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A Patient with Atezolizumab-Induced Autoimmune Diabetes Mellitus Presenting with Diabetic Ketoacidosis

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Cardiovascular Innovations and Applications 2021年第3期6卷 45-50页

作者： Sharen Lee gary tse Cardiovascular Analytics Group Laboratory of Cardiovascular PhysiologyHong KongHKGChina Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjin300211China Xiamen Cardiovascular Hospital Xiamen UniversityXiamen361015China

Background:Atezolizumab,an immune checkpoint inhibitor,is a humanized monoclonal,anti-programmed death ligand 1(PD-L1)antibody used for the treatment of metastatic urothelial carcinoma that has progressed after *** Presentation:We describe a patient with a known history of urothelial carcinoma who presented with dia-betic ketoacidosis 6 weeks following his second cycle of *** serum lactate level was slightly elevated(2 mM)and hisβ-hydroxybutyrate level was elevated(3.9 mM).High anion gap metabolic acidosis secondary to dia-betic ketoacidosis was *** testing demonstrated hemoglobin A 1c level of 9.9%,positivity for anti-glutamic acid decarboxylase antibody(0.03 nM,reference range<0.02 nM),and suppressed C-peptide level(0.1μg/L,reference range 0.9-7.1μg/L)in the absence of detectable anti-islet antigen 2(IA-2)or anti-insulin *** initial management included cessation of atezolizumab treatment,intravenous sodium chloride administration,and insulin pump infusion,after which metabolic acidosis gradually *** insulin pump was subsequently switched to Protaphane at 18 units before breakfast and 8 units before dinner,together with metformin at 1000 mg twice *** weeks later his medication was changed to human isophane insulin plus neutral insulin(70%/30%;Mixtard 30 HM;26 units/4 units).Linagliptin at 5 mg was added 1 month *** hemoglobin A 1c level declined to 8.1%1 year ***:PD-L1 inhibitors can induce type 1 diabetes,and patients can present with diabetic *** glucose levels should be regularly monitored in patients who are prescribed these medications.

关键词： Atezolizumab diabetic ketoacidosis PD-L1 inhibitors Type 1 diabetes

Successful conservative management of Class III iatrogenic aortic dissection

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Journal of Geriatric Cardiology 2018年第3期15卷 235-237页

作者： Wai Kin Chi gary tse Bryan PY Yan Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong China Division of Cardiology Prince of Wales Hospital Shatin Hong Kong China Li Ka Shing Institute of Health Sciences Faculty of Medicine The Chinese University of Hong Kong Hong Kong China

Iatrogenic aortic dissection （IAD） is a rare complication of percutaneous coronary intervention （PCI） with an estimated incidence of 0.02%--0.04%. lAD occurs more frequently in the setting of urgent PCI for acute myocardial infarction （AMI）（0.19%） than for elective procedures （0.01%）.[11 The mortality risk associated with IAD is high （16%） and is comparable to that for spontaneous aortic dissection （16%）.Urgent surgery is the treatment of choice for extensive dissection or hemodynamic instability. In this report, we present a case of severe IAD that was managed conservatively with good clinical outcome.

关键词： Conservative management Iatrogenic aortic dissection Percutaneous coronary intervention

Running with Face Masks or Respirators Can Be Detrimental to the Respiratory and Cardiovascular Systems

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Cardiovascular Innovations and Applications 2021年第3期6卷 63-65页

作者： Yidan Wang gary tse Guoliang Li Department of Cardiovascular Medicine The First Affi liated Hospital of Xi’an Jiaotong University277 Yanta West RoadXi’an710061 ShaanxiChina Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityChina

Since the fi rst cases of coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coro-navirus 2(SARS-CoV-2)were reported at the end of 2019,this infection has spread around the globe,becoming a *** use of face masks and respirators is an important public health measure to reduce or prevent transmission of *** we discuss the hypothetical mechanisms by which exercise with face masks or respirators can induce detrimental effects on the cardiovascular system,potentially explaining adverse events such as cardiac arrhythmias and spontaneous *** sudden death associated with the wearing of a face mask during running is a rare event,the risk is higher especially in those with existing cardiac *** such cases,a mask designed specifi cally for runners with no or few side effects of oxygen defi ciency should be considered instead.

关键词： COVID-19 Running Face masks Respiratory system

Novel conduction-repolarization indices for the stratification of arrhythmic risk

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Journal of Geriatric Cardiology 2016年第9期13卷 811-812页

作者： gary tse Department of Medicine and Therapeutics Faculty of Medicine Chinese University of Hong Kong Hong Kong China.

Sudden cardiac death （SCD） affects approximately 800,000 individuals per annum globally. It is most frequently due to cardiac tachy-arrhythmias, which include mono-morphic or polymorphic ventricular tachycardia （VT）, torsade de pointes and ventricular fibrillation （VF）. Risk stratification for SCD remains a challenging problem in clinical practice.

