37 results on '"Alex Chau"'
Search Results
2. Vascular Anomaly Syndromes in the ISSVA Classification System: Imaging Findings and Role of Interventional Radiology in Management
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Mindy X. Wang, Serageldin Kamel, Khaled M. Elsayes, R. Paul Guillerman, Ahmed Habiba, Lauren Heng, Margarita Revzin, Vincent Mellnick, Ionela Iacobas, and Alex Chau
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Adult ,Klippel-Trenaunay-Weber Syndrome ,Vascular Malformations ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiology, Interventional ,Child ,Hemangioma ,Musculoskeletal Abnormalities - Abstract
Vascular anomalies encompass a spectrum of tumors and malformations that can cause significant morbidity and mortality in children and adults. Use of the International Society for the Study of Vascular Anomalies (ISSVA) classification system is strongly recommended for consistency. Vascular anomalies can occur in isolation or in association with clinical syndromes that involve complex multifocal lesions affecting different organ systems. Thus, it is critical to be familiar with the differences and similarities among vascular anomalies to guide selection of the appropriate imaging studies and possible interventions. Syndromes associated with simple vascular malformations include hereditary hemorrhagic telangiectasia, blue rubber bleb nevus syndrome, Gorham-Stout disease, and primary lymphedema. Syndromes categorized as vascular malformations associated with other anomalies include Klippel-Trenaunay-Weber syndrome, Parkes Weber syndrome, Servelle-Martorell syndrome, Maffucci syndrome, macrocephaly-capillary malformation, CLOVES (
- Published
- 2022
3. The utility and promise of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the pediatric population: An evidence-based review
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Megan E. Cunningham, Adam M. Vogel, Alex Chau, Bindi Naik-Mathuria, J. Hernandez, and Giovanni Campagna
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Resuscitation ,medicine.medical_specialty ,Hemodynamics ,Hemorrhage ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine.artery ,medicine ,Humans ,Child ,Intensive care medicine ,Prospective cohort study ,Aorta ,Evidence-Based Medicine ,Resuscitative thoracotomy ,business.industry ,General Medicine ,Evidence-based medicine ,Balloon Occlusion ,Review article ,Balloon occlusion ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Surgery ,business - Abstract
Hemorrhage is the main cause of preventable death in both military and civilian trauma, and many of these patients die from non-compressible torso injuries. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive method used for hemodynamic control of the hemorrhaging patient and has been compared to resuscitative thoracotomy (RT) with cross clamping of the aorta. REBOA has received a great deal of attention in recent years for its applicability and promise in adult trauma and non-trauma settings, but its utility in children is mostly unknown. The purpose of this review article is to summarize and consolidate what is currently known about the use of REBOA in children. Some of the challenges in implementing REBOA in children include small vascular anatomy and lack of outcomes data. Although the evidence is limited, there are established instances in the literature of children and adolescents who have undergone endovascular occlusion of the aorta for hemorrhage control with positive outcomes and survival rates equivalent to their adult counterparts. There is a need for further formal evaluation of REBOA in pediatric patients with prospective studies to look at the safety, feasibility and efficacy of the technique. STUDY TYPE: Narrative Literature Review LEVEL OF EVIDENCE: IV.
- Published
- 2020
4. Percutaneous Lung Biopsy in Immunocompromised Pediatric Patients
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J. Hernandez, Gregory Gardner, Alex Chau, Zachary Jeng, Heather Cleveland, Raphael Yoo, and Wei Zhang
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Image-Guided Biopsy ,Lung Diseases ,Male ,medicine.medical_specialty ,Percutaneous ,Adolescent ,Biopsy, Fine-Needle ,Lung biopsy ,Radiography, Interventional ,Risk Assessment ,Immunocompromised Host ,Predictive Value of Tests ,Risk Factors ,Biopsy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Child ,Lung ,Ultrasonography, Interventional ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Age Factors ,Infant, Newborn ,Infant ,Retrospective cohort study ,Prognosis ,medicine.disease ,Surgery ,Fine-needle aspiration ,Pneumothorax ,Child, Preschool ,Predictive value of tests ,Female ,Patient Safety ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Purpose To determine the diagnostic yield and safety of image-guided lung biopsies in immunocompromised pediatric patients. Materials and Methods This was a retrospective pediatric cohort study conducted from June 2000 to April 2017. Subjects were 0–17 years of age (median, 10 years of age). There were 46 males (48%). A total of 73 consecutive image-guided lung biopsies were performed in 68 patients (weight range, 4.9–97.3 kg [median, 25.3 kg]). The indication for biopsy was to isolate an organism to tailor medical therapy. All patients were immunocompromised with an underlying history of bone marrow transplantation (n = 50), primary immunodeficiency (n = 14), and solid organ transplantation (n = 4). Patient and technical factors were analyzed for rates of complication. Results Overall diagnostic yield was 43 of 73 patients (60%). There were 14 minor (19%) and 8 major (11%) complications. Major complications included pneumothorax or hemoptysis requiring intervention (n = 6), and death (n = 2). The histological diagnosis was an infectious cause in 5 of 8 major complications (63%). There were statistically significant differences between the rates of complications with the imaging modality used (P = .02) and the use of fine needle aspiration (P = .02). Conclusions Image-guided percutaneous lung biopsy can be helpful in isolating an organism to tailor therapy. Biopsies performed in immunosuppressed patients result in an elevated complication risk of up to 30% and demonstrate lower diagnostic yield and increased mortality, which should warrant detailed discussion with the primary team and family.
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- 2020
5. Selective aortic balloon occlusion in placenta accreta spectrum: retrospective review of utilization and outcomes
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Mary Fang, Hendrick Lombaard, Michael A. Belfort, Amir A. Shamshirsaz, Alex Chau, Karen Chen, Kamlesh Kukreja, Amir Pezeshkmehr, and Karin A. Fox
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Obstetrics and Gynecology - Published
- 2023
6. The impact of post-operative atrial fibrillation on outcomes in coronary artery bypass graft and combined procedures
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Yau-Lam, Alex Chau, Ji, Won Yoo, Ho, Chuen Yuen, Khalid, Bin Waleed, Dong, Chang, Tong, Liu, Fang Zhou, Liu, Gary, Tse, Sharen, Lee, and Ka, Hou Christien Li
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Reseach Article - Abstract
BACKGROUND Post-operative atrial fibrillation (POAF) is a common yet understudied clinical issue after coronary artery bypass graft (CABG) leading to higher mortality rates and stroke. This systematic review and meta-analysis evaluated the rates of adverse outcomes between patients with and without POAF in patients treated with CABG or combined procedures. METHODS The search period was from the beginning of PubMed and Embase to May 18th, 2020 with no language restrictions. The inclusion criteria were: (1) studies comparing new onset atrial fibrillation before or after revascularization vs. no new onset AF before or after revascularization. The outcomes assessed included all-cause mortality, cardiac death, cerebral vascular accident (CVA), myocardial infarction (MI), repeated revascularization, major adverse cardiac event (MACE), and major adverse cardiac and cerebrovascular events (MACCEs). RESULTS Of the 7,279 entries screened, 11 studies comprising of 57,384 patients were included. Compared to non-POAF, POAF was significantly associated with higher risk of all-cause mortality (Risk Ratio (RR) = 1.58; 95% Confidence Interval (CI): 1.42−1.76, P < 0.00001) with accompanying high level of heterogeneity ( I2 = 62%). Conclusions Patients with POAF after CABG or combined procedures are at an increased risk of all-cause mortality or CVAs. Therefore, POAF after such procedures should be closely monitored and treated judiciously to minimize risk of further complications. While there are studies on POAF versus no POAF on outcomes, the heterogeneity suggests that further studies are needed.
