Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 17 de 17
Filtrar
Mais filtros










Base de dados
Tipo de estudo
Intervalo de ano de publicação
1.
Acta Ophthalmol ; 2019 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-31496121

RESUMO

PURPOSE: The decreased level of melatonin, the substance involved in the control of the sleep-wake cycle, has been reported among the patients with age-related macular degeneration (AMD). However, knowledge about the relationship between sleep disturbance and AMD is still limited. This longitudinal case-control study aims to investigate the risk of incident AMD among the patients with clinically diagnosed insomnia using the Taiwan National Health Insurance Research Database. METHODS: The insomnia cohort (n = 15 465) consisted of newly diagnosed insomnia cases aged ≥55 years between 2000 and 2009. Subjects without insomnia, matched for age, gender and enrolment time, were randomly sampled as the control cohort (n = 92 790). Cox proportional hazard regressions were performed to calculate the hazard ratios (HR) of incident AMD for the two cohorts after adjusting for potential confounders. RESULTS: Of the 108 255 sampled subjects, 2094 (1.9%) were diagnosed with AMD, including 214 (0.2%) with neovascular AMD, during a mean follow-up period of 5.1 ± 2.8 years. Insomnia patients were more likely to have subsequent AMD than those without insomnia (2.5% versus 1.8%, p < 0.001). Further, the incidence of exudative AMD was also higher in the insomnia cohort than the control cohort (0.3% versus 0.2%, p = 0.002). The adjusted HR was 1.33 (95% confidence interval [CI], 1.18-1.48, p < 0.001) for AMD and 1.67 (95% CI, 1.20-2.33, p = 0.002) for exudative AMD. CONCLUSIONS: Clinically diagnosed insomnia is an independent indicator for the increased risk of subsequent AMD development.

2.
PLoS One ; 14(4): e0214096, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30939137

RESUMO

In the NFL, kickers play a special role in determining the outcome of a match. There is a significant body of literature attributing the success of kicks to observed environmental and situational factors. However, the significance of these is not subject to agreement. In this study, we synthesize the deterministic and stochastic models based on data from the 2000-2017 NFL seasons to identify significant conditions associated with "choking." This study's empirical findings focus on integrating the statistical evidence on causality of skill and performance, and the interpretation of observed and unobserved heterogeneity of kicks, on the intervention effect of the new extra-point rule in the NFL since 2015, and on providing an in-depth evaluation of the impact of competition pressure.

3.
Eur J Clin Invest ; 49(5): e13090, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30912848

RESUMO

OBJECTIVE: Gout-related comorbidities are intricate and its clinical features may demonstrate sex difference; however, few studies have evaluated the links between comorbidities and gout in a female population. The objectives of this study were to compare the aggregation and transitive trajectories of comorbidities of gout, and their consequences in female and male gout populations. METHODS: A prospective cohort study was conducted using data from the Taiwan National Health Insurance Research Database. A female and male gout population were followed up from 2000 to 2009 to identify the comorbidities of cardiovascular disease, hyperlipidemia, hypertension, diabetes mellitus (DM) and chronic kidney disease. The cumulative incidence of stroke from 2000 to 2010 was examined. A latent trajectory analysis was used to determine the transitive trajectories of the comorbidities of gout. RESULTS: Both female and male patients with gout had five risk cluster transition (CT) phenotypes of comorbidities within 10-year follow-up: CT1 and CT2, with various persistent comorbidities; CT3, with few persistent comorbidities; and CT4 and CT5, with transfer to cluster 1 from other clusters. The female participants in CT2 predominantly experienced DM and were associated with significantly increased risk of developing stroke. CONCLUSION: Diabetes is a notable risk factor for the development of stroke in female patients with gout. Early assessment and management for the comorbidities of gout, particularly in DM, would effectively reduce future stroke risk in female gout population.

