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101.
Recent clinical and experimental studies have demonstrated that atrial fibrillation (AF) alters the electrical and mechanical remodeling of the atrium, which subsequently promote the maintenance and recurrence of AF. If atrial remodeling can be prevented with prompt and repeated cardioversion, the likelihood of AF recurrence may be reduced. Recent clinical studies have demonstrated that the strategies of transesophageal echocardiography facilitated early cardioversion and early repeated cardioversion may be clinically valuable in some patients who have persistent AF and recurrence of arrhythmia after the initial cardioversion. Furthermore, the use an implantable atrial defibrillator (IAD) for early repeated device-based cardioversion to maintain sinus rhythm appears to be safe and clinically feasible. Early cardioversion by IAD reduces AF burden, reverses atrial remodeling and prevents subsequent AF recurrence in selected patients without structural heart disease implanted with this device, indicating possible "sinus rhythm begets sinus rhythm". Despite encouraging initial observations, further long-term clinical studies in a larger patient population are needed to confirm this finding. Furthermore, whether the use of IAD in the fully automatic mode to provide immediate termination of AF episodes could intensify the potential beneficial effect and the clinical efficacy of this approach in patients with structural heart disease needs to be evaluated. 相似文献
102.
R S Chuck C R Cantor D B Tse 《Proceedings of the National Academy of Sciences of the United States of America》1990,87(13):5021-5025
CD4 and T-cell antigen receptor (TCR) comodulate from the surface of human and murine T cells following exposure to monoclonal anti-CD4 or anti-TCR. This comodulation may occur because expression of CD4 and TCR is regulated by similar transmembrane signals or because CD4 and TCR are physically associated. To study multimolecular assemblies on the plasma membrane, we developed a flow cytometric method for detecting singlet-singlet energy transfer between fluorescein isothiocyanate (FITC)- and tetramethylrhodamine isothiocyanate (TRITC)-conjugated monoclonal antibodies as sensitized TRITC emission on intact, single cells. Using this procedure, we detected CD4-TCR complexes on the surface of the transformed human leukemia T cells, HPB-ALL, in the absence of stimulation. More than one CD4 were found in association with one TCR. CD4-TCR complexes were not in rapid equilibrium with free CD4 and free TCR, and they were not induced by the dye-labeled anti-CD4 or anti-TCR. 相似文献
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Jehangir J. Appoo Leonard W. Tse Zlatko I. Pozeg Jason K. Wong Stuart J. Hutchison Alex J. Gregory Eric J. Herget 《The Canadian journal of cardiology》2014
Thoracic endovascular aortic repair, a minimally invasive technique is replacing the maximally invasive gold standard of thoracotomy and replacement of the descending thoracic aorta. With experience, indications have expanded to encroach on the arch and even ascending aorta. This review highlights the current state of technology, discusses controversies, and takes the perspective of a forward-thinking review to describe novel, innovative techniques that might make the entire thoracic aorta amenable to minimally invasive repair. 相似文献
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107.
