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Chen CM, Huang WT, Sung SF, Hsu CC, Hsu YH. Statin use associated with a reduced risk of hip fracture in patients with gout. Bone Rep 2024; 22:101799. [PMID: 39252698 PMCID: PMC11381807 DOI: 10.1016/j.bonr.2024.101799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/27/2024] [Accepted: 08/18/2024] [Indexed: 09/11/2024] Open
Abstract
Studies show that statins users are at reduced risk of fracture and improved bone mineral density. However, the clinical effectiveness of statin use in patients with gout has not been investigated. This retrospective cohort study used data from Taiwan's National Health Insurance Research Database, consisting of 3443 patients with gout using statins aged 50 years and above and 6886 gout patients of non-statin users matched by sex, age and propensity score. The Cox proportional hazards regression analysis showed that statin use was associated with a reduced risk of hip fracture (adjusted hazard ratio [aHR] = 0.78, 95 % confidence interval [CI] = 0.64-0.94) after controlling for potential confounding factors. The association was significant in both genders aged 50-64 years, with aHRs of near 0.35, but not in the elderly. In addition, women aged 50-64 years who used statins also exhibited a lower risk of vertebral fracture (aHR = 0.70, 95 % CI = 0.50-0.99), but not men. In conclusion, the stating use in gout patients could reduce fracture risk for younger patients. Further research is warranted to confirm these findings.
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Affiliation(s)
- Chun-Ming Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan
| | - Wan-Ting Huang
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan
- Department of Beauty & Health Care, Min-Hwei Junior College of Health Care Management, Tainan 73658, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli 35053, Taiwan
- Department of Family Medicine, Min-Sheng General Hospital, Taoyuan 33044, Taiwan
| | - Yueh-Han Hsu
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan 73658, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung 40447, Taiwan
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2
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Su CH, Chen YC, Yang YH, Wang CY, Ko PW, Huang PJ, Liaw CC, Liao WL, Cheng TL, Lee DY, Lo LC, Hsieh CL. Effect of the traditional Chinese herb Helminthostachys zeylanica on postsurgical recovery in patients with ankle fracture: A double-blinded randomized controlled clinical trial. JOURNAL OF ETHNOPHARMACOLOGY 2022; 295:115435. [PMID: 35671862 DOI: 10.1016/j.jep.2022.115435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Helminthostachys zeylanica (HZ), which is also called "Dao-Di-U-Gon" in Taiwan, has anti-inflammatory and antiedema effects and is commonly used to treat edema in patients with fractures. The ugonin K component of HZ can induce osteogenesis and promote bone mineralization, its therapeutic effect, however, its therapeutic effect remains unclear. Therefore, the purpose of the present study was to investigate the effect of HZ on functional recovery in patients with ankle fractures requiring surgical treatment. METHODS A double-blinded, randomized, controlled study was conducted. A total of 45 patients with ankle fractures requiring surgical treatment were assigned to either the control group (n = 23 patients), which received the oral administration of HZ placebo 1.0 g t.i.d. for 42 days continuously, or to the treatment group (22 patients), which received HZ for 42 days. RESULTS The serum amino-terminal propeptide of type 1 procollagen (PINP) levels were similar in the first assessment (V1) between the control (45.90 ± 16.31 ng/mL) and treatment groups (52.61 ± 21.02 ng/mL; p = 0.240); the differences in PINP level between the third assessment (V3) and V1 were greater in the treatment group (35.84 ± 24.56 ng/mL) than in the control group (16.34 ± 11.97 ng/mL; p = 0.002). Radiographic healing time (RHT) was 9.09 ± 1.15 weeks in the treatment group, which was shorter than the 9.91 ± 0.79 weeks (p = 0.012) in the control group. CONCLUSION Oral administration of HZ for 42 days can increase serum PINP level and reduce the RHT. Therefore, HZ can be used to treat patients with ankle fractures requiring surgical treatment. However, a larger sample size is needed in future studies.
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Affiliation(s)
- Chin-Horng Su
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan; Orthopaedic Department, Yuan-Lin Christian Hospital, Changhua County, 510, Taiwan.
| | - Ya-Chih Chen
- Nursing Department, Yuan-Lin Christian Hospital, Changhua County, 510, Taiwan.
| | - Ya-Hui Yang
- Nursing Department, Yuan-Lin Christian Hospital, Changhua County, 510, Taiwan.
| | - Chun-Yi Wang
- Orthopaedic Department, Yuan-Lin Christian Hospital, Changhua County, 510, Taiwan.
| | - Po-Wei Ko
- Orthopaedic Department, Yuan-Lin Christian Hospital, Changhua County, 510, Taiwan.
| | - Peng-Ju Huang
- Orthopedic Department, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan.
| | - Chih-Chuang Liaw
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, 804, Taiwan.
| | - Wen-Ling Liao
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan.
| | - Tsung-Lin Cheng
- Institute of Statistics and Information Science, National Changhua University of Education, Taiwan.
| | - Der-Yen Lee
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan.
| | - Lun-Chien Lo
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan; Department of Chinese Medicine, China Medical University Hospital, Taichung, 40447, Taiwan.
| | - Ching-Liang Hsieh
- Department of Chinese Medicine, China Medical University Hospital, Taichung, 40447, Taiwan; Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan; Chinese Medicine Research Center, China Medical University, Taichung, 40402, Taiwan.
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Comminuted AO-C3 fractures of the patella: good outcome using anatomically contoured locking plate fixation. INTERNATIONAL ORTHOPAEDICS 2022; 46:1395-1403. [DOI: 10.1007/s00264-022-05374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 03/06/2022] [Indexed: 10/18/2022]
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Yang W, Wang H, Wei Q, Ding K, Jia Y, Li C, Zhu Y, Chen W. Preoperative incidence and risk factors of deep vein thrombosis in patients with an isolated patellar fracture. BMC Musculoskelet Disord 2022; 23:204. [PMID: 35241054 PMCID: PMC8895776 DOI: 10.1186/s12891-022-05163-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose This study aimed to investigate the incidence, location, and related factors of preoperative deep venous thrombosis (DVT) in patients with isolated patellar fractures. Methods Patients with an isolated patellar fracture, admitted between January 2013 and December 2019 at our institution, were retrospectively analyzed. Upon admission, patients underwent routine Doppler ultrasound scanning (DUS) of the bilateral lower extremities to detect DVT; those with DVT were assigned to the case group and those without DVT to the control group. Patients in both groups did not perform preoperative off-bed weight-bearing exercises. Data on demographics, comorbidities, and laboratory test results upon admission were extracted. Variables were evaluated between the two groups using univariate analyses, and independent risk factors associated with DVT were identified by logistic regression analysis. Results During the study period, 827 patients were included, of whom 5.8% (48/827) were found to have preoperative DVT. In DVT patients, 85.4%(41/48) were injured, 8.3%(4/48) were not injured, and 6.3%(3/48) were lower limbs. Multivariate analysis showed that male (male vs. female, odds ratio, OR = 2.25), delayed from injury to DUS (in each day, OR = 1.29), and elevated plasma D-dimer level (> 0.5 µg/mL, OR = 2.47) were independent risk factors associated with DVT. Conclusions Despite the low prevalence of DVT after an isolated patellar fracture, this study underscores the importance of identifying those with a high risk of DVT, especially those with multiple identifiable factors, and encourage the early targeted use of anti-thromboembolic agents to reduce DVT occurrence.
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Affiliation(s)
- Weijie Yang
- Trauma Emergency Center, Key Laboratory of Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, PR China
| | - Haicheng Wang
- Trauma Emergency Center, Key Laboratory of Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, PR China
| | - Qun Wei
- Department of Hospital Infection Control, Department of Public Health, Hebei General Hospital, Shijiazhuang, 050051, Hebei, PR China
| | - Kai Ding
- Trauma Emergency Center, Key Laboratory of Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, PR China
| | - Yuxuan Jia
- Department of Clinical Medicine, School of Basic Medicine, Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Chao Li
- Trauma Emergency Center, Key Laboratory of Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, PR China
| | - Yanbin Zhu
- Trauma Emergency Center, Key Laboratory of Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, PR China.
| | - Wei Chen
- Trauma Emergency Center, Key Laboratory of Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, PR China.
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Wollstein R, Trouw A, Carlson L, Staff I, Mastella DJ, Ashmead D. The Effect of Age on Fracture Healing Time in Metacarpal Fractures. Hand (N Y) 2020; 15:542-546. [PMID: 30501514 PMCID: PMC7370379 DOI: 10.1177/1558944718813730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Older patients are treated for fracture with increasing frequency. Although studies on animals suggest that older mice and rats heal fractures more slowly, the clinical implications remain unclear. A better understanding of differences in healing with age can help customize fracture treatment. Our purpose was to retrospectively evaluate metacarpal fractures for healing time looking specifically at age-related differences. Methods: A retrospective review of patients treated for metacarpal fractures was conducted. Patients with incomplete charts or inadequate follow-up were excluded. One hundred ninety-eight charts were analyzed. Demographic and other patient factors were documented. Fracture characteristics and treatment type were documented. Fracture healing was determined clinically. Plain radiographs and examination were used in decision making. Results: Age was not associated with fracture healing time as a continuous variable (P = .09). Patients above 75 years were not associated with increased healing time (P = .58). Fracture characteristics were related to healing time: minimally displaced and comminuted fractures healed faster than oblique fractures, spiral fractures, or transverse fractures (P = .048). Patients undergoing surgery healed faster than those without surgery (P = .046). Renal failure negatively affected fracture healing time (P = .03). Diabetes, hypothyroidism, and gender were not associated with healing time. Complications were not associated with age or other patient or fracture-related factors. Conclusions: Age does not affect clinical fracture healing time in adult. Therefore, older patients do not require disparate treatment. Other fracture-related factors and considerations such as functional demand and support systems might influence treatment decisions in fracture care.
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Affiliation(s)
- Ronit Wollstein
- New York University, New York City, USA,Ronit Wollstein, Department of Orthopedic Surgery, School of Medicine, New York University, 180 Pulaski Road, Huntington Station, NY 11746, USA.
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Wu KL, Wu CH, Chang YF, Lin YT, Hsu JC. Budget impact analysis of osteoporosis medications for primary prevention of fractures in Taiwan. J Bone Miner Metab 2020; 38:316-327. [PMID: 31709455 DOI: 10.1007/s00774-019-01061-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 10/21/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Taiwan's national health insurance currently only covers the use of osteoporosis drugs for the secondary prevention of fractures and does not provide coverage for primary prevention. The purpose of this study is to develop a model for analyzing the budgetary impact of the use of osteoporosis medications of primary prevention. METHODS The budget impact model in this study is the "actual medication cost" minus the "medical expenses for all types of fractures that can be avoided by taking osteoporosis medications." We developed six possible insurance payment plans for primary prevention based on the age of the patients and T-scores and performed eleven steps to estimate the budget impact of each payment plan. RESULTS The results of this study indicated that there may be 71,220 (T-score ≤ - 3.0, 75 + y/o) to 157,515 (T-score ≤ - 2.5, 65 + y/o) people using the drugs, and the budget impact may be US$26.28-58.98 million in 2019. However, the payment plans may avoid 492-766 fracture events and save medical expenditures for fracture treatment by US$1.30-2.02 million. The average costs for primary prevention within a year will be US$53,386-77,006. CONCLUSION The budget impact of using osteoporosis medications to primary prevention of fractures is significant, but it can be compensated due to savings in fracture treatment costs.
