Biomedical subjects

C C Cheng

Publications and source records attributed to C C Cheng.

At least 37 records · Page 2Linked to original sources

PubMed1999

T1762/A1764 variants of the basal core promoter of hepatitis B virus; serological and clinical correlations in Chinese patients.

BACKGROUND: A double variant in the basal core promoter, converting nucleotide 1762 from A to T (T1762) and nucleotide 1764 from G to A (A[764), has been described in patients with chronic hepatitis B infection. Its prevalence and significance in Chinese chronic HBV carriers are unknown. METHODS: We studied 177 Chinese patients with chronic HBV infection (chronic hepatitis/asymptomatic: 89/88; hepatitis B e antigen positive/negative: 84/93). The double variant was detected by mismatched polymerase chain reaction and restriction fragment length polymorphism analysis. The reliability of this method was verified by sequencing in 41 serum samples with 100% matching. RESULTS: The double variant T1762/ A1764 was found in 52 of 89 patients with chronic hepatitis, but in only 6 of 59 asymptomatic carriers (p<0.001). The prevalence was significantly lower in hepatitis B e antigen positive patients (23/84) than in hepatitis B e antigen negative patients (35/64) (p<0.005). Precore variant, A1896 was detected in 40 individuals; 31 of them suffered from chronic hepatitis and 9 were asymptomatic (p<0.001). A combination of both variants T1762/A1764 and A1896 was seen in 3 of 59 asymptomatic and 22 of 89 patients with chronic hepatitis (p<0.005). CONCLUSIONS: Mismatched polymerase chain reaction with restriction fragment length polymorphism provides a reliable, easy and fast method for detection of the presence of the T1762/A1764 variant. In Chinese chronic hepatitis B carriers, T1762/A1764 variant was associated with both active liver disease and hepatitis B e antigen negativity.

Adult↗

PubMed1999

Random X chromosome methylation patterns in the carriers with clinical phenotypic expressions of X-linked recessive bulbospinal neuronopathy.

OBJECTIVES: We report the unusual phenotypic expression in 2 female carriers of a family with X-linked recessive bulbospinal neuronopathy (X-BSN). We analyze the methylation pattern of the androgen receptor (AR) gene to inspect the possibility of non-random X chromosome inactivation to be the underlying mechanism. MATERIAL AND METHODS: Twenty-three members in 3 generations of a Taiwanese family were examined and studied for genomic DNA analysis. We analyzed the sequence of the first exon of the AR gene to identify the numbers of CAG repeats, and to determine the methylation pattern by using the restriction enzymes HpaII and HhaI. RESULTS: There were 3 probands and 5 carriers and 2 of the carriers manifested clinical symptoms. Sequence analysis revealed that the numbers of trinucleotide repeats ranged from 42 to 45 in one allele of the X-chromosome in the 5 female carriers. The restriction pattern of the HpaII and HhaI recognizable sites of the X-chromosome indicated a random methylation. CONCLUSION: Our data suggest that molecular genetic studies are important in confirming the diagnosis of X-BSN and early detection of female carriers, and the random or non-random methylation pattern of the X-chromosome is not a determining factor for partial expression of the abnormal AR gene in some carriers.

Adult↗

PubMed1998

Increase of reactive oxygen species (ROS) in endothelial cells by shear flow and involvement of ROS in shear-induced c-fos expression.

Intracellular reactive oxygen species (ROS) may participate in cellular responses to various stimuli including hemodynamic forces and act as signal transduction messengers. Human umbilical vein endothelial cells (ECs) were subjected to laminar shear flow with shear stress of 15, 25, or 40 dynes/cm2 in a parallel plate flow chamber to demonstrate the potential role of ROS in shear-induced cellular response. The use of 2',7'-dichlorofluorescin diacetate (DCFH-DA) to measure ROS levels in ECs indicated that shear flow for 15 minutes resulted in a 0.5- to 1.5-fold increase in intracellular ROS. The levels remained elevated under shear flow conditions for 2 hours when compared to unsheared controls. The shear-induced elevation of ROS was blocked by either antioxidant N-acetyl-cysteine (NAC) or catalase. An iron chelator, deferoxamine mesylate, also significantly reduced the ROS elevation. A similar inhibitory effect was seen with a hydroxyl radical (.OH) scavenger, 1,3-dimethyl-2-thiourea (DMTU), suggesting that hydrogen peroxide (H202), .OH, and possibly other ROS molecules in ECs were modulated by shear flow. Concomitantly, a 1.3-fold increase of decomposition of exogenously added H2O2 was observed in extracts from ECs sheared for 60 minutes. This antioxidant activity, abolished by a catalase inhibitor (3-amino-1,2,4-triazole), was primarily due to the catalase. The effect of ROS on intracellular events was examined in c-fos gene expression which was previously shown to be shear inducible. Decreasing ROS levels by antioxidant (NAC or catalase) significantly reduced the induction of c-fos expression in sheared ECs. We demonstrate for the first time that shear force can modulate intracellular ROS levels and antioxidant activity in ECs. Furthermore, the ROS generation is involved in mediating shear-induced c-fos expression. Our study illustrates the importance of ROS in the response and adaptation of ECs to shear flow.

