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Royal Oak, MI, United States

Yang P.-Y.,Changhua Christian Hospital | Tang C.-C.,National Pingtung University | Chang Y.-C.,National Sun Yat - sen University | Huang S.-Y.,National Sun Yat - sen University | And 7 more authors.
European Journal of Pain (United Kingdom)

Background To investigate the role of the synthetic steroid tibolone in the progression of osteoarthritis (OA) and in nociceptive behaviour in an experimental rat model of OA and ovariectomy (OVX)-induced osteoporosis. Methods OA was induced in Wistar rats by anterior cruciate ligament transection (ACLT) of the right knee. Osteoporosis was induced by bilateral OVX. Groups of animals were subjected to ACLT, OVX, sham or OVX?+?ACLT. In addition, two groups were subjected to OVX?+?ACLT surgeries and were orally administered 0.1 or 0.5?mg tibolone every other day for 14 consecutive weeks, starting 6 weeks after surgery. Nociceptive behaviours (secondary mechanical allodynia and weight-bearing distribution of the hind paws) were analysed prior to and every 3 weeks after surgery up to 24 weeks. At 24 weeks, histopathological studies were performed on the cartilage and synovial membranes of the knee joints, and bone metabolism was assessed by measuring serum concentrations of calcium, phosphorus and alkaline phosphatase. Results Rats undergoing ACLT or OVX?+?ACLT surgeries showed obvious OA changes in the joints. Animals subjected to ACLT?+?OVX and treated with tibolone had significantly less cartilage degeneration and synovitis and showed improved nociceptive tests compared with animals undergoing ACLT?+?OVX surgeries alone. OVX increased the severity of the ACLT-induced OA changes. There was a significant increase in serum alkaline phosphatase in the tibolone-treated ACLT?+?OVX groups. Conclusions Treatment with tibolone attenuated the development of OA, concomitantly reduced nociception and increased serum alkaline phosphatase in ACLT?+?OVX rats. © 2013 European Pain Federation - EFIC®. Source

Sun T.-K.,Section of Cardiology | Chou H.-T.,Section of Cardiovascular Surgery
International Journal of Gerontology

Ischemic heart disease is a major cause of death in nonagenarians. These patients frequently present with comorbid conditions, including chronic kidney disease, increasing the complexity of the treatment. Both percutaneous coronary intervention and coronary artery bypass graft surgery are therapeutic options with different advantages and disadvantages. We herein report an experience of treating an octogenarian gentleman with three-vessel coronary artery disease involving the left main coronary artery, in whom the coronary lesion and deteriorated renal function were high risk factors for transcatheter intervention. We planned and performed a staged hybrid strategy: first, off-pump minimally-invasive coronary artery bypass surgery for the left anterior descending artery, and second, 2 months later, a transcatheter intervention for the left main coronary artery and left circumflex artery. We achieved complete relief of symptoms and prevented the deterioration of the patient's renal function. We reviewed the advantage of this modality and its impact on renal function. © 2012, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved. Source

Seder C.W.,Section of General Surgery | Sakwa M.P.,Section of Cardiovascular Surgery | Shannon F.L.,Section of Cardiovascular Surgery
Journal of Heart Valve Disease

Ventricular myxomas are rare, accounting for less than 5% of all benign cardiac tumors. Although histologically benign, myxomas can be a source of significant morbidity and mortality. The case is presented of a left ventricular myxoma involving the posterior papillary muscle that was resected using a minimally invasive transmitral approach. A radical mitral valve reconstruction was performed, including the replacement of two chordae tendineae, annuloplasty and valvuloplasty, resulting in excellent postoperative mitral valve function. Precise preoperative imaging and surgical planning are necessary to achieve adequate tumor margins and to minimize the likelihood of recurrence. © Copyright by ICR Publishers 2010. Source

Grist G.,Section of Cardiovascular Surgery | Whittaker C.,Section of Cardiovascular Surgery | Merrigan K.,Section of Cardiovascular Surgery | Fenton J.,Section of Cardiovascular Surgery | And 5 more authors.
Journal of Extra-Corporeal Technology