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- 2021
7. Gender- and Age-Specific Associations of Visit-to-Visit Blood Pressure Variability With Anxiety
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Jiandong Zhou, Sharen Lee, Wing Tak Wong, Keith Sai Kit Leung, Ronald Hang Kin Nam, Prudence Shun Hay Leung, Yau-Lam Alex Chau, Tong Liu, Carlin Chang, Bernard Man Yung Cheung, Gary Tse, and Qingpeng Zhang
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medicine.medical_specialty ,Generalized anxiety disorder ,030204 cardiovascular system & hematology ,Cardiovascular Medicine ,03 medical and health sciences ,risk prediction ,0302 clinical medicine ,Interquartile range ,Diabetes mellitus ,Internal medicine ,Clinical endpoint ,Medicine ,Diseases of the circulatory (Cardiovascular) system ,030212 general & internal medicine ,visit-to-visit blood pressure variability ,generalized anxiety disorder ,Original Research ,business.industry ,Incidence (epidemiology) ,medicine.disease ,anxiety ,Blood pressure ,RC666-701 ,Cohort ,Anxiety ,blood pressure variability ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: There is a bidirectional relationship between blood pressure variability (BPV) and anxiety, but few studies have examined the gender- and age-specific effects of visit-to-visit BPV on incident anxiety. We examined the predictive value of BPV for the incidence of anxiety in a family clinic cohort.Methods: Consecutive patients with a first attendance to family medicine clinics in Hong Kong between January 1, 2000, and December 31, 2002, with at least three blood pressure measurements available thereafter were included. The primary endpoint was incident anxiety as identified by ICD-9 coding.Results: This study included 48,023 (50% males) patients with a median follow-up of 224 [interquartile range (IQR): 217–229] months. Females were more likely to develop incident anxiety compared to males (incidence rate: 7 vs. 2%), as were patients of older age. Significant univariate predictors were female gender, older age, preexisting cardiovascular diseases, respiratory diseases, diabetes mellitus, hypertension, and gastrointestinal diseases, various laboratory examinations, and the number of blood pressure measurements. Higher baseline, maximum, minimum, standard deviation (SD), coefficient of variation (CV), and variability score of diastolic blood pressure significantly predicted incident anxiety, as did all systolic blood pressure measures [baseline, latest, maximum, minimum, mean, median, variance, SD, root mean square (RMS), CV, and variability score].Conclusions: The relationships between longer-term visit-to-visit BPV and incident anxiety were identified. Female and older patients with higher blood pressure and higher BPV were at the highest risks of incident anxiety.
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- 2021
8. Recanalization of Chronic Portal Vein Occlusion in Pediatric Liver Transplant Patients
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Aaditya Nagaraj, Sheena Pimpalwar, Heather Cleveland, Alex Chau, Daniel Ashton, and J. Alberto Hernandez
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Male ,medicine.medical_specialty ,Gastrointestinal bleeding ,Time Factors ,Adolescent ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,Ascites ,Occlusion ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Vascular Diseases ,Hemoperitoneum ,Child ,Vascular Patency ,Retrospective Studies ,medicine.diagnostic_test ,Portal Vein ,business.industry ,Infant ,Interventional radiology ,medicine.disease ,Liver Transplantation ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Child, Preschool ,030220 oncology & carcinogenesis ,Chronic Disease ,Portal hypertension ,Female ,Stents ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon ,Artery - Abstract
Purpose To evaluate technical and clinical success and report long-term outcomes of portal vein (PV) recanalization in pediatric orthotopic liver transplant (OLT) patients with chronic PV occlusion. Materials and Methods This is a retrospective review of 15 OLT patients (5 males) with chronic PV occlusion who underwent PV recanalization (33 procedures) between October 2011 and February 2018. Median age was 4.5 years (range, 1–16 years); median weight was 16.6 kg (range, 11.5–57.3 kg). Median time interval from OLT to first intervention was 3.25 years (range, 0.6–15.7 years). Clinical presentations included hypersplenism (n = 12), gastrointestinal bleeding (n = 9), and ascites (n = 3). One patient had incidental diagnosis of PV occlusion. Primary, primary-assisted, and secondary patency at 3, 6, 12, and 24 months were evaluated. Results Technically successful PV recanalization and reduction of PV pressure gradient to ≤ 5 mm Hg was performed in 13/15 patients (87%). Ten of 15 (67%) patients had successful recanalization with the first attempt. Clinical success, defined as improvement in signs and symptoms of portal hypertension, was achieved in 12/13 (92%) patients. Five of 33 (15%) major complications (Society of Interventional Radiology class C), including perisplenic hematoma (n = 2), hemoperitoneum (n = 2), and hepatic artery pseudo aneurysm (n = 1), were managed with pain medication and blood product replacement. Median follow-up was 22 months (range, 1–77 months). Median primary patency was 5 months. Primary patency at 3, 6, 12, and 24 months was 53.8%, 46.2%, 38.5%, and 30.8%, respectively. Primary-assisted patency was 84.6%, 76.9%, 53.8%, and 46.2%, respectively. Secondary patency was 92.3%, 84.6%, 53.8%, and 46.2%, respectively. Conclusions PV recanalization is a safe and effective minimally invasive option in the management of chronic PV occlusion after pediatric OLT.
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- 2019
9. Integration of Improvement and Implementation Science in Practice-Based Research Networks: a Longitudinal, Comparative Case Study
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Nancy C. Elder, Alex Chau, Rose Gunn, Devon K. Check, Caitlin Dickinson, Melinda M. Davis, Cullen Conway, Steven Brantley, Erin S. Kenzie, and Le Ann Michaels
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Quality management ,Knowledge management ,Relation (database) ,Strategic alignment ,As is ,media_common.quotation_subject ,Comparative case ,01 natural sciences ,03 medical and health sciences ,Oregon ,0302 clinical medicine ,Internal Medicine ,Medicine ,Humans ,Quality (business) ,030212 general & internal medicine ,0101 mathematics ,media_common ,Original Research ,Implementation Science ,Quality of Health Care ,Operationalization ,business.industry ,010102 general mathematics ,Quality Improvement ,Intervention (law) ,business - Abstract
BACKGROUND: Implementation science (IS) and quality improvement (QI) inhabit distinct areas of scholarly literature, but are often blended in practice. Because practice-based research networks (PBRNs) draw from both traditions, their experience could inform opportunities for strategic IS-QI alignment. OBJECTIVE: To systematically examine IS, QI, and IS/QI projects conducted within a PBRN over time to identify similarities, differences, and synergies. DESIGN: Longitudinal, comparative case study of projects conducted in the Oregon Rural Practice-based Research Network (ORPRN) from January 2007 to January 2019. APPROACH: We reviewed documents and conducted staff interviews. We classified projects as IS, QI, IS/QI, or other using established criteria. We abstracted project details (e.g., objective, setting, theoretical framework) and used qualitative synthesis to compare projects by classification and to identify the contributions of IS and QI within the same project. KEY RESULTS: Almost 30% (26/99) of ORPRN’s projects included IS or QI elements; 54% (14/26) were classified as IS/QI. All 26 projects used an evidence-based intervention and shared many similarities in relation to objective and setting. Over half of the IS and IS/QI projects used randomized designs and theoretical frameworks, while no QI projects did. Projects displayed an upward trend in complexity over time. Project used a similar number of practice change strategies; however, projects classified as IS predominantly employed education/training while all IS/QI and most QI projects used practice facilitation. Projects including IS/QI elements demonstrated the following contributions: QI provides the mechanism by which the principles of IS are operationalized in order to support local practice change and IS in turn provides theories to inform implementation and evaluation to produce generalizable knowledge. CONCLUSIONS: Our review of projects conducted over a 12-year period in one PBRN demonstrates key synergies for IS and QI. Strategic alignment of IS/QI within projects may help improve care quality and bridge the research-practice gap. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-021-06610-1.