4.
Aging Ment Health ; : 1-8, 2019 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-30835495

RESUMO

OBJECTIVES: Given the close relationship between sleep-wake disturbances and depression, an in-depth investigation of such a relationship is imperative. The present study aims at elucidating the relationship between various sleep-wake disturbances and depression in older adults and at examining the influence of co-occurring anxiety on such associations. METHOD: A community-based survey using the cohort from the Yilan Study in Taiwan was conducted from August 2013 to November 2016. Adults aged 65 and older were randomly selected to participate in the study. The Hospital Depression and Anxiety Scale was used to measure clinical depressive and anxiety symptoms. Insomnia and daytime sleepiness were defined through the Athens Insomnia Scale and the Epworth Sleepiness Scale, respectively. Furthermore, the use of hypnotics, subjective sleep duration and sleep-wake scheduling were evaluated. Their relationship with depression was examined through logistic regression analyses. RESULTS: There were 2620 participants surveyed and 247 (9.4%) had depression. Before controlling for anxiety, insomnia (OR: 1.78, 95% CI: 1.23-2.55), daytime sleepiness (OR: 1.79, 95% CI: 1.27-2.53), and long sleepers (OR: 1.77, 95% CI: 1.24-2.53) have a higher likelihood for depression in the multivariable regression analysis. However, when including anxiety into the multivariable regression model, only those with daytime sleepiness and long sleepers had an elevated risk for depression. Therefore, the association between insomnia and depression turned to be statistically non-significant. CONCLUSION: In older adults, various sleep-wake disturbances differ in their relationship with depression. In addition, daytime sleepiness and long sleep duration were mostly characteristic of depression when co-occurring anxiety was considered.

5.
Artigo em Inglês | MEDLINE | ID: mdl-30486260

RESUMO

Previous findings on the associations between body mass index (BMI) and subjective health outcomes among older adults are inconsistent. The aims of this study were to explore the associations of BMI with health-related quality of life (HRQoL), self-rated health (SRH) and happiness among older adults. This study was part of the Yilan study, which was a community-based survey conducted in the Yilan city in Taiwan. A total of 3722 older adults were randomly recruited during 2012⁻2016. HRQoL was measured using the Short Form-12 Health Survey physical component summary (PCS) and mental component summary (MCS) scores and SRH and happiness were also evaluated. By hierarchical regression, after adjusting for covariates, compared with normal-weight participants, overweight did not have significantly different PCS scores (B = 0.20, 95% confidence interval [CI]: -0.45 to 0.85, p = 0.546) but obese had significantly lower PCS scores (B = -0.97, 95% CI: -1.68 to -0.26, p < 0.0001); overweight and obese participants had significantly better MCS scores (B = 1.00, 95% CI: 0.40 to 1.61, p = 0.001 and B = 1.22, 95% CI: 0.60 to 1.88, p < 0.0001, respectively); overweight participants had significantly higher SRH scores (B = 1.08, 95% CI: 0.16 to 2.00, p = 0.022) but underweight had significantly lower SRH scores (B = -2.88, 95% CI: -4.81 to -0.95, p = 0.003); overweight and obese participants had better happiness scores (B = 1.55, 95% CI: 0.45 to 2.66, p = 0.006 and B = 1.68, 95% CI: 0.49 to 2.88, p = 0.006, respectively). In conclusion, compared with normal-weight individuals, overweight individuals had better mental HRQoL, SRH and happiness but underweight older people reported poorer SRH and obese reported poorer physical HRQOL but better mental HRQoL and self-rated happiness.


