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Biomedical subjects

B N Chiang

Publications and source records attributed to B N Chiang.

At least 91 records · Page 5Linked to original sources
PubMed1990

Detection of dysfunctioning mitral prosthetic regurgitation: transesophageal echocardiography in comparison with transthoracic echocardiography and angiography.

Transesophageal echocardiography has been increasingly used in addition to the transthoracic approach. It not only allows an unobstructed window for viewing the left atrium, but also provides high-quality imaging to improve diagnosis of prosthetic valve dysfunction. To determine the value of transesophageal echocardiography in detection of dysfunctioning mitral prosthetic regurgitation, 11 patients clinically suspected of dysfunctioning mitral prosthesis were studies by transthoracic, transesophageal echocardiography and was documented by a left ventricular angiography. There were 7 biological tissue valves and 4 metallic Bjork-Shiley valves. Compared with a left ventricular angiography, the transthoracic approach to 8 patients made an underestimation of the grade of regurgitation. The angiographic grading confirmed the transesophageal approach in all patients except one who was graded as mild regurgitation by left ventricular angiography, moderate regurgitation by transesophageal echocardiography, but no regurgitation by transthoracic echocardiography. Our results indicated that in patients with suspected mitral prosthetic dysfunction, a transesophageal echocardiography is more sensitive than a transthoracic echocardiography in detecting mitral regurgitation.

Adult↗
PubMed1990

The effect of intravenous captopril on right and left ventricular load and function in moderate-severe essential hypertension.

The acute haemodynamic effects of intravenous captopril were measured, and left ventricular function was analysed by radionuclide angiography in eleven patients with moderate to severe hypertension. All subjects received 1 mg captopril by bolus injection initially, followed at 10 minute intervals by 2 mg or 5 mg injections according to blood pressure response. Eight patients experienced an acute reduction of blood pressure whilst three patients remained unresponsive. The onset of action was within 5 minutes with a peak effect at 5 to 10 minutes and duration of action lasting 20 to 30 minutes. The haemodynamic effects were characterised by arteriolar dilatation (reduced systemic vascular resistance P less than 0.01), and apparent venous dilatation (reduced right atrial, pulmonary wedge pressure, P less than 0.05 and 0.01 respectively). Pulmonary vascular resistance was not altered, ejection fraction remained unchanged and isovolumic relaxation period was lengthened (119 +/- 20.1 to 147.39 +/- 21.15, P less than 0.05). Coronary perfusion pressure gradients dropped (123.8 +/- 5.6 to 107.1 +/- 11.3 mmHg, P less than 0.001) following intravenously administered captopril. Intravenous captopril is effective in reducing arterial pressure rapidly with minimal adverse effects. This suggests that it may be useful as an alternative regimen for severe hypertension. The prolongation of the isovolumic relaxation period accounted for the decrease of coronary filling load.

Blood Pressure↗
PubMed1989

Normal limits of the electrocardiogram in a Chinese population.

12-lead electrocardiograms (ECGs) from 503 healthy Chinese individuals were computer-analyzed to derive the normal limits of the ECG in a Chinese population. With respect to ECG amplitudes, there were highly significant differences between men and women. The mean S wave amplitude in V2 decreased with increasing age, but the mean R wave amplitude in V5, for example, remained remarkably constant throughout the age groups. The QRS duration was on average 7.6 msec shorter in women than in men. The mean frontal QRS axis shifted superiorly by 17 degrees with increasing age, resulting in an upward trend in R wave amplitude in leads I and aVL. It was concluded that ECG diagnostic criteria for Chinese individuals should be age- and sex-dependent.

Adult↗
PubMed1989

Pacemaker activity is modulated by tissue levels of cyclic adenosine 3',5'-monophosphate in human atrial fibers.

We studied the role of tissue cyclic AMP levels in the chronotropic effects of theophylline on automatic human atrial fibers obtained from the hearts of 17 patients undergoing corrective open-heart surgery. Atrial fibers were perfused with Tyrode solution and transmembrane action potentials were recorded with a conventional microelectrode technique. In normal Tyrode solution, theophylline (0.1-1 mM) often decreased the late diastolic slope and the spontaneous rate. In the presence of 0.3-1 microM epinephrine, however, theophylline dose-dependently increased the diastolic slope, the rate of spontaneous discharges and the force of contraction. The increase in tissue level of cyclic AMP (+288 +/- 69%) induced by 0.3 mM theophylline in the presence of epinephrine was much greater than the increase (+73 +/- 19%) in the absence of epinephrine. It is concluded that pacemaker activity in human atrial fibers is modulated by tissue levels of cyclic AMP and theophylline may induce atrial tachycardia through an increase in the diastolic slope and the rate of discharges of automatic atrial fibers.

Action Potentials↗
PubMed1989

Role of acetylcholine in induction of repetitive activity in human atrial fibers.

