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Use of antiarrhythmic drugs in elderly patients

Journal of Geriatric Cardiology 2011年第3期8卷 184-194页

作者： Hon-Chi Lee Kristin tl Huang Win-Kuang Shen Division of Cardiovascular Diseases Department of Internal Medicine Mayo Clinic 200 First Street SW Rochester MN 55905 USA Harvard Medical School 25 Shattuck Street Boston MA 02115 USA Division of Cardiovascular Diseases Department oflnternal Medicine Mayo Clinic 13400 East Shea Blvd. Scottsdale AZ 85259 USA

Human aging is a global issue with important implications for current and future incidence and prevalence of health conditions and disability. Cardiac arrhythmias, including atrial fibrillation, sudden cardiac death, and bradycardia requiring pacemaker placement, all increase exponentially after the age of 60. It is important to distinguish between the normal, physiological consequences of aging on cardiac electrophysiology and the abnormal, pathological alterations. The age-related cardiac changes include ventricular hypertrophy, senile amyloidosis, cardiac valvular degenerative changes and annular calcification, fibrous infiltration of the conduction system, and loss of natural pacemaker cells and these changes could have a profound effect on the development of arrhythmias. The age-related cardiac electrophysiological changes include up- and down-regulation of specific ion channel expression and intmcellular Ca2＋ overload which promote the development of cardiac arrhythmias. As ion channels are the substrates of antiarrhythmic drugs, it follows that the pharmacokinetics and pharmacodynamics of these drugs will also change with age. Aging alters the absorption, distribution, metabolism, and elimination of antiarrhythmic drugs, so liver and kidney function must be monitored to avoid potential adverse drug effects, and antiarrhythmic dosing may need to be adjusted for age. Elderly patients are also more susceptible to the side effects of many antiarrhytbanics, including bradycardia, orthostatic hypotension, urinary retention, and falls. Moreover, the choice of antiarrhythmic drugs in the elderly patient is frequently complicated by the presence of co-morbid conditions and by polypharmacy, and the astute physician must pay careful attention to potential drug-drug interactions. Finally, it is important to remember that the use of antiarrhythmic drugs in elderly patients must be individualized and tailored to each patient＇s physiology, disease processes, and medication

关键词： aging antiarrhythmic drugs pharmacokinetics pharmacodynamics polypharmacy cardiac electrophysiology ion channels

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Rabeprazole vs esomeprazole in non-erosive gastro-esophageal reflux disease: A randomized, double-blind study in urban Asia

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World Journal of Gastroenterology 2005年第20期11卷 3091-3098页

作者： KM Fock EK Teo tl Ang TS Chua TM Ng YL Tan Division of Gastroenterology Department of Medicine Changi General Hospital Singapore

AIM：Gastro-esophageal reflux disease (GERD) is becoming increasingly common in Asia. Data on the efficacy of proton pump inhibitors in patients with non-erosive GERD (NERD)in Asia is lacking. This double-blind study compared the efficacy and safety of rabeprazole with esomeprazole in relief of symptoms in patients with ***: One hundred and thirty-four patients with reflux symptoms of NERD and normal endoscopy were randomized to receive rabeprazole 10 mg or esomeprazole 20 mg once daily for 4 wk. Symptoms were recorded in a diary and changes in severity of symptoms ***: At 4 wk of treatment, rabeprazole 10 mg and esomeprazole 20 mg were comparable with regards to the primary endpoint of time to achieve 24-h symptomfree interval for heartburn 8.5 d vs9 d and regurgitation 6 d vs 7.5 d. Rabeprazole and esomeprazole were also similarly efficacious in term of patient's global evaluation with 96% of patients on rabeprazole and 87.9% of patients on esomeprazole, reporting that symptoms improved(P=NS). Satisfactory relief of day- and night-time symptoms was achieved in 98% of patients receiving rabeprazole and 81.4% of patients receiving esomeprazole. Adverse events were comparable in both groups (P = NS).CONCLUSION: Rabeprazole 10 mg has a similar efficacy and safety profile in Asians with NERD as esomeprazole 20 mg. Further study is necessary to investigate whether the small differences between the two drugs seen in this study are related to the improved pharmacodynamicpro perties of rabeprazole. Both drugs were well tolerated.