Assuntos
Índice de Massa Corporal , Nível de Saúde , Inquéritos Epidemiológicos/estatística & dados numéricos , Modelos Logísticos , Qualidade de Vida/psicologia , Inquéritos e Questionários/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Taiwan/epidemiologia , Magreza/epidemiologia
6.
BMC Geriatr ; 18(1): 90, 2018 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-29653515

RESUMO

BACKGROUND: Fall episodes are not unusual among community residents, especially the elderly, and lower muscle strength is an important issue to address in order to prevent falls. METHODS: A community health survey was conducted in a suburban area of Taiwan, and 1067 older adults were selected for enrollment in the present study. All the enrolled subjects had been visited at their homes; the subjects' strength of both hands and muscle mass of both legs were measured and well-established questionnaires were finished by certificated paramedic staffs. RESULTS: The incidence of fall episodes in the previous 1 year in the Yilan elderly population was 15.1%, and the female predominance was significant. A significantly higher prevalence of cataracts was found in group who experienced a fall in the past year (64% vs. 54.9% in the non-fall group). Mild or more severe dementia was much more prevalent in the group who experienced a recent fall (33.8% vs. 25.7% in the non-fall group). The strength of both hands tested as the physical function was 17.6 ± 8.0 kg in the recent fall group, significantly weaker than that in the non-fall group (20.7 ± 8.7 kg). Multivariate regression analysis revealed a greater weekly exercise duration and greater strength of both hands reduced the occurrence of falls among the whole and the female population. The standardized effect sizes of hand grip strength between both groups, not trivial, were 0.29 and 0.37 for the total population and the female subpopulation respectively. CONCLUSIONS: Less weekly exercise duration and weaker muscle strength were f ound to be independent risk factors of fall episode(s) in an elderly Taiwanese population, especially in the female sub-population. Muscle strength, measured by average of both hands grip strength, was the most significantly factor of one-year fall episode(s) accessed retrospectively.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Exercício/fisiologia , Inquéritos Epidemiológicos , Força Muscular/fisiologia , Acidentes por Quedas/prevenção & controle , Idoso , Feminino , Humanos , Incidência , Masculino , Prevalência , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
7.
J Gerontol A Biol Sci Med Sci ; 72(7): 929-936, 2017 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-28369199

RESUMO

Backgrounds: The aims of the present study were to determine the associations and sex-specific relationships between extreme sleep duration and cardiac autonomic control in a cohort of older individuals. Methods: A community-based survey was conducted in Yilan City, Taiwan. Community-dwelling older adults aged ≥65 were randomly selected to participate. Extreme sleep durations were defined as either short sleep (≤5 hours) or long sleep (≥8 hours). Cardiac autonomic control was evaluated using the parameters of frequency-domain analysis of heart rate variability. Results: Of 1,721 participants, 58.7% were female. In multiple logistic regression analyses, short sleep duration did not correlate with any of the unhealthier parameters of heart rate variability. In contrast, long sleep duration was associated with elevated risk for poor high-frequency values (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.34-2.50) and the unfavorable low-frequency values (OR: 1.44, 95% CI: 1.05-1.97). When stratified by sex, the associations between extreme sleep duration and poor heart rate variability were more robust in males. Conclusions: Poor cardiac autonomic control may underlie the link between extreme sleep duration and adverse health outcomes in older adults. A sex-specific relationship between poor cardiac autonomic function and extreme sleep duration also was found.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Frequência Cardíaca , Coração , Transtornos do Sono-Vigília , Idoso , Feminino , Inquéritos Epidemiológicos , Coração/inervação , Coração/fisiopatologia , Humanos , Vida Independente/estatística & dados numéricos , Masculino , Avaliação de Resultados da Assistência ao Paciente , Distribuição Aleatória , Medição de Risco/métodos , Fatores Sexuais , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/fisiopatologia , Estatística como Assunto , Taiwan/epidemiologia
8.
Sleep ; 40(4)2017 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-28199721