Acetylcysteine↗

PubMed1998

Affinity capillary electrophoresis in biomolecular recognition.

Affinity capillary electrophoresis is a new method for studies of biomolecular recognition. Applications reported in the literature include chiral separation of racemic biomolecules, measurement of binding constants, estimation of kinetic on- and off-rate constants, determination of binding stoichiometries (a useful tool in examining electrostatic interactions), estimation of effective charges and molecular weights of proteins, characterization of enzymatic activities and library screening for tight-binding drug candidates in solution. This technique demands only small amounts of sample (nanolitre injection volumes, picograms of proteins), involves no radiolabelled materials or chemically immobilized ligands, and does not require changes in spectroscopic characteristics upon binding. This paper reviews the most recent applications of affinity capillary electrophoresis and its use in the analysis of biomolecules.

Electrophoresis, Capillary↗

PubMed1998

X-linked recessive bulbospinal neuronopathy: clinical and molecular studies in a Taiwanese family.

We describe clinical, biochemical, and molecular studies on a Taiwanese family with X-linked recessive bulbospinal neuronopathy. There were three probands and five female carriers among the 23 members examined. The clinical manifestations included progressive muscle weakness, diffuse fasciculation, postural tremor, muscle cramps, dysarthria, dysphagia, diabetes, and gynecomastia. Phenotypic expression varied among the affected subjects. Two carriers also had postural tremor and perioral fasciculation. Endocrine tests were normal except for a mild increase in serum testosterone and/or growth hormone in one patient and one carrier. Type IV hyperlipoproteinemia was observed in two patients, one carrier, and one healthy offspring. Molecular genetic studies confirmed elongation of the CAG triplet repeat in exon 1 of the gene for the androgen receptor. Sequence analysis showed that there were 42 to 43 CAG repeats in the three probands and 42 to 45 in the five carriers. The mutant allele had a tendency to increase by one or two repeats from one generation to the next. The length of CAG repeats at which the mutant allele became unstable was shorter in our family than in previous reports. The normal allele was also unstable and had a tendency to shrink by one of five repeats during transmission. These findings suggest that the number of CAG triplet repeats is variable in both the mutant and normal alleles.

Adolescent↗

PubMed1997

Reduced folate carrier gene (RFC1) expression and anti-folate resistance in transfected and non-selected cell lines.

Methotrexate transport deficiency due to decreased reduced folate carrier (RFC) activity has been observed in several cell lines selected for resistance to methotrexate (MTX). Since MTX resistance is multifactorial, however, it is difficult to quantify the relative importance of changes in RFC activity in selected cell lines and even more so to determine the relative contribution of naturally occurring RFC activity in the MTX sensitivity of non-selected cell lines. We examined the role of RFC in MTX resistance by studying a transport-deficient cell line transfected with the gene for human RFC, RFC1, and by correlating relative RFC1 expression with MTX and trimetrexate (TMTX) growth inhibition (GI50) in a panel of cell lines used in the NCI Anticancer Drug Screen. Clones of transport-deficient, MTX-resistant ZR-75-1 human breast cancer cells (MTX(R) ZR-75-1) transfected with RFC1 were 250-fold more sensitive to MTX and 300-fold more resistant to TMTX than control cell clones, showing that restoration of RFC activity has a significant impact on MTX and TMTX cytotoxicity. We also surveyed 40 of the 60 cell lines in the NCI drug screen panel for RFCI RNA levels by a quantitative RT-PCR assay. RFCI RNA levels varied over a range of 15-fold, with only 1 cell line found to be null in expression. Using data from the 6-day drug exposure assay, RFC1 correlated positively with MTX and negatively with TMTX cytotoxicity. As predicted by transfection studies, the calculated difference between MTX and TMTX potency was even more strongly correlated with RFC1 RNA levels of the cell lines. In addition, compounds in the NCI Anticancer Drug Screen database with cytotoxicity profiles which correlated with RFC1 RNA levels or with the calculated difference in MTX-TMTX potency were examined for MTX uptake inhibition and cytotoxicity in the RFC1-transfected MTX(R) ZR-75-1 cell line. Overall, our data demonstrate the importance of RFC1 in MTX resistance both as a transgene and as a constitutively expressed gene in non-selected cell lines.

