Survival from cardiovascular events as predicated by carotid (common carotid artery) intima-media thickness and Doppler values in ischaemic Chinese patients requiring coronary angiogrm

INTRODUCTION: Carotid intima-media thickness (cIMT) of the common carotid artery may be correlated to the presence of coronary artery disease. However, the role of the cIMT and Doppler findings in predicting subsequent cardiovascular events has not been established. The aim of this study was to investigate the predictive value. METHODS: A total of 212 consecutive Chinese patients undergoing clinically driven coronary angiogram were evaluated. Carotid parameters (cIMT, peak systolic velocity [PSV] and end diastolic velocity, at the bulb, internal and common carotid artery, on both sides) were analysed using the IE33 auto-detection program. Patients were followed up and monitored for the occurrence of the primary composite end-point (PCEP), defined as all cardiovascular deaths, non-fatal MI, stroke, CHF, ACS or arrhythmias requiring hospitalisation or intervention. RESULTS: To date, the mean follow-up time was 534±234 days. The PCEP was reached in 25 subjects (11.8%). The right common cIMT was shown to be a predictor for critical coronary stenosis requiring PCI (area under ROC curve=0.626, P=0.001). cIMT <0.8 mm was associated with a better survival (log rank test, P=0.029). Univariate analysis, a right common cIMT of ≥0.8mm, the right common carotid PSV, and the waist circumference were independent predictors for the PCEP. Cox proportional hazards model adjusted for age showed the right common carotid PSV was the only independent predictor for the PCEP (HR=0.963; 95% CI, 0.939-0.987, P=0.002). Similar correlations were not observed with the overall (left and right) cIMT or the left cIMT in this study. CONCLUSION: The right common carotid PSV and the right common cIMT ≥0.8 mm are shown to predict the cardiovascular survival in this study. The latter also strongly correlates with the presence of critical coronary stenosis requiring intervention.published_or_final_versionThe 14th Medical Research Conference, Department of Medicine, The University of Hong Kong, Hong Kong, 10 January 2009. In Hong Kong Medical Journal, 2009, v. 15 suppl. 1, p. 23, abstract no. 3

'Isolated' left ventricular diastolic dysfunction - The condition need to be redefined

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Prognostic implications of PR-segment depression in inferior leads in acute inferior myocardial infarction

Background: Concurrent atrial ischemia is usually overlooked in acute myocardial infarction (MI) due to its subtle electrocardiographic (ECG) changes, lack of clear-cut clinical picture, and prognostic significance. PR-segment depression in the inferior leads is a simplified ECG sign for detecting possible underlying atrial ischemia. Hypothesis: The purpose of this study was to document the incidence, clinical characteristics, and prognostic implications of this ECG sign in the setting of acute inferior MI. Methods: Demographics, clinical characteristics, and outcomes of 463 consecutive patients presenting with acute inferior MI were reviewed. The in-hospital ECG was examined by two independent reviewers. The results were then compared between those with and without ECG sign. Results: Profound PR-segment depression ≥ 1.2 mm in inferior leads was found in 9 of 463 (1.9%) patients. Patients with atrial ischemia tended to present earlier (2.4 ± 2.6 vs. 7.0 ± 8.2 h, p = 0.000) and had a higher frequency of first-degree atrioventricular block (77.8 vs. 30.6%, p = 0.028) and supraventricular arrhythmias (55.5 vs. 20.2%, p = 0.022). Of greater importance, it was significantly associated with an increased rate of cardiac free-wall rupture (33.3 vs. 2.0%, p = 0.001) and in-hospital mortality (44.4 vs. 11.7%, p = 0.015). Conclusion: Profound PR-segment depression ≥ 1.2 mm in inferior leads was associated with a complicated hospital course and poor short-term outcome in acute inferior MI. These patients were at high risk for the development of atrioventricular block, supraventricular arrhythmias, and cardiac free-wall rupture.link_to_subscribed_fulltex

Transient Giant R-Wave, Right Axis Deviation, and Intraventricular Conduction Delay during Exercise Treadmill Testing: A Case Report

A 53-year-old man complained of chest pain during an exercise treadmill test. Electrocardiogram revealed transient giant R-wave, right-axis deviation, intraventricular conduction delay, and ST-segment elevation in the inferolateral leads. Subsequent coronary angiography showed an 80% lesion in mid part of a nondominant left circumflex artery, whereas the other coronary arteries had mild atherosclerosis only. Percutaneous coronary intervention and stenting was performed on the left circumflex artery lesion. A follow-up exercise thallium scan 3 months later still showed an intermediate-sized, mild reversible perfusion defect in the inferior and lateral wall but the giant R-wave ECG pattern was not inducible anymore. Restudy coronary angiography showed no in-stent restenosis, but there was disease progression in the midpart of the right coronary artery. The initial electrocardiographic pattern is typical of the "giant R-wave syndrome." Severe coronary spasm superimposed on the underlying mild atherosclerotic lesion of the right coronary artery is hypothesized to be the cause of the initial event. Ad hoc direct stenting was performed on the right coronary artery lesion. The patient remained symptom-free with a normal thallium scan 9 months later.link_to_subscribed_fulltex

A Self-Narrative Study: Changes in Physical Ability and Social Communication in Children with Autism through Taekwondo Training with Elements of Music Therapy from the Parents' Perspective.

Autism spectrum disorder (ASD) significantly affects social and motor skills development in early, middle or even late childhood. To promote social and motor skills development among autistic children, an intervention consisting of Taekwondo and elements of music therapy was designed and implemented in Hong Kong. The objective of the current study is to investigate the effectiveness of this training, based on parents' observations of their children who had completed the key stage of the training. Thirteen parents or caregivers (n = 13) whose children with autism participated in our Taekwondo training for two months were interviewed. Three major themes were identified by thematic analysis: (A) social skills-related change after the intervention, (B) motor skills-related change after the intervention, (C) characteristics of the intervention (i.e., session arrangement, tutor/coach attitude). Our findings show that our training was perceived by parents to have a significant impact on the promotion of physical ability and social communication in autistic children

Motivation for writing and Chinese writing performance among adolescents.

