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Bai KY, Liu GH, Fan CH, Kuo LT, Hsu WH, Yu PA, Chen CL. 12-week curcumin supplementation may relieve postexercise muscle fatigue in adolescent athletes. Front Nutr 2023; 9:1078108. [PMID: 36687718 PMCID: PMC9846492 DOI: 10.3389/fnut.2022.1078108] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction High-intensity exercise causes oxidative stress, muscle soreness, and muscle fatigue, leading to reduced exercise performance. Curcumin possesses antioxidative and anti-inflammatory properties and thus alleviates postexercise damage. Therefore, this study evaluated the effect of curcumin on athletes' postexercise recovery. Methods A non-randomized prospective cohort investigation was done. We recruited middle and high school athletes engaged in wrestling, soccer, and soft tennis. During the 12-week daily exercise training, the participants were assigned to receive curcumin supplementation (curcumin group) or not (control group). Body composition, exercise performance, inflammatory factors, muscle fatigue, and muscle soreness were recorded at the baseline and end of the study. We used the Mann-Whitney U test to compare the participants' demographics, such as age, height, weight, and training years. The Wilcoxon test was used to compare the differences between the groups before and after curcumin supplementation. Results Of 28 participants (21 men and 7 women, with a mean age of 17 years), 13 were in the curcumin group and 15 in the control group. A significant decrease in muscle fatigue and muscle soreness scores was observed in the curcumin group after 12 weeks. Moreover, a significant decrease in the 8-hydroxy-2 deoxyguanosine level and a significant increase in basic metabolic rate and fat-free mass were observed in the curcumin group. Conclusion Curcumin can reduce muscle fatigue and soreness after exercise, indicating its potential to alleviate postexercise damage. It could be considered to cooperate with nutritional supplements in regular training in adolescent athletes.
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Affiliation(s)
- Kai-Yuan Bai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Gin-Hua Liu
- Department of Nutrition, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chun-Hao Fan
- Sports Medicine Center, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Liang-Tseng Kuo
- Sports Medicine Center, Chang Gung Memorial Hospital, Chiayi, Taiwan,Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan,School of Medicine, Chang Gung University, Taoyuan, Taiwan,*Correspondence: Liang-Tseng Kuo,
| | - Wei-Hsiu Hsu
- Sports Medicine Center, Chang Gung Memorial Hospital, Chiayi, Taiwan,Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan,School of Medicine, Chang Gung University, Taoyuan, Taiwan,Wei-Hsiu Hsu,
| | - Pei-An Yu
- Sports Medicine Center, Chang Gung Memorial Hospital, Chiayi, Taiwan,Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chi-Lung Chen
- Sports Medicine Center, Chang Gung Memorial Hospital, Chiayi, Taiwan,Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
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Lee CW, Chiang YC, Yu PA, Peng KT, Chi MC, Lee MH, Fang ML, Lee KH, Hsu LF, Liu JF. A Role of CXCL1 Drives Osteosarcoma Lung Metastasis via VCAM-1 Production. Front Oncol 2021; 11:735277. [PMID: 34760697 PMCID: PMC8573405 DOI: 10.3389/fonc.2021.735277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Osteosarcoma, a common aggressive and malignant cancer, appears in the musculoskeletal system among young adults. The major cause of mortality in osteosarcoma was the recurrence of lung metastases. However, the molecular mechanisms of metastasis involved in osteosarcomas remain unclear. Recently, CXCL1 and CXCR2 have been crucial indicators for lung metastasis in osteosarcoma by paracrine releases, suggesting the involvement of directing neutrophils into tumor microenvironment. In this study, overexpression of CXCL1 has a positive correlation with the migratory and invasive activities in osteosarcoma cell lines. Furthermore, the signaling pathway, CXCR2/FAK/PI3K/Akt, is activated through CXCL1 by promoting vascular cell adhesion molecule 1 (VCAM-1) via upregulation of nuclear factor-kappa B (NF-κB) expression and nuclear translocation. The in vivo animal model further demonstrated that CXCL1 serves as a critical promoter in osteosarcoma metastasis to the lung. The correlated expression of CXCL1 and VCAM-1 was observed in the immunohistochemistry staining from human osteosarcoma specimens. Our findings demonstrate the cascade mechanism regulating the network in lung metastasis osteosarcoma, therefore indicating that the CXCL1/CXCR2 pathway is a worthwhile candidate to further develop treatment schemas.