Antineoplastic Agents↗

PubMed1997

Accessory atrioventricular pathways with only antegrade conduction in patients with symptomatic Wolff-Parkinson-White syndrome. Clinical features, electrophysiological characteristics and response to radiofrequency catheter ablation.

Information about accessory pathways conducting only in the antegrade direction is limited. The purposes of the present study were to prospectively investigate the clinical features, electrophysiological characteristics, effects of radiofrequency catheter ablation and recurrent atrial fibrillation after successful ablation in patients with accessory pathways conducting only in the antegrade direction, and to compare them with those who had pathways capable of bidirectional conduction in a consecutive series of 759 patients. Electrophysiological studies and radiofrequency catheter ablation were performed in 33 study patients with antegrade-only accessory pathways and in 377 patients with bidirectional accessory pathways for comparison. The patients with accessory pathways conducting only in the antegrade direction were older (47 +/- 16 vs 40 +/- 16 years, P = 0.037) and had a higher incidence of atrial fibrillation (100% vs 27.1%, P < 0.001) as well as related syncope (33.3% vs 10.1%, P = 0.001). The study patients also had more accessory pathways located in the posterior septum and a higher incidence of retrograde atrioventricular nodal conduction. The biophysical variables, success and complication rates of radiofrequency ablation were similar in both groups. During the follow-up period of 32 +/- 12 months, symptomatic atrial fibrillation after successful ablation did not recur in 79% and 81% of patients with unidirectional and bidirectional accessory pathways, respectively. Furthermore, old age and cardiovascular diseases were independent predictors of recurrent atrial fibrillation after radiofrequency ablation. In conclusion, this study showed that atrial fibrillation with preexcitation was the usual presentation in patients who had symptomatic Wolff-Parkinson White syndrome with an antegrade-only accessory pathway, and might be related to antegrade conduction of the accessory pathway. Therefore elimination of antegrade-only and bidirectional pathways by radiofrequency ablation could prevent the recurrence of symptomatic atrial fibrillation in younger patients without cardiac disease.

Adult↗

PubMed1997

Bilateral increases in histamine after unilateral nasal allergen challenge.

Studying the inflammatory response that follows the early response to nasal challenge with antigen provides a better understanding of allergic rhinitis than just studying the immediate (early) response. Nine allergic volunteers were challenged unilaterally with antigen-containing discs, and bilateral changes in physiologic responses as well as in the concentration of histamine in nasal secretions were measured for 11 h. We found significant immediate increases in symptoms, sneezes, ipsilateral nasal airway resistance, and ipsilateral histamine in the early phase response. Two-thirds of the allergen-challenged volunteers showed increases in physiologic parameters or histamine in the hours after allergen challenge. The pooled data of all subjects exhibited significant increases in bilateral nasal airway resistance and in ipsilateral and contralateral histamine, hours after unilateral provocation. These responses differed significantly from control subjects. In another group of 11 volunteers challenged ipsilaterally with antigen, the number of basophils increased both on the side of challenge and on the contralateral side. The magnitude of the increase on the ipsilateral side correlated with the increase on the contralateral side (r(s) = 0.72). The basophils are the most likely source of the contralateral increase in histamine as they are on the ipsilateral side. Although the mechanisms underlying this contralateral increase in basophils and histamine are not known, we speculate that delayed, neurogenic responses play a contributory role.

Adult↗

PubMed1997

Primary hyperparathyroidism with cardiac abnormalities: a case report.

