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Biomedical subjects

K Tan

Publications and source records attributed to K Tan.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Current status of cancer pain control in home hospice care--assessment by family members].

To improve the quality of life of terminally ill cancer patients, we care for them in the home whenever possible, making use of home parenteral nutrition (HPN) and continuous intravenous infusion of morphine. The purpose of this study was to assess the current status of and problems associated with our home hospice care program, with emphasis placed on the effectiveness of cancer pain control as viewed by the family of the patient. A questionnaire was sent to six families of patients who died at home. The members of each family were divided into two groups (spouse group or non-spouse group) and evaluated for their reaction to the patient's suffering. It was found that the two groups displayed a different reaction to the patient's suffering. The difference may have derived from the different mixture of objectivity and affection in each group. Therefore, we believe it is necessary to provide emotional support to each group based on this point of view. All respondents expressed a desire to receive home hospice care if they themselves were afflicted with end-stage cancer. This result showed that overall our home hospice care was successful. We intend to proceed with our program to provide patients and their families with more comfortable care, paying due regard to the difference in the reaction of family members to the patient's suffering depending on their relation to patient.

Aged↗
PubMed1997

Atomic structure of a thermostable subdomain of HIV-1 gp41.

Infection by HIV-1 involves the fusion of viral and cellular membranes with subsequent transfer of viral genetic material into the cell. The HIV-1 envelope glycoprotein that mediates fusion consists of the surface subunit gp120 and the transmembrane subunit gp41. gp120 directs virion attachment to the cell-surface receptors, and gp41 then promotes viral-cell membrane fusion. A soluble, alpha-helical, trimeric complex within gp41 composed of N-terminal and C-terminal extraviral segments has been proposed to represent the core of the fusion-active conformation of the HIV-1 envelope. A thermostable subdomain denoted N34(L6)C28 can be formed by the N-34 and C-28 peptides connected by a flexible linker in place of the disulfide-bonded loop region. Three-dimensional structure of N34(L6)C28 reveals that three molecules fold into a six-stranded helical bundle. Three N-terminal helices within the bundle form a central, parallel, trimeric coiled coil, whereas three C-terminal helices pack in the reverse direction into three hydrophobic grooves on the surface of the N-terminal trimer. This thermostable subdomain displays the salient features of the core structure of the isolated gp41 subunit and thus provides a possible target for therapeutics designed selectively to block HIV-1 entry.

Amino Acid Sequence↗
PubMed1997

Ambulatory patient-activated arrhythmia monitoring: comparison of a new wrist-applied monitor with a conventional precordial device.

A wrist-applied transtelephonic device (WrTTD) and a precordial (PrTTD) patient-activated transtelephonic electrocardiographic (ECG) recorder were compared objectively (quality of ECG traces) and subjectively (device preference) in a prospective randomized crossover study of 24 patients. All underwent cardioversion for chronic atrial fibrillation and were then randomized to each device for 1 month. The ECG traces were sent weekly with additional traces if symptomatic. Self-administered questionnaires were completed after 1 month with each device, and the first five telemetered ECG traces for each patient were blindly assessed by two experienced cardiologists. Although the QRS complexes were smaller with the WrTTD (P < .001), the quality of the traces was similar. In particular, there was no significant difference in number of nondiagnostic traces, ability to detect atrial activity, degree of baseline fluctuation, or amount of artifact. Overall, patients preferred the PrTTD (P = .02). Patients found the PrTTD easier to use (P = .007) and were able to apply it more rapidly (P = .02). The quality of ECG traces obtained from the upper limbs by using a wrist-applied transtelephonic device was concluded to be comparable with those obtained by direct precordial application. In order to increase patient acceptability of the former, further improvements to simplify its operation are necessary.

Adolescent↗
PubMed1997

Is mode switching beneficial? A randomized study in patients with paroxysmal atrial tachyarrhythmias.