关键词： Conduction Depolarization QRS QT dispersion Repolarization Transmural dispersion of repolarization Wavelength

Both transmural dispersion of repolarization and of refractoriness are poor predictors of arrhythmogenicity： a role for iCEB （QT/QRS）？

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Journal of Geriatric Cardiology 2016年第9期13卷 813-814页

作者： gary tse Department of Medicine and Therapeutics Faculty of Medicine Chinese University of Hong Kong Hong Kong China.

We read the original article by Nuis, et al. and the reply by Dogan, et al. with great interest. Nuis, et al. examined whether transcatheter aortic valve implantation （TAVI） in patients suffering from severe aortic stenosis led to changes in corrected QT dispersion （cQTD）, previously used to predict arrhythmic risk. Dogan, et al. proposed that a different marker, transmural dispersion of repolariza- tion （TDR）, has better accuracy in risk prediction.

关键词： Depolarization Excitation wavelength QT dispersion Transmural dispersion of repolarization Transmural dispersion of refractoriness QT/QRS

Impact of SGLT2 inhibitors on major clinical events and safety outcomes in heart failure patients:a meta-analysis of randomized clinical trials

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Journal of Geriatric Cardiology 2021年第10期18卷 783-795页

作者： George Bazoukis Stamatis S.Papadatos Costas Thomopoulos gary tse Stefanos Cheilidis Konstantinos Tsioufis Dimitrios Farmakis Department of Cardiology Larnaca General HospitalLarnacaCyprus Department of Anatomy Histology and EmbryologyMedical SchoolUniversity of IoanninaIoanninaGreece Department of Cardiology Helena Venizelou HospitalAthensGreece Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina University of Cyprus Medical School NicosiaCyprus First Cardiology Clinic Hippokration HospitalAthens UniversityAthensGreece

BACKGROUND Sodium-glucose co-transporter-2 inhibitors(SGLT2i)significantly reduce the risk of cardiovascular(CV)and renal adverse events in patients with diabetes mellitus,heart failure(HF)and/or chronic kidney *** performed a meta-analysis to explore the impact of several different SGLT2i on all-cause mortality,CV mortality,HF hospitalizations and the combined outcome CV death/HF hospitalization in HF patients across the spectrum of left ventricular ejection fraction(LVEF)*** A systematic search in MEDLINE database and Cochrane library through March 2021 was performed without *** clinical trials that provided data about the impact of SGLT2i on all-cause mortality,CV mortality,HF hospitalizations or the combined outcome of CV death/HF hospitalization in HF patients were included.A random effects model was used for calculating the effect *** Nine studies(n=16,723 patients,mean age:65.9 years,males:70.7%)were included in the quantitative *** to placebo,SGLT2i use was associated with 14%lower risk of all-cause mortality[hazard ratio(HR)=0.86,95%CI:0.78−0.94,I^(2)=0,P=0.0008],32%lower risk of HF hospitalizations(HR=0.68,95%CI:0.62−0.74,I^(2)=0,P<0.001),14%lower risk of CV mortality(HR=0.86,95%CI:0.77−0.95,I^(2)=0,P=0.003)and 26%lower risk of CV death/HF hospitalization(HR=0.74,95%CI:0.68−0.80,I^(2)=0,P<0.001).Regarding the safety outcomes,our data revealed no significant differences between SGLT2i and placebo groups in drug related discontinuations,amputations,severe hypoglycemia,hypotension,volume depletion,ketoacidosis and genital *** contrast,a protective role of SGLT2i against placebo was found for serious adverse events and acute kidney *** In patients with HF,regardless of LVEF phenotype,all SGLT2i had an excellent safety profile and significantly reduced the risk of all-cause mortality,CV mortality,HF hospitalizations and CV deaths/HF hospitalizations compared to placeb

关键词： patients clinical protective

Electrocardiogram-based artificial intelligence for the diagnosis of heart failure:a systematic review and meta-analysis

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Journal of Geriatric Cardiology 2022年第12期19卷 970-980,1011-1015页

作者： Xin-Mu LI Xin-Yi GAO gary tse Shen-Da HONG Kang-Yin CHEN Guang-Ping LI Tong LIU Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina Kent and Medway Medical School CanterburyUnited Kingdom National Institute of Health Data Science at Peking University Peking UniversityBeijingChina Institute of Medical Technology Peking University Health Science CenterBeijingChina

