1
|
Lau RWL, Cheuk KY, Hung VWY, Yu FWP, Tam EMS, Wong LLN, Zhang J, Lee WYW, Cheng JCY, Lam TP, Lau AYC. Handgrip strength assessment at baseline in addition to bone parameters could potentially predict the risk of curve progression in adolescent idiopathic scoliosis. Front Pediatr 2023; 11:1258454. [PMID: 38027290 PMCID: PMC10655030 DOI: 10.3389/fped.2023.1258454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Adolescent idiopathic scoliosis (AIS) is characterized by deranged bone and muscle qualities, which are important prognostic factors for curve progression. This retrospective case-control study aims to investigate whether the baseline muscle parameters, in addition to the bone parameters, could predict curve progression in AIS. Methods The study included a cohort of 126 female patients diagnosed with AIS who were between the ages of 12 and 14 years old at their initial clinical visit. These patients were longitudinally followed up every 6 months (average 4.08 years) until they reached skeletal maturity. The records of these patients were thoroughly reviewed as part of the study. The participants were categorized into two sub-groups: the progressive AIS group (increase in Cobb angle of ≥6°) and the stable AIS group (increase in Cobb angle <6°). Clinical and radiological assessments were conducted on each group. Results Cobb angle increase of ≥6° was observed in 44 AIS patients (34.9%) prior to skeletal maturity. A progressive AIS was associated with decreased skeletal maturity and weight, lower trunk lean mass (5.7%, p = 0.027) and arm lean mass (8.9%, p < 0.050), weaker dominant handgrip strength (8.8%, p = 0.027), deranged cortical compartment [lower volumetric bone mineral density (vBMD) by 6.5%, p = 0.002], and lower bone mechanical properties [stiffness and estimated failure load lowered by 13.2% (p = 0.005) and 12.5% (p = 0.004)]. The best cut-off threshold of maximum dominant handgrip strength is 19.75 kg for distinguishing progressive AIS from stable AIS (75% sensitivity and 52.4% specificity, p = 0.011). Discussion Patients with progressive AIS had poorer muscle and bone parameters than patients with stable AIS. The implementation of a cut-off threshold in the baseline dominant handgrip strength could potentially be used as an additional predictor, in addition to bone parameters, for identifying individuals with AIS who are at higher risk of experiencing curve progression.
Collapse
Affiliation(s)
- Rufina Wing Lum Lau
- School of Medical and Health Sciences, Tung Wah College, Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ka Yee Cheuk
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Vivian Wing Yin Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Fiona Wai Ping Yu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Elisa Man Shan Tam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Lyn Lee Ning Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jiajun Zhang
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wayne Yuk Wai Lee
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jack Chun Yiu Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tsz Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Adam Yiu Chung Lau
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| |
Collapse
|
2
|
Wu Z, Zhu X, Xu L, Liu Z, Feng Z, Hung VWY, Cheng JCY, Qiu Y, Lee WYW, Lam TP, Zhu Z. More Prevalent and Severe Low Bone-Mineral Density in Boys with Severe Adolescent Idiopathic Scoliosis Than Girls: A Retrospective Study of 798 Surgical Patients. J Clin Med 2023; 12:jcm12082991. [PMID: 37109327 PMCID: PMC10143180 DOI: 10.3390/jcm12082991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION A total of 0.1-0.8% of AIS patients progress to severe stages without clear mechanisms, and AIS girls are more prone to curve progression than boys. Recent studies suggest that AIS girls have systemic and persistent low bone-mineral density (BMD), which has been shown to be a significant prognostic factor of curve progression in AIS. The present study aimed to (a) investigate the prevalence of low BMD in patients with severe AIS and (b) assess the sexual dimorphism and independent risk factors of low BMD in severe AIS patients. MATERIALS AND METHODS A total of 798 patients (140 boys vs. 658 girls) with AIS who reached surgical threshold (Cobb ≥ 40°) were recruited. BMD were assessed using BMD Z-scores from dual-energy X-ray absorptiometry (DXA). Demographic, clinical, and laboratory values of the subjects were collected from their medical records. Logistic regression analysis was performed to identify independent risk factors of low BMD. RESULTS The overall prevalence of BMD Z-score ≤ -2 and ≤ -1 were 8.1% and 37.5%, respectively. AIS boys had significantly lower BMD Z-scores (-1.2 ± 0.96 vs. -0.57 ± 0.92) and higher prevalence of low BMD (Z-score ≤ -2: 22.1% vs. 5.2%, p < 0.001; Z-score ≤ -1: 59.3% vs. 32.8%, p < 0.001) than girls. Sex, BMI, serum alkaline phosphatase, and potassium were independent factors of low BMD in the severe AIS patients. CONCLUSIONS The present large cohort of surgical AIS patients revealed that low BMD is more prevalent and severe in boys than in girls with severe curves. Low BMD may serve as a more valuable predictive factor for curve progression to the surgical threshold in boys than girls with AIS.