Poster Session II: no. 27Purpose: The present study aimed to examine the relationships between writing motivation and Chinese written composition among Hong Kong Chinese high school students. Particularly, in light of the Self-determination theory (Ryan & Deci, 2000), this study investigated the extent that intrinsic and extrinsic motivations (intrinsic motivation, external regulation, introjected regulation and identified regulation) facilitated writing processes. Method: A total of 238 Chinese students in Grade 8 and Grade 10 in Hong Kong was administered an adapted version of the Academic Self-Regulation Questionnaire-Adapted (Deci, Hodges, Pierson, & Tomassone, 1992) to assess their various intrinsic and extrinsic motivations in writing and a Chinese argumentation written composition task. Results: Multiple regression analysis results showed that intrinsic motivation and identified regulation were significant predictors of Chinese written composition when the four types of writing motivation were entered into the equation simultaneously. The interaction effect between grade and intrinsic motivation and the interaction effect between grade and identified regulation were not significant. Conclusions: Our results suggested the significance of intrinsic motivation and identified regulation in Chinese written composition development among high school students. These findings were different from those reported in a study by Yeung et al. (2015) among elementary grade students, in which students’ writing performance was significantly predicted by introjected regulation and identified regulation. The importance of self-determination in writing development seems to be stronger among high school students than among elementary grade students. These findings have pedagogical implications for the writing instructions in schools in Hong Kong, which tend to place less emphasis on authentic writing goals and contexts

Serum beta-2 microglobulin level is elevated in patients with acute coronary syndrome

Background Beta-2 microglobulin (B2M) is a marker of renal dysfunction and immune activation. We previously reported that serum B2M is related to age, renal function, cardiovascular and all-cause mortality in Americans. Acute coronary syndrome (ACS) is a common cause of hospital admission and cardiovascular mortality. We tested the hypothesis that the serum level of B2M is elevated in ACS in a prospective study. Methods We recruited 167 Chinese patients (118 men and 49 women; mean age±SD, 64±13 years), of whom 88 had ACS and 79 were controls matched for age and sex. Serum B2M was measured in an accredited laboratory using a latex-enhanced immunoassay (intra-assay coefficient of variation 3.4%). Results In our patients, the serum B2M level (mean±SE) was 2.27±0.12 µg/mL. Because the upper reference level of serum B2M in our laboratory is 1.42 µg/mL, only 24 subjects (14%) had a serum B2M within the reference range. Serum B2M levels (mean±SE) were 2.52±0.21 in ACS patients and 1.99±0.06 µg/mL in controls (p=0.02). There was no significant correlation between serum B2M and troponin level. Serum B2M correlated with serum creatinine (ρ=0.62, p<0.001), age (Spearman’s ρ=0.52, p<0.001) and male gender (ρ=0.19, p=0.01). Conclusions Serum B2M level is increased in ACS patients. It is also related to age and gender, and the serum level of creatinine but not troponin. Our study shows for the first time that serum B2M is a cardiovascular risk marker in Chinese as it is in Americans. B2M is an established prognostic marker in multiple myeloma and so the test is widely available. A prospective study with long follow-up is warranted to evaluate B2M as a prognostic marker after ACS

The role of affective-motivational factors in writing among Chinese elementary grade students

No. 27The importance of affective-motivational factors (self efficacy, value of writing, writing apprehension, external motivation and internal motivation) in Chinese writing was investigated among 132 Chinese students in Grade 3 and Grade 5. Multiple regression analysis results showed that only value of writing and identified regulation contributed unique variance to Chinese written composition after controlling for the contribution of cognitive-linguistic measures. These underscore the affective-motivational characteristics of Chinese learners and help inform Chinese writing instruction

Angiographic and clinical implications of combined ST-segment elevation in anterior and inferior leads in acute myocardial infarction

Background: The clinical and angiographic findings of patients suffered from acute myocardial infarction (MI) and presented with combined ST elevation in both anterior and inferior leads remain unclear. Hypothesis: These patients might have ≥1 coronary arteries occluded. Methods: From January 2002 to December 2006, 49 consecutive patients were found to have ST elevation in both anterior and inferior leads during myocardial infarction. Patients who had left circumflex artery occlusion (acute or chronic) were excluded. These patients were divided into 4 types according to the infarct-related artery (IRA) and status of the contralateral vessel patency: left anterior descending artery (LAD) as the IRA with a patent right coronary artery (RCA) (type 1A, n = 25); LAD as IRA with an occluded RCA (type 1B, n = 1); RCA as IRA with a patent LAD (type 2A, n = 19); and RCA as IRA with an occluded LAD (type 2B, n = 4). Results: Single vessel occlusion (type A angiographic pattern) was found in 90% of patients. Type 1A patients had a larger infarct size than that of 2A. ST elevation in V2 ≥ V3 identified RCA as the IRA with a high specificity (92%) and sensitivity (74%). Type 2B patients (2-vessel occlusion) had a larger infarct size than that of 2A; however, no electrocardiogram (ECG) criteria could reliably differentiate them. Conclusion: In a real world situation, single vessel occlusion is found in the majority of cases of combined ST elevation in anterior and inferior leads. ST elevation in V2 ≥ V3 distinguishes RCA against LAD as the IRA with high accuracy. © 2009 Wiley Periodicals, Inc.link_to_subscribed_fulltex