RESUMO

Study objectives: Different pathomechanisms may underlie the age-related decline in muscle mass and muscle power in older adults. This study aimed to examine the independent relationship between sleep duration and muscle power. Methods: Older adults, aged 65 years and older, were randomly selected to participate in a community-based survey in Yilan city, Taiwan. Data on self-reported sleep duration, sociodemographic information, lifestyle, chronic medical and mental health conditions, sleep-related parameters, and anthropometric measurements were collected. Participants who slept ≤4 hr, 5 hr, 6-7 hr, 8 hr, and ≥9 hr were defined as shortest, short, mid-range, long, and longest sleepers, respectively. Muscle power was estimated using hand grip strength. Results: A total of 1081 individuals participated. Their average age was 76.3 ± 6.1 years, and 59.4% were female. After controlling for covariates, including muscle mass of the upper extremities, both long (estimated mean [95% confidence interval, CI]: 19.2 [18.2-20.2], p = .03) and longest sleepers (estimated mean [95% CI]: 17.8 [16.4-19.2], p = .001) had weaker hand grip strength than mid-range sleepers (estimated mean [95% CI]: 20.9 [20.3-21.4]). When stratified by sex, the association between longest sleep duration and weaker hand grip strength was noted among men only. Conclusions: Older adults with long sleep duration had weaker hand grip strength irrespective of muscle mass. This finding suggests that decreased muscle power may mediate or confound the relationship between long sleep duration and adverse health outcomes.


Assuntos
Força da Mão/fisiologia , Sono/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Inquéritos Epidemiológicos , Humanos , Estilo de Vida , Masculino , Autorrelato , Taiwan , Fatores de Tempo
9.
Tohoku J Exp Med ; 238(1): 75-83, 2016 01.
Artigo em Inglês | MEDLINE | ID: mdl-26725845

RESUMO

Atrial fibrillation (AF) is currently recognized as one of the most common cardiac arrhythmias worldwide, with the increasing prevalence that has been estimated to be as high as 9% among the elderly. Health-related quality of life (HRQoL) has become an important patient-centered health outcome measurement, but the impacts created by AF and other arrhythmias with similar symptoms, such as frequent atrial and ventricular premature contractions (APCs and VPCs, defined as ≥ 3 beats/5 minutes), have not been extensively evaluated. The Yilan Study is a population-based community health survey, which in part aims to evaluate the prevalence and impacts of these arrhythmias on the HRQoL in a community dwelling elderly population. A total of 1,732 citizens from the Yilan, Taiwan, aged 65 years or older (45.8% male) were enrolled and visited at their homes, where HRQoL was measured utilizing the Short Form-12 Health Survey. Each participant's heart rhythm was recorded with an electrocardiographic monitor for 5 minutes. The results disclosed that the prevalence of AF of this aged population was 5.8%, similar to the mean global prevalence. Besides, the prevalence of frequent APCs and frequent VPCs in these elderly people were 7.1% and 5.5%, respectively. After multiple regression analysis, elderly people with AF had lower scores in the physical component of HRQoL, while those elderly people with frequent VPCs had lower scores in the mental component. Ultimately, these findings can provide additional useful and population-specific information about AF, and assist medical professionals in designing more effective strategies for cardiac arrhythmia treatments.


Assuntos
Fibrilação Atrial/complicações , Complexos Cardíacos Prematuros/complicações , Qualidade de Vida , Idoso , Fibrilação Atrial/epidemiologia , Demografia , Feminino , Humanos , Masculino , Prevalência , Análise de Regressão , Taiwan/epidemiologia
10.
PLoS One ; 9(9): e107609, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25226168

RESUMO

BACKGROUND: Cardiovascular disease and stroke have emerged as substantial and growing health challenges to populations around the world. Besides for the survival and medical prognosis, how to improve the health-related quality of life (HRQoL) might also become one of the goals of treatment programs. There are multiple factors that influence HRQol, including comorbidity, mental function and lifestyle. However, substantial research and investigation have still not clarified these underlying pathways, which merit further attention. The purpose of this study was to determine how psychological factors affect the link between cardiovascular disease and stroke with HRQoL. METHODS AND RESULT: A total of 1,285 elder subjects at least 65 years of age (47.2% male) were enrolled. The mental function and HRQol of each patient was then measured using the Hospital Anxiety and Depression Scale and Short Form-12. After multiple regression analysis, anxiety, depression, cardiovascular disease, stroke, education level and age were shown to be associated with both mental component score (MCS) and physical component score (PCS). In the mediation analysis using the SPSS macro provided by Preacher and Hayes, cardiovascular disease and stroke affected HRQoL via anxiety and depression, respectively. CONCLUSIONS: These results suggest that cardiovascular disease and stroke have negative impacts on patient MCS and PCS through different underlying pathways. Cardiovascular disease influences the HRQoL both directly and indirectly with the mediation of anxiety, and stroke influences the HRQoL by way of depression. These findings support the proposition that different combinations of both physical and psychological support are necessary to best manage these diseases.