- Published
- 2021
10. Multispecialty Intraoperative Approach for Treatment of Intra-Articular Knee Venous Malformations
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J. Herman Kan, Sameer Kini, Alex Chau, Sudhen B. Desai, Kamlesh Kukreja, and Scott D. McKay
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medicine.medical_specialty ,Intra articular ,business.industry ,medicine ,Orthopedics and Sports Medicine ,business ,Surgery - Published
- 2020
11. Ultrasound-guided cervical puncture for nusinersen administration in adolescents
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Timothy Lotze, Alex Chau, Carlos B Ortiz, and Kamlesh Kukreja
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Male ,medicine.medical_specialty ,Adolescent ,Oligonucleotides ,Punctures ,Scoliosis ,030218 nuclear medicine & medical imaging ,Muscular Atrophy, Spinal ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Local anesthesia ,Child ,Ultrasonography, Interventional ,Retrospective Studies ,Neuroradiology ,business.industry ,Retrospective cohort study ,Spinal muscular atrophy ,medicine.disease ,SMA ,Surgery ,Treatment Outcome ,Pediatrics, Perinatology and Child Health ,Orthopedic surgery ,Female ,Nusinersen ,business ,030217 neurology & neurosurgery - Abstract
Spinal muscular atrophy (SMA) is an autosomal-recessive disease affecting motor neurons and is the most common genetic cause of death in infants. Intrathecal nusinersen is the only therapy approved by the U.S. Food and Drug Administration for SMA. Deformities and spinal instrumentation from orthopedic surgeries are common in children with SMA, complicating traditional intrathecal access for nusinersen delivery. Cervical punctures are routinely performed in adults for cervical myelograms and should be considered for children with SMA as a viable form of intrathecal access. This retrospective study assessed technical feasibility and complications of ultrasound-guided cervical puncture for nusinersen administration. We reviewed 14 consecutive ultrasound-guided cervical punctures for nusinersen administration with local anesthesia. We reviewed technical success and complications. All procedures were technically successful. There were no major complications. Two minor complications included headaches that resolved by observation within 24 h after the procedure. Our series describes a successful novel method of ultrasound-guided cervical spine access for intrathecal administration of nusinersen, adding to the armamentarium of procedures for delivering nusinersen to adolescents with challenging lumbar spine access caused by scoliosis and spinal instrumentation. This technique has the advantages of real-time ultrasound guidance and potential avoidance of general anesthesia in children.
- Published
- 2018
12. Temporal Evolution and Management of Fast Flow Vascular Anomalies in PTEN Hamartoma Tumor Syndrome
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Alex Chau, Ionela Iacobas, Sheena Pimpalwar, Judith F. Margolin, Raphael Yoo, and Daniel Ashton
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medicine.medical_specialty ,medicine.diagnostic_test ,biology ,business.industry ,medicine.medical_treatment ,Magnetic resonance imaging ,Arteriovenous malformation ,medicine.disease ,030218 nuclear medicine & medical imaging ,Vascular anomaly ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,biology.protein ,Sclerotherapy ,Mucositis ,PTEN ,Hamartoma ,Radiology ,Embolization ,Cardiology and Cardiovascular Medicine ,business - Abstract
Phosphatase and tensin homolog (PTEN) hamartoma tumor syndrome (PHTS) is characterized by formation of recurrent benign tumors described as PTEN hamartoma of soft tissue that may contain fast flow vascular anomalies (FFVA). The purpose of this study is to review the temporal evolution and management of FFVA in PHTS. A retrospective review of 22 patients (9 males), age 1 to 18 (median 9) years diagnosed with PHTS at a tertiary care pediatric hospital between October 2002 and August 2017 revealed 4 patients with FFVA. Imaging, management, and treatment complications were reviewed. During median follow-up of 8 (range: 4–13) years, ultrasound and magnetic resonance imaging performed for recurrent pain, showed progressive increase in the size of hamartomas and development of new FFVA in three-fourth patients. Medical management included pain medications, oral sirolimus, and physical and psychiatric therapy. Surgical excision of hamartoma (n = 1) resulted in recurrence within 3 months. Between 4 and 24 (average 1.5/year) embolizations were performed per patient. Pain related to FFVA responded well to embolization. Pain secondary to PTEN hamartoma responded poorly to percutaneous sclerosant injection, but demonstrated improvement with sirolimus. There was no correlation between serum sirolimus levels and frequency/timing of recurrence of FFVA/hamartoma. Complications included sclerosant migration into digital arteries (n = 1), subclavian vein stenosis due to glue migration (n = 1), oral mucositis (n = 4), and elevated triglycerides (n = 4). Patients with PHTS present with recurrent pain requiring life-long management with a multi-disciplinary team. Pain due to FFVA responds to embolization, and pain due to hamartoma responds to sirolimus. This improves quality of life, but does not prevent disease progression.
- Published
- 2018
13. Equivalent success and complication rates of tunneled common femoral venous catheter placed in the interventional suite vs. at patient bedside
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Alex Chau, Kamlesh Kukreja, Daniel Ashton, J. Hernandez, and Sheena Pimpalwar
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Male ,Catheterization, Central Venous ,medicine.medical_specialty ,Adolescent ,030204 cardiovascular system & hematology ,Radiography, Interventional ,Peripherally inserted central catheter ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,symbols.namesake ,Postoperative Complications ,0302 clinical medicine ,Catheterization, Peripheral ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Child ,Fisher's exact test ,Retrospective Studies ,Neuroradiology ,Central line ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,Infant ,Interventional radiology ,Femoral Vein ,medicine.disease ,Thrombosis ,Surgery ,Catheter ,Treatment Outcome ,Catheter-Related Infections ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,symbols ,Female ,Complication ,business - Abstract
Femoral tunneled central line placement in the pediatric population offers an alternative means for intravenous (IV) access, but there is concern for higher complication and infection rates when placed at bedside. To describe the complications and infection outcomes of primary femoral tunneled central venous catheter placement in the interventional radiology suite compared to the portable bedside location at a single tertiary pediatric institution. We conducted a retrospective review comparing interventional radiology suites vs. bedside primary tunneled common femoral vein central line placement (January 2014 to December 2015). We identified 244 primary femoral placements in pediatric patients, ages 1 day to 18 years, using our electronic medical record and collected into a Research Electronic Data Capture. We compared categorical variables using the Fisher exact test. We compared continuous variables using the Wilcoxon rank test. In total, 2,375 pediatric patients received peripherally inserted and central lines; 244 of these were primary femoral tunneled central venous catheters (in 140 boys and 104 girls). In 140 children (mean age: 206 days), lines were inserted in the interventional radiology (IR) suite (technical success of 100%), with 14 (10.0%) complications including infection (n=7), malposition (n=2), bleeding (n=0), thrombosis (n=1) and line occlusion (n=4). The infection rate was 2.1 per 1,000 line days. In 104 children (mean age: 231 days), lines were placed at bedside (technical success 100%) with 14 (13.3%) complications including infection (n=3), malposition (n=5), bleeding (n=0), thrombosis (n=2) and line occlusion (n=4). The infection rate was 0.78 per 1,000 line days. The total line days were 7,109, of which 3,258 were in the IR suite and 3,851 in the bedside group. There was no statistical significance for complication rate (P=0.55) or infection rate (P=0.57) between bedside and interventional suite placements. In a cohort of children receiving primary femoral tunneled central venous catheters, the complication and infection rates in a bedside setting are not significantly increased compared to the lines placed in an IR suite. The perception of increased infection and complications from bedside-placed tunneled central venous catheters appears to be hyperbolized.