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Affiliation(s)
- Kun-Ling Wu
- Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
- Outpatient Clinic Department, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
| | - Chih-Hsing Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Geriatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yin-Fan Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yun-Ting Lin
- Department of Pharmacy, College of Medicine, National Cheng Kung University, No. 1 Daxue Rd., East Dist., Tainan, Taiwan
| | - Jason C Hsu
- Department of Pharmacy, College of Medicine, National Cheng Kung University, No. 1 Daxue Rd., East Dist., Tainan, Taiwan.
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Kao YT, Huang CY, Fang YA, Liu JC. The association between renin angiotensin aldosterone system blockers and future osteoporotic fractures in a hypertensive population - A population-based cohort study in Taiwan. Int J Cardiol 2020; 305:147-153. [PMID: 31955975 DOI: 10.1016/j.ijcard.2019.12.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 01/08/2023]
Abstract
Some cohort studies showed the possibility of renin-angiotensin-aldosterone system (RAAS) blockade in preventing future osteoporotic fractures. The study aimed to evaluate the association between angiotensin converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and future osteoporotic fracture in a hypertensive population. We queried the Taiwan Longitudinal Health Insurance Database between 2001 and 2012. We used propensity score matching and the total cohort was made up of 57,470 participants (28,735 matched-pairs using or not using RAAS blockers). The mean follow-up period was 6 years. The number of incident fractures was 3757. Hazard ratios (HRs) [95% confidence interval (CI)] of ACEIs and ARBs use with incident fractures were calculated. The incidence of future osteoporotic fracture was significantly lower in the ACEI and ARB user groups but not in the group using an ACEI plus ARB concomitantly, when compared with RAAS blocker nonusers. Comparing ACEI users with RAAS blocker non-users and ARB users with RAAS blocker non-users, the HRs for composite fractures were 0.70 (0.62-0.79) and 0.58 (0.51-0.65), respectively. Sensitivity analysis confirmed a lower incidence of future osteoporotic fracture in patients taking an ACEI for >55 cumulative defined daily doses (cDDDs) and those who received an ARB for >90 cDDDs. These results suggested a lower incidence of future osteoporotic fracture in a hypertensive population who were using an ACEI or ARB compared with RAAS blocker nonusers but not in the group taking an ACEI and ARB concomitantly.
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Affiliation(s)
- Yung-Ta Kao
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Yu-Ann Fang
- Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
| | - Ju-Chi Liu
- Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
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Phan DV, Yang NP, Kuo CY, Chan CL. Deep learning approaches for sleep disorder prediction in an asthma cohort. J Asthma 2020; 58:903-911. [PMID: 32162565 DOI: 10.1080/02770903.2020.1742352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Sleep is a natural activity of humans that affects physical and mental health; therefore, sleep disturbance may lead to fatigue and lower productivity. This study examined 1 million samples included in the Taiwan National Health Insurance Research Database (NHIRD) in order to predict sleep disorder in an asthma cohort from 2002-2010. METHODS The disease histories of the asthma patients were transferred to sequences and matrices for the prediction of sleep disorder by applying machine learning (ML) algorithms, including K-Nearest Neighbors (KNN), Support Vector Machine (SVM), and Random Forest (RF), and deep learning (DL) models, including Recurrent Neural Network (RNN), Long Short-Term Memory (LSTM), Gated Recurrent Units (GRU), and Convolution Neural Network (CNN). RESULTS Among 14,818 new asthma subjects in 2002, there were 4469 sleep disorder subjects from 2002 to 2010. The KNN, SVM, and RF algorithms were demonstrated to be successful sleep disorder prediction models, with accuracies of 0.798, 0.793, and 0.813, respectively (AUC: 0.737, 0.690, and 0.719, respectively). The results of the DL models showed the accuracies of the RNN, LSTM, GRU, and CNN to be 0.744, 0.815, 0.782, and 0.951, respectively (AUC: 0.658, 0.750, 0.732, and 0.934, respectively). CONCLUSIONS The results showed that the CNN model had the best performance for sleep disorder prediction in the asthma cohort.
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Affiliation(s)
- Dinh-Van Phan
- Department of Information Management, Yuan Ze University, Taoyuan, ROC.,Statistics and Informatics Department, University of Economics, The University of Danang, Da Nang, Vietnam.,Teaching and Research Team for Business Intelligence, University of Economics, The University of Danang, Da Nang, Vietnam
| | - Nan-Ping Yang
- Hualien Hospital, Ministry of Health and Welfare, Hualien, ROC
| | - Ching-Yen Kuo
- Department of Medical Administration, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, ROC
| | - Chien-Lung Chan
- Department of Information Management, Yuan Ze University, Taoyuan, ROC.,Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, ROC
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Outcomes after locked plating of displaced patella fractures: a prospective case series. INTERNATIONAL ORTHOPAEDICS 2019; 43:2807-2815. [PMID: 31041522 DOI: 10.1007/s00264-019-04337-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Tension band wiring remains a common treatment for patella fractures, but complication rates are high, with unsatisfactory results. The purpose of this observation study was to evaluate clinical results and complication rates of a novel patella locking plate fixation. METHODS Twenty patients (mean age, 59.2 ± 18 years) with displaced patella fractures were prospectively enrolled. Range of motion, knee scores (Tegner, Lysholm, Kujala), complications, and revision surgeries were assessed six weeks, six months, 12 months, and 24 months after surgery. Results were compared to the situation before trauma in regards to the time of follow-up using a paired sample t test. RESULTS According to the OTA classification, the fractures were classified as follows: one A1, four C1, six C2, and nine C3. Range of motion improved from 121° after six weeks to 140°, 141°, and 143° within the follow-up period. While the Tegner, Lysholm, and Kujala scores were 4.1/97/97, respectively, before trauma, they improved from 2.6/80/89 to 3.6/94/89, 3.7/95/94, and 4.1/97/97 within the follow-up period. Three patients had a complication (15%): one fracture dislocation, one reactive bursitis, and one renewed fracture. Four patients reported discomfort or anterior knee pain especially when kneeling on the implant. CONCLUSIONS The patella locking plate is a safe and effective treatment for patella fractures, including comminuted fractures. Function can be restored within six months after surgery, and the complication rate is low. Nonetheless, the implant can cause discomfort or anterior knee pain especially when kneeling, which can necessitate an implant removal.
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10
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Ellwein A, Lill H, Jensen G, Gruner A, Katthagen JC. [Plate osteosynthesis after patellar fracture - the technique and initial results of a prospective study]. Unfallchirurg 2019; 120:753-760. [PMID: 27435484 DOI: 10.1007/s00113-016-0213-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tension band wiring after patellar fractures is related to a high number of implant-related complications (22-53 %). Revision surgery is necessary in 10-55 % of patients mostly with unsatisfactory results. The patella plate is an alternative treatment with the advantages of locked plating. The purpose of this study was to evaluate the first clinical prospective results and complications of this new implant. MATERIALS AND METHODS Between April 2013 and May 2015 all patients that were treated with locked plating for patella fractures were included in this prospective study. Patients were followed-up clinically after six weeks and six months. RESULTS Included in this study were 17 patients, 6 women and 11 men, with a mean age of 58 years (19-87). The knee range of motion was 120° after 6 weeks and improved to 138° after 6 months, corresponding to 84 % and 97 % of the range of motion of the healthy opposite knee. The Tegner activity scale increased from 2,5 to 3,5 (initial value: 4), the Lysholm score increased from 78 to 92 points (initial value: 97) and the Kujala score increased from 72 to 88 points (initial value: 96). Two complications occurred: one patient had a reactive bursitis prepatellaris and one patient sustained a loss of reduction. CONCLUSION Locked plating of patella fractures is a reliable alternative treatment with good functional outcomes and low complication rates.
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Affiliation(s)
- A Ellwein
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Hamburg im DIAKOVERE Friederikenstift, Humboldtstr. 5, 30169, Hannover, Deutschland.
| | - H Lill
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Hamburg im DIAKOVERE Friederikenstift, Humboldtstr. 5, 30169, Hannover, Deutschland
| | - G Jensen
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Hamburg im DIAKOVERE Friederikenstift, Humboldtstr. 5, 30169, Hannover, Deutschland
| | - A Gruner
- Orthopädische Klinik, Herzogin Elisabeth Hospital, Braunschweig, Deutschland
| | - J C Katthagen
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Hamburg im DIAKOVERE Friederikenstift, Humboldtstr. 5, 30169, Hannover, Deutschland
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11
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Chen KY, Wu MY, Yang PS, Chiang JH, Hsu CY, Chen CY, Yen HR. Utilization of Chinese herbal medicine and its association with the risk of fracture in patients with Parkinson's disease in Taiwan. JOURNAL OF ETHNOPHARMACOLOGY 2018; 226:168-175. [PMID: 30118835 DOI: 10.1016/j.jep.2018.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 06/08/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Traditional Chinese medicine (TCM) has been used for over two thousand years to treat motor impairments corresponding to the clinical manifestations of Parkinson's disease (PD). AIM OF THE STUDY This study aimed to investigate the prescription of Chinese herbal medicine (CHM) for the management of PD and further determine whether CHM can improve motor function and decrease the risk of incident fracture. MATERIALS AND METHODS Patients older than 40 years newly diagnosed with PD between January 1997 and December 2010 were selected from the National Health Insurance Research Database (NHIRD) and followed up until the end of 2013. We used 1:1 frequency matching by age, sex, index year, and initial diagnostic year to compare the TCM users and non-TCM users. We used a Cox regression model and the Kaplan-Meier method to estimate the risk of developing fracture among the TCM and non-TCM users. RESULTS In total, 7197 patients older than 40 years were newly diagnosed with PD between 1997 and 2010 in Taiwan. Among these patients, 3456 were TCM users, and 3730 were non-TCM users. We compared 2007 PD patients with comparable demographic characteristics and comorbidity profiles between the two cohorts. During the follow-up period, compared with the non-TCM cohort, fewer patients in the TCM cohort had incident fractures (adjusted hazard ratio: 0.5, 95% CI: 0.44-0.56). The cumulative incidence of fracture was lower in the TCM cohort (log-rank test, p < 0.0001). Shi-Chang-Pu (Acorus gramineus Aiton), Yuan-Zhi (Polygala tenuifolia Willd), Bei-Mu (Fritillaria cirrhosa D. Don), Hai-Piao-Xiao (Sepiella maindronide Rochebrune; Sepia esculenta Hoyle), and Tian-Ma (Gastrodia elata Blume) constituted the core Chinese herbal medicine prescriptions used to treat PD patients. CONCLUSIONS The present study identified the core prescription pattern for the management of PD in Taiwan. Complementary CHM therapy was associated with a reduced risk of fracture in PD patients.