Kui Kai Lau Yuen Kwun Wong Yap Hang Chan Kay Cheong Teo Koon Ho Chan Leonard Sheung Wai Li Raymond Tak Fai Cheung Chung Wah Siu Shu Leong Ho Hung Fat Tse 《Atherosclerosis》2014
Background
Visit-to-visit blood pressure variability (BPV) is a simple surrogate marker for the development of atherosclerotic diseases, cardiovascular and all-cause mortality. Nevertheless, the relative prognostic value of BPV in comparison with other established vascular assessments remain uncertain.Methods
We prospectively followed-up 656 high-risk patients with diabetes or established cardiovascular or cerebrovascular diseases for the occurrence of major adverse cardiovascular events (MACEs). Baseline brachial endothelial function, carotid intima-media thickness (IMT) and plaque burden, ankle-brachial index and arterial stiffness were determined. Visit-to-visit BPV were recorded during a mean 18 ± 9 outpatient clinic visits.Results
After a mean 81 ± 12 month's follow-up, 123 patients (19%) developed MACEs. Patients who developed a MACE had significantly higher systolic BPV, more severe endothelial function, arterial stiffness and systemic atherosclerotic burden compared to patients who did not develop a MACE (all P < 0.01). BPV significantly correlated with all of the vascular assessments (P < 0.01). A high carotid IMT had the greatest prognostic value in predicting development of a MACE (area under receiver operating characteristic curve (AUC) 0.69 ± 0.03, P < 0.01). A high BPV also had moderate prognostic value in prediction of MACE (AUC 0.65 ± 0.03, P < 0.01). After adjustment of confounding factors, a high BPV remained a significant independent predictor of MACE (hazards ratio 1.67, 95% confidence interval 1.14-2.43, P < 0.01).Conclusions
Compared with established surrogate markers of atherosclerosis, visit-to-visit BPV provides similar prognostic information and may represent a new and simple marker for adverse outcomes in patients with vascular diseases. 相似文献108.
Yap-Hang Chan Kai-Hang Yiu Kui-Kai Lau Yuen-Fung Yiu Sheung-Wai Li Tai-Hing Lam Chu-Pak Lau Chung-Wah Siu Hung-Fat Tse 《Atherosclerosis》2014
Objectives
To investigate whether the CHADS2 and CHA2DS2-VASc scores have clinical utility for prediction of adverse vascular function and vascular dysfunction-mediated incident cardiovascular (CV) events among high-risk patients without atrial fibrillation (AF), and the additional value of incorporating PR prolongation to the scores.Methods
We analyzed 579 high-risk CV outpatients without clinical AF in a prospective cohort for new-onset ischemic stroke, myocardial infarction (MI), congestive heart failure (CHF), and CV death. Brachial flow-mediated dilation (FMD) and nitroglycerin-mediated dilatation (NMD), carotid intima-media thickness (IMT) and pulse wave velocity (PWV) were determined.Results
Baseline CHADS2 score was associated with lower FMD (Pearson r = −0.16, P < 0.001) and NMD (r = −0.17, P < 0.001), higher carotid IMT (r = 0.30, P < 0.001) and PWV (r = 0.35, P < 0.001; similar for CHA2DS2-VASc score: All P < 0.05). After follow-up of 63 ± 11 months, 82 patients (14.2%) developed combined CV endpoint. ROC curve analysis showed that both CHADS2 and CHA2DS2-VASc scores were predictors for ischemic stroke (C-Statistic: CHADS2 0.70, P = 0.004; CHA2DS2-VASc 0.68, P = 0.010), MI (CHADS2 0.63, P = 0.030; CHA2DS2-VASc 0.70, P = 0.001), and CV death (CHADS2 0.63, P = 0.022; CHA2DS2-VASc 0.65, P = 0.011). Higher CHADS2 score was associated with reduced event-free survival from combined CV endpoints (log-rank = 16.7, P < 0.001) with differences potentiated if stratified by CHA2DS2-VASc score (log-rank = 29.2, P < 0.001). Incorporating PR prolongation, the CHA2DS2-VASc-PR score achieved the highest C-Statistic for CV death prediction (0.70, P < 0.001) superior to the CHADS2 score (chi-square: 12.1, P = 0.0005).Conclusions
The CHADS2 and CHA2DS2-VASc predict vascular dysfunction and cardiovascular events in high-risk CV patients without clinical AF, with further improved performance incorporating PR prolongation. 相似文献109.
Amanda J. Nicoll Stuart K. Roberts Ricky Lim Joanne Mitchell Martin Weltman Jacob George Alan Wigg Katherine Stuart Paul Gow Gerry MacQuillan Edmund Tse Miriam Levy Siddharth Sood Amany Zekry Wendy Cheng Jonathan Mitchell Richard Skoien William Sievert Simone I. Strasser Geoffrey W. McCaughan 《Alimentary pharmacology & therapeutics》2019,49(10):1314-1322