- Published
- 2018
14. Skin‐colored lateral forehead nodule
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Carly Dunn, Denise W. Metry, Emily K Burns, and Alex Chau
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Skin Neoplasms ,business.industry ,Nodule (medicine) ,Dermatology ,Anatomy ,medicine.anatomical_structure ,Colored ,Pediatrics, Perinatology and Child Health ,Forehead ,Humans ,Medicine ,medicine.symptom ,business ,Skin - Published
- 2021
15. New approach to management of traumatic phacocele with iris loss
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Xiao-Wei Ting, Jelinar Mohamed Noor, Mimiwati Zahari, Geng-Yi Yong, Alex Chau-Sim Yee, and Shin-Wei Pan
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medicine.medical_specialty ,genetic structures ,business.industry ,medicine.medical_treatment ,Cornea edema ,Intraocular lens ,Ocular trauma ,medicine.disease ,eye diseases ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Ophthalmology ,0302 clinical medicine ,Blunt ,Crystalline Lens Dislocation ,medicine.anatomical_structure ,030221 ophthalmology & optometry ,medicine ,Scleral rupture ,Surgery ,sense organs ,Iris (anatomy) ,business ,Hyphema - Abstract
We present a case of a 77-year-old woman who sustained blunt ocular trauma leading to a scleral rupture, superonasal subconjunctival crystalline lens dislocation, iris loss, and hyphema. Computed tomography aided in the diagnosis of traumatic phacocele. Surgical exploration revealed an 11.0 mm anterior scleral rupture that was then repaired. Secondary implantation of the uniquely designed tripodal anterior chamber intraocular lens (AC IOL) was the choice because of the presence of extensive iris loss, scleral rupture, cornea edema, and hyphema at the primary setting. This case demonstrates successful restoration of globe integrity and a good visual outcome from an appropriate AC IOL selection and timing of IOL implantation.
- Published
- 2018
16. Cost Comparison of In-Suite Versus Portable Tunneled Femoral Central Line Placements in Children Using Time-Driven Activity-Based Costing
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Ellen G. Wadler, Alberto J. Hernandez, Alex Chau, Matt H. Levine, Robert C. Orth, and Shireen E. Hayatghaibi
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Male ,medicine.medical_specialty ,Catheterization, Central Venous ,Total cost ,Tertiary care ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Fluoroscopy ,Humans ,Radiology, Nuclear Medicine and imaging ,Activity-based costing ,Child ,Retrospective Studies ,Ultrasonography ,Central line ,medicine.diagnostic_test ,Cost comparison ,business.industry ,Electronic medical record ,Infant ,Interventional radiology ,Surgery ,030220 oncology & carcinogenesis ,Child, Preschool ,Costs and Cost Analysis ,Female ,business - Abstract
Objective Compare the cost of placing tunneled femoral central lines in the interventional radiology suite to portable bedside placement using time-driven activity-based costing. Methods Detailed process maps were created using information generated from interviews with frontline staff, direct shadowing of patient procedures (19 patients—8 in-suite, 11 portable; patient age 4 days to 37 months; 6 males, 13 females), and electronic medical record review (80 patients—44 in-suite, 36 portable; patient age 1 day to 20 months; 42 males, 38 females) who underwent a tunneled femoral central line placement at a tertiary care pediatric hospital from January 1, 2018, to June 30, 2018. Procedures were conducted in-suite using fluoroscopy guidance or portably at the patient’s bedside using ultrasound. Capacity cost rates for each resource in the process maps were calculated for personnel, equipment, facilities, and supply costs. Costs for each process step were then calculated by multiplying the capacity cost rate by the mean duration of each step. Stepwise costs were summed for the entire process to generate a cost for each tunneled femoral central line placement pathway. Results Total pathway time for tunneled femoral central lines placement in-suite was 123 to 134 min (nonsedated) and 120 to 131 min (sedated) for a cost of $923 to $990 and $1,262 to $1,386, respectively. Total pathway time for tunneled femoral central lines placed portably were 117 to 119 min (nonsedated) and 115 to 147 min (sedated) for a cost of $1,060 to $1,066 and $1,379 to $1,393, respectively. Conclusion Total costs of tunneled femoral central lines placed in-suite were similar to total costs for lines placed portably. Cost should not be a primary consideration when deciding upon tunneled femoral central line approach in these patients.
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- 2019
17. Acute approach to orbital lymphatic malformations
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Sudhen B. Desai, Amit R. Bhatt, Jackson M. Bennett, and Alex Chau
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medicine.medical_specialty ,business.industry ,General surgery ,medicine.medical_treatment ,Eye pain ,Psychological intervention ,General Medicine ,Eyelid mass ,Tertiary care ,030218 nuclear medicine & medical imaging ,Eyelid swelling ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Sclerotherapy ,Lymphatic malformations ,Presentation (obstetrics) ,business - Abstract
Pediatric lymphatic malformations (LMs) represent a rare, benign subtype of vascular malformations that can commonly occur in the head or neck region, specifically in or around the orbit. Orbital LMs typically require a multidisciplinary team of specialists and diagnostic imaging. Historically, treatment options for these periorbital LMs include imaging-guided drainage with sclerotherapy in addition to surgery, at times in conjunction with medical management. There exists debate in terms of an approach for management timing of these lesions across various treatment centers, and interventional radiologists should be informed regarding treatment timing considerations in evaluating patients for potential intervention. The aim of this case series is to review the current standards regarding therapeutic interventions for LMs in the literature and discuss an organized approach to guide the optimal treatment timing for the management of these lesions. In this case series, two pediatric patients – one 2 years old and one 12 years old – presented with a unilateral periorbital LM and received treatment at an academic tertiary care children’s hospital. The first patient was diagnosed with macrocystic periorbital LM after presenting with eye pain and eyelid swelling. After initial ultrasound-guided drainage to relieve eye pressure, the patient rebled into the LM and underwent sclerotherapy intervention. The second case involved a periorbital LM with intralesional hemorrhage presenting as a violaceous eyelid mass diagnosed after bumping into a swing. The patient was treated medically with interval growth of the LM and underwent subsequent sclerotherapy. Both patients responded well to ultrasound-guided sclerotherapy. The management timing and decision to intervene were based on consults from multidisciplinary services, age, risk factors, and clinical stability on presentation. We present two cases of pediatric periorbital LM and review an organized institutional approach for treatment timing based on paradigms in the literature.