The actions of acetylcholine and its interactions with epinephrine were studied in human atrial tissues by recording transmembrane potentials and contractile force. Acetylcholine (0.55-5.5 microM) reduced force, shortened the duration and shifted to more negative values the plateau of action potentials, abolished phase 4 depolarization, and suppressed the activity of spontaneous fibers. During the recovery, often there was a rebound increase in some parameters of the action potential and in force. Epinephrine (0.3-2.8 microM) induced oscillatory potentials and aftercontractions and acetylcholine abolished them. However, during the washout of acetylcholine in the presence of epinephrine, the oscillatory potentials and aftercontractions were larger than before acetylcholine, and repetitive activity was often induced. The inhibitory and excitatory effects of acetylcholine were mimicked by methacholine (5.1 microM) and abolished by atropine (1.5 microM). The postacetylcholine rebound was also potentiated by theophylline (0.6-2 mM) but was not blocked by propranolol (1-3.4 microM), prazosin (1 microM), and diltiazem (0.1 microM). It is concluded that in human atrial fibers acetylcholine has inhibitory as well as excitatory effects that are exaggerated in the presence of epinephrine and are mediated by the activation of the muscarinic receptor. The interaction between acetylcholine and epinephrine involves an antagonism at an intracellular level.

Acetylcholine↗
PubMed1989

Prevalence of stroke in Taiwan.

We investigated the prevalence of stroke in Taiwan in an epidemiologic study of stroke, diabetes, and cardiovascular disease that used a two-phase survey design. The study population was drawn by cluster sampling and consisted of both urban and rural communities from four regions of Taiwan. There were 8,705 people 36 years of age or older interviewed during the period of October 1 to December 31, 1986, and 143 cases of completed stroke were later identified by a neurologist. The point prevalence rate for people aged 36 or older in our study was 1,642/100,000 population (95% confidence interval 1,389-1,942/100,000). Prevalence rates differed significantly among the four study regions and between urban and rural communities; prevalence was greater in northern Taiwan and in urban communities. Percentages of the major types of stroke in 143 stroke survivors were as follows: cerebral infarction 67.1% (96 cases), cerebral hemorrhage 14.0% (20 cases), subarachnoid hemorrhage 4.2% (six cases), and unclassified 14.7% (21 cases). Of the stroke survivors, 67.1% were independent in activities of daily living, and 75.5% were independent in ambulation. Hypertension, heart disease, diabetes mellitus, and a family history of stroke were significantly more common in stroke survivors than in strokefree individuals.

Adult↗
PubMed1989

Alteration of mitogenic responses of mononuclear cells by anti-ds DNA antibodies resembling immune disorders in patients with systemic lupus erythematosus.

Anti-double-stranded DNA antibodies (anti-DNA) purified from pooled active SLE sera by lambda phage DNA-affinity chromatography was found to affect phytohemagglutinin (PHA) and pokeweek mitogen (PWM)-induced responses of normal mononuclear cells. Anti-DNA at a concentration of 0.25 mg/ml (equivalent to 21 units/ml of DNA binding activity) significantly suppressed the PHA-induced [3H]thymidine incorporation of mononuclear cells in 3 days of culture but had no effect on 5-day and 7-day cultures. In contrast, a biphasic effect of anti-DNA on PWM response was found such that early phase (3-day culture) was inhibited whereas late phase (from 5 days to 9 days of culture) was enhanced by the antibodies. Anti-DNA also increased the immunoglobulin synthesis by PWM-stimulated B cells. The inhibition of PHA response in 3-day culture by anti-DNA is not due to changes in T cell subpopulations. Because interleukin 1 (10 units/ml) could restore the PHA response, it appears that anti-DNA suppressed the IL-1 production by monocyte/macrophage. The biphasic effect of anti-DNA on PWM response is the result of monocyte impairment and B cell stimulation by the antibodies. In the early phase (on day 3) the inhibition would seem to be due to impairment of accessory cell function by anti-DNA, though in late phase (after day 5) the anti-DNA may stimulate B lymphocytes to incorporate more thymidine in the presence of PWM. These biological effects of anti-DNA in vitro resemble the in vivo immunologic disorders in patients with SLE, in that impaired cell-mediated immunity and B cell hyperactivity are frequently observed.

Antibodies, Antinuclear↗
PubMed1989

Defective helper T cell function in IgM rheumatoid factor synthesis in patients with ankylosing spondylitis.

