[Evaluation of the effect of internet-based dietary self-management on blood pressure in high-risk population of hypertension in Haikou City community]

To explore the effect of Internet+diet self-management intervention technology on the blood pressure control of hypertension high-risk population through the intervention of hypertension high-risk population in Haikou City community, so as to provide scientific evidence for the prevention and treatment of cardiovascular diseases (CVD). The multi-stage cluster sampling method was used, and 295 hypertension high-risk participants were recruited from 15 communities in Haikou City from July to December 2021. The 15 communities were randomly divided into three groups: blank group, traditional group and Internet plus group by random number table method. The blank group referred to the group (99 participants) that did not take special intervention measures but the routine interventions in accordance with the "National Basic Public Health Service Standards (the Third Edition) Health Education Service Standards". On the basis of the blank group, the traditional group (95 participants) was intervened by giving additional traditional methods such as holding lectures and distributing popular science books. The Internet plus group (101 participants) was given additional Internet measures on the basis of the intervention of the traditional group. After 6 months, questionnaires, laboratory biochemical tests, and physical measurements were conducted. SPSS 25.0 software was applied for data analysis. Measurement data that followed normal distribution were statistically described by using mean±standard deviation, analysis of variance was used for inter group comparisons before intervention, analysis of covariance was used for inter group comparisons after intervention, and Bonferroni adjustment was used for pairwise comparisons between groups. Measurement data that did not follow the Normal distribution were represented by M (Q1, Q3). The rank sum test was used for inter group comparison. The k sample Kruskal Wallis single factor ANOVA was used to compare the distribution between different groups. Counting data were described by composition ratio or rate. Under the premise of balanced comparison between groups before intervention, Chi-squared test was used for inter group comparison after intervention, and Bonferroni adjustment method was used for pairwise comparison between groups. The results showed that a total of 295 participants were included, with males accounting for 35.6% (105) and females accounting for 64.4% (190). The age ranged from 55 to 74 years old, with an average age of (64.69±5.73) years. The number of married accounted for 95.6% (282 participants). There were no statistically significant differences in gender, age, family history, education level, occupation, marital status, drinking habits, regular exercise, dietary status, SBP (systolic blood pressure), DBP (diastolic blood pressure), pulse pressure difference, BMI (body mass index), folic acid, and 24-hour urine sodium among the three groups upon enrollment (P values>0.05). After the intervention, the drinking rate was as follows: Internet plus group (29, 28.7%) Collapse

Key Words Collapse

MESH Headings

• Male
• Female
• Humans
• Middle Aged
• Aged
• Blood Pressure
• Self-Management
• Hypertension/epidemiology
• Hypertension/prevention & control
• Cardiovascular Diseases/prevention & control
• Diet
• Sodium
• Internet
• Folic Acid

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Grants

• 81860577 National Natural Science Foundation of China
• 2017YFC0907104 National Key Research and Development Program of China

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[Effect of splenic hilar lymphadenectomy on locally advanced Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction with a tumor diameter ≥4 cm: a five-year survival analysis]

Objective: To examine the long term outcome of splenic hilar lymphadenectomy (SHL) for locally advanced Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG) with a tumor diameter ≥4 cm. Methods: A total of 489 locally advanced Siewert type Ⅱ and Ⅲ AEG patients with a tumor diameter ≥4 cm who underwent radical resection from January 2010 to April 2016 were included. There were 383 males and 106 females. There were 225 patients aged≥65 years and 264 patients aged <65 years. SHL was conducted in 270 patients(SHL group). Wilcoxon rank-sum test or χ² test were conducted for inter-group comparison. Cox proportional hazard regression was used to analyze the long term outcome of SHL and the prognosis factors of overall survival. Kaplan-Meier curve was drawn finally. The results of survival analysis were verified by Log-rank test. Results: Followed-up to April 2021,the median follow-up time was 78.0 months (range: 74.0 to 85.0 months), the follow-up rate was 95.5%(467/489). The splenic hilar lymphnode metastasis rate of the SHL group was 12.6% (34/270). Younger patients (<65 years old), less complications, higher proportion of patients received adjuvant chemotherapy were demonstrated in the SHL group (χ²: 5.644 to 6.744, all P<0.05). Multivariate analysis showed that SHL was the independent prognosis factor of overall survival for patients with Siewert type Ⅱ and Ⅲ AEG and a tumor diameter≥4 cm (HR=0.68, 95%CI: 0.52 to 0.88, P=0.004) along with preoperative CA19-9, pathological T stage, pathological N stage, adjuvant chemotherapy and postoperative complication. Further subgroup analysis demonstrated that the SHL group had better 5-year overall survival than non-SHL group (62.4% vs. 39.2%, χ²=17.983, P=0.006) in Siewert type Ⅲ AEG rather than in Siewert type Ⅱ AEG(57.3% vs. 53.7%, χ²=3.031, P=0.805). Conclusion: In experienced center, splenic hilar lymphadenectomy can improve the prognosis of Siewert type Ⅲ AEG with a tumor diameter ≥4 cm.

[Quality of life after totally laparoscopic versus laparoscopic-assisted total gastrectomy: a retrospective cohort study with propensity score matching]

Objective: To evaluate the postoperative quality of life in patients after totally laparoscopic total gastrectomy (TLTG). Methods: A retrospective cohort study based on propensity score matching was performed. Clinical and follow-up data of patients who underwent laparoscopic radical gastrectomy at Union Hospital of Fujian Medical University from January 2014 to May 2015 were collected. Case indusion criteria: (1) primary gastric cancer confirmed by postoperative pathology; (2) receiving TLTG or laparoscopic-assisted total gastrectomy (LATG);(3) R0 resection; (4) completing follow-up for 12 months and complete follow-up data. Exclusion criteria: (1) gastric stump cancer; (2) concurrent tumor; (3) distal metastasis found during operation; (4) history of upper abdominal operation. According to surgical procedures, patients were divided into the LATG group (1076 cases) and the TLTG group (106 cases). To eliminate potential bias in baseline data between the two groups, the propensity score was calculated using a logistic regression model with the following covariates, including age, sex, body mass index, American Society of Anesthesiologists score, tumor location, tumor size, pathology type, and stage. The two groups were matched using a 1:2 propensity assessment ratio and a caliper width of 0.01 standard deviation was specified. The primary outcomes were the quality of life of the two groups at 3, 6 and 12 months after gastrectomy, including physical symptoms and social function. Higher function score indicated better function, and higher symptom score presented worse symptoms. Quality of life score = (100 - somatic symptom scale score + social function scale score) / 2. The secondary outcomes were postoperative nutritional recovery and food tolerance at 3, 6 and 12 months after gastrectomy. The categorical variables were expressed as n(%), and compared using the χ² test or Fisher exact test. The continuous variables conforming to the normal distribution were represented by Mean ± SD and compared with the paired t-test. Repeated measurement of variance was used to compare nutrition-related indicators within the group among pre-operation, postoperative 1, 3, 6, 12 months. Results: After PSM, there were no significant differences in clinicopathological baseline data between the TLTG group (n=104) and the LATG group (n=208) (all P>0.05). The physical symptoms scores in the TLTG group before operation and 3, 6 and 12 months after operation were 8.6±5.8, 15.5±8.4, 10.1±5.9 and 6.1±2.4 respectively (F=43.493, P<0.001). In the LATG group, the above mentioned scores were 9.7±6.9, 23.7±10.4, 13.3±8.3 and 8.5±4.2 respectively (F=112.588, P<0.001). Compared with the LATG group, the symptom scores in the TLTG group were lower at 3 and 6 months after operation, and the differences were statistically significant (t=-3.653, P<0.001; t=-2.513, P=0.012). At 12 months after operation, although the physical symptom score in the TLTG group was also lower than that in LATG group, the difference was not statistically significant (t=-1.487, P=0.138). The social function scores in the TLTG group before operation and 3, 6 and 12 months after operation were 90.3±8.9, 77.5±14.3, 87.4±10.3 and 91.7±6.7 respectively (F=28.524, P<0.001). In the LATG group, the above mentioned scores were 92.5±6.3, 68.5±16.8, 79.8±14.7 and 84.7±11.1 respectively (F=57.975, P<0.001). Compared with the LATG group, the social function scores of patients in the LATG group were higher at 3, 6 and 12 months after operation (t=3.543, P<0.001; t=3.216, P=0.001; t=2.235, P=0.026). The total scores of quality of life at 3, 6 and 12 months after operation in the TLTG group were 81.0±15.6, 88.3±8.1 and 93.3±9.1 respectively, and the above mentioned scores in the LATG group were 72.4±13.6, 83.3±11.5 and 88.1±7.7 respectively, whose differences at corresponding time point were all significant between the two groups (all P<0.05). The change of total body mass[(-8.4±1.4)% vs. (-13.2±1.6)%, t=2.273, P=0.024], serum albumin[(-5.1±0.7)% vs. (-7.4±0.8)%,t=2.095, P=0.037], meal quantity [(-15.6±4.7)% vs. (-24.1±6.0)%, t=2.885, P=0.004] and meal times [(20.8±7.1)% vs. (30.6±11.5)%, t=3.043, P<0.001] in the TLTG group were significantly lower than those in the LATG group one year after operation (all P<0.05). At 3, 6 and 12 months after operation, the diet proportions of solid and soft food in the TLTG group were higher than those in the LATG group (all P<0.05). Conclusions: Compared with LATG, patients with gastric cancer undergoing TLTG have better health-related quality of life and faster recovery of nutrition.