- Published
- 2020
18. Dynamic contrast enhanced magnetic resonance lymphangiography: Categorization of imaging findings and correlation with patient management
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Ponraj Chinnadurai, Daniel Ashton, Mercedes Pereyra, Prakash Masand, Alex Chau, Siddharth P. Jadhav, Rajesh Krishnamurthy, and Sheena Pimpalwar
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Contrast Media ,030204 cardiovascular system & hematology ,Anastomosis ,Chylothorax ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,Child ,Chylous Ascites ,Ligation ,Lymphatic Diseases ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Reflux ,Central venous pressure ,Infant ,Lymphography ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,Image Enhancement ,Embolization, Therapeutic ,Magnetic Resonance Imaging ,Lymphatic system ,Child, Preschool ,Female ,Radiology ,business ,Shunt (electrical) - Abstract
Objective To review the technical aspects and categorize the imaging findings of dynamic contrast enhanced magnetic resonance lymphangiography (DCMRL) and correlate the findings with patient management options. Materials and methods A retrospective review of patients who underwent DCMRL between June 2012 and August 2017 at a tertiary care paediatric hospital was performed. Twenty-five DCMRL studies were performed in 23 patients (9 males, 13 females, 1 ambiguous gender) with a median age of 4 years (range: 1 month–29 years). DCMRL imaging findings were reviewed, categorized and the impact on patient management was studied. Results DCMRL was technically successful in 23/25 (92%) studies. DCMRL findings were categorized based on the status of central conducting lymphatics (CCL) and alternate lymphatic pathways as follows: Type 1 – normal CCL with no alternate lymphatic pathways, Type 2 – partial (2a) or complete (2b) non-visualization of CCL with reflux of contrast into alternate pathways and Type 3 – normal CCL with additional filling of alternate pathways. Type 1 DCMRL patients (n = 5) were reassured and conservative management was continued, Type 2 patients (n = 10) had evidence of CCL obstruction hence thoracic duct ligation or embolization was avoided and other options such as lymphatic fluid diversion using Denver® shunt or lympho-venous anastomosis were used, and Type 3 patients (n = 8) were evaluated for elevated central venous pressure as a cause of lymphatic backflow in addition to Denver® shunt, lympho-venous anastomosis, thoracic duct ligation or embolization. Conclusion DCMRL is an evolving imaging technique for understanding abnormalities of the central conducting lymphatics. Categorization of imaging findings may be helpful in guiding selection of management options.
- Published
- 2018
19. 03:00 PM Abstract No. 411 A slice of normal liver in pediatric liver tumors: do we need it?
- Author
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Kamlesh Kukreja, A. Pezeshkmehr, Alex Chau, J. Hernandez, C. Ortiz, G. Gardner, R. Yoo, and K. Patel
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medicine.medical_specialty ,business.industry ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
20. Pentraxin-3 as a marker of sepsis severity and predictor of mortality outcomes: A systematic review and meta-analysis
- Author
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William K.K. Wu, Yunlong Xia, Tong Liu, Sunny H. Wong, Martin C.S. Wong, Gary Tse, Alex Chau, Mengqi Gong, Wing Tak Wong, Guangping Li, Yee Ting Lee, George Bazoukis, and Konstantinos Lampropoulos
- Subjects
Microbiology (medical) ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Disease severity ,Internal medicine ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,Intensive care medicine ,Severe sepsis ,Pentraxin-3 ,Aged ,business.industry ,Mean age ,Middle Aged ,medicine.disease ,Serum Amyloid P-Component ,Infectious Diseases ,Standard error ,C-Reactive Protein ,Meta-analysis ,Female ,business ,Biomarkers - Abstract
Pentraxin-3 (PTX-3) is a multi-functional pattern recognition molecule produced by various cell types of peripheral tissues in different infections. It is raised in sepsis, but its values in predicting disease severity or mortality outcomes have been controversial. Therefore, we conducted a systematic review and meta-analysis of these associations.PubMed and Embase were searched until July 18, 2017 for studies that evaluated the relationship between PTX-3 levels and disease severity or mortality in sepsis.A total of 23 and 10 entries were retrieved from both databases, respectively, of which 16 studies were included in the final meta-analysis. A total of 3001 patients (56% male, mean age 63 ± 15 years; mean follow-up duration of 207 days) were analysed. PTX-3 was significantly higher in patients with more severe sepsis compared to those with less severe sepsis (standard mean difference = 18.5 ng/mL, standard error: 4.5 ng/mL, P 0.0001) and higher in non-survivors compared to survivors (standard mean difference = 40.3 ng/mL, standard error: 6.8 ng/mL, P 0.0001). Elevated PTX-3 levels significantly increased the risk of all-cause mortality (hazard ratio: 1.91, 95% CI: 1.53 to 2.46, P 0.0001).PTX-3 significantly predicts disease severity and mortality in sepsis.
- Published
- 2017
21. 3:36 PM Abstract No. 115 Portal vein recanalizations in pediatric liver transplant patients: single-center experience
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Heather Cleveland, Daniel Ashton, Aaditya Nagaraj, Sheena Pimpalwar, J. Hernandez, and Alex Chau
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medicine.medical_specialty ,business.industry ,Portal vein ,Medicine ,Radiology, Nuclear Medicine and imaging ,Transplant patient ,Cardiology and Cardiovascular Medicine ,business ,Single Center ,Surgery - Published
- 2018
22. Sa2056 RENDEZVOUS TECHNIQUE (ERCP AND PTC) IN PEDIATRIC PATIENTS: SINGLE CENTER EXPERIENCE
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Douglas S. Fishman, Karen Queliza, Alex Chau, and J. Alberto Hernandez
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medicine.medical_specialty ,business.industry ,General surgery ,Gastroenterology ,Rendezvous ,Medicine ,Radiology, Nuclear Medicine and imaging ,Single Center ,business - Published
- 2019
23. 3:00 PM Abstract No. 111 Pediatric lung biopsy: risk worth the reward? A single-center experience
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Heather Cleveland, S. Desai, Alex Chau, Z. Jeng, J. Hernandez, G. Gardner, and R. Yoo
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medicine.medical_specialty ,business.industry ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Lung biopsy ,Cardiology and Cardiovascular Medicine ,business ,Single Center - Published
- 2018
24. Ethnic differences of the presence and severity of coronary atherosclerosis
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Philip H. Tseng, Roger S. Blumenthal, Ferdinand Flores, Khurram Nasir, Sandy T. Liu, Songshou Mao, Alex Chau, and Matthew J. Budoff
- Subjects
Male ,medicine.medical_specialty ,Hypercholesterolemia ,Ethnic group ,Coronary Artery Disease ,Severity of Illness Index ,Electron beam tomography ,Asymptomatic ,White People ,Asian People ,Risk Factors ,Internal medicine ,Diabetes mellitus ,Diabetes Mellitus ,Prevalence ,medicine ,Humans ,Sex Distribution ,Risk factor ,Coronary atherosclerosis ,medicine.diagnostic_test ,business.industry ,Racial Groups ,Calcinosis ,Hispanic or Latino ,Middle Aged ,medicine.disease ,United States ,Surgery ,Black or African American ,Hypertension ,Population study ,Female ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Dyslipidemia - Abstract
Although cardiovascular risk factor levels are substantially different in Caucasians, African-American, Hispanics, and Asians, the relative rates of coronary heart disease in these groups are not consistent with these differences. The objective of the study is to assess the differences in the prevalence and severity of coronary artery calcification, as a measure of atherosclerosis, in these different ethnic groups.Electron-beam tomography was performed in 16,560 asymptomatic men and women (Asians=1336, African-Americans=610, Hispanics=1256) agedor=35 years referred by their physician for cardiovascular risk evaluation. The study population encompassed 70% males, aged 52+/-8 years.Caucasians were more likely to present with dyslipidemia (p0.0001), while African-Americans and Hispanics had a higher prevalence of smoking, diabetes, and hypertension (all p0.001). After adjustment for age, gender, risk factors, and treatment for hypercholesterolemia, compared with Caucasians, the relative risks for men having coronary calcification were 0.64 (95% CI: 0.48-0.86) in African-Americans, 0.88 (95% CI: 0.67-1.15) in Hispanics, and 0.66 (95% CI: 0.55-0.80) in Asians. After similar adjustments, the relative risks for women having coronary calcification, were 1.58 (95% CI: 1.13-2.19) for African-Americans, 0.84 (95% CI: 0.66-1.06) in Hispanics, and 0.71 (95% CI: 0.56-0.89) in Asian women. After adjusting for age and risk factors using multivariable analysis, African-American men were least likely to have any coronary calcium while African-American women had significantly higher OR of any calcification. Asian men and women had significantly lower OR of any calcification. There was no significant difference in prevalence or severity of atherosclerosis between Hispanics and Caucasians, in men or women.Our study results demonstrate significant difference in the presence as well as severity of calcification according to ethnicity, independent of atherosclerotic risk factors. Results from this study (physician referred) closely parallel the results from MESA (population based, measured risk factors). Ethnic specific data on the predictive value of differing coronary calcium scores are needed.