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Affiliation(s)
- Chiang-Wen Lee
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Puzi, Taiwan.,Division of Basic Medical Sciences, and Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Puzi, Taiwan
| | - Yao-Chang Chiang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Puzi, Taiwan.,Division of Basic Medical Sciences, and Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Puzi, Taiwan
| | - Pei-An Yu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan.,Sports Medicine Center, Chang Gung Memorial Hospital at Chia Yi, Chiayi, Taiwan
| | - Kuo-Ti Peng
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Miao-Ching Chi
- Division of Basic Medical Sciences, and Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Puzi, Taiwan.,Department of Respiratory Care, Chang Gung University of Science and Technology, Puzi, Taiwan.,Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ming-Hsueh Lee
- Department of Respiratory Care, Chang Gung University of Science and Technology, Puzi, Taiwan.,Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Mei-Ling Fang
- Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung, Taiwan.,Super Micro Research and Technology Center, Cheng Shiu University, Kaohsiung, Taiwan
| | - Kuan-Han Lee
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Lee-Fen Hsu
- Department of Respiratory Care, Chang Gung University of Science and Technology, Puzi, Taiwan.,Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ju-Fang Liu
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Chen CT, Lin SJ, Kuo LT, Chen TH, Hsu WH, Chen CL, Yu PA, Peng KT, Tsai YH. Effect of chronic kidney disease on outcomes following proximal humerus fragility fracture surgery in diabetic patients: A nationwide population-based cohort study. PLoS One 2021; 16:e0258393. [PMID: 34624055 PMCID: PMC8500432 DOI: 10.1371/journal.pone.0258393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The proximal humerus fracture (PHF) is the third most common fragility fracture. Diabetes mellitus (DM) and chronic kidney disease (CKD) are both risks for fragility fractures; however, the interplay of DM and CKD makes treatment outcomes unpredictable. This study aimed to investigate and compare early and late outcomes following proximal humerus fracture fixation surgery in diabetic patients with different renal function conditions. METHODS DM patients receiving PHF fixation surgery during 1998-2013 were recruited from Taiwan's National Health Insurance Research Database. According to their renal function, patients were divided into three study groups: non-chronic kidney disease (CKD), non-dialysis CKD, and dialysis. Outcomes of interest were early and late perioperative outcomes. Early outcomes included in-hospital newly-onset morbidities. Late outcomes included infection, revision, readmission, and all-cause mortality. RESULTS This study included a total of 10,850 diabetic patients: 2152 had CKD (non-dialysis CKD group), 196 underwent permanent dialysis (dialysis group), and the remaining 8502 did not have CKD (non-CKD group). During a mean follow-up of 5.56 years, the dialysis group showed the highest risk of overall infection, all-cause revision, readmission, and mortality compared to the non-dialysis CKD group and non-CKD group. Furthermore, subgroup analysis showed that CKD patients had a higher risk of surgical infection following PHF surgery than non-CKD patients in cases with a traffic accident or fewer comorbidities (Charlson Comorbidity Index, CCI <3) (P for interaction: 0.086 and 0.096, respectively). Also, CKD patients had an even higher mortality risk after PHF surgery than non-CKD patients, in females, those living in higher urbanization areas, or with more comorbidities (CCI ≥3) (P for interaction: 0.011, 0.057, and 0.069, respectively). CONCLUSION CKD was associated with elevated risks for infection, revision, readmission, and mortality after PHF fixation surgery in diabetic patients. These findings should be taken into consideration when caring for diabetic patients.
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Affiliation(s)
- Chien-Tien Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Su-Ju Lin
- Division of Nephrology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Liang-Tseng Kuo
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- * E-mail:
| | - Tien-Hsing Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wei-Hsiu Hsu
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chi-Lung Chen
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Pei-An Yu
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuo-Ti Peng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hung Tsai
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
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Tan CW, Hsu WH, Yu PA, Chen CL, Kuo LT, Chi CC, Kim D, Park G. Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years: A Systematic Review and Meta-analysis. Orthop J Sports Med 2020; 8:2325967120915698. [PMID: 32426406 PMCID: PMC7218932 DOI: 10.1177/2325967120915698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/03/2020] [Indexed: 12/22/2022] Open
Abstract
Background: There is no consensus regarding the best treatment approach for middle-aged patients with anterior cruciate ligament (ACL) injuries. Chronic ACL-deficient knees are often associated with instability as well as secondary meniscal and cartilage lesions. ACL reconstruction (ACLR) has achieved satisfactory outcomes in younger patients; however, the effectiveness and safety of ACLR in middle-aged patients remain uncertain. Purpose: To compare the patient-reported functional scores, arthrometric outcomes, and complications of primary ACLR between older (≥50 years) and younger (<50 years) patients. Study Design: Systematic review; Level of evidence, 3. Methods: We conducted a systematic review of cohort studies that compared the clinical outcomes of ACLR between patients aged ≥50 years and those aged <50 years. The Cochrane Central Register of Controlled Trials, Embase, and MEDLINE databases were searched for relevant studies. The Methodological Index for Non-randomized Studies (MINORS) criteria was used to assess the risk of bias and conducted a random-effects meta-analysis to combine the data, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the overall quality of the body of retrieved evidence. The primary outcome was knee functional outcomes, and secondary outcomes were arthrometric outcomes of ACLR and complications. Results: This study included 4 retrospective cohort studies with a total of 287 participants (129 in the older group and 158 in the younger group). All included studies reported significant improvements in clinical outcomes in both groups after ACLR. No significant differences were noted in the improvement of International Knee Documentation Committee (IKDC) scores (mean difference [MD], 0.20 [95% CI, −2.65 to 3.05]; P = .89) and Lysholm scores (MD, −1.98 [95% CI, −6.93 to 2.98]; P = .43) between the 2 groups. No significant differences were observed in anteroposterior stability or risk of complications between the groups. Conclusion: ACLR may be performed in middle-aged patients (≥50 years) without concern for inferior clinical and arthrometric results compared with younger patients (<50 years).
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Affiliation(s)
- Chong-Wei Tan
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan
| | - Wei-Hsiu Hsu
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-An Yu
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan
| | - Chi-Lung Chen
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan
| | - Liang-Tseng Kuo
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Chi Chi
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Dokyung Kim
- School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Geon Park
- School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
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Kuo LT, Chen HM, Yu PA, Chen CL, Hsu WH, Tsai YH, Chen KJ, Chen VCH. Depression increases the risk of rotator cuff tear and rotator cuff repair surgery: A nationwide population-based study. PLoS One 2019; 14:e0225778. [PMID: 31765424 PMCID: PMC6876882 DOI: 10.1371/journal.pone.0225778] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/12/2019] [Indexed: 01/22/2023] Open
Abstract
Background Chronic inflammation is known to be associated with both rotator cuff tears (RCTs) and depression. However, no epidemiological studies with a longitudinal follow-up have been performed to prove this association. We aimed to investigate whether depressed patients had an elevated risk of RCT and subsequent repair surgery compared with those without depression. Methods This retrospective cohort study comprised of patients diagnosed with depression between 2000 and 2010 (depression cohort) and patients without depression (non-depression cohort, 1:2 age and sex matched). The risk of RCT and rotator cuff repair surgery were determined during a 13-year follow-up (2000–2013) between these two cohorts. Results This study included 26,868 patients with depression and 53,736 patients without depression. The incidence of RCT was 648 and 438 per 100,000 person-years in the depression and non-depression cohorts, respectively. The adjusted hazard ratio (HR) was 1.46 (95% confidence interval [CI], 1.36–1.57) for depressed patients. The incidence of rotator cuff repair surgery was 28 and 18 per 100,000 person-years in the depression and non-depression cohorts, respectively. Depressed patients also had a significantly increased risk of subsequent rotator cuff repair surgery (adjusted HR = 1.46; 95% CI, 1.04–2.06). Conclusion The present study showed that depression was associated with an increased risk of rotator cuff tear and rotator cuff repair surgery.
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Affiliation(s)
- Liang-Tseng Kuo
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hong-Ming Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Pei-An Yu
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chi-Lung Chen
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Hsiu Hsu
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hung Tsai
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ko-Jung Chen
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Vincent Chin-Hung Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
- * E-mail:
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Huang PH, Chen TH, Lin YS, Lin SJ, Kuo LT, Chen CL, Yu PA, Hsu WH. Chronic Kidney Disease Worsens Health Outcomes in Diabetic Patients After Hip Fracture Surgery: An Asian Nationwide Population-Based Cohort Study. J Bone Miner Res 2019; 34:849-858. [PMID: 30742350 DOI: 10.1002/jbmr.3663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/22/2018] [Accepted: 01/05/2019] [Indexed: 01/23/2023]
Abstract
There is an increased tendency for hip fractures in patients with chronic kidney disease (CKD). Although surgery is the mainstay of treatment for hip fractures, there is scant information on outcomes after hip fracture surgery in diabetic patients at different stages of CKD. In this population-based cohort study, we compared the surgical outcome, readmission, and mortality rates after osteosynthesis of hip fractures in diabetic patients with different stages of renal function. Diabetic patients who received primary osteosynthesis for hip fracture between January 1997 and December 2013 were enrolled. The primary outcomes were surgical outcomes, including infection and revision surgery. The secondary outcomes were all-cause readmission and mortality. This study included 44,065 patients; 11,954 had CKD (diabetic CKD group), 1662 patients were receiving dialysis (diabetic dialysis group), and 30,449 patients had no CKD (diabetic non-CKD group). We found that the diabetic dialysis group had a significantly higher risk of infection and revision surgery compared with diabetic non-CKD patients (HR = 1.52, 95% CI, 1.24 to 1.87; HR = 1.62, 95% CI, 1.33 to 1.97, respectively, both P < 0.001) and diabetic CKD patients (HR = 1.62, 95% CI, 1.32 to 1.99; HR = 1.48, 95% CI, 1.22 to 1.80, respectively, both P < 0.001). Diabetic CKD patients had a comparable risk of surgical complications including infection and revision as diabetic non-CKD patients. For readmission and mortality, the diabetic dialysis group had the highest risk among the three groups at all time-points (3 months after surgery, 1 year, and the last follow-up, all P < 0.001). Compared with the diabetic non-CKD group, the diabetic CKD group had an elevated risk of readmission and mortality at all time-points (all P < 0.001). In conclusion, CKD was associated with worse outcomes after hip fracture fixation surgery. Although at significantly higher risk of readmission and mortality, CKD patients still had a comparable risk of infection and revision to non-CKD patients. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Po-Hua Huang
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Su-Ju Lin
- Division of Nephrology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Liang-Tseng Kuo
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chi-Lung Chen
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Pei-An Yu
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Hsiu Hsu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
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Yu PA, Hsu WH, Hsu WB, Kuo LT, Lin ZR, Shen WJ, Hsu RWW. The effects of high impact exercise intervention on bone mineral density, physical fitness, and quality of life in postmenopausal women with osteopenia: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e14898. [PMID: 30882707 PMCID: PMC6426501 DOI: 10.1097/md.0000000000014898] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Osteoporosis and osteopenia prevailed in postmenopausal women and predisposed to osteoporotic fractures that increase mortality, morbidity, and the cost of social care. Here, we investigated the effect of 24 weeks of aerobic dancing on the bone miner density, physical fitness and health-related quality of life (HRQoL) in postmenopausal women with osteopenia. Total 80 participants (control [CON]: 40; exercise [EX]: 40) were included in the final analysis. The EX group underwent a 24-week aerobic dance intervention. Bone mineral density (BMD), physical fitness, and SF-36 questionnaire were assessed at baseline and 24-weeks. The BMD change in the femoral neck at the 24-weeks were significantly different between the 2 groups (CON: -1.3 ± 2.7%, EX: 3.1 ± 4.6%, P = .001). Grip strength, sidestep and physical functional domain of HRQoL in the EX group were significantly improved compared to the CON. The results were suggested 24-week aerobic dance intervention could result in the lower the incidence of bone fracture through increasing BMD and decreasing fall risk for postmenopausal women.
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Affiliation(s)
- Pei-An Yu
- Department of Orthopaedic Surgery
- Sports Medicine Center, Chiayi Chang Gung Memorial Hospital
| | - Wei-Hsiu Hsu
- Department of Orthopaedic Surgery
- Sports Medicine Center, Chiayi Chang Gung Memorial Hospital
- School of Medicine, Chang Gung University, Taoyuan
| | - Wei-Bin Hsu
- Sports Medicine Center, Chiayi Chang Gung Memorial Hospital
| | - Liang-Tseng Kuo
- Department of Orthopaedic Surgery
- Sports Medicine Center, Chiayi Chang Gung Memorial Hospital
| | - Zin-Rong Lin
- Department of Athletic Sports, National Chung Cheng University
| | | | - Robert Wen-Wei Hsu
- Department of Orthopaedic Surgery
- Sports Medicine Center, Chiayi Chang Gung Memorial Hospital
- School of Medicine, Chang Gung University, Taoyuan
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Hsu WH, Fan CH, Yu PA, Chen CL, Kuo LT, Hsu RWW. Effect of high body mass index on knee muscle strength and function after anterior cruciate ligament reconstruction using hamstring tendon autografts. BMC Musculoskelet Disord 2018; 19:363. [PMID: 30305072 PMCID: PMC6180445 DOI: 10.1186/s12891-018-2277-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 09/24/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Increased body mass index (BMI) has been associated with poorer function in patients who have undergone anterior cruciate ligament (ACL) reconstruction. However, the effect of high BMI on muscle strength in these patients remained unclear. The current study aimed to compare knee muscle strength and Knee injury and Osteoarthritis Outcome Score (KOOS) in ACL-reconstructed patients with a variety of different BMIs. METHODS From November 2013 to March 2016, we prospectively enrolled 30 patients who underwent ACL reconstruction (18-60 years of age). Anthropometric parameters, body compositions, isokinetic muscle strength and KOOS were assessed preoperatively, and at post-operative 16th week and 28th week. The patients were stratified into two groups by BMI, i.e. normal BMI (18.5-24.9 kg/m2) and high BMI (≥25.0 kg/m2). RESULTS Twelve patients in the normal BMI group completed the follow-up, while sixteen patients did so in the high BMI group. In comparison of muscle strength between baseline and 28th week follow-up, the normal BMI group had significant increases in overall knee muscle strength, while the high BMI group only had increases in extensors of uninjured knee and flexors of the injured knee. However, there were significant increases in all KOOS subscales for the high BMI group. The high BMI patients reported increased KOOS, which may reflect the contribution of ligament stability in the presence of inadequate muscle strength. CONCLUSIONS The normal BMI patients had improvement in all knee muscle strength following ACL reconstruction, while high BMI patients only had increases in certain knee muscles. High BMI patients had a decreased quadriceps muscle symmetry index, as compared to their normal BMI counterparts. Increases in quadriceps muscle strength of the uninjured knee and ACL reconstruction were associated with improvements in KOOS in high BMI patients.
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Affiliation(s)
- Wei-Hsiu Hsu
- Sports Medicine Center, Chang Gung Memorial Hospital at Chia Yi, Chia Yi, Taiwan. .,Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chia Yi, No 6 West section, Chia Pu Road, Puzih, Chia Yi Hsien, 613, Taiwan. .,School of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
| | - Chun-Hao Fan
- Sports Medicine Center, Chang Gung Memorial Hospital at Chia Yi, Chia Yi, Taiwan
| | - Pei-An Yu
- Sports Medicine Center, Chang Gung Memorial Hospital at Chia Yi, Chia Yi, Taiwan.,Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chia Yi, No 6 West section, Chia Pu Road, Puzih, Chia Yi Hsien, 613, Taiwan
| | - Chi-Lung Chen
- Sports Medicine Center, Chang Gung Memorial Hospital at Chia Yi, Chia Yi, Taiwan.,Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chia Yi, No 6 West section, Chia Pu Road, Puzih, Chia Yi Hsien, 613, Taiwan.,School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Liang-Tseng Kuo
- Sports Medicine Center, Chang Gung Memorial Hospital at Chia Yi, Chia Yi, Taiwan.,Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chia Yi, No 6 West section, Chia Pu Road, Puzih, Chia Yi Hsien, 613, Taiwan.,School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Robert Wen-Wei Hsu
- Sports Medicine Center, Chang Gung Memorial Hospital at Chia Yi, Chia Yi, Taiwan.,Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chia Yi, No 6 West section, Chia Pu Road, Puzih, Chia Yi Hsien, 613, Taiwan
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Kuo LT, Chen CL, Yu PA, Tsai YS, Hsu WH, Chi CC, Yoo JC. Bone marrow-stimulating techniques in arthroscopic rotator cuff repair: a systematic review protocol. BMJ Open 2018; 8:e022086. [PMID: 30269066 PMCID: PMC6169743 DOI: 10.1136/bmjopen-2018-022086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Bone marrow-stimulating (BMS) techniques during arthroscopic rotator cuff repair surgery theoretically enhance the biological component for healing and hence improve tendon healing, but their efficacy remains unproven. The purpose of this review is to determine the effects and associated harms of BMS in arthroscopic rotator cuff repair surgery. METHODS AND ANALYSIS We will perform a systematic review and meta-analysis of randomised-controlled trials (RCTs) and retrospective cohort studies (RCS) that compare outcomes following BMS use against no use of BMS during arthroscopic rotator cuff repair surgery. We will search the databases including the Cochrane Central Register of Controlled Trials, Medline and Embase, and clinical trial registries for relevant studies. We will include studies published from start of indexing until 23 August 2018. Two reviewers will independently assess the eligibility for studies. For each included trial, we will conduct duplicate independent data extraction and risk of bias assessment. We will use the Cochrane Collaboration tool to assess the risk of bias of included RCTs, while we will use the Risk Of Bias In Non-randomised Studies - of Interventions tool to evaluate the risk of bias of RCS. We will perform a random-effects meta-analysis in calculating the pooled risk estimates when appropriate. We will assess the overall quality of the data for each individual outcome using the Grading of Recommendations, Assessments, Development and Evaluation approach. The primary outcomes are tendon healing rate, overall pain and shoulder functions. The secondary outcomes are the proportion of participants with adverse events related to interventions, the range of motion and the proportion of participants with return to previous activities. ETHICS AND DISSEMINATION We will report this review according to the guidance of the PRISMA statement. The results of this review will be disseminated through conference presentations and publications in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42018087161.
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Affiliation(s)
- Liang-Tseng Kuo
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Chiayi, Taiwan
- Center of Evidence-Based Medicine, Chang Gung Memorial Hospital, Chaiyi, Chiayi, Taiwan
| | - Chi-Lung Chen
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Chiayi, Taiwan
| | - Pei-An Yu
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Chiayi, Taiwan
| | - Yu-Shiun Tsai
- Center of Evidence-Based Medicine, Chang Gung Memorial Hospital, Chaiyi, Chiayi, Taiwan
| | - Wei-Hsiu Hsu
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Chi Chi
- Center of Evidence-Based Medicine, Chang Gung Memorial Hospital, Chaiyi, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Jae Chul Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hsu WH, Yu PA, Lai LJ, Chen CL, Kuo LT, Fan CH. Effect of Extracorporeal Shockwave Therapy on Passive Ankle Stiffness in Patients With Plantar Fasciopathy. J Foot Ankle Surg 2018; 57:15-18. [PMID: 29108686 DOI: 10.1053/j.jfas.2017.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Indexed: 02/03/2023]
Abstract
Plantar fasciopathy (PF) is the most common cause of heel pain. Extracorporeal shockwave therapy (ESWT) improves the gait pattern in patients with PF. However, the effects of ESWT on the biomechanics of the ankle in these patients remains unclear. Sixteen participants were included in the present study. Of the 16 participants, 8 patients with PF were assigned to receive extracorporeal shockwave therapy, and 8 healthy participants served as an external control group. ESWT was applied to the PF group for 1500 pulses at an energy flux of 0.26 mJ/mm2 every 3 weeks for 3 sessions. The biomechanics of the ankle joints were then assessed using an isokinetic dynamometer, and a health-related quality of life questionnaire was administered at baseline and at the final follow-up session 12 weeks after the initial treatment. Passive stiffness was calculated and compared between the foot affected with PF, the opposite foot, and both feet of those in the healthy control group. The Kruskal-Wallis 1-way analysis of variance with repeated measures was performed, and statistical significance was considered present at the 5% (p ≤ .05) level. Ankle dorsiflexion in the affected limb increased from 14° ± 3° to 17° ± 2° after ESWT (p < .05). No statistically significant differences were noted in the strength of dorsiflexion or plantarflexion at baseline and after ESWT. However, a statistically significant increase in the ratio of strength in ankle dorsiflexion versus plantarflexion was found after ESWT (p < .05). No differences in the passive stiffness of the ankle joint were demonstrated. Patients reported an improved physical function score after ESWT (p < .05). An increased dorsiflexion/plantarflexion torque ratio and maximal dorsiflexion associated with decreased pain might contribute to the improved physical function after ESWT for PF.