Primary hyperparathyroidism, characterized by hypersecretion of parathyroid hormone (PTH) leading to hypercalcemia and relative hypophosphatemia, is quite common in the elderly. Most patients with primary hyperparathyroidism have only mild hypercalcemia and are symptomless. But others experience various other organ diseases. Primary hyperparathyroidism is also associated with cardiovascular abnormalities, including QT interval shortening, heart block, cardiac arrhythmias, hypertension, myocardial hypertrophy, myocardial calcification and, though rarely, with valvular heart disease. We described a case of primary hyperparathyroidism associated with cardiac abnormalities. An 82-year-old male presented with the complaints of chest discomfort, fatigue, general weakness, nausea and vomiting over a period of months and was admitted in July 1996. Physical examination with heart auscultation showed a pansystolic murmur over the right sternal border and apex region, and a blowing diastolic murmur over the left sternal border. Biochemistry profiles revealed elevations of serum calcium (14.3 mg/dl) and chloride/phosphate ratio (> 33). Endocrinological studies showed elevations of serum PTH-C (4.8 ng/ml) and PTH-intact (705 pg/ml) concentrations. Kidney ultrasonography revealed a left renal stone. A spine X-ray revealed spondylosis and a compression fracture of the lumbar-spine with osteoporotic change. Thyroid ultrasonography and Thallium (Tl201)-technetium (Tc99m) subtraction scan showed parathyroid adenoma in the low pole of the right thyroid bed. Parathyroid aspiration cytology revealed few and discrete cells. Echocardiogram revealed moderate to severe aortic valvular calcification as well as stenosis with moderate aortic regurgitation, mitral regurgitation and myocardial calcification. The patient received parathyroidectomy one month later. During his postoperative days, he suffered from muscle twitching with positive Trousseau's sign and Chvostek's sign. The patient received calcium carbonate and vitamin D for hypocalcemia, diltiazem and capoten for his heart problems. A repeated echocardiogram two months after surgery showed no improvement of valvular calcification.

Aged↗

PubMed1996

Longitudinal clinical and electrophysiological assessment of patients with symptomatic Wolff-Parkinson-White syndrome and atrioventricular node reentrant tachycardia.

BACKGROUND: Functional changes of the accessory AV pathways and dual AV node pathways are very important for patients with Wolff-Parkinson-White syndrome or AV node reentrant tachycardia who refuse to receive long-term medication or radiofrequency catheter ablation. However, no studies of serial clinical and electrophysiological characteristics in these patients have been performed. METHODS AND RESULTS: One hundred thirteen patients with Wolff-Parkinson-White syndrome or AV node reentrant tachycardia were included in this study. The first and second follow-up electrophysiological studies were performed in years 5 and 10 after the baseline study, respectively. Conduction properties of the accessory pathways became poor over time. After a mean follow-up period of 9 +/- 1 years, antegrade ventricular preexcitation and retrograde accessory pathway conduction disappeared in 22.5% and 7.8% (P < .01), respectively; dual AV node pathway physiology persisted and retrograde fast pathway disappeared in 10.8% of the patients. Baseline conduction properties of the antegrade and retrograde accessory pathways and the retrograde fast pathway independently predicted late loss of conduction. Spontaneous disappearance of the original tachyarrhythmias occurred in 10.3% of all patients, and newly developed tachyarrhythmias in 15.2%. The incidence (38.5%) of newly developed atrial fibrillation was significantly higher in patients with manifest accessory pathways. Furthermore, symptom scores and attack frequency increased significantly over time in the patients with accessory pathways and AV node reentrant tachycardia. CONCLUSIONS: Disappearance of the original tachycardia and changing patterns of tachycardia, also with an increase in symptom scores and attack frequency, suggested that a detailed evaluation of these events is important and early intervention with radiofrequency ablation would be helpful.

Adolescent↗

PubMed1996

Electrophysiological mechanisms in successful radiofrequency catheter modification of atrioventricular junction for patients with medically refractory paroxysmal atrial fibrillation.