- Published
- 2006
25. Comparison of Three Generations of Electron Beam Tomography on Image Noise and Reproducibility, a Phantom Study
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Matthew J. Budoff, Songshou Mao, Ambarish Gopal, Philip H. Tseng, Hans Fischer, and Alex Chau
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Scanner ,Reproducibility ,Tomography Scanners, X-Ray Computed ,medicine.diagnostic_test ,Phantoms, Imaging ,business.industry ,Image quality ,Calcinosis ,Reproducibility of Results ,Coronary Artery Disease ,General Medicine ,Calcium Measurement ,Coronary Vessels ,Electron beam tomography ,Imaging phantom ,Coronary Calcium Score ,Image Processing, Computer-Assisted ,Image noise ,Feasibility Studies ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Tomography, X-Ray Computed ,business ,Nuclear medicine - Abstract
UNLABELLED The detection of coronary artery calcification (CAC) using the electron beam tomography (EBT) scanner provides a noninvasive indicator for coronary artery disease (CAD). Physicians interested in preventative medicine also are using this modality to track atherosclerosis over time. Two new iterations of the EBT scanner have been introduced. We sought to evaluate the image quality of each machine to examine whether patients scanned on a previous model would have similar image quality and results to those scanned on the newest scanner. METHODS This study used the C-150 XP, C300, and the e-Speed EBT scanners in high-resolution volume mode. A cork chest phantom was constructed for use as a human chest. A mixture of calcium phosphate, cornstarch and glue was placed inside the wells to simulate coronary calcium. The foci masses were 3, 5, 7, 10, 15, 20, 40, 60, 80, 100, and 200 mg (calcium mass), which provided the 55 foci of different masses and densities to simulate coronary calcium in the chest phantom. Each phantom was scanned multiple times, using both 1.5- and 3-mm slice thickness and table collimation settings with each scanner. RESULTS There were no statistical differences found between the 1.5-mm and 3.0-mm slice thickness calcium foci scores (Agatston & volumetric) for all 3 EBT scanners. The C-150 XP scanner had a variability of 6.01% between 1.5-mm and 3.0-mm slice thickness. Analysis by t test revealed that the mean noise value of C-150 XP was significantly higher than the C300, e-Speed (50 milliseconds), and e-Speed (100 milliseconds) with P values of 0.001, 0.025, and 0.001, respectively. Comparison of 1.5-mm versus 3.0-mm slice thickness noise value showed a significant difference only for the C-150 XP scanner (P < 0.05). CONCLUSIONS The use of the 3 EBT scanners in longitudinal studies of patients coronary calcium score is feasible to obtain similar calcium score values. The C-150 XP has the greatest noise effect in comparison to the C300 and e-Speed scanners. Improved image noise should improve reproducibility of the calcium measurement with these newer devices.
- Published
- 2006
26. Multiphase Contrast Medium Injection For Optimization Of Computed Tomographic Coronary Angiography
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Songshou Mao, Matthew J. Budoff, Jerold S. Shinbane, Alex Chau, Sivi Carson, Janis Child, and Stephen H. Liu
- Subjects
Adult ,Male ,Coronary angiography ,medicine.medical_specialty ,media_common.quotation_subject ,Aortic Diseases ,Contrast Media ,Coronary Artery Disease ,Coronary Angiography ,Computed tomographic ,Coronary artery disease ,Coronary circulation ,Coronary Circulation ,Hounsfield scale ,medicine ,Humans ,Contrast (vision) ,Radiology, Nuclear Medicine and imaging ,Aged ,media_common ,Aged, 80 and over ,Analysis of Variance ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,Contrast medium ,medicine.anatomical_structure ,Injections, Intra-Arterial ,Angiography ,Female ,Radiology ,Tomography, X-Ray Computed ,business ,Nuclear medicine - Abstract
Electron beam angiography is a minimally invasive imaging technique. Adequate vascular opacification throughout the study remains a critical issue for image quality. We hypothesized that vascular image opacification and uniformity of vascular enhancement between slices can be improved using multiphase contrast medium injection protocols.We enrolled 244 consecutive patients who were randomized to three different injection protocols: single-phase contrast medium injection (Group 1), dual-phase contrast medium injection with each phase at a different injection rate (Group 2), and a three-phase injection with two phases of contrast medium injection followed by a saline injection phase (Group 3). Parameters measured were aortic opacification based on Hounsfield units and uniformity of aortic enhancement at predetermined slices (locations from top [level 1] to base [level 60]).In Group 1, contrast opacification differed across seven predetermined locations (scan levels: 1st versus 60th, P.05), demonstrating significant nonuniformity. In Group 2, there was more uniform vascular enhancement, with no significant differences between the first 50 slices (P.05). In Group 3, there was greater uniformity of vascular enhancement and higher mean Hounsfield units value across all 60 images, from the aortic root to the base of the heart (P.05).The three-phase injection protocol improved vascular opacification at the base of the heart, as well as uniformity of arterial enhancement throughout the study.
- Published
- 2006
27. Detection of small vessels with electron beam computed tomographic angiography using 1.5 and 3 mm collimator protocols
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Alex Chau, Stephen H. Liu, Ferdinand Flores, Matthew J. Budoff, Jerold S. Shinbane, Ronald J. Oudiz, Shaojun Wang, Yanlin Gao, and Songshou Mao
- Subjects
Male ,Coronary angiography ,medicine.medical_specialty ,Scanner ,Coronary Disease ,Computed tomography ,Coronary artery angiography ,Coronary Angiography ,Collimated light ,law.invention ,Imaging, Three-Dimensional ,law ,parasitic diseases ,Image Processing, Computer-Assisted ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Cardiac imaging ,medicine.diagnostic_test ,Phantoms, Imaging ,business.industry ,Collimator ,Computed tomographic angiography ,cardiovascular system ,Female ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
To evaluate the effect of scanner collimation on the ability to detect small cardiac vessels using electron beam CT coronary angiography (EBA).EBA scans from 40 patients who underwent study on two separate occasions with 3 mm (initial scan) and 1.5 mm (follow-up scan) collimation protocols were analyzed. Vessels of2 mm in diameter were identified.The 1.5 mm collimation allowed 3-D visualization of 129 vessels2 mm in diameter, while 3 mm collimation only allowed visualization of 89 vessels (p0.001). The right coronary artery branches and distal LAD segments though were not displayed satisfactorily in almost half of the 3-D studies with either protocol.There was significant improvement in detection of small cardiac vessels with a 1.5 mm collimation EBA protocol compared to a 3 mm protocol. Both protocols though were insufficient for reliable visualization of the right coronary artery branches and distal LAD segments.