OBJECTIVES: We sought 1) to compare three pacing modalities-DDDR with mode switching (DM), DDDR with conventional upper rate behavior (DR) and VVIR (VR)-in patients with a history of atrial tachyarrhythmias, and 2) to assess the efficacy of six mode-switching algorithms. BACKGROUND: A history of atrial tachyarrhythmias has been a relative contraindication to dual-chamber pacing. Several mode-switching algorithms have recently been developed to prevent rapid tracking of atrial tachyarrhythmias. METHODS: Forty-eight patients (mean age 64 years, 58% male) with a history of atrial tachyarrhythmias and heart block had a DM pacemaker implanted. Pacemakers were programmed to DM, DR and VR modes for 4 weeks each in a randomized crossover design. All subjects used a patient-activated electrocardiographic (ECG) recorder throughout the study and additionally underwent ambulatory ECG monitoring and a treadmill exercise test in each mode. They completed three symptom questionnaires at the end of each pacing period. At the end of the study, patients chose their preferred pacing period. RESULTS: DM was significantly better than VR mode objectively (exercise time DM 8.1 min, VR 7.0 min, p < 0.01) and subjectively (perceived well-being DM 69, VR 51, p < 0.001; functional class DM 2.2, VR 2.5, p < 0.05; subjective symptom score DM 21.2, VR 26.8, p = 0.01). Patient-perceived well-being was significantly better with DM than with DR mode (DM 69, DR 60, p = 0.02). DM mode was the preferred pacing period (DM 51%, DR 14%, VR 14%). Early termination of pacing because of adverse symptoms was requested by 33% of patients during VR, 19% during DR but only 3% during DM mode. A higher proportion of patients with a fast mode-switching device preferred DM mode (fast 55%, slow 49%), whereas no patients with a fast mode-switching device chose VR as the preferred mode (fast 0%, slow 19%). In the subgroup of patients who had had atrioventricular node ablation, DM was also preferred to VR mode (DM 53%, VR 27%). Overall, there were only two cases of inappropriate mode switching and one case of inappropriate tracking of an atrial tachyarrhythmia. CONCLUSIONS: DM is the pacing mode of choice of patients with paroxysmal atrial tachyarrhythmias. With optimal programming, inappropriate mode switching and tracking of atrial tachyarrhythmias was very uncommon.

Algorithms↗
PubMed1997

The Colorectal Cancer Recurrence Support (CARES) System.

Colorectal cancer has risen in incidence to become the second commonest form of cancer in Singapore. The primary treatment is surgery but up to 50% of patients still suffer from recurrence of the cancer after surgery. Early identification of recurrence will increase the effectiveness of therapy and the survival of patients. This paper describes the CARES (Cancer Recurrence Support) System, whose objective is to predict the recurrence of colorectal cancer, using Case-based Reasoning (CBR), and supported by other techniques such as data mining and natural language processing. The CARES System employs CBR to compare and contrast between the new and past colorectal cancer patient cases, and makes inferences based on those comparisons to determine the high risk patient groups. The features and functionality of the system are described.

Artificial Intelligence↗
PubMed1996

Dual sensor VVIR mode pacing: is it worth it?

Dual sensor ventricular demand rate responsive (VVIR mode) pacing was compared with single sensor rate responsive pacing to assess whether this new development should be more widely incorporated in modern pacemaker devices. A within patient randomized, double-blind crossover study involving ten patients, mean age 67.4 years (70% male), had Medtronic Legend Plus dual sensor VVIR pacemakers implanted for high grade AV block and chronic or persistent paroxysmal atrial fibrillation. Performance values were compared to 20 healthy control subjects of a similar age and gender. Patients were both subjectively and objectively assessed after 2 weeks of out-of-hospital activity in VVIR mode (minute ventilation sensing), VVIR mode (activity sensing), VVIR mode (dual sensor), and VVI mode (no rate response). All patients were assessed for subjective preference for, and objective improvement in, any pacing modality as assessed by standardized daily activity protocols and graded exercise treadmill testing. Subjective perception of exercise capacity and functional status was significantly lower in VVI mode (P < 0.05) compared to any of the VVIR modes, which did not differ. After completion of the study 70% of patients chose VVIR as their preferred mode, with 30% expressing no preference. Forty percent preferred activity sensor VVIR mode pacing, 30% preferred dual sensor VVIR mode pacing, and 70% found either dual sensor VVIR mode, minute ventilation sensor VVIR mode, or both modalities least acceptable. No patient found activity sensing VVIR mode least acceptable. Graded treadmill testing revealed significantly lower exercise tolerance during VVI mode pacing (P < 0.01) compared to the VVIR modalities, which did not differ. Overall, chronotropic response was best with dual sensor pacing during standardized daily activity protocols and during the standard car journey. The data from this study suggest that there is no marked clinical advantage obtained from the use of dual sensor devices over current activity sensing ventricular demand rate responsive pacemakers, but with the probable added disadvantages of increased size, complexity, cost, and decreased longevity.

Activities of Daily Living↗
PubMed1996

Evaluation of a new pacing algorithm to prevent rapid tracking of atrial tachyarrhythmias.