Assuntos
Ansiedade , Doenças Cardiovasculares/psicologia , Depressão , Qualidade de Vida , Acidente Vascular Cerebral/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Vigilância em Saúde Pública , Fatores de Risco
11.
J Chin Med Assoc ; 73(4): 199-204, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20457441

RESUMO

BACKGROUND: We investigated the health effects of low-dose radiation on cardiologists exposed to scattered radiation while performing cardiac catheterization (CC) in a hospital setting from 2003 to 2006. METHODS: We performed a 4-year retrospective study on 2, 292 medical doctors, using claims data from all contracted hospitals of the Bureau of National Health Insurance, Taiwan. We gathered statistical data regarding radiation-related diseases using the International Classification of Diseases, 9(th) Revision, Clinical Modification record numbers of each doctor. RESULTS: Of the 2,292 doctors evaluated, 1,721 were aged 35-50 years and the remaining 571 were aged 51-65 years. There were 892 cardiologists who performed CC (experimental group), and the majority of these (733/892, 82.17%) were aged 35-50 years. There were 1,400 medical doctors who performed no CC from 2003 to 2006 (control group). A total of 988 of these belonged to the 35-50 years age group and 412 to the 51-65 years group. In the 35-50 years group, the controls had significantly more medical visits for hematological and thyroid cancer (p <0.05), skin disease (p <0.001), and acute upper respiratory tract infection (p <0.001) compared with the experimental group. In contrast, cardiologists who performed catheterization had more cataracts compared with the control group, but this difference was not significant. CONCLUSION: Doctors who did not perform CC had more visits for radiation-related diseases than those who performed catheterization. In the experimental group, cardiologists aged 35-50 years who were exposed to radiation during CC had more visits for cataracts than the control group. We recommend that radiation protection concepts be emphasized to cardiologists, and that hospital managers be obligated to upgrade angiography equipment because the newer models have less scattered radiation.


Assuntos
Cateterismo Cardíaco , Cardiologia , Exposição Ocupacional/efeitos adversos , Proteção Radiológica , Adulto , Idoso , Catarata/epidemiologia , Catarata/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/epidemiologia , Estudos Retrospectivos
12.
J Chin Med Assoc ; 70(6): 236-40, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17591582

RESUMO

BACKGROUND: Urinary tract infections commonly cause hospitalizations in community-dwelling geriatric populations. Our aim was to understand the impact of urinary catheterization on geriatric inpatients with community-acquired urinary tract infections (CAUTIs). METHODS: Retrospective analyses were performed using electronic discharge summaries in a rural community hospital of northeastern Taiwan in 2004. We screened data with ICD-9-CM codes and performed chart reviews on inpatients aged >or= 65 years with CAUTIs. RESULTS: A total of 294 subjects who experienced CAUTIs were enrolled; 114 subjects had urinary catheterization and the other 180 did not. The mean frequency of admission was 1.2 times (range, 1-4 times); 251 subjects were admitted only once. We reviewed and enrolled 348 records of CAUTIs. Subjects with urinary catheterization showed significantly more advanced age, more female predominance, higher immobility ratio, and more frequent admissions than those without urinary catheterization (p < 0.05). Records of urinary catheterization showed that subjects had longer hospital stays, higher pathogen isolation after culture, and less comorbid pyelonephritis than subjects without urinary catheterization (p < 0.05). The distribution of infecting microorganisms differed insignificantly between the 2 groups (p = 0.077). Female gender, hospitalization > 2 times, age >or=75 years, immobility, hospital stay > 7 days, and low prevalence of comorbid pyelonephritis served as significant predictive variables for urinary catheterization in subjects with CAUTIs. CONCLUSION: For geriatric inpatients, urinary catheterization must be evaluated cautiously before being performed. The impact of urinary catheterization on the distribution of microorganisms in CAUTIs was shown to be insignificant.