- Published
- 2005
28. Comparison of coronary artery calcium screening image quality between C-150 and e-Speed electron beam scanners1
- Author
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Matthew J. Budoff, Jerold S. Shinbane, Yanlin Gao, Janis Child, Ronald J. Oudiz, Sivi Carson, Alex Chau, Songshou Mao, and Philip Tseng
- Subjects
Scanner ,medicine.medical_specialty ,business.industry ,Image quality ,Coronary artery calcium ,medicine.anatomical_structure ,Hounsfield scale ,Right coronary artery ,medicine.artery ,Temporal resolution ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,business ,Nuclear medicine ,Image resolution ,Artery - Abstract
Rationale and objective The newest generation of electron beam tomographic scanner (e-Speed) has increased spatial and temporal resolution compared with the C-150 XP scanner. The aim of this study was to evaluate coronary artery calcium screening image quality between the e-Speed and C-150 scanners (GE Imatron, San Francisco, CA). Materials and methods Studies from 41 patients (14 women and 27 men) who underwent serial coronary artery calcium screening with the C-150 (first study) and the e-Speed (second study) were analyzed. Individual computed tomography (CT) slices were assessed for coronary artery motion artifacts, and CT Hounsfield units (HU) and noise values (CT HU standard deviation) at 16 discrete cardiac sites were measured and averaged. Results With the e-Speed scanner, there were significant decreases in right coronary artery motion artifacts compared with the C-150 scanner (0.3% versus 1.8%, P < .001) as well as decreased noise values (24.3 versus 32.0 HU, P < .001). Conclusion Image quality is significantly improved with use of the e-Speed scanner, due to its improved temporal and spatial resolution, compared with the C-150 scanner.
- Published
- 2005
29. Synthesis, characterization and structures of zirconocene complexes of sterically demanding pentaphenylcyclopentadienyl and tetraphenyl-m-tolyl cyclopentadienyl ligands
- Author
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Iris Cruz, Brian Schick, Tambi Wenj, Carmen Mendez, Alex Chau, Katherine A. Kantardjieff, Wayne Tikkanen, Marisa J. Monreal, and Deborah L Greene
- Subjects
Steric effects ,Zirconium ,Cyclopentadiene ,Chemistry ,Stereochemistry ,Organic Chemistry ,chemistry.chemical_element ,Biochemistry ,Medicinal chemistry ,Catalysis ,Inorganic Chemistry ,chemistry.chemical_compound ,Monomer ,Cyclopentadienyl complex ,Materials Chemistry ,Reactivity (chemistry) ,Physical and Theoretical Chemistry ,Methyl acrylate - Abstract
The synthesis, characterization and catalytic activity of zirconium complexes containing bulky pentaarylcyclopentadienyl ligands are reported. The monocyclopentadienyl 12-electron complex, trichloropentaphenylcyclopentadienylzirconium(IV), C5Ph5ZrCl3 (I), has an unusual monomeric structure in the solid state and has short Zr–ligand distances suggesting that the complex has significant Lewis acidity. The phenyl rings adopt a propeller arrangement in the solid state; VT 1H-NMR measurements of the analogous trichloro(tetraphenyl-m-tolylcyclopentadienyl)zirconium(IV) (II) indicate that there is rapid rotational motion of the phenyl rings. The Lewis acidity of this complex is manifested in its ability to catalyze the [4+2] cycloadditions of acrolein and methyl acrylate to cyclopentadiene. The sandwich complex, C5Ph5CpZrCl2 (III), has more typical Zr–ligand distances, but has a more parallel arrangement of the two cyclopentadienyl rings and does not display the reactivity shown by I and II.
- Published
- 2003
30. Three‐dimensional computed tomography imaging of left atrial anatomy for atrial fibrillation ablation
- Author
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Richard A. Kerensky, Jerold S. Shenbane, Marc J. Girsky, Alex Chau, Songshou Mao, and Matthew J. Budoff
- Subjects
medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Computed tomography ,Pulmonary vein ,Imaging, Three-Dimensional ,Left atrial ,Atrial Fibrillation ,Medicine ,Humans ,Heart Atria ,medicine.diagnostic_test ,business.industry ,Images in Cardiology ,Atrial fibrillation ,General Medicine ,Ablation ,medicine.disease ,Computed tomographic angiography ,Pulmonary Veins ,cardiovascular system ,Tomography ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed - Abstract
Computed tomographic angiography can visualize detailsof left atrial structure relevant for atrial fibrillation (AF) abla-tion. In this example from a patient with a history of paroxys-mal AF referred for pre-ablation assessment of pulmonaryveins, three-dimensional images define pulmonary vein loca-tions and demonstrate an additional small pulmonary veinnear the right lower pulmonary vein (Fig. 1). Endocardial im-ages provide anatomic detail of the spatial relationships be-tween the ostia of the pulmonary veins (Fig. 2). These imagessupplement and enhance the understanding of two-dimension-al images, providing a more comprehensive analysis of atrialstructure for left atrial ablation procedures. Reference
- Published
- 2006
31. Comparison of coronary artery calcium screening image quality between C-150 and e-Speed electron beam scanners
- Author
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Matthew J, Budoff, Jerold S, Shinbane, Ronald J, Oudiz, Janis, Child, Sivi, Carson, Alex, Chau, Philip, Tseng, Yanlin, Gao, and Songshou, Mao
- Subjects
Male ,Time Factors ,Tomography Scanners, X-Ray Computed ,Calcinosis ,Coronary Disease ,Middle Aged ,Coronary Angiography ,Radiographic Image Enhancement ,Image Processing, Computer-Assisted ,Humans ,Mass Screening ,Female ,Artifacts ,Tomography, X-Ray Computed - Abstract
The newest generation of electron beam tomographic scanner (e-Speed) has increased spatial and temporal resolution compared with the C-150 XP scanner. The aim of this study was to evaluate coronary artery calcium screening image quality between the e-Speed and C-150 scanners (GE Imatron, San Francisco, CA).Studies from 41 patients (14 women and 27 men) who underwent serial coronary artery calcium screening with the C-150 (first study) and the e-Speed (second study) were analyzed. Individual computed tomography (CT) slices were assessed for coronary artery motion artifacts, and CT Hounsfield units (HU) and noise values (CT HU standard deviation) at 16 discrete cardiac sites were measured and averaged.With the e-Speed scanner, there were significant decreases in right coronary artery motion artifacts compared with the C-150 scanner (0.3% versus 1.8%, P.001) as well as decreased noise values (24.3 versus 32.0 HU, P.001).Image quality is significantly improved with use of the e-Speed scanner, due to its improved temporal and spatial resolution, compared with the C-150 scanner.