BACKGROUND The electrocardiogram(ECG)is an inexpensive and easily accessible investigation for the diagnosis of cardiovascular diseases including heart failure(HF).The application of artificial intelligence(AI)has contributed to clinical practice in terms of aiding diagnosis,prognosis,risk stratification and guiding clinical *** aim of this study is to systematically review and perform a meta-analysis of published studies on the application of AI for HF detection based on the *** We searched Embase,PubMed and Web of Science databases to identify literature using AI for HF detection based on ECG *** quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2(QUADAS-2)***-effects models were used for calculating the effect estimates and hierarchical receiver operating characteristic curves were *** analysis was *** and the risk of bias were also *** A total of 11 studies including 104,737 subjects were *** area under the curve for HF diagnosis was 0.986,with a corresponding pooled sensitivity of 0.95(95%CI:0.86–0.98),specificity of 0.98(95%CI:0.95–0.99)and diagnostic odds ratio of 831.51(95%CI:127.85–5407.74).In the patient selection domain of QUADAS-2,eight studies were designated as high *** According to the available evidence,the incorporation of AI can aid the diagnosis of ***,there is heterogeneity among machine learning algorithms and improvements are required in terms of quality and study design.

关键词： diagnosis assessed specificity

Clinical, sonographic characteristics and long-term prognosis of valvular heart disease in elderly patients

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Journal of Geriatric Cardiology 2019年第1期16卷 33-41页

作者： Feier SONG Fang-Zhou LIU Yuan-Feng LIANG gary tse Xin LI Hong-Tao LIAO Ji-Yan CHEN Department of Cardiology Guangdong Cardiovascular InstituteGuangdong Provincial Key Laboratory of Coronary Heart Disease PreventionGuangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina Department of Cardiology Guangdong Cardiovascular InstituteGuangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina Guangdong Geriatric Institute Guangdong Provincial People s Hospital and Guangdong Academy of Medical SciencesGuangzhouChina Department of Medicine and Therapeutics Faculty of MedicineChinese University of Hong KongHong KongChina Iinstitute of Health Sciences Faculty of MedicineChinese University of Hong KongHong KongChina

Background Valvular heart disease(VHD)is expected to become more prevail as the population ages and disproportionately affects older ***,direct comparison of clinical characteristics,sonographic diagnosis,and outcomes in VHD patients aged over 65 years is *** objective of this study was to evaluate the differences in clinical characteristics and prognosis in two age-groups of geriatric patients with *** We retrospectively enrolled consecutive individuals aged>65 years from Guangdong Provincial Peopled Hospital and screened for VHD using transthoracic echocardiography(TTE)or transesophageal echocardiography(TEE).Finally,260(48.9%)patients were in the 65-74 years group,and 272(51.1%)were in the>75-year *** that affected long-term survival was explored.A multivariable Cox hazards regression was performed to identify the predictors of major adverse cardiac events(MACEs)in each *** In our population,the older group were more likely to have chronic obstructive pulmonary disease(COPD),degenerative VHD,but with less rheumatic VHD,aortic stenosis(AS)and mitral stenosis(MS).Compared with those aged 65-74 years,the older group had a higher incidence of all-cause death(10.0%vs.16.5%,P=0.027),ischemic stroke(13.5%vs.20.2%,P=0.038)and MACEs(37.3%vs.48.2%,P=0.011)at long-term *** multivariable Cox regression analysis,mitral regurgitation,a history of COPD,chronic kidney disease,diabetes,hypertension,atrial fibrillation and New York Heart Association(NYHA)functional class were identified as independent predictors of MACEs in the older *** Advanced age profoundly affect prognosis and different predictors were associated with MACEs in geriatric patients with VHD.

关键词： Echocardiography Geriatrics Mortality Prognosis The aged Valvular heart disease

ST-Segment Depression in Leads I and aVL: Artifactual or Pathophysiological Findings ?

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Cardiovascular Innovations and Applications 2021年第4期6卷 109-111页

作者： Sharen Lee gary tse Xin Wang Adrian Baranchuk Tong Liu Cardiovascular Analytics Group Laboratory of Cardiovascular PhysiologyHong KongChina Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina Department of Medicine Kingston General HospitalQueen’s UniversityKingstonOntarioCanada

The 12-lead electrocardiogram(ECG)is a routinely performed test but is susceptible to misinterpretation even by experienced *** report a case of a 72-year-old lady with no prior cardiac history presented to our hospital with atypical chest *** initial electrocardiogram shows an initial ST depression followed by positive defl ections leads I and ***-physiological ST segment and T-wave changes are also observed in the precordial leads V2 to *** contrast,these abnormalities are notably absent in lead II.A repeat of the ECG taken 30 minutes later reveals the resolution of most abnormalities seen in the initial ECG on a background of high-frequency noise in the limb *** was referred to the cardiology department for further *** urgent echocardiogram revealed no regional wall motion abnormalities with preserved ejection fraction,and her coronary angiogram revealed no signifi cant coro-nary *** case illustrates the importance of understanding different factors that can cause ST segment abnor-malities,notably artifactual changes that can mimic ST segment myocardial infarction.

关键词： ST segment artifact