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Affiliation(s)
- Kuan-Yu Chen
- Department of Public Health, China Medical University, Taichung 404, Taiwan; Department of Chinese Medicine, Taipei City Hospital, Yangming Branch, Taipei 111, Taiwan.
| | - Mei-Yao Wu
- Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan.
| | - Pei-Shan Yang
- Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan.
| | - Jen-Huai Chiang
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung 404 Taiwan
| | - Chung-Y Hsu
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung 404, Taiwan; Brain Disease Research Center, China Medical University Hospital, Taichung 404, Taiwan.
| | - Chiu-Ying Chen
- Department of Public Health, China Medical University, Taichung 404, Taiwan; Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung 404, Taiwan; Brain Disease Research Center, China Medical University Hospital, Taichung 404, Taiwan.
| | - Hung-Rong Yen
- Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan; Research Center for Chinese Herbal Medicine, China Medical University, Taichung 404, Taiwan; Chinese Medicine Research Center, China Medical University, Taichung 404, Taiwan; Department of Biotechnology, Asia University, Taichung 413, Taiwan.
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12
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Chan CL, Phan DV, Yang NP, Pan RH, Wu CY, Chen CL, Kuo CY. A survey of ambulatory-treated asthma and correlation with weather and air pollution conditions within Taiwan during 2001-2010. J Asthma 2018; 56:799-807. [PMID: 30012027 DOI: 10.1080/02770903.2018.1497649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: This study of asthma was performed to evaluate annual trends in emergency department (ED) for 10 years. Weather and air pollution factors affecting asthma were also studied in order to identify the important factors and alert the public in advance. Methods: A survey of ambulatory-treated asthma patients was performed and the correlations with weather and air pollution factors examined in a cohort of one million patients in 2010. The fixed-cohort study analyzed trends, medical costs, and annual prevalence grouped by age and gender. Results: The number of asthma patients visiting EDs and non-emergency (non-ED) clinics significantly increased, with average annual percentage changes (AAPCs) of 2.3 and 4.6%, respectively. The average direct medical cost for EDs was increased significantly as compared with that of non-ED visits. Classification of asthma visits by hospital level indicated that local hospitals and others exhibited a significantly increasing trend (AAPC =15.3% [95% CI: 14.3-16.2]). The annual prevalence of asthma in males, females, and children was significantly increased (AAPCs of 1.5, 1.8, and 3.9%, respectively). Asthma patient hospitalizations were significantly correlated with temperature, humidity, and air pollution factors. Conclusions: The number of non-ED visits due to asthma increased, and the average direct medical cost for ED admissions also increased. Asthma patients tended to visit local hospitals primarily. Asthma visits by children increased, but a decrease was observed in adults. The number of hospitalized asthma patients was negatively correlated with temperature and humidity but positively correlated with the levels of PM2.5, PM10, and NO2.
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Affiliation(s)
- Chien-Lung Chan
- a Department of Information Management, Yuan Ze University , Taoyuan , Taiwan, Republic of China.,b Innovation Center for Big Data and Digital Convergence, Yuan Ze University , Taoyuan , Taiwan, Republic of China
| | - Dinh-Van Phan
- a Department of Information Management, Yuan Ze University , Taoyuan , Taiwan, Republic of China.,b Innovation Center for Big Data and Digital Convergence, Yuan Ze University , Taoyuan , Taiwan, Republic of China.,c Faculty of Statistics - Informatics, University of Economics, The University of Danang , Da Nang , Vietnam
| | - Nan-Ping Yang
- d Department of Surgery & Orthopedics, Keelung Hospital, Ministry of Health & Welfare , Keelung , Taiwan, Republic of China.,e Faculty of Medicine, School of Medicine, National Yang-Ming University , Taipei , Taiwan, Republic of China
| | - Ren-Hao Pan
- a Department of Information Management, Yuan Ze University , Taoyuan , Taiwan, Republic of China.,b Innovation Center for Big Data and Digital Convergence, Yuan Ze University , Taoyuan , Taiwan, Republic of China
| | - Chiung-Yi Wu
- a Department of Information Management, Yuan Ze University , Taoyuan , Taiwan, Republic of China.,b Innovation Center for Big Data and Digital Convergence, Yuan Ze University , Taoyuan , Taiwan, Republic of China
| | - Chia-Li Chen
- a Department of Information Management, Yuan Ze University , Taoyuan , Taiwan, Republic of China.,f Department of Information Management, Lung Hwa University of Science and Technology , New Taipei City , Taiwan, Republic of China
| | - Ching-Yen Kuo
- a Department of Information Management, Yuan Ze University , Taoyuan , Taiwan, Republic of China.,g Department of Medical Administration, Taoyuan General Hospital, Ministry of Health and Welfare , Taoyuan , Taiwan, Republic of China
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Yang TY, Huang TW, Chuang PY, Huang KC. Treatment of displaced transverse fractures of the patella: modified tension band wiring technique with or without augmented circumferential cerclage wire fixation. BMC Musculoskelet Disord 2018; 19:167. [PMID: 29793461 PMCID: PMC5968519 DOI: 10.1186/s12891-018-2092-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Displaced transverse fractures of the body of the patella are usually associated with disruption of extensor mechanism and should be fixed surgically. The most common method is a tension band wiring (TBW) technique. Some surgeons concurrently employ an augmented circumferential cerclage wiring (ACCW) technique to help fracture stabilization and aid in fracture healing; however, its role and effect on the treatment outcomes is unclear. METHODS We performed a STROBE-compliant retrospective observational cohort study on all cases of acute closed patella fracture that were treated at our institution between 2006 and 2012. Of 185 episodes, 72 (38.9%) were eligible for this study according to our inclusion/exclusion criteria. We classified these subjects with AO/OTA type 34-C1.1 or 34-C2 lesions into two groups for analyses: fractures treated with modified TBW and ACCW (group 1, n = 27) and those treated with modified TBW alone (group 2, n = 45). Plain radiographs were used to evaluate radiographic outcomes and the effect of potential risk factors on fixation failure was analyzed by subgroup comparisons. RESULTS Our results revealed that there were no significant differences in the rates of fixation failure (P = 0.620), nonunion (P = 0.620), and revision surgery (P = 0.620) between the groups. Although not statistically significant, there was a trend towards a positive risk association between fixation failure and age distribution > 60 years (10.0% vs. 0.0%, P = 0.124; OR = 8.0, P = 0.168) and > 70 years (9.4% vs. 2.5%, P = 0.321; OR = 4.0, P = 0.237) and the superficial level of the K-wires (12.0% vs. 1.5%, P = 0.117; OR = 6.3, P = 0.121). Regarding those modified TBW patients concurrently treated with an ACCW, the potential risk association between fixation failure and the superficial level of the K-wire was prone to increase further (28.6% vs. 0.0%, P = 0.060; OR = 18.6, P = 0.071). CONCLUSIONS Concurrent application of an ACCW might be needless and not efficacious to help fracture stabilization and healing in patients having been treated with modified TBW for displaced transverse fractures of the body of the patella. Adherence to correct surgical technique such as putting the K-wires at the proper level and securing control of the both ends of the K-wires may be more important and help in improving outcomes.
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Affiliation(s)
- Tien-Yu Yang
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tsan-Wen Huang
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Po-Yao Chuang
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuo-Chin Huang
- Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,, Putz City, Taiwan.
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14
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Greenberg A, Kadar A, Drexler M, Sharfman ZT, Chechik O, Steinberg EL, Snir N. Functional outcomes after removal of hardware in patellar fracture: are we helping our patients? Arch Orthop Trauma Surg 2018; 138:325-330. [PMID: 29185046 DOI: 10.1007/s00402-017-2852-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Functional outcomes after Open Reduction Internal Fixation (ORIF) of the patella are variable. Common complications of patella ORIF include persistent anterior knee pain, limited range of motion and symptomatic hardware. The purpose of this study was to evaluate if removal of hardware is beneficial to symptomatic patients after patellar fracture fixation. METHODS Patients who presented to our institution between December 2006 and November 2014 with patella fractures treated with ORIF were eligible for inclusion. Patella ORIF was performed using (1) K-wires (KW) with a tension band construct or (2) Cannulated Screws (CS) with a tension band construct. Radiological analyses included (1) AO classification and (2) measurements of prominent hardware length. Patient medical charts were reviewed for demographic and intraoperative data as well as peri/postoperative complications. All patients completed the SF-12 score, visual analog scale, Kujala score, Lysholm score and questionaries' regarding return to previous activity levels. RESULTS Forty-seven patients met the inclusion criteria. The average time from fracture fixation to removal of hardware was 15.8 (SD ± 14.9) months. The mean follow-up was 43.1 (SD ± 27.1) months. Patella fixation was accomplished using tension band constructs with KW in 28 patients (59.5%) or with CS in 19 patients (40.5%). Patient reported quality of life and pain outcomes improved significantly after removal of hardware (p = 0.001, and p = 0.002 respectively). Functional outcome scores (Kujala and Lysholm) did not improve significantly after hardware removal in the KW or CS groups. Significantly more patients in the KW group returned to pre-injury activity (p = 0.005). CONCLUSIONS Hardware removal after patella ORIF significantly improves patient reported pain and quality of life outcomes but not functional outcomes. Patients should be counseled regarding the expected outcome of hardware removal following patella ORIF and diabetic patients should be given special consideration before undergoing this procedure.
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Affiliation(s)
- Arieh Greenberg
- Joint Arthroplasty and Sports Medicine Department, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, 6423906, Tel-Aviv, Israel
| | - Assaf Kadar
- Joint Arthroplasty and Sports Medicine Department, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, 6423906, Tel-Aviv, Israel
| | - Michael Drexler
- Joint Arthroplasty and Sports Medicine Department, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, 6423906, Tel-Aviv, Israel
| | - Zachary T Sharfman
- Joint Arthroplasty and Sports Medicine Department, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, 6423906, Tel-Aviv, Israel
| | - Ofir Chechik
- Joint Arthroplasty and Sports Medicine Department, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, 6423906, Tel-Aviv, Israel
| | - Ely L Steinberg
- Joint Arthroplasty and Sports Medicine Department, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, 6423906, Tel-Aviv, Israel
| | - Nimrod Snir
- Joint Arthroplasty and Sports Medicine Department, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, 6423906, Tel-Aviv, Israel.