Despite chronic inflammation and the presence of hypergammaglobulinemia, rheumatoid factor (RF) is rarely found in the blood of patients with ankylosing spondylitis (AS). We used ELISA to compare spontaneous and pokeweed mitogen (PWM)-induced IgG, IgM and IgM rheumatoid factor (IgM-RF) production in normals and in patients with rheumatoid arthritis (RA) and AS. The IgG and IgM synthesis in these three groups did not differ. However, the IgM-RF level in PWM-induced mononuclear cell cultured supernatants of AS was significantly decreased, compared with normal and RA patients. Furthermore, mixing experiments by co-culture of normal T or B cells with patient's B or T cells in the presence of PWM revealed a deficiency of the helper T cell function in patients with AS. These results illustrate the cellular mechanism of the seronegativity of the rheumatoid factor in patients with ankylosing spondylitis.

Arthritis, Rheumatoid↗
PubMed1989

Defective phagocytosis, decreased tumour necrosis factor-alpha production, and lymphocyte hyporesponsiveness predispose patients with systemic lupus erythematosus to infections.

Twenty-three patients with systemic lupus erythematosus (SLE) were studied in order to understand the mechanism of increased susceptibility to infection in SLE patients. We found that phagocytosis by polymorphonuclear leucocytes (PMN) was significantly defective in untreated (24.2 +/- 3.1%) and immunosuppressant-treated SLE patients (30.0 +/- 3.6%) compared with normals (47.9 +/- 0.6%), while the generation of superoxide anion radicals was normal. The defective phagocytosis in SLE could be increased by human recombinant tumour necrosis factor alpha (TNF-alpha). However, the percentages of phagocytosis in SLE before and after TNF-alpha stimulation were 56.6% and 60.7% of the normal values. This indicates that certain populations of PMN in SLE are not only defective as regards phagocytosis but also unresponsive to TNF-alpha stimulation. In an ELISA, TNF-alpha production by phorbol myristate acetate (PMA)-stimulated mononuclear cells from SLE patients was significantly decreased (181.4 +/- 22.7 pg/ml vs. 533.0 +/- 81.9 pg/ml, p = 0.002). In addition, the percentage of phytohaemagglutinin (PHA)-stimulated mononuclear cells in S phase in the cell cycle was deficient in patients with SLE (17.2 +/- 1.8% vs. 29.7 +/- 2.9%, p less than 0.001). These results lead us to propose that defective PMN in spontaneous and TNF-alpha-induced phagocytosis, decreased production of TNF-alpha, and lymphocyte hyporesponsiveness predispose patients with SLE to infections.

Adolescent↗
PubMed1989

Proton nuclear magnetic resonance studies of plasma to determine metabolic status of patients with adult respiratory distress syndrome.

Adult respiratory distress syndrome (ARDS) is a non-cardiogenic pulmonary edema of various etiologies. Here we report the first application of proton nuclear magnetic resonance (NMR) for the detection of abnormal metabolites in plasma from patients with ARDS. By comparing plasma obtained from the systemic artery with that obtained from the pulmonary artery, we could study the metabolic status of the lung in patients with ARDS. Although their concentrations may vary, the peaks for acetate, acetoacetate, beta-hydroxybutyrate, phenylalanine, and other unidentified compounds in water-suppressed NMR of these patients' plasma were higher than in the normal controls. The proton NMR resonance at a chemical shift of about 7.4 ppm (relative to sodium tetradeutero-3-trimethyl-silylpropionate), presumably caused by phenylalanine and its related metabolites produced by a disordered amino acid metabolism, is detected in greater than 65% of the samples from ARDS patients. We discuss the detection of abnormal metabolites in terms of possible deranged metabolism of carbohydrates, lipids, or amino acids in this syndrome.

3-Hydroxybutyric Acid↗
PubMed1988

Assessment of HBV persistent infection in an adult population in Taiwan.

In order to study the prevalence of hepatitis B virus (HBV) in the adult population of Taiwan, we screened for the presence of HBV DNA in 205 blood samples from adult (20-59-year-old) volunteers. According to the serological markers of HBV, samples were divided into three groups: group I (173 subjects) was negative for both HBsAg and HBeAg; group II (14 subjects) was positive for both HBsAg and HBeAg; and group III consisted of 18 subjects who were HBsAg-positive but HBeAg-negative. Plasma HBV DNA was not detected in group I, but it was found in 85.7% and 11.8% of samples in group II and group III, respectively. A free-form HBV DNA was found in 14.3% of the leukocyte samples in group II. Furthermore, an integrated form of HBV DNA was detected in the leukocytes of two cases of group I who remained healthy based on clinical data. HBV DNA was also detected in the spermatozoa and liver cells of one of the cases.

Adult↗
PubMed1988

The molecular basis of HbH disease in Taiwan.

We have determined the molecular characteristics of alpha-thalassemia in 12 HbH subjects from Taiwan by restriction endonuclease mapping with alpha- and zeta-specific probes. We have found four types of defects in the alpha-thalassemia-2 genetic determinant: -alpha 3.7 type I; -alpha 4.2; alpha CS alpha; and alpha alpha T. All HbH subjects carried the --SEA genotype in the alpha-thalassemia-1 determinant. At least two different subtypes of --SEA genotype were observed in this study.