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Affiliation(s)
- Wei-Hsiu Hsu
- Associate Professor, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia Yi, Puzt City, Taiwan.
| | - Pei-An Yu
- Surgeon, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia Yi, Puzt City, Taiwan
| | - Li-Ju Lai
- Assistant Professor, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Lung Chen
- Assistant Professor, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia Yi, Puzt City, Taiwan
| | - Liang-Tseng Kuo
- Assistant Professor, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia Yi, Puzt City, Taiwan
| | - Chun-Hao Fan
- Clinical Investigator, Sports Medicine Center, Chang Gung Memorial Hospital at Chia Yi, Puzt City, Taiwan
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Kuo LT, Chen CL, Yu PA, Hsu WH, Chi CC, Yoo JC. Epinephrine in irrigation fluid for visual clarity in arthroscopic shoulder surgery: a systematic review and meta-analysis. Int Orthop 2018; 42:2881-2889. [PMID: 29934716 DOI: 10.1007/s00264-018-4021-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/04/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate whether epinephrine in irrigation fluid improves visual clarity in arthroscopic shoulder surgery. METHODS We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared the surgical outcomes of patients who did and did not receive epinephrine during arthroscopic shoulder surgery. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for relevant RCTs. We used the Cochrane Collaboration's tool to assess the risk of bias and adopted random-effects model meta-analysis to combine data. We used the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology to evaluate the overall quality of the body of the retrieved evidence. The primary outcome was visual clarity. The secondary outcomes were operative time, amount of irrigation fluid, the need for increased pump pressure, and adverse cardiovascular events. RESULTS This study included three RCTs with a total of 238 participants (124 in the epinephrine group and 114 in the non-epinephrine group). The use of epinephrine in irrigation fluid for shoulder arthroscopy achieved better visual clarity (standardized mean difference, 1.01; 95% confidence interval [CI] 0.63 to 1.39; p < 0.0001) and less need for increased pump pressure (risk ratio, 0.40; 95% CI 0.25 to 0.64; p = 0.0001) compared to the non-epinephrine group. No significant differences were noted in operative time (mean difference - 5.08; 95% CI - 14.46 to 4.31; p = 0.29) and amount of irrigation fluid (mean difference - 1.04; 95% CI - 2.38 to 0.39; p = 0.12) between the two groups. No adverse events were recorded in any of the included trials. CONCLUSIONS The current evidence shows that the use of epinephrine in arthroscopic shoulder surgery may improve visualization and does not appear to have any major disadvantages. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Liang-Tseng Kuo
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 6 West Sec, Chia-Pu Road, Putz City, Chiayi, 61363, Taiwan
- Center for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chi-Lung Chen
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 6 West Sec, Chia-Pu Road, Putz City, Chiayi, 61363, Taiwan
| | - Pei-An Yu
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 6 West Sec, Chia-Pu Road, Putz City, Chiayi, 61363, Taiwan
| | - Wei-Hsiu Hsu
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 6 West Sec, Chia-Pu Road, Putz City, Chiayi, 61363, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ching-Chi Chi
- Center for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Department of Dermatology, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Linkou, Taoyuan, 33305, Taiwan.