The new SMARTracking (SMT) algorithm was evaluated in seven patients with the Intermedics Relay DDDR pacemakers and a history of atrial tachyarrhythmias. The SMT algorithm uses the sensor calculated rate to define a physiological band whose upper limit is defined by the SMT rate. Pacemakers were programmed to DDDR with SMT (DDDRSM), DDDR with Conditional Ventricular Tracking Limit (DDDRC), DDDR with standard upper rate behavior, and VVIR, for a period of one month each. Patients underwent a CAEP exercise test and 24-hour ECG Holter monitoring in each mode. They also had ambulatory ECG monitoring during daily activities including rest, slow and fast walk, stairs ascent and descent. Three patients were in atrial fibrillation during the daily activities protocol. Their ventricular rates were paced and highly irregular, in both DDDRSM and DDDRC modes. The heart rate was lower in DDDRSM than DDDRC at rest and low levels of exercise but not during more strenuous activity. Two patients in DDDRSM and 3 in DDDRC requested early change of their mode due to unacceptable symptoms. Two patients exhibited Wenckebach behavior at atrial rates below the upper rate limit in both DDDRSM and DDDRC modes. In conclusion, CVTL or SMARTracking are not adequate protection against atrial tachyarrythmias in patients with DDDR pacemakers.

Activities of Daily Living↗
PubMed1996

Pacemaker upgrade for recurrent pacemaker syndrome using a redundant contralateral electrode in a patient with bilateral venous stenoses.

Following His-bundle ablation and VVIR pacemaker implantation, severe pacemaker syndrome developed and was treated with DDDR pacing, in a 70-year-old woman. Due to bilateral subclavian vein stenoses, DDDR pacing could not be maintained and an unusual method of restoring atrioventricular synchrony is described using the contralateral redundant atrial electrode connected to the ipsilateral dual chamber pacemaker and ventricular electrode.

Aged↗
PubMed1996

Pacemaker upgrade for recurrent pacemaker syndrome using a redundant contralateral electrode in a patient with bilateral venous stenoses.

Following His-bundle ablation and VVIR pacemaker implantation, severe Pacemaker syndrome developed and was treated with DDDR pacing in a 70-year-old woman. Due to bilateral subclavian vein stenosis, DDDR pacing could not be maintained and an unusual method of restoring atrioventricular synchrony is described using the contralateral redundant atrial electrode connected to the ipsilateral dual chamber pacemaker and ventricular electrode.

Aged↗
PubMed1995

Clinical and lesion morphologic determinants of coronary angioplasty success and complications: current experience.

OBJECTIVES: This study evaluated the validity of the American College of Cardiology/American Heart Association ABC lesion classification scheme and its modifications. BACKGROUND: With the continued refinement in angioplasty technique and equipment evolution, the lesion morphologic determinants of immediate angioplasty outcome have changed significantly. Hence, the validity of the classification scheme has been questioned. METHODS: We assessed the lesion morphologic determinants of immediate angioplasty outcome in 729 consecutive patients who underwent coronary angioplasty of 994 vessels and 1,248 lesions. RESULTS: Angioplasty success was achieved in 91% of lesions, and abrupt closure occurred in 3%. Success was achieved in 96%, 93% and 80% of type A, B and C lesions, respectively (A vs. B, p = NS; B vs. C, p < 0.001; A vs. C, p < 0.001; A vs. B1, p = NS; A vs. B2, p = 0.03; B1 vs. B2, p = 0.02; B2 vs. C, p < 0.001; C1 vs. C2, p = NS). Abrupt closure occurred in 2.1%, 2.6% and 5% of type A, B and C lesions, respectively (A vs. B, B vs. C, A vs. C and A vs. B1, all p = NS; B1 vs. B2, p = 0.01; B2 vs. C1, p = NS; C1 vs. C2, p = 0.04). Type B characteristics had a success rate ranging from 74% to 95% and an abrupt closure rate ranging from 2.2% to 14%. Type C characteristics had a success rate ranging from 57% to 88% and an abrupt closure rate ranging from 0% to 16%. Longer lesions, calcified lesions, diameter stenosis of 80% to 99% and presence of thrombus were predictive of a lower success rate. Longer lesions, angulated lesions, diameter stenosis of 80% to 99% and calcified lesions were predictive of an abrupt closure. CONCLUSIONS: The previously proposed classification schemes are outdated and need to be changed for application in current angioplasty practice. Analyzing specific lesion morphologic characteristics rather than applying a simple lesion classification score when evaluating angioplasty outcome may be more useful because it provides a more precise profile of the lesion and allows better patient stratification and selection.

Adult↗
PubMed1995

Regional variations of urokinase-type plasminogen activator in human colorectal cancer: a quantitative study by image analysis.

