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Articles by D Lin
Total Records ( 6 ) for D Lin
  A Moshaver , D Lin , R Pinto and I. J. Witterick
 

Objective  To assess the hemodynamic and hemostatic effects of 2 different concentrations of epinephrine in local anesthetic used during functional endoscopic sinus surgery (FESS). Injection of local anesthetic containing epinephrine during endoscopic sinus surgery, while providing hemostasis, has been associated with cardiac adverse effects such as tachycardia, hypertension, as well as arrhythmias.

Design  Double-blind, randomized clinical trial.

Setting  Tertiary referral center.

Patients  A total of 140 patients undergoing FESS randomly divided into 2 groups, with group 1 receiving lidocaine hydrochloride, 2%, with 1:100 000 epinephrine and group 2, lidocaine, 2%, with 1:200 000 epinephrine.

Main Outcome Measures  Baseline and postinjection hemodynamic parameters were recorded at 1-minute intervals for 5 minutes. Patient demographics, the extent of surgery, and the presence of polyps were recorded in both groups. Hemodynamic and hemostatic parameters and intraoperative blood loss were compared.

Results  Significant hemodynamic fluctuations were noted following injection of lidocaine, 2%, with 1:100 000 epinephrine (group 1). Increases in heart rate and systolic, diastolic, and mean arterial blood pressure were noted in group 1 patients. The increase was found to be significant (< .001) in the first and second minutes after injection and decreased to baseline level by the fifth minute. This fluctuation was not noted in group 2 patients, who received lidocaine, 2%, with 1:200 000 epinephrine. Using a standardized scale to assess surgical bleeding, no statistical difference in the 2 groups was observed (> .05).

Conclusion  Submucosal injection of lidocaine, 2%, with 1:200 000 epinephrine during FESS does not lead to hemodynamic fluctuations or increased intraoperative bleeding compared with lidocaine, 2%, with 1:100 000 epinephrine.

Trial Registration  clinicaltrials.gov Identifier: NCT00852410

  C Wu , Z Hu , D Yu , L Huang , G Jin , J Liang , H Guo , W Tan , M Zhang , J Qian , D Lu , T Wu , D Lin and H. Shen
 

Recent three genome-wide association studies have mapped a lung cancer susceptibility locus to chromosome 15q25 in Caucasians. However, the reported risk single nucleotide polymorphisms (SNPs) are extremely rare in Asians, arguing against any of these being causative variants. This study sought to identify other variants on 15q25 associated with lung cancer susceptibility in Chinese. Two-stage case-control studies were conducted in subjects derived from both Northern and Southern China. The first-stage, consisting of 576 cases and 576 controls, was to discover novel risk variants using a haplotype-tagging SNP approach, and these variants were then replicated in the second-stage, consisting of 2,989 cases and 2,880 controls. Associations were estimated by logistic regression models, and function of the variants was examined by biochemical assays. We found that the three risk SNPs reported in Caucasians were not associated with lung cancer risk in Chinese. However, we identified four novel SNPs (rs2036534C>T, rs667282C>T, rs12910984G>A, and rs6495309T>C) that were associated with significantly increased lung cancer risk and smoking behavior, which were all confirmed in the replication analyses [odds ratios (95% confidence intervals) in the dominant model: 1.39 (1.23–1.57; P = 2.3 x 10–7), 1.52 (1.35–1.71; P = 2.0 x 10–12), 1.44 (1.28–1.63; P = 2.7 x 10–9), and 1.43 (1.27–1.61; P = 2.6 x 10–9), respectively]. We characterized the rs6495309T>C change in the CHRNA3 promoter as a functional variant because it affected the Oct-1 binding ability, resulting in increased CHRNA3 expression. These results support 15q25 as a susceptibility region for lung cancer in Chinese but underscore the difference in genetic markers among different ethnic populations. [Cancer Res 2009;69(12):5065–72]

  J. F Roux , E Zado , D. J Callans , F Garcia , D Lin , F. E Marchlinski , R Bala , S Dixit , M Riley , A. M Russo , M. D Hutchinson , J Cooper , R Verdino , V Patel , P. S Joy and E. P. Gerstenfeld
 

Background— Atrial arrhythmias are common early after atrial fibrillation (AF) ablation. We hypothesized that empirical antiarrhythmic drug (AAD) therapy for 6 weeks after AF ablation would reduce the occurrence of atrial arrhythmias.

Methods and Results— We randomized consecutive patients with paroxysmal AF undergoing ablation to empirical antiarrhythmic therapy (AAD group) or no antiarrhythmic therapy (no-AAD group) for the first 6 weeks after ablation. In the no-AAD group, only atrioventricular nodal blocking agents were prescribed. All patients wore a transtelephonic monitor for 4 weeks after discharge and were reevaluated at 6 weeks. The primary end point of the study was a composite of (1) atrial arrhythmias lasting more than 24 hours; (2) atrial arrhythmias associated with severe symptoms requiring hospital admission, cardioversion, or initiation/change of antiarrhythmic drug therapy; and (3) intolerance to antiarrhythmic agent requiring drug cessation. Of 110 enrolled patients (age 55±9 years, 71% male), 53 were randomized to AAD and 57 to no-AAD. There was no difference in baseline characteristics between groups. During the 6 weeks after ablation, fewer patients reached the primary end point in the AAD compared with the no-AAD group (19% versus 42%; P=0.005). There remained fewer events in the AAD group (13% versus 28%; P=0.05) when only end points of AF >24 hours, arrhythmia-related hospitalization, or electrical cardioversion were compared.