A previous review from our institution established clinically measured cut-points that defined the late implementation of extracorporeal membrane oxygenation (ECMO) correlating to increased mortality in neonatal and pediatric respiratory patients. Using the same methods, this review evaluates pediatric and neonatal cardiac and congenital diaphragmatic hernia (CDH) patients to determine if the same cut-points exist in this higher risk patient population. Neonatal and pediatric cardiac and CDH patients placed on ECMO between November 1989 and December 2008 were retrospectively reviewed to determine the first adjusted anion gap (AGc), the first venoarterial carbon dioxide (CO 2) gradient (p[v-a]CO 2), and the first Viability Index (AGc + p[v-a]CO 2 = INDEX) on ECMO. These markers were then analyzed to identify the presence of specific cut-points that marked an increased risk of mortality. The timing of surgery was also reviewed to assess the surgical morbidity on survival. The review of neonatal and pediatric cardiac and CDH patients (n = 205) with an overall survival of 46% showed that all three markers were elevated to varying degrees in the expired patients (n = 110). Histograms identified the following specific cut-points for increased mortality: the AGc ≥ 23 mEq/L, the p[v-a]CO 2 ≥ 16 mmHg, and the INDEX ≥ 28. An elevated AGc and INDEX correlated with a significantly higher risk for mortality (p < .05), survival to discharge being 20% or less. Patients under the cut-points had survival rates of 51% or higher. The timing of surgery (before or after ECMO initiation) did not significantly impact survival in the combined cardiac and CDH group. An INDEX ≥ 28 correlates with non-survival. We speculate that the late implementation of ECMO may lead to reperfusion injury, which causes reduced survival, and that ECMO intervention prior to reaching the cutpoints may improve survival in neonatal and pediatric cardiac and CDH patients. Source

Tsai C.-L.,Section of Cardiovascular Surgery | Lin C.-L.,Data Management | Wu Y.-Y.,China Medical University at Taichung | Shieh D.-C.,Hungkuang University | And 3 more authors.
Diabetes/Metabolism Research and Reviews

Background: Studies have associated diabetes mellitus (DM) with the reduced risk of abdominal aortic aneurysm and thoracic aortic aneurysm and dissection. We used the national insurance data of Taiwan to examine these correlations for an Asian population. The association was also evaluated by DM severity. Methods: We identified 160 391 patients with type 2 DM diagnosed from 1998 to 2008 and 646 710 comparison subjects without DM, frequency matched by diagnosis date, sex and age (mainly the elderly). The DM severity was partitioned into advanced and uncomplicated status according to DM-related comorbidities. Results: By the end of 2010, the overall pooled incidence rate of thoracic aortic aneurysm and abdominal aortic aneurysm was 15% lower in the type 2 DM cohort than in non-DM cohort, with an adjusted hazard ratio of 0.64 [95% confidence interval (CI) 0.56-0.74] in the multivariable Cox model. Patients with advanced type 2 DM were significantly associated with reduced thoracic aortic aneurysm rupture and abdominal aortic aneurysm without rupture, with adjusted hazard ratios of 0.50 (95% CI 0.35-0.71) and 0.53 (95% CI 0.40-0.69), respectively. Uncomplicated type 2 DM was also associated with reduced abdominal aortic aneurysm without rapture (aHR=0.58, 95% CI 0.45-0.74). Conclusions: Our results demonstrate that patients with diabetes in this Asian population have reduced prevalence of thoracic and abdominal aortic aneurysms. The observed paradoxical inverse relationship between severity of DM and aortic aneurysms is clear. Further research is required to investigate the underlying mechanisms for the reduced risk of aortic aneurysms associated with diabetes. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd. 31 2 February 2015 10.1002/dmrr.2585 Research Article Research Articles Copyright © 2014 John Wiley & Sons, Ltd. Source

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