Orbital competition of Mn3+ and V3+ ions in Mn1+x V2-x O4

The structural and magnetic properties of Mn1+x V2-x O4 (0 < x ⩽ 1) have been investigated by the heat capacity, magnetization, x-ray diffraction and neutron diffraction measurements, and a phase diagram of temperature versus composition was built up. For x ⩽ 0.3, a cubic-to-tetragonal (c > a) phase transition was observed. For x > 0.3, the system maintained the tetragonal lattice. Although the collinear and noncollinear magnetic transitions of V3+ ions were obtained in all compositions, the canting angles between the V3+ ions decreased with Mn3+-doping, and the ordering of the Mn3+ ions was only observed as x > 0.4. In order to study the dynamics of the ground state, the first principles simulation was applied to analyze not only the orbital effects of Mn2+, Mn3+, and V3+ ions, but also the related exchange energies.

Consensus Statement on the Use of Bone Turnover Markers for Short-Term Monitoring of Osteoporosis Treatment in the Asia-Pacific Region

Osteoporosis is a major health issue. By 2050, a greater than 2-fold increase in patients number with hip fractures will occur in Asia representing 50% of all hip fractures worldwide. For the Asia-Pacific (AP) region, more efforts on controlling osteoporosis and the subsequent fractures are crucial. Bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA) is commonly used to diagnose osteoporosis and monitor osteoporosis treatment. However, the inconvenience, cost, limited availability of DXA and the delay in detection of BMD changes after treatment initiation support an important role for bone turnover markers (BTMs), as short-term tools to monitor therapy. With regards to low adherence rates of medical treatment of osteoporosis, the experts reached consensus on the use of BTMs for both raising awareness and short-term monitoring of osteoporosis treatment in the AP region. The experts endorse the use of BTMs, especially serum C-terminal telopeptide of type 1 collagen (CTX) and serum procollagen type 1 N propeptide (P1NP), as short-term monitoring tools to help clinicians assess the responses to osteoporosis therapies and appropriately adjust treatment regimens earlier than BMD. Either the absolute values or the degree of change from baseline in BTMs can be used to monitor the potential efficacy of osteoporosis therapies. The use of BTMs can be incorporated in osteoporosis care programs, such as fracture liaison service (FLS), to improve patient adherence and treatment outcomes. Encouraging sufficient reimbursement from health care systems may facilitate widespread use of BTMs in clinical practice in the AP region.

Effect modification of hyperlipidemia and hypertension on the association between type 2 diabetes and gout

AIMS

We evaluated the association between type 2 diabetes and gout by a retrospective cohort study.

METHODS

Data of 17,259 male and 18,318 female patients with type 2 diabetes were retrieved for the 1998-2010 period. These patients were matched to a comparison group (n=34,518 and n=36,636, respectively) in a 1:2 ratio by age and region.

RESULTS

We found that patients with type 2 diabetes after adjustment for hyperlipidemia and hypertension had a lower risk of incident gout than the matched population (incidence rate ratio, men: 0.39 [95% CI: 0.36-0.42]; women: 0.78 [0.72-0.84]). Specifically, type 2 diabetes alone without hyperlipidemia and hypertension was associated with a reduced risk of incident gout in men (adjusted relative risk [RR]: 0.29, 95% CI: 0.22-0.39), but not in women (0.86, 95% CI: 0.55-1.36). We found that insulin users with hyperlipidemia and hypertension associated with risk of incident gout and no sex-specific differences were noted (adjusted RR, men: 1.28 [95% CI: 1.11-1.48]; women: 1.32 [95% CI: 1.14-1.53]). Specifically, insulin users alone without hyperlipidemia and hypertension were not statistically significantly associated with gout risk (P≥.0954).

CONCLUSIONS

The results of this study indicated that hyperlipidemia and hypertension modified the association between type 2 diabetes and gout.

Risk of incident gout in kidney transplant recipients: A retrospective cohort study

AIM

Gout is a common complication in kidney transplant recipients. This study evaluated the association between kidney transplant recipients and the long-term risk of incident gout.

METHOD

For this age-matched and sex-matched retrospective cohort study, the Catastrophic Illness Certificate Database and the National Health Insurance Research Database were combined between 1997 and 2010. The study included 5917 patients with kidney transplants and 23 668 matched kidney transplant-free subjects. Hazard ratio (HR) for risk of incident gout was calculated using the Cox proportional hazards regression.

RESULTS

In this study, of the 5917 kidney transplant recipients, 521 (8.8%) had gout. The kidney transplant group had a higher risk of incident gout than those in the matched kidney transplant-free group (adjusted HR = 1.55, 95% confidence intervals [CI] = 1.36-1.77), particularly within 3 years following kidney transplant recipients (adjusted HR = 2.61, 95% CI = 2.13-3.20). We observed that at the >3 to 6 years and the >6 to 9 years follow-up, patients with kidney transplant did not have a significant association with risk of incident gout (adjusted HR = 0.92, P = 0.4806 and adjusted HR = 1.26, P = 0.1901, respectively).

CONCLUSION

These findings revealed that risk of incident gout increased within 3 years following kidney transplant recipients and the individual's long-term risk of incident gout between kidney transplant recipients and the general population remained similar.

Correction to: Consensus on best practice standards for Fracture Liaison Service in the Asia-Pacific region

In this article the name of the sixth author, E. Michael Lewiecki was rendered incorrectly. The publisher regrets this error and apologizes for the inconvenience caused.