DNA Restriction Enzymes↗
PubMed1988

Local suppressive effect of clonidine on penile erection in the dog.

Dogs, 8.5 to 10 kg. in weight, were anesthetized with sodium pentobarbital (35 mg./kg.), intraperitoneally. Penile erection as indicated by an increase in the intracorporal pressure (ICP-increase) was produced by electrical stimulation of the right cavernous nerves. Drugs were administered into the internal pudendal artery (IPA) and femoral vein. A low dose (0.2 to 0.4 microgram/kg.) of clonidine, an alpha 2 adrenoceptor agonist, which could not affect either ICP or systemic arterial pressure (SAP) through an intravenous route, did suppress the ICP-increase markedly via direct injection into the IPA which supplies the penile blood flow. By intra-IPA injection, yohimbine (2.5 micrograms/kg.), an alpha 2 adrenoceptor antagonist, remarkably restored the ICP to the erection state. By intravenous injection, clonidine at a dose of 1.6 to 3.2 micrograms/kg. also profoundly reduced the ICP-increase, but only negligibly lowered the SAP. The IPA blood flow (IPAF) decreased coincidentally when the ICP-increase was effectively reduced by either intravenous or intra-IPA injection of clonidine. These findings suggest clonidine could act locally in the penile structure to suppress penile erection, possibly resulting from a penile vasoconstriction involving alpha 2 adrenoceptor. Whether this vasoconstriction is caused by a direct alpha 2 stimulating effect on the vascular smooth muscle or by an alpha 2 presynaptic inhibition of the vasodilator nerve (cavernous nerve) endings has been discussed.

Animals↗
PubMed1988

The influence of verapamil and nifedipine on hepatic indocyanine green clearance in patients with HBsAg-positive cirrhosis and ascites.

The influence of verapamil and nifedipine on hepatic indocyanine green kinetics was studied in 12 patients with HBsAg-positive cirrhosis and ascites. Hepatic clearance and its two biologic determinants, hepatic blood flow and metabolic activity (intrinsic clearance [maximum velocity/metabolite elimination rate constant, or Vmax/km]), were determined from hepatic indocyanine green elimination at steady state in patients with cirrhosis. Acute intravenous administration 10 mg verapamil significantly increased the hepatic indocyanine green blood flow (p less than 0.05), but significantly decreased the hepatic clearance (p less than 0.05), extraction ratio (p less than 0.05) and Vmax/km (p less than 0.05). However, acute sublingual administration of 10 mg nifedipine resulted in no significant change in any parameters of hepatic elimination function. These results show that verapamil, but not nifedipine, might impair the transhepatic extraction activity of hepatocytes in patients with HBsAg-positive cirrhosis and ascites.

Aged↗
PubMed1988

A noninvasive pre-atrial activity recording by signal averaging using esophageal electrode.

A noninvasive method employing the technique of signal averaging has been developed for recording sinoatrial (S-A) activity (pre-P wave). Recordings were obtained in man at the time of right heart catheterization. A bipolar esophageal electrode was utilized to record the prominent P waves that were used for triggering in the averaging process. After summing 150 beats, which had coefficients of correlation 0.97 or larger, deflections of small amplitude (less than 40 microV) were obtained preceding the atrial activity. Direct catheter recordings were also taken for comparison. With the new noninvasive method, the sinoatrial conduction time (SACT) estimated for patients with sick sinus syndrome (SSS) was 106 +/- 24 ms (101 +/- 20 ms for the same group measured directly). The SACT for healthy subjects used as the control group was 55 +/- 18 ms. There was good correlation between the pre-atrial activity recorded noninvasively by the esophageal electrode method and invasively from the direct catheter method. The linear correlation coefficient between these two techniques was 0.89 (P less than 0.001) in 17 patients.

Adult↗
PubMed1988

Differential diagnosis of chronic lymphocytic leukemia and diffuse well-differentiated lymphoma using monoclonal antibodies.

Diffuse well-differentiated lymphocytic lymphoma (DWDL) with leukemic change and chronic lymphocytic leukemia (CLL) are not significantly different in morphology, immunophenotype and clinical course. Two monoclonal antibodies (MoAbs), designated L20 and A01, were established with respective reactivity against DWDL and CLL cells. The L20 MoAb reacted with both DWDL and CLL cells, and 20-50% of normal B cells. The second MoAb, A01, reacted not only with CLL cells but also with 33% of non-T, non-B cells. Immunoprecipitation patterns of L20 and A01 MoAbs against 125I-surface-labeled BALL and Daudi cell extracts revealed respective bands with molecular weights of 86 and 66 kilodaltons. These results showed that DWDL and CLL cells are different in nature, and that these two MoAbs can be used to distinguish DWDL from CLL cells.

Adult↗