Conclusions— AAD treatment during the first 6 weeks after AF ablation is well tolerated and reduces the incidence of clinically significant atrial arrhythmias and need for cardioversion/hospitalization for arrhythmia management.

  W. S Tzou , F. E Marchlinski , E. S Zado , D Lin , S Dixit , D. J Callans , J. M Cooper , R Bala , F Garcia , M. D Hutchinson , M. P Riley , R Verdino and E. P. Gerstenfeld
  Background—

Pulmonary vein isolation (PVI) is increasingly used for treatment of atrial fibrillation (AF), but few reports exist regarding long-term success. We determined 5-year outcomes of PVI among patients with freedom from AF off antiarrhythmic drugs (AAD) for 1 year after PVI.

Methods and Results—

Consecutive patients with paroxysmal or persistent AF who underwent PVI at the University of Pennsylvania from 2000 to 2003 and were free from AF 1 year after ablation were included. Proximal isolation of PVs and non-PV triggers of AF was performed. Long-term ablation success, defined as freedom from AF off AAD after a single ablation procedure, was determined. All patients had transtelephonic monitoring at 3 to 6 months and 12 months and at least yearly contact thereafter. One hundred twenty-three patients were free of AF without AAD at 1 year. AF freedom off AAD was 85% at 3 years and 71% at 5 years, with an approximate 7% per year late recurrence rate after the first year. Patients with recurrent AF ≥5 years after index PVI were older, had larger left atrial size, more AF triggers and more likely had persistent AF. In multivariate analysis, persistent AF (odds ratio, 2.8; 95% confidence interval, 1.4 to 5.7, P=0.005) and age (odds ratio, 1.1; 95% confidence interval, 1.0 to 1.1, P=0.036) independently predicted long-term AF recurrence.

Conclusions—

Among patients with paroxysmal or persistent AF and AF freedom 1 year after segmental PVI, the majority (71%) remained free of AF for up to 5 years, with an approximate late recurrence rate of 7% per year. Continued vigilance for recurrent AF after PV isolation is warranted, particularly in patients with persistent AF.

  M. P Riley , E Zado , R Bala , D. J Callans , J Cooper , S Dixit , F Garcia , E. P Gerstenfeld , M. D Hutchinson , D Lin , V Patel , R Verdino and F. E. Marchlinski
  Background—

The endocardial substrate for ventricular arrhythmias in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is thought to be caused by a progressive degenerative process. Many clinical decisions and treatment plans are guided by this pathophysiologic assumption, but the extent of progression of macroscopic endocardial scar and right ventricular (RV) dilatation have not been assessed.

Methods and Results—

Eleven patients with ARVD/C and ventricular tachycardia had 2 detailed sinus rhythm electroanatomic endocardial voltage maps (average, 291±122 points per map; range, 114 to 558 points) performed a mean of 57 months apart (minimum, 9 months) as part of ventricular tachycardia ablation procedures. Voltage-defined scar (<1.5 mV) and RV volume were measured by area and volume measurement software and compared. Two of the 11 patients had a clear increase in scar area (47 cm2; 32 cm2) confirmed by visual inspection. The remaining 9 (81%; 95% CI, 48% to 98%) patients had no increase (<10-cm2 difference) in scar area between studies. In contrast, 10 of the 11 patients had a significant increase in RV volume, with an average increase of 24% (212±67 mL to 263±52 mL; P≤0.01).

Conclusions—

In patients with ARVD/C and ventricular tachycardia, progressive RV dilatation is the rule, and rapid progression of significant macroscopic endocardial scar occurs in only a subset of patients. These results have important management implications, suggesting that efforts to prevent RV dilatation in this population are needed and that an aggressive substrate-based ablation strategy offers the potential to provide long-term ventricular tachycardia control.

  P Leong Sit , E Zado , D. J Callans , F Garcia , D Lin , S Dixit , R Bala , M. P Riley , M. D Hutchinson , J Cooper , E. P Gerstenfeld and F. E. Marchlinski
  Background—

Young patients with atrial fibrillation (AF) tend to be more symptomatic and less willing to take long-term medications, yet catheter ablation remains recommended as second-line therapy for AF regardless of age. This study seeks to characterize the effectiveness and risk of AF ablation in the young.

Methods and Results—

Consecutive (n=1548) patients who underwent 2038 AF ablation procedures were included. Major procedural complications and efficacy were analyzed on the basis of age at the initial procedure: <45 years (group 1), 45 to 54 years (group 2), 55 to 64 years (group 3), and ≥65 years (group 4). AF control was defined as no or rare AF on or off antiarrhythmic drugs. The primary outcome of AF control was similar in all groups; it was achieved in 87% in group 1, 88% in group 2, 88% in group 3, and 82% in group 4 (P=0.06). However, more group 1 patients demonstrated freedom from AF off antiarrhythmic drugs (76%) compared with group 2 at 68%, group 3 at 65%, and group 4 at 53% (P<0.001). There were no major complications in group 1, 10 (1.7%) in group 2, 14 (1.4%) in group 3, and 10 (2.6%) in group 4 (P=0.01).

Conclusions—

In patients younger than 45 years, there is a lower major complication rate and a comparable efficacy rate, with a greater chance of being AF free without antiarrhythmic drugs. These findings suggest that it may be appropriate to consider ablative therapy as first-line therapy in this age group.

 
 
 
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