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15
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Chen CI, Yeh JS, Tsao NW, Lin FY, Shih CM, Chiang KH, Kao YT, Fang YA, Tsai LW, Liu WC, Nakagami H, Morishita R, Kuo YJ, Huang CY. Association between renin-angiotensin-aldosterone system blockade and future osteoporotic fracture risk in hypertensive population: A population-based cohort study in Taiwan. Medicine (Baltimore) 2017; 96:e8331. [PMID: 29145244 PMCID: PMC5704789 DOI: 10.1097/md.0000000000008331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Tissue renin-angiotensin-aldosterone system (RAAS) activation in sites of osteoporosis had been demonstrated in animal studies; however, the possibility of RAAS blockade to prevent future osteoporotic fracture had rarely been verified in clinical studies. We Used the Taiwan Longitudinal Health insurance database 2000 to 2008, the cohort study comprised patients age over 40 with a recorded new diagnosis of hypertension between January 1, 2000 to December 31, 2008, in addition, patients who had diagnosis of osteoporosis before the date of cohort enter were excluded. After the definite diagnosis of hypertension, each patient was followed until osteoporotic fracture happened or the end of 2008. The occurrence of osteoporotic fracture was evaluated in patients who either were or without taking RAAS blockade agents. Cox proportional hazard regressions were used to evaluate the osteoporotic fracture incidence after adjusting for known confounding factors. In total, 57,132 hypertensive patients comprised the study cohort. Our study results showed that the incidence of osteoporosis fracture in the whole cohort was significantly higher in the RAAS blockade non-user group than the user group. This phenomenon was observed in both sex and all age categories. Sensitivity analysis further showed the concordant lower osteoporosis fracture risk in patients with various RAAS blockers usage durations; the risk of osteoporosis fracture was the lowest in those drug use >365 days when compared with the non-user cohort. In conclusion, our study result demonstrated the lower future osteoporotic fracture risk in hypertensive subjects who received long term RAAS blocker treatment.
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Affiliation(s)
| | | | | | - Fen-Yen Lin
- Department of Internal Medicine
- Graduate Institute of Clinical Medicine, School of Medicine, College of Medicine
- Division of Cardiology and Cardiovascular Research Center
| | - Chun-Ming Shih
- Department of Internal Medicine
- Graduate Institute of Clinical Medicine, School of Medicine, College of Medicine
- Division of Cardiology and Cardiovascular Research Center
| | - Kuang-Hsing Chiang
- Department of Internal Medicine
- Division of Cardiology and Cardiovascular Research Center
| | - Yung-Ta Kao
- Department of Internal Medicine
- Division of Cardiology and Cardiovascular Research Center
| | - Yu-Ann Fang
- Center of Excellence for Cancer Research
- Cancer Center, Taipei Medical University Wang Fung Hospital
| | - Lung-Wen Tsai
- Graduate Institute of Biomedical Informatics, Taipei Medical University
- Evidence-base Medicine Center
- Department of Business
- Institute of Clinical Medical Sciences, Chang Gung University
- Department of Living Science, National Open University, Taipei, Taiwan
| | - Wen-Chi Liu
- Department of Business
- Institute of Clinical Medical Sciences, Chang Gung University
- Department of Living Science, National Open University, Taipei, Taiwan
| | | | - Ryuichi Morishita
- Department of Clinical Gene Medicine, Osaka University, Osaka, Japan
| | - Yi-Jie Kuo
- Department of Surgery, Taipei Medical University Hospital
| | - Chun-Yao Huang
- Department of Internal Medicine
- Division of Cardiology and Cardiovascular Research Center
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16
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Trends and Comparisons of Utilization of Emergency Departments Due to Traumatic or Non-Traumatic Causes among the HIV-Positive Population in Taiwan, 2006-2011. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101214. [PMID: 29019947 PMCID: PMC5664715 DOI: 10.3390/ijerph14101214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/02/2017] [Accepted: 10/09/2017] [Indexed: 12/05/2022]
Abstract
It is important that the utilization of emergency departments (EDs) among people living with the human immunodeficiency virus (HIV) be epidemiologically evaluated in order to assess and improve the HIV care continuum. All participants newly-diagnosed with HIV in Taiwan registered in the National Health Insurance Database from 2000 to 2005 were enrolled in this study and followed-up from 2006 to 2011. In total, 3500 participants newly-diagnosed with HIV in 2000–2005 were selected as a fixed-cohort population and followed-up from 2006 to 2011. Overall, 704, 645, 591, 573, 578, and 568 cases made 1322, 1275, 1050, 1061, 1136, and 992 ED visits in 2006, 2007, 2008, 2009, 2010 and 2011, respectively, with an average number of ED visits ranging from 1.75 to 1.98 per person, accounting for 20.1–22.6% of the whole HIV-positive population. Fewer ED visits were due to traumatic reasons, accounting for 19.6–24.4% of all cases. The incidence of traumatic and non-traumatic ED visits among the HIV-positive participants ranged from 7.2–9.3 and 27.0–33.9 per 100 people, respectively. The average direct medical cost of traumatic and non-traumatic ED visits ranged from $89.3–112.0 and $96.6–120.0, respectively. In conclusion, a lower incidence of ED visits for all reasons and fewer ED visits owing to traumatic causes were observed in the population living with HIV in comparison with the general population; however, the direct medical cost of each ED visit owing to both traumatic and non-traumatic causes was greater among those living with HIV than in the general population.
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17
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Huang HK, Lin SM, Yang CSH, Liang CC, Cheng HY. Post-ischemic stroke rehabilitation is associated with a higher risk of fractures in older women: A population-based cohort study. PLoS One 2017; 12:e0175825. [PMID: 28414796 PMCID: PMC5393872 DOI: 10.1371/journal.pone.0175825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/22/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Rehabilitation can improve physical activity after stroke. However, patients may be more prone to falls and fractures because of balance and gait deficits. Few reports have studied the relationship between rehabilitation and subsequent fractures after ischemic stroke. OBJECTIVE To investigate whether post-stroke rehabilitation affects fracture risk. METHODS We conducted a population-based retrospective cohort study based on the Taiwan National Health Insurance Research Database. Patients with a newly diagnosed ischemic stroke between 2000 and 2012 were included. After propensity score matching, a total of 8,384 patients were enrolled. Half of the patients (4,192) received post-stroke rehabilitation within 1 month; the other half did not receive any post-stroke rehabilitation. Cox proportional hazards regression model was used to calculate hazard ratios (HRs) for fractures among patients with and without rehabilitation within 1 year after ischemic stroke. Patients were further stratified by sex and age (20-64 and ≥65 years). RESULTS Patients receiving post-stroke rehabilitation had a higher incidence of fracture (6.2 per 100 person-years) than those who did not (4.1 per 100 person-years) after adjustment for sociodemographic and coexisting medical conditions [HR = 1.53, 95% confidence interval (CI) = 1.25-1.87, p < 0.001]. The analyses performed after stratifying for sex and age showed that only older women undergoing rehabilitation had a significantly higher risk of fracture (HR = 1.62, 95% CI = 1.21-2.17, p = 0.001). CONCLUSION Rehabilitation after ischemic stroke is associated with an increased fracture risk in older women.
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Affiliation(s)
- Huei Kai Huang
- Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Shu Man Lin
- Department of Physical Medicine and Rehabilitation, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Clement Shih Hsien Yang
- Department of Physical Medicine and Rehabilitation, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chung Chao Liang
- Department of Physical Medicine and Rehabilitation, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Hung Yu Cheng
- Department of Physical Medicine and Rehabilitation, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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Karam E, Shivji FS, Bhattacharya A, Bryson DJ, Forward DP, Scammell BE, Ollivere BJ. A cross-sectional study of the impact of physiotherapy and self directed exercise on the functional outcome of internally fixed isolated unimalleolar Weber B ankle fractures. Injury 2017; 48:531-535. [PMID: 27889109 DOI: 10.1016/j.injury.2016.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/29/2016] [Accepted: 11/16/2016] [Indexed: 02/02/2023]
Abstract
This study aimed to measure the functional outcome and quality of life in a group of patients with the same fracture type (unimalleolar Weber B ankle fractures) treated operatively at various time points and to explore the determinants of such outcomes. A cross-sectional retrospective population study was conducted. Validated Patient Related Outcome Measures (PROMs) and patient interviews were used. Fifty-one patients were included with a mean age of 54.9 years. Mean follow-up was 25 months (range 4-46 months). Mean functional scores were high (mean AOFAS 79.2, O&M 75.7, VAS-FA 80.5). However, 32% of patients did not classify themselves as fully recovered during interviews. Patient reported self-directed exercise had a statistically significant positive effect on self-reported patient perceptions of outcome (p=0.022) and PROMs (AOFAS p=0.01, O&M p=0.016, VAS-FA p=0.011). Formal physiotherapy rehabilitation was found to have no effect on self-reported patient perceptions (p=0.242) or PROMs (AOFAS p=0.8, O&M p=0.73, VAS-FA p=0.46). Our finding that physical activity is associated with improved outcome would suggest structured exercise programmes should be considered in place of physiotherapy to optimise patient outcomes.
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Affiliation(s)
- E Karam
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - F S Shivji
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Bhattacharya
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D J Bryson
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D P Forward
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - B E Scammell
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - B J Ollivere
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
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Wu TY, Hu HY, Lin SY, Chie WC, Yang RS, Liaw CK. Trends in hip fracture rates in Taiwan: a nationwide study from 1996 to 2010. Osteoporos Int 2017; 28:653-665. [PMID: 27858121 DOI: 10.1007/s00198-016-3783-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/22/2016] [Indexed: 02/08/2023]
Abstract
UNLABELLED There was an initial increase and a later decrease in hip fracture rates in Taiwan between 1996 and 2010 (457.9 to 390.0 fractures per 100,000 people per year). Mortality rates decreased but re-emerged later (2.26 to 1.91 deaths per 100 hip fracture admissions). The turning point for change in trends was 2003. INTRODUCTION Fractures of the proximal femur remain a major cause of mortality and morbidity. We aimed to examine recent trends in hip fracture rates, in-hospital mortality rates, and length of hospital stay (LOS) due to hip fractures in people aged 55 and over in Taiwan. METHODS This is a time-trend study. We used data from the National Health Insurance Research Database between 1996 and 2010 in Taiwan. Insurants aged 55 and over were included. The outcome measures were age-adjusted hip fracture rates, age-adjusted in-hospital mortality rates, and LOS due to hip fractures. We classified hip fractures into femoral neck, trochanteric, and subtrochanteric fractures. RESULTS We identified 250,919 hospitalizations for hip fractures. The total number of hip fractures increased steadily from 12,479 to 19,841 cases. There was a trend towards initial increase and then later decrease in hip fracture rates (from 457.9 to 390.0 fractures per 100,000 people per year). LOS decreased by 46.5 % (17.53 to 9.38 days). By contrast, mortality rates for hip fractures decreased initially, but re-emerged later with a total decrement of 15.5 % (2.26 to 1.91 deaths per 100 hip fracture admissions). Women outnumbered men in all types of hip fractures, but men had higher in hospital mortality rates. LOS was similar between genders and among age groups. The turning point for change in trends was year 2003. CONCLUSIONS While LOS shortened gradually since 1996, the absolute number of hip fractures in Taiwan continues to rise. There is still room for improvement in reducing mortality due to hip fractures.