The development of Taiwan Fracture Liaison Service network

Osteoporosis and its associated fragility fractures are becoming a severe burden in the healthcare system globally. In the Asian-Pacific (AP) region, the rapidly increasing in aging population is the main reason accounting for the burden. Moreover, the paucity of quality care for osteoporosis continues to be an ongoing challenge. The Fracture Liaison Service (FLS) is a program promoted by International Osteoporosis Foundation (IOF) with a goal to improve quality of postfracture care and prevention of secondary fractures. In this review article, we would like to introduce the Taiwan FLS network. The first 2 programs were initiated in 2014 at the National Taiwan University Hospital and its affiliated Bei-Hu branch. Since then, the Taiwan FLS program has continued to grow exponentially. Through FLS workshops promoted by the Taiwanese Osteoporosis Association (TOA), program mentors have been able to share their valuable knowledge and clinical experience in order to promote establishments of additional programs. With 22 FLS sites including 11 successfully accredited on the best practice map, Taiwan remains as one of the highest FLS coverage countries in the AP region, and was also granted the IOF Best Secondary Fracture Prevention Promotion award in 2017. Despite challenges faced by the TOA, we strive to promote more FLS sites in Taiwan with a main goal of ameliorating further health burden in managing osteoporotic patients.

Risk of incident benign prostatic hyperplasia in patients with gout: a retrospective cohort study

BACKGROUND

This retrospective cohort study evaluated the association between gout and the risk of benign prostatic hyperplasia among men by using data from Taiwan's National Health Insurance Research Database.

METHODS

Population-based representative insurance (outpatient and inpatient) claims data of 29,269 patients with gout and 29,269 matched patients without gout (1:1 ratio) for the period of 1997-2010 in Taiwan were identified. The association between gout and benign prostatic hyperplasia was evaluated using the Cox proportional hazards model. The associations of age by gout and gout phenotypes with benign prostatic hyperplasia risk were estimated.

RESULTS

Patients with gout had a higher incidence rate of benign prostatic hyperplasia than those in the matched gout-free group (19.62 vs. 10.11 events per 1000 person-years). Compared with the gout-free group, the adjusted hazard ratios (HRs) (95% confidence intervals (CIs)) for benign prostatic hyperplasia were 1.30 (1.24-1.36). The gout-to-benign prostatic hyperplasia association was modified by age (P_interaction < 0.0001) in gout patients the age groups of 20-40 years (adjusted HR 2.74, P < 0.0001) and 41-60 years (adjusted HR 1.39, P < 0.0001) but not in the age group of >60 years (adjusted HR 1.07, P = 0.063). Compared with gouty tophi, a higher risk of benign prostatic hyperplasia was noted in gouty nephropathy (adjusted HR 1.30, 95% CI 1.12-1.50).

CONCLUSIONS

Our results suggest that male gout is positively related to benign prostatic hyperplasia, particularly in young gout patients and those with gouty nephropathy.

Outcomes of percutaneous trigger finger release with concurrent steroid injection

Percutaneous release (PR) of the A1 pulley is a quick, safe, and minimally invasive procedure for treating trigger fingers. The purpose of this study is to identify if PR with additional steroid injections can shorten the recovery to reach unlimited range of motion. Between January 2013 and December 2013, we included 432 trigger fingers with actively correctable triggering or severer symptoms without previous surgical release or steroid injections from two hand clinic offices (A and B). The same experienced surgeon performed PR at the office. Patients from Clinic A received PR with steroid injections and those from Clinic B received PR without steroid injections. Patients returned for follow-up 1 week, 6 weeks, and 12 weeks after the procedure. Between the steroid group and the nonsteroid group, there is no significant difference in the mean time for patients to return to normal work and the rate of residual extensor lag. Middle fingers showed a 5.09-fold chance of having a residual extensor lag over that of the other fingers. High grade trigger fingers recovered more slowly than low grade ones. The success rate of a 12-week follow-up was 98.4%. There was no significant difference between the steroid group (97.5%) and the nonsteroid group (99.1%). PR can treat trigger fingers effectively, but additional steroid injection does not provide more benefit. Some fingers showed temporary extensor lag, especially in middle fingers and high grade trigger fingers, but 85% of those will eventually reach full recovery after self-rehabilitation without another surgical release.

Association Between Gout and Incident Type 2 Diabetes Mellitus: A Retrospective Cohort Study

OBJECTIVE

We investigated the association between gout and the risk of type 2 diabetes mellitus.

METHODS

Population-based representative insurance (outpatient and inpatient) claims data of 29,765 patients with gout and 59,530 controls without gout (1:2 case:control ratio) between 1998 and 2010 in Taiwan were identified. The association between gout and type 2 diabetes was evaluated using the Cox proportional hazards model. Moreover, the combined effects of sex and incident gout on the risk of type 2 diabetes were estimated.

RESULTS

In total, 3940 patients (13.24%) with gout and 6334 controls (10.64%) developed type 2 diabetes in the follow-up period. Multivariate analyses revealed a significant association between gout and type 2 diabetes. Compared with the control group, the adjusted hazard ratios (95% confidence intervals) for type 2 diabetes were 1.62 (1.54-1.70) in men, 1.97 (1.81-2.14) in women, and 1.70 (1.62-1.77) overall. The multiplicative interaction was β = 0.18 and P = .0001, suggesting a positive interaction between sex and incident gout. Moreover, compared with men without gout, a significantly higher risk of type 2 diabetes was noted in women without gout (adjusted relative risk [95% confidence interval], 1.17 [1.10-1.24]), men with gout (1.11 [1.06-1.16]), and women with gout (1.47 [1.37-1.57]) (P for interaction = .0058).

CONCLUSIONS

Gout is a strong and independent risk factor for type 2 diabetes, and female patients with gout are at a higher risk of type 2 diabetes than are male patients with gout.

Confirmatory Factor Analysis of the Boston Carpal Tunnel Questionnaire

PURPOSE

Carpal tunnel syndrome (CTS) is one of the most common hand problems and a major cause of work disability. The purpose of this study was to use confirmatory factor analysis (CFA) to assess the factor structure of the Boston Carpal Tunnel Questionnaire (BCTQ) in patients with CTS.

METHODS

One hundred and twenty-three patients with CTS were recruited from two hospitals. Each patient completed the functional status scale and the symptom severity scale of the BCTQ. CFA was used to assess the model fit between the data and pre-established theoretical measurement models.

RESULTS

CFA showed that all three-factor models were better than the original two-factor model. Among the three-factor models, the simplified model, with 11 items assessing daytime pain, nocturnal numbness/tingling, and hand function was the best, for the model fit the data better than did the other models. Specifically, the Comparative Indices were larger than 0.95 (Tucker-Lewis Index and Comparative Fit Index values), and the Absolute Fit Indices and information-theoretic measures were the smallest. Moreover, all factor loadings were significant and high in magnitude (ranging from 0.66 to 0.99), the composite reliabilities exceeded 0.60 (ranging from 0.78 to 0.94), and the average variance extracted exceeded 0.50 (ranging from 0.61 to 0.89).

CONCLUSION

The simplified model showed the highest reliability and validity, and the factor structure was the simplest/clearest one. The simplified model is recommended for clinical use due to its convenience and precision for assessing the problems of patients with CTS.

Prevalence of gout with comorbidity aggregations in southern Taiwan

OBJECTIVE

Comorbidity is an important concern for chronic gout patients. We evaluated the relationship between comorbidity profiles and gout in Taiwan aborigines and Taiwanese Han.

METHODS

We used the claims data from the Taiwan national health insurance database for 2004 to 2006. Physician-diagnosed gout and comorbidities were coded using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Total sampling from Pingtung County of southern Taiwan included 37,482 aborigines (gout cases, n=3906 and controls, n=33,576) and 37,451 Han (gout cases, n=1115 and controls, n=36,336).