Assuntos
Infecções Comunitárias Adquiridas/etiologia , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Retrospectivos
13.
J Cardiovasc Electrophysiol ; 17(3): 266-9, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16643398

RESUMO

INTRODUCTION: The anatomic proximity between the esophagus and the coronary sinus (CS) might render the esophagus vulnerable to thermal injury during ablation. Therefore, we investigated the anatomic relationship between the esophagus and the CS in patients with atrial fibrillation (AF). METHODS AND RESULTS: Thirty patients (25 males, mean age = 54 +/- 11 years) with drug-refractory paroxysmal AF were included. Sixteen-slice multidetector computed tomography was performed to depict the course of the esophagus and relationship to the CS. The esophagus was in direct contact with the CS in 57% (17/30) of patients (group 1). The mean length of the contact was 6.1 +/- 3.4 mm. In the remaining 13 patients, the esophagus did not come in direct contact with the CS (group 2). The shortest distance between the esophagus and the CS was 4.0 +/- 2.6 mm. The CS diameter (9.4 +/- 1.8 vs 8.5 +/- 2.4 mm, P = 0.15), esophagus width (18.6 +/- 1.6 vs 18.6 +/- 1.7 mm, P = 0.87), anteroposterior diameter of the left atrium (35.9 +/- 3.8 vs 35.0 +/- 3.3 mm, P = 0.58), thickness of the anterior wall of the esophagus (2.9 +/- 0.6 vs 2.9 +/- 0.6 mm, P = 0.97), and shortest distance from the esophagus to the CS ostium (19.3 +/- 5.4 vs 25.0 +/- 6.2 mm, P = 0.02) and to the great cardiac vein (8.5 +/- 5.3 vs 12.1 +/- 6.9 mm, P = 0.10) were compared between the two groups. CONCLUSIONS: In 57% of our patients, the esophagus was in direct contact with the CS, and a significantly shorter distance between the esophagus and the CS ostium was noted in these patients. It is important to prevent esophageal damage when applying energy within the CS.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Esôfago/anatomia & histologia , Adulto , Idoso , Ablação por Cateter/efeitos adversos , Distribuição de Qui-Quadrado , Esôfago/diagnóstico por imagem , Esôfago/lesões , Feminino , Coração/anatomia & histologia , Humanos , Masculino , Pessoa de Meia-Idade , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios X
14.
Chest ; 128(4): 2581-7, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16236927