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Affiliation(s)
- T Y Wu
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, 5F, No. 17, Hsu-Chow Rd., Taipei, 100, Taiwan
- Department of Family Medicine, Renai Branch, Taipei City Hospital, 10F, No. 10, Sec. 4, Ren-Ai Rd., Taipei, 106, Taiwan
| | - H Y Hu
- Department of Education and Research, Taipei City Hospital, 10F, No. 10, Sec. 4, Ren-Ai Rd., Taipei, 106, Taiwan
- Institute of Public Health and Department of Public Health, National Yang-Ming University, No.155, Sec. 2, Li-nong St., Beitou District, Taipei, 112, Taiwan
| | - S Y Lin
- Department of Education and Research, Taipei City Hospital, 10F, No. 10, Sec. 4, Ren-Ai Rd., Taipei, 106, Taiwan
| | - W C Chie
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, 5F, No. 17, Hsu-Chow Rd., Taipei, 100, Taiwan
- Department of Public Health, College of Public Health, National Taiwan University, 5F, No. 17, Hsu-Chow Rd., Taipei, 100, Taiwan
| | - R S Yang
- Department of Orthopedics, College of Medicine, National Taiwan University Hospital, 11F, No.7, Chung-Shan S. Rd., Taipei, 100, Taiwan
| | - C K Liaw
- Department of Orthopedics, College of Medicine, National Taiwan University Hospital, 11F, No.7, Chung-Shan S. Rd., Taipei, 100, Taiwan.
- Department of Orthopedics, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen-Chang Rd., Taipei, 111, Taiwan.
- School of Medicine, Fu-Jen Catholic University, No. 510, Zhong-Zheng Rd., Xin-Zhuang Dist, New Taipei, 242, Taiwan.
- Department of Healthcare Information and Management, Ming Chuan University, No.5, De-Ming Rd., Gui-Shan Dist, Taoyuan County, 333, Taiwan.
- , 5F, No. 11, Aly. 25, Lan. 208, Rui-an St., Taipei, 10661, Taiwan.
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Yang NP, Phan DV, Lee YH, Hsu JC, Pan RH, Chan CL, Chang NT, Chu D. Retrospective one-million-subject fixed-cohort survey of utilization of emergency departments due to traumatic causes in Taiwan, 2001-2010. World J Emerg Surg 2016; 11:41. [PMID: 27579054 PMCID: PMC5004311 DOI: 10.1186/s13017-016-0098-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidemiological study was needed to evaluate trends in emergency department (ED) utilization that could be taken into account when making policy decisions regarding the delivery and distribution of medical resources. METHODS A retrospective fixed-cohort study of emergency medical utilization from 2001 to 2010 was performed based on one-million people sampled in 2010 in Taiwan. Focusing on traumatic cases, the annual incidences in various groups split according to sex and age were calculated, and further information regarding location of trauma and type of trauma was obtained. RESULTS In 2010, significantly greater proportions of male and younger subjects were visitors to EDs with a traumatic injury. During 2001-2010, the number of both traumatic cases and non-traumatic cases presenting at EDs significantly increased (average annual percentage change, AAPC 4.7 and 3.6, respectively) and a significantly greater direct medical cost associated with traumatic cases than non-traumatic cases was noted. Focusing on traumatic cases, most of these cases were directed to highest-level hospitals, accounting for 73.5-78.8 % of all traumatic cases, with a significant AAPC of 5.6. The traumatic ED visit annual incidence in males was 58.63 in 2001, which significantly increased to 69.35 per 1000 persons in 2010 (AAPC 1.5); and in females was 38.96 in 2001, which significantly increased to 50.73 per 1000 persons in 2010 (AAPC 2.5). Most of the traumatic cases treated in EDs were minor injuries, such as contusion with the skin intact, open wound of the upper limbs, open wound of the head, neck, or trunk, and other superficial injury (accounting for about 60 % of all cases). The traumatic categories of sprains/strains of joints and adjacent muscles, fractures of upper limbs, fractures of lower limbs, and fractures of the spine/trunk required greater medical resources and significantly positive AAPC values (4.3, 4.0, 4.5 and 6.8, respectively). CONCLUSIONS Increased ED utilization due to traumatic causes, as assessed by the annual number of cases and incidence, average direct medical cost and highest-level hospital utilization, was observed from 2001 to 2010. Orthopedic-related injuries, including soft tissue trauma of extremities and various fractures, were the categories with the greatest increase in incidence.
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Affiliation(s)
- Nan-Ping Yang
- Department of Surgery & Orthopedics, Keelung Hospital, Ministry of Health & Welfare, Keelung, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Dinh-Van Phan
- Department of Information Management, Yuan Ze University, Taoyuan, Taiwan.,Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, Taiwan
| | - Yi-Hui Lee
- Department of Nursing, School of Nursing, College of Medicine, Chang-Gang University, Taoyuan, Taiwan
| | - Jin-Chyr Hsu
- Department of Medicine, Taipei Hospital, Ministry of Health & Welfare, Taipei, Taiwan
| | - Ren-Hao Pan
- Department of Information Management, Yuan Ze University, Taoyuan, Taiwan.,Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, Taiwan
| | - Chien-Lung Chan
- Department of Information Management, Yuan Ze University, Taoyuan, Taiwan.,Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, Taiwan
| | - Nien-Tzu Chang
- Department of Nursing, School of Nursing, College of Medicine, Chang-Gang University, Taoyuan, Taiwan.,School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Dachen Chu
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan.,Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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21
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Lee JM, Yoon SJ, Park MS, Song KJ. Clinical Outcome of a Precontoured Symphysis Pubis Plate with Tension Band Wiring for Traumatic Symphysis Pubis Rupture in Pelvic Fractures. JOURNAL OF TRAUMA AND INJURY 2016. [DOI: 10.20408/jti.2016.29.1.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Sun Jung Yoon
- Trauma-Team, Chonbuk National University Hospital,
- Department of Orthopedic Surgery, Chonbuk National University Hospital,
| | | | - Kyung Jin Song
- Trauma-Team, Chonbuk National University Hospital,
- Department of Orthopedic Surgery, Chonbuk National University Hospital,
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22
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Yao F, He Y, Qian H, Zhou D, Li Q. Comparison of Biomechanical Characteristics and Pelvic Ring Stability Using Different Fixation Methods to Treat Pubic Symphysis Diastasis: A Finite Element Study. Medicine (Baltimore) 2015; 94:e2207. [PMID: 26656353 PMCID: PMC5008498 DOI: 10.1097/md.0000000000002207] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The intention of this study was to compare the biomechanical characteristics using 5 internal fixation methods used clinically to stabilize a pubic symphysis diastasis (PSD, Tile type B1).A 3-dimensional finite element model of PSD was simulated using 5 implants, including single superior plate (Single-Plate), superior and anterior plate (Dual-Plate), single cannulated screw (Single-Screw), crossed dual cannulated screws (Cross-Screw), and parallel dual cannulated screws (Para-Screw). Three loads were distributed in all models, including dual-leg standing, single-leg stance, and rotation. To evaluate the biomechanical properties, the construct stiffness, the stress distribution, and the von Misses stress were recorded and analyzed. To evaluate pelvic ring stability, the micromotion of the pubic symphysis and iliosacral joint was analyzed.Disruption of pubic symphysis dramatically decreased the pelvic ring stability. Cross-screw and Para-Screw showed higher stiffness than other methods. All implants endured the maximum von Misses stress under single-leg stance. For Plate-Screw system, the maximum stress occurred at a place where it strides over pubic symphysis and adjacent Plate-Screw interface. The single implant and Para-Screw had a tendency to fail. Para-Screw showed the best fixation effect under dual-leg conditions. Cross-screw showed superior antishearing force capacity under single-leg stance. Dual-Plate provided maximum antihorizontal rotation. Para-Screw provided the maximum stabilization for the posterior pelvic ring.This study showed the biomechanical advantages of dual-implant for PSD only from the finite element view. The Para-Screw provided high construct stiffness under 3 load conditions. The single implant and Para-Screw had a tendency to fail. The better anterior and posterior pelvic stabilization were obtained by the dual-implant fixation than other methods. Therefore, the Cross-Screw and Dual-Plate fixation methods should be preferred in the treatment of pubic symphysis from the finite element view.
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Affiliation(s)
- Feng Yao
- From the Department of Intensive Care Unit, Wujiang First People's Hospital, Jiangsu (FY, HQ); and Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, People's Republic of China (YH, DZ, QL)
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23
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Lee FH, Shen PC, Jou IM, Li CY, Hsieh JL. A Population-Based 16-Year Study on the Risk Factors of Surgical Site Infection in Patients after Bone Grafting: A Cross-Sectional Study in Taiwan. Medicine (Baltimore) 2015; 94:e2034. [PMID: 26632703 PMCID: PMC5058972 DOI: 10.1097/md.0000000000002034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Bone grafting is a commonly used orthopedic surgical procedure that will provide bone formation in bone defects or regions of defective bone healing. A major complication following bone grafting is a postoperative recipient graft site infection that is associated with substantial mortality and increased use of medical resources. The purpose of the study was to identify the risk factors associated with infection after bone-grafting surgery.Data from 1,303,347 patients listed in the Taiwan National Health Insurance Research Database (NHIRD) and admitted to hospitals from 1997 through 2012 who underwent primary bone grafting (mean age: 46.57 years old; mean length of hospital stay: 8.04 days) were analyzed. The incidence of infection by age, hospital stay, gender, income, chronic disease (tuberculosis [TB]; diabetes mellitus [DM]; acquired immunodeficiency syndrome [AIDS]), fracture complications (nonunion; delayed union fracture), types of graft and hospital was evaluated.Three percent of the patients developed a postoperative recipient graft site infection. Multivariable analysis revealed that patients were more likely to develop a post bone-grafting surgery infection if they were older, had a longer hospital stay, were male, had a lower income, or had comorbid TB, DM, or AIDS. Patients were more likely to develop an infection if they had a nonunion, an alloplast graft, or treated in a local clinic.Our findings should provide a clinically relevant reference for surgeons who perform bone grafting. Patients should be informed of the potential risks.
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Affiliation(s)
- Fang-Hsin Lee
- From the Department of Nursing, Chung Hwa University of Medical Technology (F-HL, J-LH); Department of Orthopedics, Tainan Hospital, Ministry of Health and Welfare (P-CS); Department of Orthopedics, National Cheng Kung University Medical College (I-MJ); Department of Public Health, National Cheng Kung University Medical College, Tainan (C-YL); and Department of Public Health (C-YL), College of Public Health, China Medical University, Taichung, Taiwan
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24
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Wu VC, Huang KH, Peng KY, Tsai YC, Wu CH, Wang SM, Yang SY, Lin LY, Chang CC, Lin YH, Lin SL, Chu TS, Wu KD. Prevalence and clinical correlates of somatic mutation in aldosterone producing adenoma-Taiwanese population. Sci Rep 2015; 5:11396. [PMID: 26066391 PMCID: PMC4464349 DOI: 10.1038/srep11396] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/28/2015] [Indexed: 12/18/2022] Open
Abstract
Primary aldosteronism (PA) is a common form of secondary hypertension and has significant cardiovascular consequences. Mutated channelopathy due to the activation of calcium channels has been recently described in aldosterone-producing adenoma (APA). The study involved 148 consecutive PA patients, (66 males; aged 56.3 ± 12.3years) who received adrenalectomy, and were collected from the Taiwan PA investigator (TAIPAI) group. A high rate of somatic mutation in APA was found (n=91, 61.5%); including mutations in KCNJ5 (n=88, 59.5%), ATP1A1 (n=2, 1.4%), and ATP2B3 (n=1, 0.7%); however, no mutations in CACNA1D were identified. Mutation-carriers were younger (<0.001), had lower Cyst C (p=0.042), pulse wave velocity (p=0.027), C-reactive protein (p=0.042) and a lower rate of proteinuria (p=0.031) than non-carriers. After multivariate adjustment, mutation carriers had lower serum CRP levels than non-carriers (p=0.031. Patients with mutation also had a greater chance of recovery from hypertension after operation (p=0.005). A high incidence of somatic mutations in APA was identified in the Taiwanese population. Mutation-carriers had lower CRP levels and a higher rate of cure of hypertension after adrenalectomy. This raises the possibility of using mutation screening as a tool in predicting long-term outcome after adrenalectomy.
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Affiliation(s)
- Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Kuo-How Huang
- Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Kang-Yung Peng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Yao-Chou Tsai
- Division of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taiwan
| | - Che-Hsiung Wu
- Internal Medicine, Buddhist Tzu Chi General Hospital, Taipei Branch, Taiwan
| | - Shuo-Meng Wang
- Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Shao-Yu Yang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Lian-Yu Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Chin-Chen Chang
- Medical Imagine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Shuei-Liong Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Tzong-Shinn Chu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Kwan-Dun Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
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25
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Berggren SS, Tiderius CJ. The Cedell method (cerclage wire and staple) leads to less reoperations than the AO method: a retrospective comparative study of 347 lateral ankle fractures. Acta Orthop 2015; 86:384-7. [PMID: 25417836 PMCID: PMC4443465 DOI: 10.3109/17453674.2014.988526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Fractures of the lateral malleolus often require open reduction and internal fixation (ORIF). Despite uneventful fracture healing, many patients will suffer from long-term detriments after ORIF, such as local tenderness that requires hardware removal. In Sweden, there are 2 major fixation methods, either the AO method (plate and screws) or the Cedell method (cerclage wire and staple). The purpose of this study was to establish whether there is a difference in extraction frequency between the 2 methods. PATIENTS AND METHODS We performed a retrospective comparative study of all isolated fractures through the lateral malleolus that were operated at Skåne University Hospital, Sweden, during the period January 2007 to December 2010. 347 patients fulfilled the inclusion criteria (dislocated Weber B isolated fractures of the lateral malleolus) and were categorized according to fixation method. The numbers of reoperations, with preceding indication, were established from the charts. The median follow-up time was 59 (38-86) months after the primary surgery. RESULTS 22% of the 110 patients treated with the AO method underwent a reoperation, as compared to 8% of the 237 patients treated with the Cedell method (p < 0.001). The median time to extraction was 16 (4-55) months. INTERPRETATION Less implant removal is needed with the Cedell method than with the conventional AO method. This favors the use of the Cedell method in uncomplicated Weber B lateral ankle fractures, provided that other clinical parameters are comparable.
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Affiliation(s)
- Sara S Berggren
- Department of Orthopedics, Lund University and Skåne University Hospital, Lund, Sweden.
| | - Carl Johan Tiderius
- Department of Orthopedics, Lund University and Skåne University Hospital, Lund, Sweden.
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26
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Lin KB, Chan CL, Yang NP, Lai RK, Liu YH, Zhu SZ, Pan RH. Epidemiology of appendicitis and appendectomy for the low-income population in Taiwan, 2003-2011. BMC Gastroenterol 2015; 15:18. [PMID: 25888516 PMCID: PMC4329676 DOI: 10.1186/s12876-015-0242-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/29/2015] [Indexed: 12/14/2022] Open
Abstract
Background Although numerous epidemiological studies on appendicitis have been conducted worldwide, only a few studies have paid attention to the effect of socioeconomic status on appendicitis, particularly studies focusing on the low-income population (LIP). Methods We analyzed the epidemiological features of appendicitis in Taiwan using data from the National Health Insurance Research Database from 2003 to 2011. All cases diagnosed as appendicitis were enrolled. Results Between 2003 and 2011, 2,916 patients from the LIP and 209,206 patients from the normal population (NP) were diagnosed with appendicitis. Our finding revealed that the ratios of comorbidities, complicated appendicitis, and readmissions in LIP patients were slightly higher than those of NP patients. LIP patients were more likely to live in suburban and rural areas, and hence a higher proportion of them were hospitalized in a district or regional hospital compared with NP patients. The crucially finding was that the overall incidence ratios of appendicitis, acute appendicitis, and perforated appendicitis in the LIP were substantially higher than those in the NP (36.25%, 35.33%, and 37.28%, respectively). The mean LOS in LIP patients was longer than that of NP patients. The overall case-fatality ratio of appendectomy in the LIP was higher when compared with the NP (0.41% versus 0.12%, p < 0.05). We also observed that appendicitis was occurred frequently in male patients, with a higher incidence for those aged 15–29 years in both the LIP and NP. The incidences of incidental appendectomy showed a decreasing trend in both the LIP and NP. Finally, a valuable discovery was that the total hospital cost was comparable between the laparoscopic appendectomy (LA) and open appendectomy (OA) (1,178 ± 13 USD versus 1,191 ± 19 USD, p < 0.05) in LIP patients because they saved more hospitalization costs than NP patients when the previous one chose the LA. Conclusion This study confirmed that a lower socioeconomic status has significantly negative impact on the occurrence and treatment of appendicitis and appendectomy. In terms of hospital costs and LOS, LIP patients benefit more from the LA approach than they do from the OA approach in the treatment of appendicitis.
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Affiliation(s)
- Kai-Biao Lin
- School of Computer & Information Engineering, Xiamen University of Technology, Xiamen, 361024, China. .,Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, 32003, Taiwan.
| | - Chien-Lung Chan
- Department of Information Management, Yuan Ze University, Taoyuan, 32003, Taiwan. .,Innovation Center for Big data and Digital Convergence, Yuan Ze University, Taoyuan, 32003, Taiwan.
| | - Nan-Ping Yang
- Management Center, Keelung Hospital, Ministry of Health and Welfare, Keelung City, Taiwan. .,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
| | - Robert K Lai
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, 32003, Taiwan. .,Innovation Center for Big data and Digital Convergence, Yuan Ze University, Taoyuan, 32003, Taiwan.
| | - Yuan-Hung Liu
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, 32003, Taiwan. .,Innovation Center for Big data and Digital Convergence, Yuan Ze University, Taoyuan, 32003, Taiwan. .,Section of Cardiology, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| | - Shun-Zhi Zhu
- School of Computer & Information Engineering, Xiamen University of Technology, Xiamen, 361024, China.
| | - Ren-Hao Pan
- Innovation Center for Big data and Digital Convergence, Yuan Ze University, Taoyuan, 32003, Taiwan.
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The definition of a prolonged intensive care unit stay for spontaneous intracerebral hemorrhage patients: an application with national health insurance research database. BIOMED RESEARCH INTERNATIONAL 2014; 2014:891725. [PMID: 25126579 PMCID: PMC4122095 DOI: 10.1155/2014/891725] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/18/2014] [Accepted: 06/24/2014] [Indexed: 11/26/2022]
Abstract
Introduction. Length of stay (LOS) in the intensive care unit (ICU) of spontaneous intracerebral hemorrhage (sICH) patients is one of the most important issues. The disease severity, psychosocial factors, and institutional factors will influence the length of ICU stay. This study is used in the Taiwan National Health Insurance Research Database (NHIRD) to define the threshold of a prolonged ICU stay in sICH patients. Methods. This research collected the demographic data of sICH patients in the NHIRD from 2005 to 2009. The threshold of prolonged ICU stay was calculated using change point analysis. Results. There were 1599 sICH patients included. A prolonged ICU stay was defined as being equal to or longer than 10 days. There were 436 prolonged ICU stay cases and 1163 nonprolonged cases. Conclusion. This study showed that the threshold of a prolonged ICU stay is a good indicator of hospital utilization in ICH patients. Different hospitals have their own different care strategies that can be identified with a prolonged ICU stay. This indicator can be improved using quality control methods such as complications prevention and efficiency of ICU bed management. Patients' stay in ICUs and in hospitals will be shorter if integrated care systems are established.
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Vosseller JT, Karl JW, Greisberg JK, Zhang C, Zhou Z. Incidence of syndesmotic injury. Orthopedics 2014; 37:e226-9. [PMID: 24762148 DOI: 10.3928/01477447-20140225-53] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/25/2013] [Indexed: 02/03/2023]
Abstract
Injury to the tibiofibular syndesmosis can occur with ankle sprain or fracture. The incidence of syndesmotic injury has not been specifically studied at a population level. Data on syndesmotic injury were obtained from the Healthcare Cost and Utilization Project (HCUP), a federal-state-private partnership. It is administered by the Agency for Healthcare Research and Quality, a division of the US Department of Health and Human Services. Two HCUP databases were queried for 8 states: the State Inpatient Database and the State Emergency Department Database. The first 6 International Classification of Diseases, Ninth Edition (ICD-9) code diagnoses were searched for codes that are used for syndesmotic injury (ie, 845.03). These data, along with data from the 2010 US census, were used to yield incidence rates for syndesmosis injury, as well as for various demographic groups. National estimates of injury totals were also calculated. In the 8 states, there were a total of 1821 syndesmotic injuries. Given the population of these states, the incidence rate of syndesmotic injury was 2.09 syndesmotic injuries per 100,000 person-years. This incidence correlates to an estimated 6445 syndesmotic injuries per year in the United States. These data provide some baseline numbers as to the incidence of syndesmotic injury in the United States. Although the incidence was low relative to some other injuries, the fact that syndesmotic injuries tend to occur in younger patients may have a greater effect in terms of productive years of life lost.