关键词： Non-erosive esophageal reflux disease New proton pump inhibitors

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Treatment of children with neurogenic bladder dysfunctions using dynamic nero-electrostimulation(DENS) and M-Cholinolytic therapy

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中国现代医学杂志 2013年第2期23卷 13-16页

作者： Zubarenko AV Stoeva NV Godlevska tl Department of Pediatrics Odessa National Medical University(rector-academic of NAMS in UkraineProfessor Zaporozhan V.N.)Valikhovsky lane 2Kyiv 65082Ukraine

【Objective】 To investigate effects of combined usage of dynamic neuro-electric stimulation(DNES) and M-cholynolytic therapy(oxybutynin) upon manifestations of neurogenic bladder dysfunctions(NBD) in children.【Method】 Urodynamics examination included registration of extemporaneous urinary excretion,urofluometry,and retrograde cytometry in horizontal and vertical position by example of urodynamic system(UDS) ACS 180 Plus(MENFIS BioMed.,USA).In accordance to severity of clinician manifestations,three groups of patients have been defined(27-highest one,49-middle and 51 low levels).Dynamic neuro-electrostimulation(DNES) procedures were conducted using the"DiaDNES-PKM"device(Russian Federation).The children were exposed to juxtaspinal stimulation on S1-S3 level-altogether 10 sessions have been ***(driptan) was used in dosage of 2.5 mg per diem.【Result】It was established that combined usage of DNES and oxybutynin in the group with highest severity caused the reduction of manifestations by 3.1 times while separately given DNES and basic therapy were followed by 34.1% and 28.0% reduction ***,DNES and oxybutynin reduced severity in patients with pronounced disturbances by 7.5 *** usage of oxybutynin and DNES in severely manifested NBD increased the effective volume of bladder by 2.3 *** significant reduction of both intrabladder pressure(by 48.0%) and compliance of the bladder(by 4.8 times) were detected under condition of combined usage of DNES and *** mentioned indices were modified to less extent in case of separate usage of DNES or oxybutynin when compared with the one registered after the combined their usage(P <0.05).【Conclusion】Combined usage of DENS and oxybutinin(driptan) is effective in most severe cases in children suffered from neurogenic overactive bladder.

关键词：医学临床诊断疾病

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May mesenchymal stem cell transplantation be a solution for COVID-19 induced cytokine storm?

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World Journal of Transplantation 2021年第8期11卷 344-355页

作者： Hüseyin Sütlüoğlu ÖnerÖzdemir Faculty of Medicine Sakarya UniversityAdapazarı54100SakaryaTurkey Division of Pediatric Allergy and Immunology Sakarya University Medical FacultyAdapazarı54100SakaryaTurkey

The recently emergent disease caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),transmitted by droplets and aerosols,was named coronavirus disease 2019(COVID-19)by World Health ***,the disease progress is asymptomatic or mild,but one-fifth of the patients advance to severe or critical *** severe COVID-19 patients,type-2 T helper cells release numerous cytokines;this excessive immune response is named as cytokine *** cytokine storm,which is the hallmark of the COVID-19 induced by the disease and aggravates due to lack of proper immune response,similar to SARS and Middle East respiratory syndrome(MERS),and the disease status may progress forward to acute respiratory distress syndrome(ARDS),systemic inflammatory response syndrome,multi-organ dysfunction syndrome,and *** stromal cell transplantation is up-and-coming in treating many diseases such as HIV,hepatitis B,influenza,coronavirus diseases(SARS,MERS),lung injuries,and *** closer inspection on respiratory diseases,COVID-19,influenza,SARS,and MERS have similarities in patho-genesis,especially cytokine and immune response *** comparable features in terms of the cytokine storm will provide hints for the treatment of COVID-19.