RESUMO

STUDY OBJECTIVES: Atrioesophageal fistulas have been reported to be a lethal complication following catheter ablation of atrial fibrillation (AF). The purpose of this study was to investigate the relationship between the esophagus and posterior left atrium (LA) and provide the anatomic information necessary to minimize the risk of esophageal injury during AF ablation. METHODS AND RESULTS: Forty-eight patients (43 men; mean +/- SD age, 59 +/- 12 years) with drug-refractory paroxysmal AF and 32 control subjects (26 men; mean age, 60 +/- 9 years) were included. All underwent a CT scan for delineation of the relationship between the esophagus and posterior LA. In the paroxysmal AF group, two major types of esophageal routes were demonstrated. Type 1 routes were found in 42 patients with the lower portion of esophagus close to the ostium of the left inferior pulmonary vein (LIPV), including three subtypes of courses according to the proximity to the left superior pulmonary vein (PV) and LIPV. Type 2 routes were found in six patients with the lower portion of esophagus close to the ostium of the right inferior pulmonary vein (RIPV), including three subtypes of courses according to the proximity to the right superior PV and RIPVs. The mean shortest distance of the esophagus to the four individual PVs significantly differed between type 1 and type 2: 28.4 +/- 6.1 mm vs 10.5 +/- 5.7 mm (to the right superior), 19.6 +/- 7.0 mm vs 3.7 +/- 3.4 mm (to the right inferior), 10.1 +/- 3.4 mm vs 22.8 +/- 4.2 mm (to the left superior), and 2.8 +/- 2.5 mm vs 18.7 +/- 5.2 mm (to the left inferior), respectively (p < 0.001 for all). Contact of the esophagus and middle part of posterior LA was observed in each patient. However, direct contact of the aorta with the posterior LA wall was more frequent in type 2 than in type 1 (p = 0.001). The clinical characteristics, type of esophageal routes, distance from the esophagus to the four PVs, and diameter of the thoracic cage, LA, and aorta in the control group were similar to those in the AF group (p > 0.05 for all). CONCLUSION: Although the anatomic relationship between the esophagus and LA posterior wall varied widely, two major patterns of esophageal routes could be depicted. This information is important for deciding the location of the ablation lesions around the PV ostia and LA and for avoiding the potential risk of esophageal injury.


Assuntos
Fibrilação Atrial/terapia , Ablação por Cateter/métodos , Esôfago/anatomia & histologia , Átrios do Coração/anatomia & histologia , Idoso , Eletrofisiologia/métodos , Esôfago/diagnóstico por imagem , Esôfago/fisiopatologia , Feminino , Coração/anatomia & histologia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Cardiopatias/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
15.
J Chin Med Assoc ; 67(9): 472-5, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15617308

RESUMO

Severe acute respiratory syndrome (SARS) is a new respiratory tract infectious disease caused by a novel coronavirus. As of this report, there were 3 probable SARS cases in I-Lan County. Of them, 1 was deceased in another hospital and the remaining 2 were cured and discharged. This report describes the clinical manifestations of the 2 surviving probable cases. The first case had a travel history to Guangdong province, China, and the second case probably contracted the disease from a hospital outbreak. They both developed infiltrations over uni- or bilateral lungs but recovered without intubations. Their treatment modalities included empirical antibiotics, steroids, and anti-viral agents. As SARS becomes an emerging infectious disease in the 21st century, its clinical manifestations and treatment will be discussed.


Assuntos
Síndrome Respiratória Aguda Grave/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Síndrome Respiratória Aguda Grave/diagnóstico
16.
Am J Cardiol ; 90(9): 974-82, 2002 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-12398965