BACKGROUND: Mechanisms and changes of electrophysiological (EP) characteristics in successful radiofrequency (RF) modification of right midseptal and posteroseptal areas for controlling rapid ventricular response to atrial fibrillation (Af) are not clear. METHODS AND RESULTS: We studied 50 patients with medically refractory paroxysmal Af. Group 1 consisted of 40 patients without dual atrioventricular (AV) node physiology with modification sites located in the mid/posteroseptal area. Of the 40 patients, 36 had successful modification (follow-up of 14 +/- 8 months), and 3 had AV block. Late follow-up electrophysiological study (98 +/- 10 days) showed pattern 1 (67%) with prolongation of AV node effective refractory period (ERP, > or =40 milliseconds) and Wenckebach block cycle length (WBCL, > or =40 milliseconds); pattern 2 (22%) with prolongation of AH interval (> or =20 milliseconds), ERP, and WBCL; and pattern 3 (11%) without any change in AV node conduction parameter. Change in ventricular rate negatively correlated with change of WBCL in patterns 1 (r=-.691, P=.019) and 2 (r=-.90, P=.01). Group 2 consisted of 10 patients with dual AV node pathway; elimination of slow pathway property was performed. Late follow-up electrophysiological study (92+/-7 days) showed that change in ventricular rate negatively correlated with change in AV node ERP (r=-.926, P=.0001) and WBCL (r=-.969, P=.0001). Four patients without significant modification effect had success after RF energy was delivered to higher levels (follow-up, 15+/-7 months). CONCLUSIONS: RF modification of right mid/posteroseptal area is feasible in 92% of patients with paroxysmal Af. Mechanisms of successful modification might be elimination of posterior input and/or partial injury of the compact node. Furthermore, simple elimination of slow pathway might be inadequate for control of ventricular rate in patients with little difference in conduction properties between fast and slow pathways.

Adult↗

PubMed1996

Radiofrequency catheter ablation of common atrial flutter: comparison of electrophysiologically guided focal ablation technique and linear ablation technique.

OBJECTIVES: The purpose of this study was to study electrophysiologic characteristics and compare the electrophysiologically guided focal ablation technique and linear ablation technique in patients with common atrial flutter in a prospective randomized fashion. Background. Catheter ablation of the common atrial flutter circuit can be performed with different techniques. To date, these two techniques have not been compared prospectively in a randomized study. METHODS: Sixty patients with drug-refractory common atrial flutter were randomly assigned to undergo radiofrequency catheter ablation performed with the electrophysiologically guided focal ablation (Group I) or linear ablation technique (Group II). In Group I, radiofrequency energy was delivered to the site characterized by concealed entrainment with a short stimulus-P wave interval (<40 ms) and a postpacing interval equal to the atrial flutter cycle length. In Group II, continuous migratory application of radiofrequency energy was used to create two linear lesions in or around the inferior vena cava-tricuspid ring isthmus. Serial 24-h ambulatory electrocardiographic (Holter) and follow-up electrophysiologic studies were performed to assess recurrence of tachycardia and possible atrial arrhythmogenic effects. RESULTS: Successful elimination of the flutter circuit was achieved in 28 of 30 patients in Group I and 29 of 30 patients in Group II. More atrial premature beats and episodes of short run atrial tachyarrhythmias in the early period (within 2 weeks) after ablation were found in Group II. Recurrence rate (2 of 28 vs. 3 of 29) and incidence of new sustained atrial tachyarrhythmias (3 of 28 vs. 3 of 29) was similar in the two groups. Occurrence of recurrent atrial flutter and new sustained atrial tachyarrhythmias was related to associated cardiovascular disease and atrial enlargement in both groups. However, in Group II, the procedure time (104 +/- 17 vs. 181 +/- 29 min, p<0.01) were significantly shorter than those in Group I. CONCLUSIONS: Radiofrequency ablation of the common atrial flutter circuit was safe and effective with either the electrophysiologically guided focal ablation or linear ablation technique. However, the linear ablation technique was time-saving.

Aged↗

PubMed1996

Prediction of successful ablation site of concealed posteroseptal accessory pathways by a novel algorithm using baseline electrophysiological parameters: implication for an abbreviated ablation procedure.