关键词： Mesenchymal stem cell Mesenchymal stromal cell COVID-19 Cytokine storm Immunosuppression Transplantation

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The utility of coronary computed tomography angiography in elderly patients

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Journal of Geriatric Cardiology 2019年第7期16卷 507-513页

作者： Jordan Laggoune Nitesh Nerlekar Kiran Munnur Brian SH Ko James D Cameron Sujith Seneviratne Dennis tl Wong Monash Cardiovascular Research Centre Monash University and MonashHeartMonash HealthClaytonVictoriaAustralia South Australian Health Medical Research Institute AdelaideAustralia

Background Coronary computed tomography angiography(CCTA)is often avoided in elderly patients due to a presumption that a high proportion of patients will have heavily calcified plaque limiting an accurate *** sought to assess the image quality,luminal stenosis and utility of CCTA in elderly patients with suspected coronary artery disease(CAD)and stable chest *** Retrospective analysis of elderly patients(>75 years)who underwent 320-detector row CCTA between 2012–2017 at *** CCTA was analysed for degree maximal coronary stenosis by CAD-RADS classification,image quality by a 5-point Likert score(1-poor,2-adequate,3-good,4-very good,5-excellent)and presence of artefact limiting *** 1011 elderly patients(62%females,78.8±3.3 years)were *** risk factor prevalence included:hypertension(65%),hyperlipidaemia(48%),diabetes(19%)and smoking(21%).The CCTA was evaluable in 68%of patients which included 52%with non-obstructive CAD(50%)*** Likert score was 3.1±0.6 corresponding to good image *** the 323(32%)of patients with a non-interpretable CCTA,80%were due to calcified plaque and 20%due to motion *** gender(P=0.009),age(P=0.02),excess motion(P78 years of age are significantly less likely to have interpretable scans.

关键词： Coronary artery calcium Coronary CT angiography Multi-detector row CT The elderly

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Inferior vena cava reconstruction in extended right hepatectomy

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Hepatobiliary & Pancreatic Diseases International 2024年第5期23卷 533-534页

作者： Karin KY Ho Sui Ling Sin Kin Pan Au Henry HY Lee Daniel tl Chan Albert Chan Department of Surgery The University of Hong Kong102 Pok Fu Lam RoadHong KongChina Department of Surgery Yan Chai Hospital7 Yan Chai StreetHong KongChina State Key Laboratory of Liver Research(Li Ka Shing Faculty of Medicine The University of Hong Kong)102 Pok Fu Lam RoadHong KongChina

To the Editor : Barcelona Clinic Liver Cancer(BCLC) Stage C hepatocellular carcinoma(HCC) with vascular invasion has been considered unresectable. However, the curative rate from systemic treatment is rather dismal. Even with the use of immunotherapy, complete remission is less than 10% [ 1 ]. On the contrary, recent advances in transplant oncology, especially in the application of liver transplant-related surgical techniques in complex liver resections, make the operation possible for patients with locally advanced HCC who were previously considered to be unresectable [ 2 ]. We hereby present the surgical management of a patient with giant HCC in right liver lobe with inferior vena cava(IVC) invasion.

关键词： invasion vena Liver

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描绘裂缝油气藏的特征

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油气田开发工程译丛 1992年第11期 11-13页

作者： Davi.,tl 马迪生

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Prostate cancer detection upon transrectal ultrasound-guided biopsy in relation to digital rectal examination and prostate-specific antigen level： what to expect in the Chinese population？

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Asian Journal of Andrology 2015年第5期17卷 821-825,I0010页

作者： Jeremy YC Teoh Steffi KK Yuen James HL Tsu Charles KW Wong Brian SH Ho Ada tl Ng Wai-Kit Ma Kwan-Lun Ho Ming-Kwong Yiu Department of Surgery Division of Urology Queen Mary Hospital University of Hong Kong Hong Kong China

We investigated the prostate cancer detection rates upon transrectal ultrasound （TRUS）-guided biopsy in relation to digital rectal examination （DRE） and prostate-specific antigen （PSA）, and risk factors of prostate cancer detection in the Chinese population. Data from all consecutive Chinese men who underwent first TRUS-guided prostate biopsy from year 2000 to 2013 was retrieved from our database. The prostate cancer detection rates with reference to DRE finding and PSA level of 〈 4, 4-10, 10.1-20, 20.1-50 and 〉 50 ng ml^-1 were investigated. Multivariate logistic regression analyses were performed to investigate for potential risk factors of prostate cancer detection. A total of 2606 Chinese men were included. In patients with normal DRE, the cancer detection rates were 8.6%, 13.4%, 21.8%, 41.7% and 85.2% in patients with PSA 〈 4, 4-10, 10.1-20, 20.1-50 and 〉 50 ng ml^-1 respectively. In patients with abnormal DRE, the cancer detection rates were 12.4%, 30.2%, 52.7%, 80.6% and 96.4% in patients with PSA 〈 4, 4-10, 10.1-20, 20.1-50 and 〉 50 ng m1-1 respectively. Older age, smaller prostate volume, larger number of biopsy cores, presence of abnormal DRE finding and higher PSA level were associated with increased risk of prostate cancer detection upon multivariate logistic regression analyses （P 〈 0.001）. Chinese men appeared to have lower prostate cancer detection rates when compared to the Western population. Taking the different risk factors into account, an individualized approach to the decision of TRUS-guided biopsy can be adopted.

关键词： Chinese digital rectal examination prostate biopsy prostate cancer prostate-specific antigen

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增加采油量的加密钻井

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油气田开发工程译丛 1990年第4期 4-13,25页

作者： Goul.,tl 汪加其

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The performance characteristics of prostate-specific antigen and prostate-specific antigen density in Chinese men

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Asian Journal of Andrology 2017年第1期19卷 113-116页

作者： Jeremv YC Teoh Steffi KK Yuen James HL Tsu Charles KW Wong Brian SH Ho Ada tl Ng Wai-Kit Ma Kwan-Lun Ho Ming-Kwong Yiu Division of Urology Department of Surgery Queen Mary Hospital University of Hong Kong Hong Kong China

We investigated the performance characteristics of prostate-specific antigen （PSA） and PSA density （PSAD） in Chinese men. All Chinese men who underwent transrectal ultrasound-guided prostate biopsy （TRUS-PB） from year 2000 to 2013 were included. The receiver operating characteristic （ROC） curves for both PSA and PSAD were analyzed. The sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） at different cut-off levels were calculated. A total of 2606 Chinese men were included. For the ROC, the area under curve was 0.770 for PSA （P〈 0.001） and 0.823 for PSAD （P〈 0.001）. PSA of 4.5 ng ml^-1 had sensitivity of 94.4%, specificity of 14.1%, PPV of 29.5%, and NPV of 86.9%; PSAD of 0.12 ng ml^-1cc^-1 had sensitivity of 94.5%, specificity of 26.6%, PPV of 32.8%, and NPV of 92.7%. On multivariate logistic regression analyses, PSA cut-off at 4.5 ng ml^-1 （OR 1.61, 95% CI 1.05-2.45, P = 0.029） and PSAD cut-off at 0.12 ng ml^-1 cc^-1 （OR 6.22, 95% CI 4.20-9.22, P 〈 0.001） were significant predictors for prostate cancer detection on TRUS-PB. In conclusion, the performances of PSA and PSAD at different cut-off levels in Chinese men were very different from those in Caucasians. PSA of 4.5 ng ml^-1 and PSAD of O. 12 ng ml^-1 cc^-1 had near 95% sensitivity and were significant predictors of prostate cancer detection in Chinese men.

关键词： Chinese prostate cancer transrectal ultrasound-guided prostate biopsy prostate-specific antigen prostate-specific antigen density

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