RESUMO

Angiotensin-converting enzyme (ACE) inhibition has been shown to improve clinical myocardial ischemia in patients with syndrome X (angina pectoris, positive treadmill exercise test, normal coronary angiograms, and no evidence of coronary spasm). This study was conducted to investigate the effects of long-term ACE inhibitors on endothelial nitric oxide (NO) metabolism and coronary microvascular function in patients with syndrome X. After a 2-week washout period, 20 patients with syndrome X were randomized to receive either enalapril, an ACE inhibitor, 5 mg twice daily (n = 10) or placebo (n = 10) in a double-blind design for 8 weeks. Another 6 age- and gender-matched subjects with negative treadmill exercise tests were also studied as controls. Compared with control subjects, patients with syndrome X had significantly reduced coronary flow reserve, reduced plasma levels of nitrate and nitrite (NOx), and a reduced plasma L-arginine to asymmetric dimethylarginine (ADMA) ratio (an index of systemic NO metabolism), as well as reduced endothelial function. These patients also had increased plasma levels of ADMA, which is an endogenous inhibitor of NO synthase and of von Willebrand factor, a marker of endothelial injury. Baseline characteristics including exercise performance and coronary flow reserve were similar between enalapril and placebo groups. After an 8-week treatment period, exercise duration (p = 0.001) and coronary flow reserve (p = 0.001) significantly improved with enalapril but not with placebo. Enalapril treatment, but not placebo, reduced plasma von Willebrand factor (p = 0.03) and ADMA levels (p = 0.01) and increased NOx levels (p = 0.01) and the ratio of L-arginine to ADMA (p <0.01). In patients with syndrome X, the plasma NOx level was positively and ADMA level inversely correlated with coronary flow reserve before and after the treatment. In conclusion, long-term ACE inhibitor treatment with enalapril improved coronary microvascular function as well as myocardial ischemia in patients with syndrome X. This may be related to the improvement of endothelial NO bioavailability with the reduction of plasma ADMA levels.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/farmacocinética , Arginina/análogos & derivados , Arginina/sangue , Arginina/efeitos dos fármacos , Circulação Coronária/efeitos dos fármacos , Circulação Coronária/fisiologia , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/metabolismo , Microcirculação/efeitos dos fármacos , Microcirculação/fisiologia , Angina Microvascular/sangue , Angina Microvascular/tratamento farmacológico , Óxido Nítrico/metabolismo , Idoso , Disponibilidade Biológica , Método Duplo-Cego , Enalapril/farmacocinética , Teste de Esforço , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Estatística como Assunto , Tempo , Resultado do Tratamento , Fator de von Willebrand/efeitos dos fármacos
17.
Catheter Cardiovasc Interv ; 55(3): 331-7, 2002 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11870937

RESUMO

Patients with angiographically proven stent restenoses do not necessarily develop adverse cardiac events. Which clinical, procedural, or angiographic parameters relate to the development of adverse cardiac events among these patients has not been determined. This study included 155 patients (167 stented lesions) with angiographically proven restenosis (> or = 50% diameter stenosis) within the stent or at its margins in routine follow-up angiograms that was obtained at 6.5 +/- 3.6 months after successful stenting. Thirty-six patients (22%) had adverse cardiac events (including unstable angina necessitating target lesion revascularization, acute myocardial infarction, or cardiac death) during follow-up and 119 patients (78%) were event-free. These two groups of patients were compared to determine the parameters related to adverse cardiac events. Univariate determinants of adverse events included hypertension (P = 0.023), unstable angina at initial presentation (P = 0.002), target lesion in proximal left anterior descending artery (P = 0.041), TIMI grade 0-2 flow in follow-up angiograms (p < 0.001), impaired left ventricular function at follow-up (P = 0.002), follow-up minimal lumen diameter < or = 0.6 mm (P = 0.003), follow-up diameter stenosis > 75% (P = 0.005), late loss > 2 mm (P = 0.01), and loss index > 1.127 (P < 0.001). Multivariate analysis demonstrated hypertension (odds ratio, OR, = 3.6; P = 0.019), unstable angina at initial presentation (OR = 2.6; P = 0.007), TIMI grade 0-2 flow at follow-up (OR = 2.8; P = 0.05), impaired LV function at follow-up (OR = 4.2; P = 0.004), and loss index > 1.127 (OR = 3.6; P = 0.017) as independent risk factors for adverse cardiac events. Classification and regression tree analysis identified loss index > 1.127 and impaired LV function as the two strongest determinant of adverse cardiac event. Therefore, hypertensive patients whose initial clinical presentation were unstable angina should be managed carefully to optimize the angiographic results and, most importantly, followed up more closely for development of impaired LV function after coronary stenting in order to prevent the occurrence of adverse cardiac event at follow-up.


Assuntos
Angina Instável/diagnóstico , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/etiologia , Infarto do Miocárdio/diagnóstico , Stents/efeitos adversos , Idoso , Angina Instável/etiologia , Angiografia Coronária , Reestenose Coronária/patologia , Morte Súbita Cardíaca/etiologia , Feminino , Seguimentos , Humanos , Hipertensão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Revascularização Miocárdica , Fatores de Risco , Fatores de Tempo , Função Ventricular Esquerda
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA