton Therapy with Oxygen Enhancement Ratio Effect

        Yoo Seung Hoon,Geng Hui,Lam Wai Wang,Kong Chi Wah,Yang Bin,Chiu Tin Lok,Wu Po Man,Cheung Kin Yin,Yu Siu Ki,Shin Dongho,Min Byung Jun 한국물리학회 2020 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.77 No.7

        The purpose of this study was to investigate the oxygen enhancement ratio (OER) effects on treatment planning for a hypoxic prostate tumor with proton scanning beams. Two different OER-based dose calculation models (the average model and the voxel model) were investigated by using hypoxic tumor models in this simulation study. For the hypoxic tumor model, an oxygen distribution with a range of 2.4-9.4 mmHg was used according to the clinical data. The results given by the average model and the voxel model were compared for 50% and 90% tumor control probabilities with variations in the hypoxic tumor volume and fractionation. Comparison between the treatment plans with OER-based higher predicted dose and with the conventional prescription dose was conducted to investigate the organ-at-risk (OAR) doses for the prostate case. The average model showed a higher calculated dose than the voxel model. The voxel model with a 50% control probability showed good agreement with the current prescription dose. The OER values of the average model ranged from 1.05 to 1.25, which were applied to the whole tumor volume in treatment planning. The voxel-model-based OERs were higher (1.50-1.75) than those of average model, and these OERs should be applied only for the hypoxic boost region. Regarding treatment plans, the doses of the rectum and the bladder were reduced to the tolerable range V80Gy (volume receiving equal to or greater than 80Gy) < 15% and V75Gy (volume receiving equal to or greater than 75Gy) < 15% respectively after an optimization, but the maximum dose to femoral heads was higher than 50 Gy. In conclusion, we investigated the possible ranges of the OER (1.3-1.8) for proton-beam treatment of prostate cases. A dose escalation of up to about 1.8 times can be applied for the small hypoxic region. This result, which was obtained using a model study, should be verified through clinical experiment.

      • KCI등재

        Endovascular Management of Hepatic Artery Pseudoaneurysms: A Case Series

        Pui Lam Cheung,Yat Sing Lee,Chong Boon Tan,Hin Yue Lau,Chi Wai Siu,Chik Xing Chan,Wai Tat Chan,Cheuk Him Ho 대한혈관외과학회 2023 Vascular Specialist International Vol.39 No.1

        Although rare, hepatic artery aneurysms are associated with a high morbidity and mortality, necessitating a prompt diagnosis. A significant proportion of hepatic artery aneurysms are pseudoaneurysms, and the major risk factors of which have already been identified in previous literatures. Presentation can be variable, but diagnosis almost relies entirely on computed tomography and digital subtraction angiography. The endovascular approach has progressively become the preferred option due to its better performance when compared to the traditional surgical approach. However, formulation of an endovascular treatment plan for these lesions remains difficult as multiple factors should be considered to identify the best endovascular treatment modality. Five cases of pseudoaneurysm due to recent Whipple operation, hepatobiliary infections, and underlying malignancy are presented in this article to illustrate the effectiveness and complexity of endovascular treatment in this disease entity.

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