| | - Jae-Chul Yoo
- Department of Orthopaedic Surgery, College of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
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Kuo LT, Lin SJ, Chen CL, Yu PA, Hsu WH, Chen TH. Chronic kidney disease is associated with a risk of higher mortality following total knee arthroplasty in diabetic patients: a nationwide population-based study. Oncotarget 2017; 8:100288-100295. [PMID: 29245978 PMCID: PMC5725020 DOI: 10.18632/oncotarget.22215] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/24/2017] [Indexed: 11/25/2022] Open
Abstract
Diabetes and chronic kidney disease (CKD) are associated with a higher rate of complications in patients undergoing total knee arthroplasty (TKA). The purpose of this study was to determine the effects of CKD and diabetes in patients after TKA. Diabetic patients who received unilateral primary TKA between January 2008 and December 2011 were enrolled. The follow-up period was more than 6 months. The primary outcome was a TKA-related infection and the secondary outcome was all-cause mortality. The study cohort included 13844 patients who were followed for a mean period of 2 years, of whom 1459 (10.5%) had CKD. The patients with CKD were older than those without CKD (71.6 versus 70.3 years, P<0.0001) and had higher rates of hypertension, gouty arthritis, ischemic heart disease, chronic pulmonary obstructive disease, pulmonary embolism and deep vein thrombosis (all P<0.0001). After adjustment of comorbidities, the CKD group had a higher incidence of urinary tract infections (OR: 1.61, 95% CI: 1.19-2.17). There were no significant differences in wound infections, pneumonia, pulmonary embolism or in-hospital death between the two groups. After adjustment of confounders, the CKD group had higher rates of myocardial infarction (HR: 2.06, 95% CI: 1.26–3.39) and mortality (HR: 1.99, 95% CI: 1.59–2.48). The risk of TKA-related infection during follow-up was comparable between the two groups (HR: 1.31, 95% CI: 0.94–1.82). In conclusion, CKD is associated with increased risks of urinary tract infections, myocardial infarction and all-cause mortality after TKA. Surgeons should be aware of this when evaluating TKA patients with renal disease.
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Affiliation(s)
- Liang-Tseng Kuo
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Su-Ju Lin
- Division of Nephrology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chi-Lung Chen
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Pei-An Yu
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Hsiu Hsu
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
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13
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Kuo LT, Yu PA, Chen CL, Hsu WH, Chi CC. Tourniquet use in arthroscopic anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomised controlled trials. BMC Musculoskelet Disord 2017; 18:358. [PMID: 28830402 PMCID: PMC5567632 DOI: 10.1186/s12891-017-1722-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the effects of tourniquet use in arthroscopic anterior cruciate ligament (ACL) reconstruction surgery. METHODS We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) that compared surgical outcomes following tourniquet use against non-tourniquet use during ACL reconstruction surgery. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE for relevant RCTs. We used the Cochrane Collaboration's tool to assess the risk of bias of included RCTs, and performed a random-effects meta-analysis in calculating the pooled risk estimates. The primary outcomes was postoperative pain measured by visual analogue scale, verbal rating scale, or required morphine dose. The secondary outcomes were blood loss in drainage, operative time, muscle strength, and calf and thigh girth. RESULTS We included 5 RCTs with 226 participants (116 in the tourniquet group and 110 in the non-tourniquet group). Postoperative pain and morphine doses were not significantly different between the two groups. Compared to the non-tourniquet group, the tourniquet group had a significantly increased blood loss in the drain (mean difference: 94.40 ml; 95% CI 3.65-185.14; P = 0.04). No significant differences in the operative time and muscle strength were found between the two groups. Tourniquet use was associated with a greater decrease in thigh girth but not in calf girth. CONCLUSIONS The current evidence shows that compared to tourniquet use, ACL reconstruction surgery without tourniquet does not appear to have any major disadvantages and does not prolong operation time. There might be less drain blood loss associated with tourniquet use, though drains are no longer routinely used in ACL reconstruction surgery.
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Affiliation(s)
- Liang-Tseng Kuo
- Department of Orthopedic Surgery, Division of Sports Medicine, Chang Gung Memorial Hospital, 6, Sec West, Chia-Pu Rd, Puzih, Chiayi, 61363, Taiwan.,Centre for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Pei-An Yu
- Department of Orthopedic Surgery, Division of Sports Medicine, Chang Gung Memorial Hospital, 6, Sec West, Chia-Pu Rd, Puzih, Chiayi, 61363, Taiwan
| | - Chi-Lung Chen
- Department of Orthopedic Surgery, Division of Sports Medicine, Chang Gung Memorial Hospital, 6, Sec West, Chia-Pu Rd, Puzih, Chiayi, 61363, Taiwan
| | - Wei-Hsiu Hsu
- Department of Orthopedic Surgery, Division of Sports Medicine, Chang Gung Memorial Hospital, 6, Sec West, Chia-Pu Rd, Puzih, Chiayi, 61363, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ching-Chi Chi
- Centre for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Dermatology, Chang Gung Memorial Hospital, Linkou, 5, Fuxing St, Guishan Dist, Taoyuan, 33305, Taiwan.