BACKGROUND: Radiofrequency catheter ablation of concealed posteroseptal accessory pathways (APS) has been a relatively difficult task for electrophysiologists. Without a detailed mapping procedure, the left versus the right posteroseptal AP could not be distinguished. We investigated the electrophysiological characteristics of concealed posteroseptal APs and defined criteria from baseline parameters to predict the successful ablation site. Validity of the criteria was prospectively verified. METHODS AND RESULTS: Eighty-nine consecutive patients with a single concealed posteroseptal AP underwent successful radiofrequency catheter ablation. Of the initial 48 patients (group 1), the right posteroseptal area was first mapped. If no ideal electrogram could be obtained, or after several ineffective radiofrequency pulses, the left posteroseptal area was then mapped. Special attention was paid to the stability of the coronary sinus catheter with the most proximal electrode straddling the ostium, verified by coronary sinus venography, in all patients. Six patients (12.5%) had the earliest retrograde atrial activation at the middle electrode of the coronary sinus catheter, and successful ablation could only be achieved at the left posteroseptal area. For patients who presented with the earliest atrial activation at the proximal electrode, the presence of long RP' tachycardia suggested a right endocardial approach, while the delta VA (defined as the difference in the VA intervals between that recorded at the His bundle catheter and that at one of the electrode groups recording the earlier atrial activation) >-25 ms during tachycardia suggested a left endocardial approach. The subsequent 41 patients (group 2) were randomized into two subgroups. The initial mapping site was guided by the algorithm in group 2B, while it was not in group 2A. The successful ablation site could be predicted accurately in 18 (90%) of the 20 patients in group 2B. The radiofrequency pulses, ablation time, and fluoroscopic time were markedly reduced in Group 2B, mainly because of the omission of unnecessary mapping procedure in the right posteroseptal area in patients with "left atrio-left ventricular" fibers. CONCLUSIONS: By the algorithm based on baseline electrophysiological parameters, the successful ablation site could be accurately predicted in a majority of patients with concealed posteroseptal APs. Radiofrequency pulses, ablation time, and fluoroscopic time were markedly reduced.

Adult↗

PubMed1996

Enhancement of chemosensitivity by tyrphostin AG825 in high-p185(neu) expressing non-small cell lung cancer cells.

The HER-2/neu gene product, p185(neu), is a membrane-bound receptor with tyrosine kinase activity. High levels of p185(neu) is correlated with intrinsic chemoresistance of non-small cell lung cancer (NSCLC) cell lines. We investigated the effects of tyrphostin AG825, a selective tyrosine kinase inhibitor preferentially inhibiting HER-2/neu kinase, on the chemosensitivities and on the drug-induced cell cycle changes of NSCLC cell lines that expressed different levels of p185(neu). Compared to the low-p185(neu) expressing cell lines, we found that the high-p185(neu) expressing cell lines were more resistant to doxorubicin, etoposide, and cis-diamminedichloroplatinum(II) but more sensitive to AG825. AG825 was able to significantly enhance the chemosensitivities of the high-p185(neu) expressing cell lines, whereas it had little effect on the chemosensitivities of the low-p185(neu) expressing cells, with a few exceptions in which minor antagonistic effects were observed. Although high concentrations of AG825 could reduce the drug-induced G(2) arrest that was accompanied by the activation of phosphorylated p34(cdc2), we failed to find any remarkably differential effects of AG825 on drug-induced G(2), arrest and the accompanying phosphorylation status of p34(cdc2) of the high- and and the low-p185(neu) expressing cell lines. In summary, tyrphostin AG825 can enhance chemosensitivity in high- but not in low-p185(neu) expressing NSCLC cell lines. This differential effect cannot be explained by the alterations of drug-induced cell cycle changes by AG825. Our results provide a rationale to develop p185(neu)- specific tyrphostin and to test them in combination with anticancer agents in vivo and in clinical trials.

Benzothiazoles↗

PubMed1996

Complications of diagnostic electrophysiologic studies and radiofrequency catheter ablation in patients with tachyarrhythmias: an eight-year survey of 3,966 consecutive procedures in a tertiary referral center.

Predictors and comparisons of complications in patients with electrophysiologic study or radiofrequency ablation have not been assessed in previous published reports. The purpose of this study was to prospectively evaluate the procedure-specific complications and investigate the possible causes and predictors of complications in electrophysiologic study and radiofrequency ablation. Data of diagnostic electrophysiologic studies and radiofrequency ablation were prospective, and represented a consecutive series of 2,593 patients with 3,966 procedures. The present study showed that a significantly higher complication rate occurred in radiofrequency ablation than in electrophysiologic study (3.1% vs. 1.1%, respectively, p = 0.00002) and a significantly higher complication rate occurred in elderly than in young patients with electrophysiologic study (2.2% vs 0.5%, p = 0.0002) or radiofrequency ablation (6.1% vs 2.0%, p = 0.00015). Multiple logistic analysis found that older age (p < 0.01) and systemic disease in elderly patients (p < 0.01) were the independent predictors of complications in both procedures. Furthermore, there was no temporal trend in the incidence of complication. We conclude that the incidence of complication was higher in radiofrequency ablation, and elderly patients had a higher incidence of complications in both electrophysiologic study and radiofrequency ablation; these procedures, when performed by experienced personnel in an appropriately staffed and equipped laboratory, can be undertaken with an acceptable risk.