Qualitative histological studies in the distribution of urokinase-type plasminogen activator (uPA) in human colorectal carcinomas have been well documented. However, to our knowledge the histological distribution of this enzyme has not been quantified in any tumour. For the present image analysis study, uPA was demonstrated in sections of human colorectal cancer using immunoperoxidase technique. A total of 9 colorectal carcinoma cases were used, in which 132 regions were analysed. Within each region, staining intensity measurements were made at evenly spaced intervals. Samples of normal mucosa from 6 cases were also studied. Enzyme levels were assessed with staining intensity measurements. For each section, a negative control section was included, in which the primary antibody was omitted. Staining for uPA was quantified for each region in the test section, and the measurement for the corresponding region of the negative control was then subtracted. The enzyme uPA was localised more at the tumour edge than in the tumour centre or distant host tissue. These differences were highly significant (p < 0.0001). There was also a highly significant difference in staining intensity when tumour regions adjacent to pushing edge were compared with those adjacent to infiltrating edge (p < 0.0001). Infiltrating tumours showed stronger staining for uPA than tumours with pushing edges. Since invasive activity is thought to be maximal at the edge of the tumour, localisation of uPA at this site is consistent with the role of this enzyme in the process of tumour invasion.

Adenocarcinoma↗
PubMed1994

Cloning and sequencing of four structural genes for the Na(+)-translocating NADH-ubiquinone oxidoreductase of Vibrio alginolyticus.

Oligonucleotide probes based on the N-terminal amino acid sequences of the NqrA and NqrC subunits were used to clone genes for the Na(+)-dependent NADH-ubiquinone oxidoreductase complex from Vibrio alginolyticus. Four consecutive ORFs were identified encoding subunit proteins of 48.6, 46.8, 27.7 and 22.6 kDa, respectively (NqrA-D). A further ORF, showing 71% homology to the BolA protein of Escherichia coli, was located upstream. From sequence comparisons, we conclude that the Na(+)-dependent NADH-ubiquinone oxidoreductase complex of V. alginolyticus is clearly distinct from the corresponding H(+)-dependent enzymes of both prokaryotes and eukaryotes.

Amino Acid Sequence↗
PubMed1994

Effects of proligestone and megestrol on plasma adrenocorticotrophic hormone, insulin and insulin-like growth factor-1 concentrations in cats.

This paper reports changes in adrenocorticotrophic hormone (ACTH), insulin and insulin-like growth factor-1 (IGF-1) concentrations in cats from a previously published study. The cats were given oral megestrol acetate (MA, 5 mg once daily for 14 days), subcutaneous proligestone (PRG, 100 mg on two occasions one week apart) or subcutaneous saline (1 ml as for PRG). In the cats given saline (n = 6), basal ACTH, insulin and IGF-1 did not change significantly throughout the following seven weeks. The cats given MA (n = 7) developed significant suppression of plasma ACTH concentrations and hyperinsulinaemia during treatment and for two to four weeks after MA dosage ceased. In the cats given PRG (n = 7), plasma ACTH concentrations were not significantly altered although three cats had markedly suppressed values for some time after PRG treatment had ceased. Serum insulin concentrations were not significantly altered in the PRG-treated cats. The results suggest PRG may be a preferable alternative to MA in some situations.

Adrenocorticotropic Hormone↗
PubMed1993

The spatial location of EEG electrodes: locating the best-fitting sphere relative to cortical anatomy.

The location of the international 10-20 system electrode positions and 14 fiducial landmarks are described in cartesian coordinates (+/- 1.4 mm average accuracy). Six replications were obtained on 3 separate days from 4 normal subjects, who were compared to each other with a best-fit sphere algorithm. Test-retest reliability depended on the electrode position: the parasagittal electrodes were associated with greater measurement errors (maximum 7 mm) than midline locations. Location variability due to head shape was greatest in the temporal region, averaging 5 mm from the mean. For each subject's electrode locations a best-fitting sphere was determined (79-87 mm radius, 6% average error). A surface-fitting algorithm was used to transfer the electrode locations and best-fitting sphere to MR images of the brain and scalp. The center of the best-fitting sphere coincided with the floor of the third ventricle 5 mm anterior to the posterior commissure. The melding of EEG electrode location information with brain anatomy provides an empirical basis for associating hypothetical equivalent dipole locations with their anatomical substrates.

Adult↗
PubMed1993

Bronchiolitis obliterans organizing pneumonia associated with massive L-tryptophan ingestion.

A 51-year-old woman developed acute febrile illness with respiratory failure following intake of L-tryptophan. An open lung biopsy specimen established the histopathologic nature of the lung lesion as bronchiolitis obliterans organizing pneumonia (BOOP). There was no evidence of other known causes usually associated with BOOP. Her condition improved with corticosteroid therapy. The entity of BOOP now should be added to the growing list of illnesses associated with the use of L-tryptophan.

Bronchiolitis Obliterans↗