RESULTS

In 2006, the gout prevalences were 10.42% and 2.98% (prevalence ratio [PR]=3.50) in the aborigines and Han general populations, respectively. The prevalences of uric acid nephrolithiasis and tophi were higher in aborigines (0.42% and 0.30%, respectively) than in Han (0.09% and 0.04%, respectively). When stratified by comorbidity status, the prevalences of gout were 4.49% and 27.34% in aborigines and 1.52% and 9.44% in Han (approximate PR=3.00). Similarly, the prevalence ratios of gout in the comorbidity group, compared with the non-comorbidity group, were 6.09 in aborigines and 6.23 in Han. Multivariate odds ratios [ORs] showed that hypercholesterolemia, hyperglyceridemia, essential hypertension and renal insufficiency were the common comorbidities of gout (OR≥1.63); heart failure exerted a significant effect only in aborigines (OR=1.55). For five comorbidity factors, patients with multiple comorbidities had higher gout prevalence (maximum OR=12.90).

CONCLUSION

Gout prevalence was higher in aborigines, both with and without comorbidities, than in Han. The comorbid diseases and comorbidity aggregations showed a substantial association with gout occurrence in both ethnicities.

Validation of the Chinese version of the Boston Carpal Tunnel Questionnaire

PURPOSE

Carpal tunnel syndrome (CTS) is a common diagnosis occurring in the workplace when people experience hand or wrist symptoms and difficulty performing activities. This study aimed to investigate the psychometric properties of the Chinese version of the Boston Carpal Tunnel Questionnaire (BCTQ) used to evaluate patients with CTS.

METHODS

A convenience sample of patients with CTS was recruited from two hospitals. The Symptom Severity Scale (SSS) and Functional Status Scale (FSS) of the BCTQ were used to assess symptoms and functional status. Test-retest reliability within 1 week was evaluated (n = 51). Construct validity was assessed by examining the relationship between the BCTQ and other well known measures (n = 99). Responsiveness of the scale was examined pre- and post-operatively for patients undergoing carpal tunnel surgery (n = 23).

RESULTS

High reliability was demonstrated through intraclass correlation coefficients of 0.81 and 0.83 for SSS and FSS, respectively. The minimal detectable change was 0.86 and 0.75 for SSS and FSS, respectively. Convergent validity was supported by high correlation of both scales with Disability of the Arm, Shoulder and Hand (|rho| = 0.63, 0.75 for SSS and FSS), and moderate to high correlation with the subscales of the Short-Form 36 for SSS(|rho| = 0.72 for Body Pain) and FSS (|rho| = 0.48 for Physical Function). Responsiveness was confirmed by moderate to high standardized response means for SSS (1.03) and FSS (0.62).

CONCLUSION

The Chinese BCTQ is a reliable, valid and responsive disease-specific measure for assessment of symptoms and functional status in patients with CTS.

Combinational polymorphisms of seven CXCL12-related genes are protective against breast cancer in Taiwan

Many single nucleotide polymorphisms (SNPs) have been found to be associated with breast cancer, but their SNP interactions are seldom addressed. In this study, we focused on the joint effect for SNP combinations of seven CXCL12-related genes involved in major cancer-related pathways. SNP genotyping was determined by PCR-restriction fragment length polymorphism (RFLP) in this study (case = 220, control = 334). Different numbers of combinational SNPs with genotypes called the SNP barcodes from different chromosomes were used to evaluate their joint effect on breast cancer risk. Except for vascular endothelial growth factor (VEGF) rs3025039-CT, none of these SNPs were found to individually contribute to breast cancer risk. However, for two combined SNPs, the proportion of subjects with breast cancer was significantly low in the SNP barcode with CC-GG genotypes in rs2228014-1801157 (CXCR4-CXCL12) compared to those with non-CC-GG genotypes. Similarly, the SNP barcode of rs12812942-rs2228014-rs3025039 (CD4-CXCR4-VEGF) and rs12812942-rs3136685-rs2228014-rs1801157 (CD4- CCR7-CXCR4-CXCL12) with specific genotype patterns (AT-CC-CC and AT-AG-CC-GG) among three and four combinational SNPs were significantly low in breast cancer occurrence. More SNP combinations larger than five SNPs were also addressed, and these showed similar effects. After controlling for age, and comparing their corresponding non-SNP barcodes, the estimated odds ratios for breast cancer ranged between 0.20 and 0.71 for specific SNP barcodes with two to seven SNPs. In conclusion, we have associated the potential combined CXCL12-related SNPs with genotypes that were protective against breast cancer, and that may contribute to identification of a low-risk population for the development of breast cancer.

Associations of a non-synonymous variant in SLC2A9 with gouty arthritis and uric acid levels in Han Chinese subjects and Solomon Islanders

OBJECTIVE

To study the associations of gout, tophi and uric acid levels with the gout-related SLC2A9 (solute carrier family 2, member 9) single nucleotide polymorphisms (SNPs) between two different racial groups.

METHODS

Eight SLC2A9 SNPs were genotyped in 109 subjects with gout and 191 control subjects from Han Chinese men in Taiwan and 69 subjects with gout and 168 control subjects from the Solomon Islands.

RESULTS

Non-synonymous SLC2A9 rs3733591 Arg265His was associated with risk for gout and tophaceous gout in Han Chinese subjects (p=0.0012 and p=0.0044). The genetic effect of this SNP on tophaceous gout was replicated in Solomon Islanders (p=0.0184). Patients with SLC2A9 Arg265His risk C-allele consistently had a higher risk for tophi (OR 2.05-2.15) than non-tophi (OR 0.91-1.62). SNP rs3733591 described 3.68% and 5.98% of the total variability in uric acid levels for Chinese and Solomon Island subjects, respectively.

CONCLUSION

Non-synonymous SNP rs3733591 variant within the SLC2A9 gene from two geographically diverse populations served as an important genetic checkpoint for tophaceous gout and increased uric acid levels.

SNP combinations in chromosome-wide genes are associated with bone mineral density in Taiwanese women

Osteoporosis is a major public health problem, mainly quantified by low BMD. Eleven polymorphisms were investigated in this study; TNFalpha-857 (rs1799724), TGFbeta1-509 (rs1800469), osteocalcin (rs1800247), TNFalpha-308 (rs1800629), PTH BstB I (rs6254), PTH Dra II (rs6256), IL-1ra (VNTR), HSP70 hom (rs2227956), HSP 70-2 (rs1061581), CTR (rs1801197), and BMP-4 (rs17563). The relationship between the combined polymorphisms in different genomic regions and BMD variation was investigated. Among the female subjects, the proportion of subjects with low BMD in low BMI group (< or = 18.50) was significantly higher than that of the middle (18.51-22.99) and high (> or = 23.00) BMI groups (P < 0.05). In post-menopausal women, there was a significant association between low BMD and genotypes ranging from 2 to approximately 7 SNPs. For two combined SNPs, the portion of subjects with low BMD was significantly higher in those with CC-AA genotypes in rs1799724-rs1800629, compared to those with non-CC-AA genotypes in post-menopausal women and the combination of all women. Similarly, part of the combined SNPs with rs1799724-rs1800629-rs6254-rs6256-IL-1ra-rs2227956-rs1801197 was significantly associated with reduced BMD. After controlling for age and BMI, post-menopausal women with certain specific SNP combination had a 3.54- to 4.68-fold increased risk for low BMD, comparing to other SNP combinations. In conclusion, our data suggest that several gene polymorphisms may be cooperatively involved in the development of osteoporosis.

De novo 617G-A nucleotide mutation in the ACVR1 gene in a Taiwanese patient with fibrodysplasia ossificans progressiva

Fibrodysplasia ossificans progressiva (FOP) is a rare congenital disease with autosomal dominant transmission characterized by the presence of malformations of the big toes and of postnatal progressive heterotopic endochondral osteogenesis. We report the case of 3-year-old girl with dysplasia of the first metatarsal bones and progressive heterotopic ossificans of the right thigh due to previous diphtheria-tetanus-pertussis immunizations and several inappropriate surgical interventions. Direct sequence analysis identified a 617G-A nucleotide mutation in the patient but not in her parents or brother. Pedigree analysis suggests that a de novo mutation in the ACVR1 gene is responsible for the disease in this family. This is the first report of the results of a mutation analysis in a sporadic case of FOP in a Taiwanese patient.

Revision of incompletely released trigger fingers by percutaneous release: results and complications

PURPOSE

Percutaneous trigger digit release has been reported as a safe, effective, and quick procedure, but most surgeons convert to an open method for residual triggering after percutaneous release. This study evaluates the safety and efficacy of repeated percutaneous release for patients who had residual triggering after the initial percutaneous release.

METHODS

Between January 2000 and December 2002, 31 patients with a mean age of 55 years had a repeat percutaneous release to treat residual snapping or locking symptoms. Surgery was performed in the physician's office using the tip of a 19-gauge needle mounted on a 2-mL syringe. Patients received regular postoperative follow-up examinations at 1, 6, and 12 weeks after surgery, and at the last visit, they completed a questionnaire regarding the duration of pain or swelling and when were they able to return to normal work.

RESULTS

Twenty-eight digits (90%) were completely free of triggering. Three digits (10%) during follow-up evaluation had residual snapping. Of these, 1 patient had repeated percutaneous release, which achieved an excellent outcome; 1 patient favored an open-release technique, and 1 patient refused further treatment. No complications were identified at the final follow-up examinations. Almost all patients returned to normal work within 3 days.

CONCLUSIONS

Percutaneous A1 pulley release is an effective, safe, and convenient technique for the primary trigger finger and as a secondary procedure for patients who have residual triggering after the initial surgical procedure.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Transpositional adipofascial flaps for complicated acute finger injries

Seven patients who presented with complicated acute finger injuries were treated successfully with local transpositional adipofascial flaps. This is a one-stage procedure with advantages of simplicity and rapidity. This flap is thin with good pliability and provides a very versatile and reliable covering for soft-tissue defects of the fingers. Full-thickness skin grafts were applied to the raw surface of the adipofascial flaps in all patients. All cases had excellent wound healing and restored full range of motion. This procedure facilitates early wound healing and early range of motion for finger joints; it also reduces wound pain, minimizes scar formation, and eliminates the need for second-stage surgery.

Death from colonic disease in epidermolysis bullosa dystrophica

BACKGROUND

Squamous cell carcinomas and renal failure were reported the causes of death in patients with recessive dystrophic epidermolysis bullosa (RDEB). Death from colonic disease in epidermolysis bullosa (EB) is never reported.

CASE PRESENTATION

We demonstrate a male patient with RDEB. He suffered megacolon due to fecal impaction and died from sigmoid colon perforation with peritonitis at age 35 years.

CONCLUSION

Constipation is a common clinical feature of RDEB, but fetal complications of chronic constipation are rarely reported. To the author's best knowledge, it has not been reported or recognized in the English literature previously. The aggressive assessment of constipation with fecal impaction is recommended in patients with RDEB.

Use of an External Fixation Combined with the Buttress-Maintain Pinning Method in Treating Comminuted Distal Radius Fractures in Osteoporotic Patients

BACKGROUND

It is difficult to keep the alignment of a distal radius fracture in patients with osteoporosis and prevent malunion. Therefore, we hoped to design better method to maintain alignment.

METHODS

Thirty-two patients over 65 years old with a displaced unstable distal radius fracture were treated by the external fixator combined with buttress-maintain pinning method and were compared with a group of 66 patients less than 60 years old treated by the same method.

RESULT

The radiologic results demonstrated that postoperative and final radial length and volar tilt were not statistically different between both groups. The functional result (excellent and good) in the elderly group was 87.5% and 89% to that of the control group. There was only one complication of pin tract infection in the elderly group.

CONCLUSIONS

External fixation for unstable distal radius fracture combined with buttress-maintain pinning method can be used in the osteoporotic bone of older adults with results similar to those for young adults at 18 months follow-up.

Retrospective study of open versus percutaneous surgery for trigger thumb in children

BACKGROUND

Percutaneous release for trigger finger in adults is well established, but this is not so for trigger thumb in children. The traditional treatment for trigger thumbs in children, if conservative treatment has failed, is open surgery. The authors' aim is to recommend that percutaneous release may be more appropriate in the treatment of trigger thumb in children.

METHODS

The authors performed a retrospective study of open versus percutaneous release for trigger thumb in children with a mean age of 2.4 years from December of 1984 to March of 2003. The 61 patients with 72 trigger thumbs included 35 boys and 26 girls. Thirty-two trigger thumbs were treated using open surgery before February of 1989. More recently, 40 trigger thumbs were treated using percutaneous surgery. The authors recommended a new manipulation to examine whether the A1 pulley had completely released, while the sensitive patients were operated on under general anesthesia.

RESULTS

The percutaneous procedure yielded up to a 90 percent successful release of trigger thumb in children without recurrence. The outcome of releasing trigger thumbs using these two surgical techniques showed no statistically significant difference. Thirty-seven trigger thumbs treated with percutaneous re-lease were able to achieve full extension and flexion without any residual deformity.

CONCLUSIONS

The authors developed a special manipulation to ensure complete release of the A1 pulley when general anesthesia is necessary in the cases of sensitive children and parents. The results suggest that percutaneous release for trigger thumb in children is a satisfactory alternative to open release.

Movement of finger joints induced by synergistic wrist motion

BACKGROUND

An experiment has recently been conducted to evaluate and compare the differences in tendon excursions between the flexor digitorum profundus and superficialis using three mobilization techniques. No previous studies deal with the total joint excursions with constant tendon length. The purpose of this study was to investigate the coordinated motion between the finger and wrist joints resulting from passive tension of the muscles while performing synergistic wrist motion.

METHODS

The relative joint positions of the hand and wrist were measured using a three-dimensional motion analysis system with external retroreflective markers 2 mm in diameter placed on the dorsal surface of the hand. Fifty normal subjects, with a 1:1 gender ration, ranging in age from 20 to 40 years, and with no previous history of upper extremity injury, were recruited for the experiment.

FINDINGS

The relationships of synergistic motion between the wrist and finger joints due to passive tension in the muscles were approximately linear. The ranges of wrist motion averaged 60 degrees extension and 60 degrees flexion. Moving the wrist from flexion into extension induced synergistic finger joint motion as follows: the distal interphalangeal joint angles changed from an average of 12 degrees of flexion to 31 degrees; proximal-interphalangeal joint angles changed from 19 degrees to 70 degrees; and metacarpal phalangeal joints changed from 27 degrees to 63 degrees of flexion.

INTERPRETATION

The relationships of synergistic motion between the wrist and finger joints were systematically documented. Such a relationship could be considered in optimizing the design of dynamic splints used for rehabilitation in post-surgical tendon repair, as well as providing useful information about potential diagnoses of problems with the integrity of the flexor and extensor mechanisms.

Corrosive injury from arterial injection of hydrochloric acid

This report presents a case of hydrochloric acid injection in the inguinal area in a suicide attempt, resulting in total occlusion of the external iliac artery, requiring disarticulation of the hip. To the authors' best knowledge, it has not been previously reported in the English medical literature. The accelerated destructive activity of these irritant chemicals and deep tissue damages are emphasized. Early and aggressive debridement with copious saline irrigation and circumspect monitoring are recommended.