Adult↗

PubMed1996

Electrophysiologic characteristics and radiofrequency catheter ablation in patients with multiple atrioventricular nodal reentry tachycardias.

Information about the mechanism and radiofrequency catheter ablation of multiple atrioventricular (AV) nodal reentry tachycardias is limited. Among the 550 consecutive patients with AV nodal reentry tachycardia, 36 with multiple forms of AV nodal reentry tachycardia were included in this study. Electrophysiologic characteristics, as well as the efficacy and safety of radiofrequency ablation, were evaluated. Results showed that anterograde dual pathways were seen in 32 patients and triple pathways in 2, and retrograde dual pathways were seen in 23 patients and triple pathways in 11. Twenty-two patients had 2 types, 7 had 3 types, 5 had 4 types, and 2 had 5 types of AV nodal reentry tachycardia and echoes. After delivering radiofrequency energy to the target sites, 32 patients had no induction of AV nodal reentry tachycardia and only 4 had induction of 1 echo. Furthermore, 22 patients (61%) had simultaneous elimination or modification of the slow and/or intermediate pathways in the anterograde and retrograde direction. During the follow-up period of 19 +/- 14 months, 2 patients had recurrence of tachycardia. Thus, multiple anterograde and retrograde AV nodal pathways were present in the human AV node and they constituted the substrates of reentry circuits. Radiofrequency catheter ablation was safe and effective in eliminating the slow and intermediate pathways for maintenance of multiple AV nodal reentry tachycardias.

Adult↗

PubMed1996

Paradox of accessory pathway block after radiofrequency ablation in patients with the Wolff-Parkinson-White syndrome.

Although pacing technique has demonstrated that the most common site of conduction block in a manifest accessory pathway (AP) was between the AP and the ventricle, most of the block sites have been found to be between the atrium and AP after successful radiofrequency ablation. Furthermore, the block site in a concealed AP after successful radiofrequency catheter ablation has not been reported in the literature, and comparisons between a manifest and concealed AP have not been performed. This study included 219 consecutive patients undergoing successful radiofrequency catheter ablation of a single AP. AP potential was recorded at the successful target site in 76 of 92 (82.6%) patients with manifest APs, and in 99 of 127 (77.9%) patients with concealed APs. All the left-sided APs (including left posteroseptal APs) were ablated by a ventricular approach, and right-sided APs (including anteromidseptal and right posteroseptal APs) were ablated by an atrial approach. The site of conduction block was determined by analyzing and comparing the local electrograms recorded before and after radiofrequency ablation at successful ablation sites. Conduction block of manifest APs was between the atrial-AP (A-AP) in 69 patients (75%) and between the AP-ventricle (AP-V) interface in 7 patients (7.6%), whereas the conduction block of concealed APs occurred between the AP-V in 90 patients (70.9%) and between the A-AP interface in 9 patients (7.1%). Neither the preablation electrogram nor electrophysiologic characteristics of APs predicted the site of conduction block. Furthermore, neither the location of the APs nor the position of the ablation catheter affected the block site. It was concluded that the most common site of conduction block during successful radiofrequency catheter ablation of a manifest and concealed AP was between the A-AP and AP-V interface, respectively, and the impedance mismatch theory explained only part of the findings.

Adult↗

PubMed1996

Effect of dietary L-glutamine on the hepatotoxic action of D-galactosamine in rats.

The protective effect of dietary L-glutamine against the hepatotoxic action of D-galactosamine (GaIN) was investigated by model experiments with rats. Rats fed with 20% casein diets containing 10% free amino acids were injected with GaIN, and the serum aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase activities and the hepatic glycogen content were assayed 20 hours after the injection. These enzyme activities in the group fed with 10% L-glutamine diet for 8 days were lower than those in the groups fed with the control, 10% L-glutamic acid and 10% L-alanine diets for 8 days. The more prolonged the feeding period with the 10% L-glutamine diet was, the more the serum activity levels of such enzymes were decreased. Although neomycin also lowered these enzyme activities, its simultaneous ingestion with neomycin did not show any additive or synergistic effect. The hepatic glycogen content in the 10% glutamine group still remained high after the GaIN treatment. It is therefore assumed that the effectiveness of glutamine intake would have been mediated by glycogen metabolism rather than by uridine metabolism.

Alanine↗