- Published
- 2004
32. 12.0Reproducibility of left ventricular mass measurements by different workstations with data obtained by cardiac computed tomography
- Author
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Sandy T. Liu, S.S. Mao, N. Weinberg, M.J. Budoff, Philip H. Tseng, Alex Chau, Y. Gao, Ambarish Gopal, Ferdinand Flores, and M. Lensky
- Subjects
Left ventricular mass ,medicine.medical_specialty ,Reproducibility ,Cardiac computed tomography ,business.industry ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Published
- 2007
33. Comparison of Three Generations of Electron Beam Tomography on Image Noise and Reproducibility, a Phantom Study.
- Author
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Alex Chau
- Published
- 2006
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34. Association of TLR4 and TLR9 gene polymorphisms and haplotypes with cervicitis susceptibility.
- Author
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Alex Chauhan, Nilesh Pandey, Ajesh Desai, Nitin Raithatha, Purvi Patel, Yesha Choxi, Rutul Kapadia, Ronak Khandelwal, and Neeraj Jain
- Subjects
Medicine ,Science - Abstract
BackgroundCervicitis is one of the major health problems amongst women caused by infection of various pathogens including Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) as well as human papillomavirus (HPV), and persistent cervical inflammation is one of the etiologic agents of cervical cancer. Toll-like receptors (TLRs) play an important role in the recognition and subsequent elimination of these pathogens. Variations in the Toll-like receptor genes influence susceptibility to pathogens as well as disease progression independently.MethodsTen single nucleotide polymorphisms, five each of TLR4 and TLR9 genes were analyzed among 130 cervicitis patients and 150 controls either using polymerase chain reaction-restriction fragment length polymorphism or allele specific-PCR.ResultsT. vaginalis infection was found at the highest frequency (30.7%) as compared to C. trachomatis (1.5%), N. gonorrhoeae (2.3%) and HPV (4.6%) infections in cervicitis patients. TLR4 rs11536889 CC (age-adjusted OR, 2.469 [95% CI, 1.499 to 4.065]; p < 0.001) and TLR9 rs187084 TC (age-adjusted OR, 2.165 [95% CI, 1.267-3.699]; p = 0.005) genotypes showed the higher distribution in cervicitis patients compared to controls. In addition, TLR4 rs11536889 C allele was shown to increase the risk of cervicitis (age-adjusted OR, 1.632 [95% CI, 1.132 to 2.352]; p = 0.009) compared to controls. The TLR4 haplotype GCA (OR, 0.6 [95% CI, 0.38-0.95]; p = 0.0272) and TLR9 haplotype GTA (OR, 1.99 [95% CI, 1.14-3.48]; p = 0.014) were found to be associated with decreased and increased risk of cervicitis respectively.ConclusionsTLR4 and TLR9 polymorphisms, as well as haplotypes were shown to modulate the cervicitis risk.
- Published
- 2019
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- View/download PDF
35. Absence of toll-like receptor 9 Pro99Leu polymorphism in cervical cancer [version 2; referees: 2 approved, 1 not approved]
- Author
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Alex Chauhan, Nilesh Pandey, Nitin Raithatha, Purvi Patel, Ajesh Desai, and Neeraj Jain
- Subjects
Medicine ,Science - Abstract
Background: Toll-like receptor 9 (TLR9) plays a key role in the elimination of viral pathogens by recognising their CpG DNA. Polymorphisms in the TLR9 gene may influence their recognition and subsequent elimination. Therefore, the present study was designed to elucidate the role of a rare unexplored TLR9 gene polymorphism C296T/ Pro99Leu (rs5743844) in cervical cancer susceptibility among Indian women. Methods: The genotyping of TLR9 Pro99Leu polymorphism in 110 cervical cancer patients and 141 healthy controls was performed by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). Results: The genotype frequency detected in both cervical cancer and control populations was 1.0 (CC), 0.0 (CT) and 0.0 (TT); while the allele frequency was found to be 1.0 (C) and 0.0 (T). Conclusions: The present study demonstrates no involvement of TLR9 C296T/ Pro99Leu polymorphism in cervical cancer susceptibility and supports minor allele frequency (MAF) (0.0002) status of the same as no nucleotide variation was detected in any of the study subjects.
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- 2018
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- View/download PDF
36. Risk factors of dementia in type 2 diabetes mellitus: The Hong Kong diabetes study
- Author
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Yau-Lam Alex Chau, Ji Won Yoo, Jiandong Zhou, Cosmos LiutaoGuo, Wing Tak Wong, Carlin Chang, Tong Liu, Kamalan Jeevaratnam, Qingpeng Zhang, Gary Tse, and Sharen Lee
- Subjects
Dementia ,Type 2 diabetes ,Vascular ,Risk factors ,Geriatrics ,RC952-954.6 - Abstract
This population-based cohort study investigated the risk factors of incident dementia and vascular dementia in type 2 diabetic patients (≥45 years old) attending the Hong Kong Hospital Authority between 1st January and 31st December 2009.Of the 273,876 patients included,9994 showed incident dementia (median follow-up: 4245 days). Multivariable Cox regression identified older age (HR: 1.09 [95% CI: 1.08–1.10]) and antiplatelet use (HR: 1.36 [1.14–1.62]) as risk factors for incident dementia, and older age (HR: 1.07 [1.06–1.08]), ischemic stroke (HR: 1.47 [1.09–1.98]), fasting blood glucose (HR: 1.10 [1.01–1.20]), antiplatelets (HR: 1.92 [1.51–2.44]), and calcium channel blocker (HR: 1.28 [1.04–1.57]) use as risk factors of incident vascular dementia.
- Published
- 2023
- Full Text
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37. The impact of post-operative atrial fibrillation on outcomes in coronary artery bypass graft and combined procedures.
- Author
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Alex Chau YL, Won Yoo J, Chuen Yuen H, Bin Waleed K, Chang D, Liu T, Liu FZ, Tse G, Lee S, and Hou Christien Li K
- Abstract
Background: Post-operative atrial fibrillation (POAF) is a common yet understudied clinical issue after coronary artery bypass graft (CABG) leading to higher mortality rates and stroke. This systematic review and meta-analysis evaluated the rates of adverse outcomes between patients with and without POAF in patients treated with CABG or combined procedures., Methods: The search period was from the beginning of PubMed and Embase to May 18
th , 2020 with no language restrictions. The inclusion criteria were: (1) studies comparing new onset atrial fibrillation before or after revascularization vs. no new onset AF before or after revascularization. The outcomes assessed included all-cause mortality, cardiac death, cerebral vascular accident (CVA), myocardial infarction (MI), repeated revascularization, major adverse cardiac event (MACE), and major adverse cardiac and cerebrovascular events (MACCEs)., Results: Of the 7,279 entries screened, 11 studies comprising of 57,384 patients were included. Compared to non-POAF, POAF was significantly associated with higher risk of all-cause mortality (Risk Ratio (RR) = 1.58; 95% Confidence Interval (CI): 1.42-1.76, P < 0.00001) with accompanying high level of heterogeneity ( I2 = 62%)., Conclusions: Patients with POAF after CABG or combined procedures are at an increased risk of all-cause mortality or CVAs. Therefore, POAF after such procedures should be closely monitored and treated judiciously to minimize risk of further complications. While there are studies on POAF versus no POAF on outcomes, the heterogeneity suggests that further studies are needed., (Copyright and License information: Journal of Geriatric Cardiology 2021.)- Published
- 2021
- Full Text
- View/download PDF
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