Comparison of deltopectoralis flap and free radial forearm flap in reconstruction after oral cancer ablation

Defects in the head and neck resulting from ablation of oral cancer frequently lead to disabling functional and cosmetic deformities. Rehabilitation of patients with oral cancer can be an emotionally and technically challenging endeavor. Selection of the donor tissue is clearly dependent upon the defect that is to be reconstructed. The donor tissue should be of sufficient bulk and pliability to facilitate reestablishing contour and function. Regional flap and free flap have been the mainstays of reconstruction for surgical defects after ablation of oral cancer. The records of 77 patients in whom 49 deltopectoral (DP) flaps and 28 free radial forearm flaps (FRFF) were used were analyzed. The success rate of the DP flap was 89.8% and of the FRFF was 96.4%. The minor complication rate at the transplant site (fistula, dehiscence, hematoma) for the DP flaps was 22.4% and for the FRFFs was 14.3%. Overall complication rate at the transplant site for DP flaps was 32.7% and for the FRFFs was 17.9%. The incidence of partial loss of the donor-site skin graft was 4.1% for the DP flaps and 10.7% for the FRFFs. Overall complication rate at the donor site for DP flaps was 10.2% and for the FRFFs was 39.3%. DP flaps had better aesthetic and functional results at the donor site, than FRFFs. However, the DP flap is a staged procedure and results in prolonged hospitalization. In contrast to FRFF, performing a DP flap avoids the difficult technique of microanastomosis, and therefore reduces the donor-site complication rate and the operation time. Therefore, free flaps can not be routinely substituted for regional flaps, but they represent better reconstructive alternatives for specific and selected patients.

Management of grade III giant cell tumors of bones

BACKGROUND AND OBJECTIVES

Surgical treatment of high-grade giant cell tumors (GCT) of bones with an intralesional excision or a wide excision still poses a dilemma between eradicating the tumor and saving the extremity's function. Our study evaluates the possibility of managing high grade GCT with an intralesional curettage combined with adjuvant therapies, instead of a wide excision, to better avoid limb salvage procedures with endoprostheses.

METHODS

According to the grading system of Campanacci et al., twenty-four patients with grade III giant cell bone tumors were treated between May 1983 and Aug 2001 period. We analyzed the differences in local recurrence rates, functional results, and complications between wide excision and curettage with adjuvant therapy in management of the patients diagnosed with primary lesions after a mean follow-up period of 7.5 years (range: 2.1-20.3 years).

RESULTS

Fourteen patients underwent the curettage procedure with adjuvant therapy and reconstruction with bone grafts. In the curettage group, two patients had local recurrences and three patients had fracture complications. None of the nine patients receiving wide excisions had experienced local recurrence at the time of their most recent follow-up examination. Using the Musculoskeletal Tumor Society system to evaluate average function, the results were 25.56 points for the wide excision group and 25.64 points for the curettage group, respectively.

CONCLUSIONS

Our results suggest that surgical curettage with various adjuvant modalities might be considered as the first choice for treatment of high-grade GCTs in weight-bearing areas, especially in young patients, to avoid unnecessary endoprosthesis.

Percutaneous release for trigger thumb in children under general and local anesthesia

A retrospective trial of percutaneous release for 40 trigger thumbs in 33 children under different types of anesthesia (general versus local) at a mean age of 2.5 years was conducted between February 1989 and March 2003. Based on the tolerance of the child and parents, 20 children were processed using local anesthesia at our office and 13 children were given general anesthesia. We recommend special manipulation to ensure complete release of the A1 pulley when general anesthesia is necessary. Of the 26 trigger thumbs in the local anesthesia group, 23 were successfully released. Only one patient in the general anesthesia group had an unsatisfactory outcome. Percutaneous surgery achieved a 90% successful release rate for trigger thumb in children, without recurrence. There was no statistical difference in the release of trigger thumbs with these two anesthetic procedures (p = 0.66). Overall, 37 trigger thumbs achieved full extension and flexion without any residual deformity following percutaneous release. Our results suggest that percutaneous release for trigger thumb is satisfactory, no matter which method of anesthesia is used.

Intramedullary Pinning with Tension-Band Wiring for Surgical Neck Fractures Of the Proximal Humerus in Elderly Patients

Most proximal humeral fractures in the elderly population are related to osteoporosis. Several methods have been proposed to treat surgical neck fractures of the proximal humerus in elderly people. This study investigates a new method of intramedullary pinning with tension-band wiring. From June 1998 to March 2001, 10 female patients with a mean age of 73.0 years and displaced two- or three-part surgical neck fractures of the proximal humerus were studied. Two intramedullary pins were used with tension-band wiring via a deltopectoral approach with minimum dissection. The mean follow-up was 20.6 months. Final outcome was evaluated using the constant score, visual analog scale (VAS) score, questionnaire, and an outcome assessment form. The outcome was excellent in four patients, good in five, and fair in one. The mean Constant score was 80.8 and the VAS score was 83.0. There was no nonunion, avascular necrosis, deep infection, or pin migration. No patient needed further revision open reduction with internal fixation or prosthesis replacement. We therefore concluded that intramedullary pinning with tension-band wiring is a safe, reliable method, with few complications, for treating surgical neck fractures of the proximal humerus in elderly patients.

Segmental amputation for recurrent malignant bone tumors of the distal femur

We describe an alternative method for lengthening a short femoral stump after wide amputation of a malignant bone tumor of the distal femur in two patients. The method consists of two procedures during the operation. The first procedure is amputation of the affected cylindrical segment of the involved limb. The second procedure is elongation of the amputation stump using the tumor-free segment of the ipsilateral lower leg as a free composite osseous myocutaneous graft. Both patients had good function and were satisfied with the results with no complications or tumor recurrence 4 years postoperatively. We think the segmental amputation is a good procedure that results in a longer functional stump in patients who have above-knee amputation.

Investigations of Vitamin D Receptor Polymorphism Affecting Workers’ Susceptibility to Lead

Gene polymorphism is an important factor that affects human susceptibility to toxins. For example, previous studies suggested that the ALAD genotype is an important factor affecting workers' susceptibility to lead toxic effects, including hemopoietic and nervous system. But we have had few researches in Taiwan, though there are thousands of workers involved in lead-related industries. On the other hand, although it is well known that lead deposits in the bone mineral component and interacts with calcium, vitamin D receptor may therefore be an important factor in the metabolism of lead. Some studies suggested that different vitamin D receptor genotypes have various kinds of receptor activity. The goal of this study was to investigate the polymorphism affecting workers' susceptibility to lead. Three allelic variants of the VDR gene were defined by means of the polymerase chain reaction (PCR) and three restriction enzymes (ApaI, BsmI, and TaqI). We determined the relationships of different VDR genotypes (AA, Aa, aa, BB, Bb, bb, TT, Tt, and tt) to blood lead and the index of cumulative blood lead levels (ICL). Altogether we analyzed 544 workers' VDR genotypes (BsmI, TaqI, and ApaI) and compared to their blood lead levels and ICL in the VDR genotypes. The results showed that workers had higher blood lead levels and ICL in the Apa I- aa genotypes, but this is not statistically significant when adjusted for potential confounding factors. Other characteristics, such as exposure status, smoking and alcohol drinking, were significantly associated with ICL and time-weighted ICL. Regression analyses suggested that exposure status and personal habits (smoking and alcohol drinking) are still the major effects on blood lead parameters for lead workers rather than genotypes. In conclusion, VDR genotypes did not significantly affect the long term blood lead parameters after adjustment for all factors, but industrial hygiene improvement, including engineering control and health education, are the most important ways to protect workers' health.

Close-wedge osteotomy for bony locking stiffness of the elbow in Gorham disease patients: a case report

Gorham disease is a so-called massive idiopathic osteolysis or vanishing bone disorder. Massive osteolysis remains an enigmatic condition that involves various skeletal locations and is caused by endothelial proliferation. The diagnosis is difficult and is established via the association of clinical, radiologic and histologic pictures. Treatment modalities yield variable results. We report a case of vanishing bone in the elbow joint and carpal bones following trauma. This 13-year-old boy complained of severe restricted motion and deformity of the right elbow. We managed the problem using arthroplasty with close-wedge osteotomy on the lateral condyle of the humerus.

Impact of National Health Insurance on the Survival Rate of Patients with Osteosarcoma In Taiwan: Review of 74 Patients

The 2-year survival rate for high-grade osteosarcoma was 46.9% before the introduction of National Health Insurance (NHI) in Taiwan on March 1, 1995, but increased to 73.8% after the implementation of NHI. The 5-year survival rate also increased, from 37.5% to 63.6%. Between May 1990 and May 2001, 74 patients with high-grade osteosarcoma were treated at our hospital. Median age was 17 years (range, 7-63 years). Inadequate surgical margins, poor histologic response to chemotherapy, advanced stage of disease, and incomplete treatment were strongly associated with poor prognosis. Before NHI, 10 patients had incomplete treatment, mainly because of unaffordable medical fees. After NHI, only three patients had incomplete treatment, due to personal reasons. Patient survival improved dramatically with advances in multiagent chemotherapy, but it was the NHI that enabled patients to complete expensive treatment courses, including preoperative neoadjuvant chemotherapy, limb-salvage surgery, and postoperative adjuvant chemotherapy. The NHI also improved the accessibility of medical care, with more patients presenting in the early stages of disease and, as a result, it not only improved survival rate but also increased the number of patients undergoing limb-salvage surgery. We concluded that the NHI significantly improved the survival rate for patients with osteosarcoma in Taiwan.

Rotationplasty for Limb Salvage in the Treatment of Malignant Tumors: A Report of Two Cases

Limb salvage is now more common than amputation after radical excision to treat malignant tumors. In a skeletally immature patient who has malignant tumors in a lower extremity, rotationplasty offers a more reliable and durable option than other limb salvage procedures. It is an excellent method of resolving the problem of unequal leg lengths, and preserves best limb function with few complications. Here, we present our experience with rotationplasty for limb salvage in the treatment of malignant tumors, with good functional results seen in follow-up examination 11 years after surgery.

The effect of vascular endothelial growth factor and brain-derived neurotrophic factor on cavernosal nerve regeneration in a nerve-crush rat model

OBJECTIVE

To test the hypothesis that an intracavernosal injection with brain-derived neurotrophin factor (BDNF) and vascular endothelial growth factor (VEGF) can facilitate nerve regeneration and recovery of erectile function after cavernosal nerve injury.

MATERIALS AND METHODS

The study included 25 Sprague-Dawley rats; four had a sham operation, seven bilateral nerve crushing with no further intervention, and 14 bilateral nerve crushing with either an immediate (seven) or delayed for 1 month (seven) intracavernosal injection with BDNF+VEGF. Erectile function was assessed by cavernosal nerve electrostimulation at 3 months, and neural regeneration by NADPH-diaphorase staining and tyrosine hydroxylase (TH) staining of penile tissue and major pelvic ganglia (MPG).

RESULTS

After nerve crushing, the functional evaluation at 3 months showed a lower mean (SD) intracavernosal pressure (ICP) with cavernosal nerve stimulation, at 33.9 (15.3) cmH2O, than in the sham group, at 107.8 (18.1) cmH2O. With an immediate injection with BDNF+VEGF the ICP was significantly higher than in the controls, at 67.8 (38.5) cmH2O. Even delayed injection with BDNF+VEGF improved the ICP, to 78.0 (21.8) cmH2O. Histological analysis of specimens stained for NADPH and TH showed a significant change in the morphology of terminal branches of the cavernosal and dorsal nerves, and the staining quality of the neurones in the MPG. The number of positively stained nerve fibres tended to revert to normal after treatment with BDNF+VEGF.

CONCLUSION

An intracavernosal injection with BDNF+VEGF appears to both prevent degeneration and facilitate regeneration of neurones containing neuronal nitric oxide synthase in the MPG, dorsal nerve and intracavernosal tissue. Therefore it might have therapeutic potential for enhancing the recovery of erectile function after radical pelvic surgery.

Management strategy for unicameral bone cyst

The management of a unicameral bone cyst varies from percutaneous needle biopsy, aspiration, and local injection of steroid, autogenous bone marrow, or demineralized bone matrix to the more invasive surgical procedures of conventional curettage and grafting (with autogenous or allogenous bone) or subtotal resection with bone grafting. The best treatment for a unicameral bone cyst is yet to be identified. Better understanding of the pathology will change the concept of management. The aim of treatment is to prevent pathologic fracture, to promote cyst healing, and to avoid cyst recurrence and re-fracture. We retrospectively reviewed 17 cases of unicameral bone cysts (12 in the humerus, 3 in the femur, 2 in the fibula) managed by conservative observation, curettage and bone grafting with open reduction and internal fixation, or continuous decompression and drainage with a cannulated screw. We suggest percutaneous cannulated screw insertion to promote cyst healing and prevent pathologic fracture. We devised a protocol for the management of unicameral bone cysts.

Application of a membrane bioreactor system for opto-electronic industrial wastewater treatment--a pilot study

The membrane bioreactor (MBR) system has become more and more attractive in the field of wastewater treatment. It is particularly attractive in situations where long solids retention times are required, such as nitrifying bacteria, and physical retention is critical to achieving more efficiency for biological degradation of pollutants. Although it is a new technology, the MBR process has been applied to industrial wastewater treatment for only the past decade. The opto-electronic industry, developed very fast over the past decade in the world, is a high technological manufacturing industry. The treatment of the opto-electronic industrial wastewater containing a significant quantity of organic nitrogen compounds, with a ratio over 95% in organic nitrogen (Org-N) to total nitrogen (T-N), is very difficult to meet the discharge limits. The purpose of this research is mainly to discuss the treatment capacity of high-strength organic nitrogen wastewater, and to investigate the capabilities of the MBR process. A 2 m3/day capacity MBR pilot plant consisting of anoxic and aerobic tanks and a membrane bioreactor was installed for evaluation. The operation was continued for 130 days. Over the whole experimental period, a satisfactory organic removal performance was achieved. The COD could be removed with an average of over 94.5%. For TOC and BOD5, the average removal efficiencies were 96.3 and 97.6%, respectively. The nitrification and denitrification were also successfully achieved. The effluent did not contain any suspended solids. Only a small concentration of ammonia nitrogen was found in the effluent. The stable effluent quality and satisfactory removal performance mentioned above were ensured by the efficient interception performance of the membrane device incorporated within the biological reactor. The MBR system shows promise as a means of treating very high organic nitrogen wastewater without dilution. The effluent of TKN, NOx-N and COD can fall below 20 mg/L, 30 mg/L and 50 mg/L.

Langerhans cell histiocytosis of bone--a case report

Langerhans cell histiocytosis of bone causes bone destruction and frequent bone reactions that mimic benign and malignant neoplasms as well as osteomyelitis. The bony lesion of Langerhans cell histiocytosis consists of histiocytes with variable numbers of eosinophils, lymphocytes, and neutrophils. We present a rare case of Langerhans cell histiocytosis of bone, including imaging studies and pathology. In addition, we discuss the classification and pathology of Langerhans cell histiocytosis.

Reducing Dust Using the Electrocautery Pencil with Suction Combined with the Infusion Catheter in Mastectomy

The dust from the vaporized tissue released during a mastectomy presents a hazard to the patients and the operating room personnel. More dust has been noted using the conventional electrocautery pencil in dissecting breast tissue than with the metal knife used in the past. It is very important to reduce the hazardous dust released during mastectomy. For this study 80 patients undergoing mastectomy for breast cancer from March to June 2001 were divided into two groups: 1) those whose dissections were performed with a combination of an electrocautery pencil and suction with an intravenous infusion catheter (40 cases) and 2) those whose dissections were performed with the conventional method in which the electrocautery pencil was handled by the surgeon and the metal suction tube was used separately by an assistant (40 cases). During mastectomy the personal air sampler was affixed to the operator's neck to collect the dust from the vaporized tissue. The concentrations of the total dust were significantly lower in the combined electrocautery-suction method (mean 5.56 ± 3.26 μg/m3) than in the conventional method (mean 34.81 ± 4.83 μg/m3) during mastectomy ( P < 0.05). Although the operating time and blood loss were less in the combined method than in the conventional method this difference was not statistically significant ( P > 0.05). The combined method of using the electrocautery pencil for dissecting breast tissue along with the intravenous infusion catheter reduced the concentrations of the total dust from the vaporized tissue plume. Furthermore this method reduces the hazards of dust to the surgeons and operating room personnel. Additionally the cost of this combined method is lower than that of the conventional method.

Reducing dust using the electrocautery pencil with suction combined with the infusion catheter in mastectomy

The dust from the vaporized tissue released during a mastectomy presents a hazard to the patients and the operating room personnel. More dust has been noted using the conventional electrocautery pencil in dissecting breast tissue than with the metal knife used in the past. It is very important to reduce the hazardous dust released during mastectomy. For this study 80 patients undergoing mastectomy for breast cancer from March to June 2001 were divided into two groups: 1) those whose dissections were performed with a combination of an electrocautery pencil and suction with an intravenous infusion catheter (40 cases) and 2) those whose dissections were performed with the conventional method in which the electrocautery pencil was handled by the surgeon and the metal suction tube was used separately by an assistant (40 cases). During mastectomy the personal air sampler was affixed to the operator's neck to collect the dust from the vaporized tissue. The concentrations of the total dust were significantly lower in the combined electrocautery-suction method (mean 5.56 +/- 3.26 microg/m3) than in the conventional method (mean 34.81 +/- 4.83 microg/m3) during mastectomy (P < 0.05). Although the operating time and blood loss were less in the combined method than in the conventional method this difference was not statistically significant (P > 0.05). The combined method of using the electrocautery pencil for dissecting breast tissue along with the intravenous infusion catheter reduced the concentrations of the total dust from the vaporized tissue plume. Furthermore this method reduces the hazards of dust to the surgeons and operating room personnel. Additionally the cost of this combined method is lower than that of the conventional method.

Association of vitamin D receptor gene polymorphism with sporadic breast cancer in Taiwanese patients

PURPOSE

Previous reports have suggested that polymorphism in the vitamin D receptor (VDR) gene is associated with sporadic breast cancer, but there is controversy among different authors and ethnic groups. The purpose of this study was to determine whether polymorphism in the VDR gene might also influence breast cancer risk in Taiwan, a country with a low incidence of breast cancer.

METHODS

Polymorphisms in the end of the VDR gene were genotyped for 34 Taiwanese women with sporadic breast cancer, 46 with benign breast tumors and 169 cancer-free female cohort controls.

RESULTS

The ApaI, TaqI, and BsmI polymorphisms in the 3' end of the VDR gene were associated with breast cancer risk, with a trend for increasing risk with increased numbers of BsmI B alleles and ApaI AA genotypes. When the allele frequencies of BsmI polymorphism were compared among the three populations, a significant difference was observed (chi2 = 13.684, df = 4, p = 0.0084). The OR of the Aa genotype was 0.333 (95% CI = 0.1 14-0.978) and that of the aa genotype was 0.515 (95% CI = 0.190-1.398). These data indicate that the AA genotype may be associated with an increased risk of breast cancer, while the Aa genotype tends to be associated with decreased risk. The TaqI polymorphism was not associated with breast cancer risk in this study.

CONCLUSION

These results suggest that polymorphic variation in or near the 3' end of the VDR gene may influence breast cancer risk in Taiwanese women and justifies further investigation of the role of VDR for sporadic breast cancer in low-incidence areas. These findings also should help when designing targeted therapy.

Impact of a clinical pathway for total knee arthroplasty

The purpose of this study is to evaluate the effect of a clinical pathway for total knee arthroplasty in terms of length of stay, hospital costs, and quality of care. One hundred and twenty-two patients who underwent primary total knee arthroplasty for degenerative osteoarthritis in Kaohsiung Medical University hospital were included in the study. The pre-clinical pathway group included 53 patients before clinical pathway implementation (October 1996 approximately September 1997). The clinical pathway group included 69 patients after implementation of the clinical pathway (October 1997 approximately September 1998). All patients were followed up for at least 2 years after surgery. Data collection, including length of stay, hospital costs, comorbidity, and complications, was done by chart review, and Knee Society Clinical Rating System scores were used for assessment of preoperative and postoperative knee function for each group. Statistical analysis included Student's t-test to test the impact of the clinical pathway on resource consumption and medical care processes, and multiple linear regression to control for characteristics such as age and comorbidity. The implementation of the clinical pathway reduced the length of stay by 24%. Hospital costs were reduced by 16%. The implementation of the clinical pathway also reduced the number of unnecessary medical procedures. There was no statistically significant difference between the preoperative or the postoperative knee scores of the pre-clinical pathway group and clinical pathway group. The application of clinical pathway did not affect clinical outcomes and complication rates. In conclusion, the clinical pathway is an effective medical management tool to decrease the length of stay, decrease resource consumption and control medical care expenditure, and this is accomplished without a long-term adverse effect on quality of care.

Ultrasonographic study of the coexistence of muscular torticollis and dysplasia of the hip

The consistent relationship between congenital muscular torticollis and dysplasia of the hip is now widely accepted. However, the coexistence rate of these two disorders has been reported with variations from 0 to 20%. To obtain a more accurate coexistence rate, ultrasound scanner was used as the diagnostic tool for both of these disorders.Sixty-three children (30 boys and 33 girls) younger than 6 months who had undergone ultrasound scanning of both bilateral sternocleidomastoid muscle and bilateral hips were included in this study. Forty-seven children were confirmed to have muscular torticollis, and the remaining 16 cases were diagnosed as postural torticollis. Only these 47 cases were included for analysis of the coexistence rate. Eight children were found with dysplasia of the hips associated with muscular torticollis, which included Graf's type IIa for four hips, type IIb for two hips, type IIIa for one hip, and type IIIb for one hip. From the results of the present ultrasonographic study, the coexistence rate of congenital muscular torticollis and dysplasia of the hip was concluded to be 17%. If only those dysplastic hips (type IIb, IIIa, IIIb) that required treatment were included, the coexistence rate would be lowered to 8.5%.

[Advances in the research of penile erection and erection dysfunction]

Recent advances in the research on erectile dysfunction (ED) has more clearly explained the mechanism of penile erection, which is a hemodynamic process involving relaxation of corpus cavernosum smooth muscle and related arterials, and NO-cGMP signaling pathway proven to play an important role on modulating the relaxation of corpus cavernosum smooth muscle. Studies on NOS and PDEs not only provide strong evidence for the clinical treatment of ED, but also provide the chance to develop Sildenafil. Although the gene therapy for ED is still in the laboratory stage by now, it may be one of the effective clinical therapies for ED in future.

Acute open perilunate dislocation--a case report

A rare case of acute open dorsal perilunate dislocation of the left hand was encountered in a 30-year-old man with exposure of the lunate and distal radius. No other combined injury was identified except open dislocation and chip avulsion fracture of triquetrum. Open reduction was performed through a dorsal approach after debridement. Such a severe injury, to our knowledge, has not been reported previously.