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Wang WJ, Chao CT, Huang YC, Wang CY, Chang CH, Huang TM, Lai CF, Huang HY, Shiao CC, Chu TS, Chen YM, Wu VC, Ko WJ, Wu KD. The impact of acute kidney injury with temporary dialysis on the risk of fracture. J Bone Miner Res 2014; 29:676-84. [PMID: 23929760 DOI: 10.1002/jbmr.2061] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 07/22/2013] [Accepted: 07/29/2013] [Indexed: 12/21/2022]
Abstract
Acute kidney injury (AKI) has a negative impact on long-term renal function and prognosis. However, the association between acute renal dysfunction and long-term effects on bone disorders has not yet been characterized. Using a population-based cohort study, we aimed to evaluate associations between AKI and long-term effects on bone fractures. We identified relevant data of all hospitalized patients aged >18 years with histories of dialysis-requiring AKI, with subsequent recovery and discharge, from the claim records of the Taiwan National Health Insurance database between 2000 and 2008. We determined long-term de novo bone fracture and all-cause mortality after patients' index-hospitalization discharge using propensity score-adjusted Cox proportional hazard model. Varying-time models were used to adjust for long-term effects of end-stage renal disease (ESRD) on main outcomes. Among 448 AKI patients who had dialysis and survived 90 days after index-hospitalization discharge without reentering dialysis, 273 were male (60.9%) with a mean age of 61.4 ± 16.6 years. Controls included 1792 hospitalized patients without AKI, dialysis, or bone fracture history. In the AKI recovery group, bone fracture incidence was 320 per 10,000 person-years and hazard ratio (HR) of long-term bone fracture was 1.25 (p = 0.049) compared with the control group, independent of subsequent ESRD status (HR = 1.55; p = 0.01). Both AKI recovery status (HR = 2.31; p < 0.001) and time varying factor of bone fracture (HR = 1.43; p < 0.001) were independent predictors of mortality compared with controls. In conclusion, AKI requiring temporary dialysis independently increases long-term risk of bone fracture, regardless of subsequent progression to ESRD. Long-term bone fractures may negatively impact patient mortality.
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Affiliation(s)
- Wei-Jie Wang
- Department of Internal Medicine, Tao-Yuan General Hospital, Tao-Yuan County, Taiwan
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30
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Wajnsztejn A, Ejnisman L, Zlotnik E, Zitron LR, Ejnisman B, Cohen M. Cesarean section and osteosynthesis of lower limb fractures in the same surgical procedure. Int J Surg Case Rep 2014; 5:111-3. [PMID: 24469261 PMCID: PMC3921648 DOI: 10.1016/j.ijscr.2013.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 11/10/2013] [Accepted: 11/26/2013] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION PRESENTATION OF CASE DISCUSSION CONCLUSION
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31
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Chang NT, Chan CL, Lu YT, Hsu JC, Hsu YN, Chu D, Yang NP. Invasively-treated incidence of lower extremity peripheral arterial disease and associated factors in Taiwan: 2000-2011 nationwide hospitalized data analysis. BMC Public Health 2013; 13:1107. [PMID: 24289250 PMCID: PMC4219520 DOI: 10.1186/1471-2458-13-1107] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 11/26/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Lower extremity (LE) peripheral artery disease (PAD), which is associated with a reduced quality of life and increased mortality from atherosclerotic cardio-/cerebro-vascular occlusion, is a significant public health problem, especial for an aging society such as that of Taiwan. METHODS Specific datasets of the 2000-2011 nationwide inpatient databases were analyzed. Two inclusion criteria, including one of the major diagnosis codes of PAD and one of three categorical invasive treatments of LE PAD, were used consecutively to select cases diagnosed as LE PAD and receiving invasive treatment. The epidemiology of invasively-treated PAD in Taiwan was estimated, and the influences of potential confounders on these invasively-treated methods were evaluated. RESULTS In general, the invasively-treated incidence of PAD in Taiwan doubled, from 3.73/10,000 (in 2000) to 7.48/10,000 (in 2011). On average, the total direct medical cost of one hospitalized and invasively-treated PAD case ranged from $US 4,600 to $US 5,900. The annual cases of bypass surgery for the PAD cases averaged 1,000 and the cases for limb amputation ranged from 4,100 to 5,100 annually. However, the number of percutaneous transluminal angioplasty (PTA) procedures remarkably increased by 15 times, from 600/year to 9,100/year, from 2000 to 2011. 51.3% of all the enrolled cases were treated with limb amputations, and female, young and middle-aged people (30-65 years of age), DM patients and those on a low income had a tendency to undergo amputation due to PAD. 37.6% of all the enrolled cases were treated with PTAs related to hypertension, cardiovascular disease, hyperlipidemia and catastrophic Illness. 2-year PTA failure rates of 22.13%, 11.91% and 10.61% were noted among the first (2000-2001), second (2004-2005) and the third (2008-2009) cohort groups, respectively. CONCLUSIONS In Taiwan, a gender difference and age and period effects on the invasively-treated incidence of LE PAD were observed. Female, young and middle-aged people (30-50 and 50-65 years of age), DM patients and those on a low income had a tendency to undergo amputation. The number of PTA procedures remarkably increased, but the 2-year failure rate of PTAs reduced from 2000 to 2011.
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Affiliation(s)
| | | | | | | | | | | | - Nan-Ping Yang
- Department of Medical Research, Taoyuan General Hospital, Ministry of Health & Welfare, Taoyuan, Taiwan.
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Nationwide retrospective cohort survey of orthopedic injuries in members of the Taiwanese population with psychiatric disorders, 2000-2005. J Orthop Sci 2013; 18:456-64. [PMID: 23463121 DOI: 10.1007/s00776-013-0365-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/31/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND The relationship between psychiatric disorders and musculoskeletal injuries is interesting but has not been investigated in depth. STUDY DESIGN A retrospective cohort study, based on a large-sample nationwide database, was performed during 2000-2005 in Taiwan. METHODS All subjects matching the inclusion criteria of psychiatric-associated ICD9-CM diagnostic codes in 2000 were selected as the inception cohort population. Another cohort-based case-control study was designed, and one sex-matched and age-matched (1:1) control group randomly selected from the population without any prevalent psychiatric disorder in 2000 and incident psychiatric disorder in 2001-2005 was used for comparison. RESULTS 64,662 Taiwanese people with any prevalent psychiatric disorder were enrolled in this study in 2000. The 6-year cumulative incidences of orthopedic injuries were 13.61/10,000 for femoral neck/femur fracture and 4.64/10,000, 3.40/10,000, 3.25/10,000, and 3.09/10,000 for radius/ulna or hand fracture, tibia/fibula or patella fracture, ankle or foot fracture, and humeral fracture, respectively. Compared with the control group, this Taiwanese population with prevalent psychiatric disorders had fewer incidences of all orthopedic injuries during the 6 years since 2000, and their cumulative incidence ratios ranged from 0.04 to 0.4 for the different injury sites. For lower-limb fractures, compared with the age stratum of less than 20-years-old, the odds ratios (OR) for the age strata 80-years-old or more and 60-79-years-old were 15.84 (95 % CI 4.55-55.20) and 6.11 (95 % CI 1.92-19.49), respectively. The people with organic psychotic conditions had a significantly greater tendency to suffer upper-limb and lower-limb fractures than those with other psychiatric diagnoses (the ranges of ORs were 3.23-16.67 and 2.13-25.00, respectively). CONCLUSION Subjects with prevalent psychiatric disorders had fewer occurrences of orthopedic injuries than the general population. Among this specific population, an organic psychotic condition and old age were risk factors for suffering fracture of a limb.
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Nan-Ping Y, Yi-Hui L, Chi-Yu C, Jin-Chyr H, I-Liang Y, Nien-Tzu C, Chien-Lung C. Comparisons of medical utilizations and categorical diagnoses of emergency visits between the elderly with catastrophic illness certificates and those without. BMC Health Serv Res 2013; 13:152. [PMID: 23622501 PMCID: PMC3648396 DOI: 10.1186/1472-6963-13-152] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 04/22/2013] [Indexed: 11/26/2022] Open
Abstract
Background In Taiwan, the policy of catastrophic illness certificates has benefited some populations with specific diseases, but its effect on the use of medical services and the sequence of public health has not been examined. As a pilot of a series of studies, focused on emergency department (ED) visits, the present study aimed to compare medical utilization and various diagnostic categories at EDs between the elderly with an identified catastrophic illness and the elderly without. Methods A cross-sectional study, based on a large-sample nationwide database (one million of the population, randomly sampled from Taiwan’s National Health Insurance Research Database (NHIRD)), was performed in Taiwan. The 2008 insurance records of ambulatory medical services for subjects aged 65 years or more among the above one million of the population were further selected and analyzed. Taiwan’s registered catastrophic illness dataset for 2008 was linked in order to identify the target subgroup. Results The prevalence of certificated catastrophic illness in Taiwan’s elderly utilizing ambulatory medical services was 10.16%. On average, 61.62 emergency department (ED) visits/1,000 persons (95% CI: 59.22–64.01) per month was estimated for the elderly Taiwanese with catastrophic illness, which was significantly greater than that for the elderly without a catastrophic illness (mean 33.53, 95% CI: 32.34–34.71). A significantly greater total medical expenditure for emergency care was observed in the catastrophic illness subgroup (US$145.6 ± 193.5) as compared with the non-catastrophic illness group (US$108.7 ± 338.0) (p < 0.001). The three most common medical problems diagnosed when visiting EDs were injury/poisoning (14.22%), genitourinary disorders (11.26%) and neoplasm-related morbidity (10.77%) for the elderly population with a catastrophic illness, which differed from those for the elderly without a catastrophic illness. Conclusions In Taiwan, the elderly with any certificated catastrophic illness had significantly more ED visits and a higher ED medical cost due to untypical medical complaints.