Collapse
Affiliation(s)
- Zhichong Wu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
- Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University, Hong Kong, China
| | - Xiufen Zhu
- Osteoporosis and Metabolic Bone Disease Center, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Leilei Xu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
- Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University, Hong Kong, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
- Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University, Hong Kong, China
| | - Zhenhua Feng
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
- Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University, Hong Kong, China
| | - Vivian Wing Yin Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Jack Chun Yiu Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
- Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University, Hong Kong, China
| | - Wayne Y W Lee
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Tsz Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
- Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University, Hong Kong, China
| |
Collapse
|
3
|
Ma H, Hu Z, Shi B, Liu Z, Zhu Z, Chu WCW, Lam TP, Cheng JCY, Qiu Y. Global Alignment and Proportion (GAP) score in asymptomatic individuals: is it universal? Spine J 2022; 22:1566-1575. [PMID: 35447324 DOI: 10.1016/j.spinee.2022.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The global alignment and proportion (GAP) score was established based on American and European subjects, which might limit its applicability to the Chinese population due to ethnicity-related difference of sagittal alignment. PURPOSE To analyze the applicability of GAP score in the Chinese population and to investigate the age- and gender-associated differences of spinopelvic and GAP score parameters. STUDY DESIGN A prospective cross-sectional radiographic study. PATIENTS SAMPLE Of 692 asymptomatic Chinese volunteers aged between 20 and 79 prospectively recruited between January 2017 and June 2019, 490 subjects were eventually included in this study. OUTCOME MEASURES The pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), L1-S1 lordosis, L4-S1 lordosis, sagittal vertical axis (SVA), T1 pelvic angle (TPA) and global tilt (GT) were measured on lateral X-rays. The GAP scores and its parameters including relative pelvic version (RPV), relative lumbar lordosis (RLL), lordosis distribution index (LDI) and relative spinopelvic alignment (RSA) were calculated for each subject. METHODS Subjects were divided into four groups: Group 1M: male subjects <60 years old; Group 1F: female subjects <60 years old; Group 2M: male subjects ≥60 years old and Group 2F: female subjects ≥60 years old. The GAP scores and categories were determined and compared between groups. The results of sagittal alignment were compared with the previous studies evaluating the normative sagittal alignment in other populations. Univariate linear regression analysis was carried out between pelvic incidence (PI) and sacral slope (SS), lumbar lordosis (LL) and global tilt (GT) in each group. RESULTS The distributions of GAP categories and the updated Roussouly classification were statistically different from other populations. Significantly different distribution of GAP categories was observed between Group 1M and Group 2M, Group 1F and Group 2F, and Group 1M and Group 1F. Radiographic measurements and GAP parameters were significantly different between Group 1M and Group 2M, and Group 1F and Group 2F. Gender-related difference of parameters was more prominent between Group 1M and Group 1F. Linear relationship of PI with SS, LL and GT were different from the regression models of "ideal" sagittal alignment in GAP score. CONCLUSIONS The GAP score might be inappropriate in Chinese population due to ethnicity-related alignment difference. Worse feasibility of GAP score was observed in female and old subjects.
Collapse
Affiliation(s)
- Hongru Ma
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China
| | - Zongshan Hu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China
| | - Benlong Shi
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China.
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China
| | - Tsz Ping Lam
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China; Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China
| | - Jack Chun Yiu Cheng
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China; Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China
| |
Collapse
|
4
|
Li X, Huo Z, Hu Z, Lam TP, Cheng JCY, Chung VCH, Yip BHK. Which interventions may improve bracing compliance in adolescent idiopathic scoliosis? A systematic review and meta-analysis. PLoS One 2022; 17:e0271612. [PMID: 35857763 PMCID: PMC9299303 DOI: 10.1371/journal.pone.0271612] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/01/2022] [Indexed: 11/19/2022] Open
Abstract
This review aimed to systematically review and meta-analyze the effects of interventions in improving bracing compliance among adolescent idiopathic scoliosis (AIS) patients. Eight databases were searched from their inception to April 2022. The eligibility criteria included controlled studies that used any type of intervention to enhance bracing compliance in braced AIS patients. Two researchers independently screened articles and extracted data based on the PICO (participant, intervention, comparator, and outcome) framework. Quality appraisal of included studies was performed using GRADE (overall assessment), and the risk of bias was assessed with Cochrane RoB Tool 2 for randomized controlled trials (RCT) and ROBINS-I for non-RCT studies. The primary outcome was bracing compliance and secondary outcomes included Cobb Angle and measurements for quality of life. Six eligible studies involving 523 participants were included. All studies were evaluated as low or very low quality with a high risk of bias. Four types of interventions were identified, including sensor monitoring (n = 2, RCTs), auto-adjusted brace (n = 1, RCT), more intensive or collaborated medical care (n = 2), and psychosocial intervention (n = 1). A meta-analysis of 215 patients from the three RCTs suggested that the compliance-enhancing intervention group had 2.92 more bracing hours per day than the usual care control (95%CI [1.12, 4.72], P = 0.001). In subgroup analysis, sensor monitoring significantly improved bracing wearing quantity compared to usual care (3.47 hours/day, 95%CI [1.48, 5.47], P = 0.001), while other aforementioned interventions did not show a significant superiority. Compliance-enhancing interventions may be favorable in preventing curve progression and promoting quality of life, but the improvements cannot be clarified according to limited evidence. In conclusion, although the results of this study suggested that sensor monitoring may be the most promising approach, limited high-quality evidence precludes reliable conclusions. Future well-designed RCTs are required to confirm the actual benefit of compliance-improving interventions in clinical practice.