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Tsai YH, Hsu WH, Huang KC, Yu PA, Chen CL, Kuo LT. Necrotizing fasciitis following venomous snakebites in a tertiary hospital of southwest Taiwan. Int J Infect Dis 2017; 63:30-36. [PMID: 28811229 DOI: 10.1016/j.ijid.2017.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis following venomous snakebites is uncommon. The purpose of this study was to describe the initial clinical features of necrotizing fasciitis after snakebites, and to identify the risk factors for patients with cellulitis who later developed necrotizing fasciitis. METHODS Sixteen patients with surgically confirmed necrotizing fasciitis and 25 patients diagnosed with cellulitis following snakebites were retrospectively reviewed over a 6-year period. Differences in patient characteristics, clinical presentations, snake species and laboratory data were compared between the necrotizing fasciitis and the cellulitis groups. RESULTS None of the 41 patients died after being bitten by a snake. Twenty-nine patients (70.7%) were bitten by a cobra. Enterococcus species and Morganella morganii were the most common pathogens identified in wound cultures. Relative to the cellulitis group, the necrotizing fasciitis group had significantly higher rates of hemorrhagic bullae (p=0.000), patients with underlying chronic disease (p=0.019), white blood cell counts (p=0.035), segmented white cell counts (p=0.02), and days of hospitalization (p=0.001). CONCLUSIONS Victims of venomous snakebites should be admitted for close monitoring of secondary wound infections. The risk factors of developing necrotizing fasciitis from cellulitis following snakebites were associated with chronic underlying diseases and leukocytosis (total white blood-cell counts ≥10000cells/mm3 and ≥80% of segmented leukocyte forms). Physicians should be alert to a worsening wound condition after a snakebite, and surgical interventions should be performed for established necrotizing fasciitis with the empirical use of third-generation cephalosporins plus other regimens.
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Affiliation(s)
- Yao-Hung Tsai
- Department of Orthopaedic Surgery, Chia-Yi Chang Gung Memorial Hospita, Taiwan, Republic of China; College of Medicine, Chang Gung University at Taoyuan, Taiwan, Republic of China.
| | - Wei-Hsiu Hsu
- Department of Orthopaedic Surgery, Chia-Yi Chang Gung Memorial Hospita, Taiwan, Republic of China; College of Medicine, Chang Gung University at Taoyuan, Taiwan, Republic of China
| | - Kuo-Chin Huang
- Department of Orthopaedic Surgery, Chia-Yi Chang Gung Memorial Hospita, Taiwan, Republic of China; College of Medicine, Chang Gung University at Taoyuan, Taiwan, Republic of China
| | - Pei-An Yu
- Department of Orthopaedic Surgery, Chia-Yi Chang Gung Memorial Hospita, Taiwan, Republic of China
| | - Chi-Lung Chen
- Department of Orthopaedic Surgery, Chia-Yi Chang Gung Memorial Hospita, Taiwan, Republic of China; College of Medicine, Chang Gung University at Taoyuan, Taiwan, Republic of China
| | - Liang Tseng Kuo
- Department of Orthopaedic Surgery, Chia-Yi Chang Gung Memorial Hospita, Taiwan, Republic of China; College of Medicine, Chang Gung University at Taoyuan, Taiwan, Republic of China
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Yu PA, Peng KT, Huang TW, Hsu RWW, Hsu WH, Lee MS. Injectable synthetic bone graft substitute combined with core decompression in the treatment of advanced osteonecrosis of the femoral head: A 5-year follow-up. Biomed J 2016; 38:257-61. [PMID: 25179724 DOI: 10.4103/2319-4170.138307] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head can lead to destruction of the hip joint and disabling arthritis in young adults, if left untreated. Among the salvage procedures, core decompression combined with bone graft substitutes is a viable option for joint preservation. The purpose of this study was to review the outcomes of using synthetic bone graft substitute (calcium sulfate and calcium phosphate) for the treatment of late-stage osteonecrosis of the femoral head. METHODS From November 2008 to May 2009, 19 hips in 18 patients with osteonecrosis of the femoral head [6 hips in Association Research Circulation Osseous (ARCO) stage IIC and 13 hips in stage IIIA] were treated with core decompression combined with PRO-DENSE™ (Injectable Regenerative Graft). The average age of the patients at the time of surgery was 48 years (range 25-67 years). Twelve patients (13 hips) overused alcohol, four patients (4 hips) were idiopathic, one patient (1 hip) used corticosteroids, and one patient (1 hip) was post-traumatic. The clinical failure was defined as conversion to total hip arthroplasty or progression in head collapse. RESULTS At the conclusion of the study, 3 in the 6 stage IIC hips and 8 in the 13 stage IIIA hips were converted to total hip arthroplasty in an average of 8.5 months (range 4-30 months) postoperatively. Advanced collapse of the femoral head awaiting for total hip arthroplasty was observed in the other six hips. Of the 19 hips, only 2 hips (10.5%) survived without further collapse in the 5-year follow-up. This resulted in 89.5% failure rate with early resorption of the grafting in an average of 5.3 months. CONCLUSIONS Core decompression combined with an injectable calcium sulfate and calcium phosphate composite graft (PRO-DENSE) were associated high failure rates in the early postoperative period. It is not recommended for the treatment of ARCO stage IIC and IIIA osteonecrosis of the femoral head.
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Affiliation(s)
| | | | | | | | | | - Mel S Lee
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chiayi, Chang Gung University College of Medicine, Taoyuan, Taiwan
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