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Affiliation(s)
- Yang Nan-Ping
- Institute of Public Health, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Chang NT, Lee YH, Hsu JC, Chan CL, Huang GS, Renn JH, Yang NP. Epidemiological study of orthopedic injuries in hemodialysis patients in Taiwan: a fixed cohort survey, 2004-2008. Clin Interv Aging 2013; 8:301-8. [PMID: 23682209 PMCID: PMC3653676 DOI: 10.2147/cia.s41132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The burden of chronic kidney disease (CKD) is a growing concern worldwide. The prevalence of hemodialysis in Taiwan is the highest in the world, and this may increase the prevalence of orthopedic fractures. The aim of this study was to explore the incidences of various orthopedic injuries and the related risk factors. METHODS A nationwide prospective study based on the Taiwan National Health Insurance dataset was conducted during 2004-2008. A total of 82,491 CKD patients were selected as the fixed cohort population. The International Classification of Diseases 9-CM diagnosis codes and treatment codes were identified as the inclusion criteria for orthopedic injury. RESULTS A total of 82,491 Taiwanese people with CKD were identified in 2004, and 4915 orthopedic injuries occurred during the 5-year follow-up period. The cumulative incidences of orthopedic injuries were 42.56‰ for lower limb fractures, and 12.93‰, 3.27‰, and 1.64‰ for upper limb fractures, vertebrae fractures, and joint dislocations, respectively. All three types of orthopedic fractures were more common in the oldest age stratum (≥65 years old). In the CKD patients, the risk ratio of osteoporosis was 3.47 (95% confidence interval, 3.10-3.89) for all orthopedic injuries. Patients of advanced age, the female gender, and those with high comorbidity were also at significant risk of sustaining orthopedic fractures. CONCLUSION The results from this Taiwanese CKD cohort support the strong influence of aging and osteoporosis on all kinds of orthopedic injuries. The postponing of osteoporosis may need to be taken into consideration for the prevention of orthopedic injury among CKD patients undergoing hemodialysis.
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Affiliation(s)
- Nien-Tzu Chang
- Community Health Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
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Meta-analysis of re-operation, nonunion, and infection after open reduction and internal fixation of patella fractures. J Trauma Acute Care Surg 2012; 73:928-32. [PMID: 22902732 DOI: 10.1097/ta.0b013e31825168b6] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The subcutaneous location of the patella and the demand for early knee motion contribute to the difficulty in treating patients with patella fractures. The reported rates in the literature for hardware removal after patella open reduction and internal fixation range from 0% to 60%. The wide variability of these reports leaves the true frequency of re-operation and complications after patella open reduction and internal fixation in question. Furthermore, gaining a better understanding of the factors that contribute to re-operation and complications will help to generate hypotheses and research agendas to address these difficult problems. METHODS We performed a systematic review to identify publications in which adult patients with patella fractures were surgically treated with a minimum of 6-month follow-up. The surgical technique (tension band or other), infection rate, nonunion rate, and re-operation rate (including removal of hardware) were recorded. Meta-regression analysis was used to describe the potential contributory factors for re-operation, nonunion, and infection while controlling for age, gender, open fracture, surgical technique, and date of publication. Separate regression models were constructed for each outcome depending on the number of studies available for inclusion. RESULTS The frequency of re-operation was 33.6% in a meta-analysis of 24 studies (737 patella fractures). The frequency of infection was 3.2% in a meta-analysis of 18 studies (522 patella fractures). The frequency of nonunion was 1.3% in a meta-analysis of 15 studies (464 patella fractures). There were no significant predictors for re-operation, nonunion, or infection in any of the regression analyses. CONCLUSION Although the frequencies of nonunion and infection are relatively low after surgical treatment of patella fractures, the modern rate of re-operation is substantial. LEVEL OF EVIDENCE Meta-analysis, level III+.
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Berkes MB, Little MTM, Lazaro LE, Sculco PK, Cymerman RM, Daigl M, Helfet DL, Lorich DG. Malleolar fractures and their ligamentous injury equivalents have similar outcomes in supination-external rotation type IV fractures of the ankle treated by anatomical internal fixation. ACTA ACUST UNITED AC 2012; 94:1567-72. [DOI: 10.1302/0301-620x.94b11.28662] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
It has previously been suggested that among unstable ankle fractures, the presence of a malleolar fracture is associated with a worse outcome than a corresponding ligamentous injury. However, previous studies have included heterogeneous groups of injury. The purpose of this study was to determine whether any specific pattern of bony and/or ligamentous injury among a series of supination-external rotation type IV (SER IV) ankle fractures treated with anatomical fixation was associated with a worse outcome. We analysed a prospective cohort of 108 SER IV ankle fractures with a follow-up of one year. Pre-operative radiographs and MRIs were undertaken to characterise precisely the pattern of injury. Operative treatment included fixation of all malleolar fractures. Post-operative CT was used to assess reduction. The primary and secondary outcome measures were the Foot and Ankle Outcome Score (FAOS) and the range of movement of the ankle. There were no clinically relevant differences between the four possible SER IV fracture pattern groups with regard to the FAOS or range of movement. In this population of strictly defined SER IV ankle injuries, the presence of a malleolar fracture was not associated with a significantly worse clinical outcome than its ligamentous injury counterpart. Other factors inherent to the injury and treatment may play a more important role in predicting outcome.
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Affiliation(s)
- M. B. Berkes
- Hospital for Special Surgery, 535
East 70th Street, New York, New
York 10021, USA
| | - M. T. M. Little
- Hospital for Special Surgery, 535
East 70th Street, New York, New
York 10021, USA
| | - L. E. Lazaro
- New York Presbyterian Hospital, 520
East 70th Street, Starr Pavilion 2nd Floor, New York, New
York 10021, USA
| | - P. K. Sculco
- Hospital for Special Surgery, 535
East 70th Street, New York, New
York 10021, USA
| | - R. M. Cymerman
- New York Presbyterian Hospital, 520
East 70th Street, Starr Pavilion 2nd Floor, New York, New
York 10021, USA
| | - M. Daigl
- AO Clinical Investigation and Documentation, Stettbachstrasse
6, 8600 Dubendorf, Switzerland
| | - D. L. Helfet
- Hospital for Special Surgery, 535
East 70th Street, New York, New
York 10021, USA
| | - D. G. Lorich
- New York Presbyterian Hospital, 520
East 70th Street, Starr Pavilion 2nd Floor, New York, New
York 10021, USA
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A comparison of percutaneous reduction and screw fixation versus open reduction and plate fixation of traumatic symphysis pubis diastasis. Arch Orthop Trauma Surg 2012; 132:265-70. [PMID: 22139387 DOI: 10.1007/s00402-011-1414-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE Plate fixation, the conventional treatment for traumatic symphysis pubis diastasis, carries the risk of extensive exposure, blood loss and postoperative infections. Percutaneous screw fixation is a minimally invasive treatment. The goal of the present study was to compare the outcome of plate fixation and percutaneous screw technique in the treatment of traumatic pubic symphysis diastasis. METHODS Ninety patients with traumatic symphysis pubis diastasis were treated from January 2003 to December 2009 at two level 1 regional trauma centers. The mean time of follow-up was 21 months (18 to 26). Forty-five patients were treated by percutaneous screw fixation. Forty-five patients were treated by plate and screws fixation. The demographic, distribution of fracture patterns, blood loss, incision length, fixation failure, malunion, revision surgery and functional scores were compared. RESULTS Seven cases were lost during follow-up. Demographics (age and gender), fracture classification and Injury Severity Score were comparable in the two groups (P > 0.05). Blood loss and extensive exposure were much less in screw group (P < 0.01). Patients in screw group achieved better functional performance (P = 0.01). There were no significant differences favoring plate fixation in reduction quality (P = 0.32), implant failure (P = 0.39), malunion (P = 0.15), revision surgery rates (P = 0.27), percentage of impotence in the male patients (P = 0.2) and implant removal time (P = 0.12) between the two groups. CONCLUSIONS Our results indicate that besides lower rate of iatrogenic injuries and better functional outcome, percutaneous screw fixation of the pubic symphysis is as strong as plate fixation.
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Mataliotakis GI, Giannoudis PV. Radiological measurements for postoperative evaluation of quality of reduction of unstable pelvic ring fractures: Advantages and limitations. Injury 2011; 42:1395-401. [PMID: 22019356 DOI: 10.1016/j.injury.2011.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Yang NP, Chen HC, Phan DV, Yu IL, Lee YH, Chan CL, Chou P, Renn JH. Epidemiological survey of orthopedic joint dislocations based on nationwide insurance data in Taiwan, 2000-2005. BMC Musculoskelet Disord 2011; 12:253. [PMID: 22053727 PMCID: PMC3228707 DOI: 10.1186/1471-2474-12-253] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 11/05/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The epidemiology of acute orthopedic dislocations is poorly understood. A nationwide database provides a valuable resource for examining this issue in the Taiwanese population. METHODS A 6-year retrospective cohort study of 1,000,000 randomly-sampled beneficiaries from the year 2005 was used as the original population. Based on the hospitalized and ambulatory data, the concomitant ICD9-CM diagnosis codes and treatment codes were evaluated and classified into 8 and 3 major categories, respectively. The cases matching both inclusive criteria of dislocation-related diagnosis codes and treatment codes were defined as incident cases. RESULTS During 2000-2005, the estimated annual incidence (per 100,000 population) of total orthopedic dislocations in Taiwan was 42.1 (95%CI: 38.1-46.1). The major cause of these orthopedic dislocations was traffic accidents (57.4%), followed by accident falls (27.5%). The annual incidence dislocation by location was shoulder, 15.3; elbow, 7.7; wrist, 3.5; finger, 4.6; hip, 5.2; knee, 1.4; ankle, 2.0; and foot, 2.4. Approximately 16% of shoulder dislocations occurred with other concomitant fractures, compared with 17%, 53%, 16%, 76% and 52%, respectively, of dislocated elbow, wrist, hip, knee, and ankle cases. Including both simple and complex dislocated cases, the mean medical cost was US$612 for treatment of a shoulder dislocation, $504 for the elbow, $1,232 for the wrist, $1,103 for the hip, $1,888 for the knee, and $1,248 for the ankle. CONCLUSIONS In Taiwan, three-quarters of all orthopedic dislocations were of the upper limbs. The most common complex fracture-dislocation was of the knee, followed by the wrist and the ankle. Those usually needed a treatment combined with open reduction of fractures and resulted in a higher direct medical expenditure.
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Affiliation(s)
- Nan-Ping Yang
- Community Health Research Center & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Department of Orthopedics & Department of Medical Research, Tao-Yuan General Hospital, Department of Health, Taoyuan, Taiwan
| | - Hou-Chaung Chen
- Community Health Research Center & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Department of Orthopedics, Tai-Chung General Hospital, Department of Health, Taichung, Taiwan
| | - Dinh-Van Phan
- Department of Information Management, Yuan-Ze University, Taoyuan, Taiwan
| | - I-Liang Yu
- Department of Orthopedics & Department of Medical Research, Tao-Yuan General Hospital, Department of Health, Taoyuan, Taiwan
- Department of Information Management, Yuan-Ze University, Taoyuan, Taiwan
| | - Yi-Hui Lee
- Department of Nursing, School of Nursing, Chang-Gang University, Taoyuan, Taiwan
| | - Chien-Lung Chan
- Department of Information Management, Yuan-Ze University, Taoyuan, Taiwan
| | - Pesus Chou
- Community Health Research Center & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Jenn-Huei Renn
- Community Health Research Center & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Executives Yuan, Kaohsiung, Taiwan
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