Collapse
Affiliation(s)
- Xue Li
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhaohua Huo
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zongshan Hu
- Department of Spine Surgery, Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Tsz Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong SAR, China
| | - Jack Chun Yiu Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong SAR, China
| | - Vincent Chi-ho Chung
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Benjamin Hon Kei Yip
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- * E-mail:
| |
Collapse
|
5
|
Deng M, Chen Q, Deng Q, Shi L, Cheng CCN, Yeung KH, Zhang R, Yu WPF, Lam TP, Cheng JCY, Chu WCW. Statistical changes of lung morphology in patients with adolescent idiopathic scoliosis after spinal fusion surgery—a prospective nonrandomized study based on low-dose biplanar X-ray imaging. Quant Imaging Med Surg 2022; 12:3325-3339. [DOI: 10.21037/qims-21-1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/27/2021] [Indexed: 11/06/2022]
|
6
|
Hui SSC, Lau RWL, Cheng JCY, Lam TP. High-impact weight-bearing home exercises in girls with adolescent idiopathic scoliosis: a pilot study (abridged secondary publication). Hong Kong Med J 2022; 28 Suppl 3:31-33. [PMID: 35701228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- S S C Hui
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong
| | - R W L Lau
- School of Medical and Health Sciences, Tung Wah College, Hong Kong, China
| | - J C Y Cheng
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong
| | - T P Lam
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong
| |
Collapse
|
7
|
Yang KG, Lee WYW, Hung ALH, Hung VWY, Tang MF, Leung TF, Kong APS, Cheng JCY, Lam TP. Decreased cortical bone density and mechanical strength with associated elevated bone turnover markers at peri-pubertal peak height velocity: a cross-sectional and longitudinal cohort study of 396 girls with adolescent idiopathic scoliosis. Osteoporos Int 2022; 33:725-735. [PMID: 34643755 DOI: 10.1007/s00198-021-06200-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
UNLABELLED Decreased cortical bone density and bone strength at peak height velocity (PHV) were noted in girls with adolescent idiopathic scoliosis (AIS). These findings could provide the link to the previously reported observation that low bone mineral density (BMD) could contribute as one of the prognostic factors for curve progression that mostly occurs during PHV in AIS. INTRODUCTION As part of the studies related to aetiopathogenesis of AIS, we assessed bone qualities, bone mechanical strength and bone turnover markers (BTMs) focusing at the peri-pubertal period and PHV in AIS girls. METHODS 396 AIS girls in two separate cohorts were studied. Skeletal maturity was assessed using the validated thumb ossification composite index (TOCI). Bone qualities and strength were evaluated with high-resolution peripheral quantitative computed tomography (HR-pQCT) and finite element analysis (FEA). RESULTS Cohort-A included 179 girls (11.95 ± 0.95 years old). Girls at TOCI-4 had numerically the highest height velocity (0.71 ± 0.24 cm/month) corresponding to the PHV. Subjects at TOCI-4 had lower cortical volumetric BMD (672.36 ± 39.07 mg/mm3), cortical thickness (0.68 ± 0.08 mm) and apparent modulus (1601.54 ± 243.75 N/mm2) than: (a) those at TOCI-1-3 (724.99 ± 32.09 mg/mm3 (p < 0.001), 0.79 ± 0.11 mm (p < 0.001) and 1910.88 ± 374.75 N/mm2 (p < 0.001), respectively) and (b) those at TOCI-8 (732.28 ± 53.75 mg/mm3 (p < 0.001), 0.84 ± 0.14 mm (p < 0.001), 1889.11 ± 419.37 N/mm2 (p < 0.001), respectively). Cohort-B included 217 girls (12.22 ± 0.89 years old). Subjects at TOCI-4 had higher levels of C-terminal telopeptide of type 1 collagen (1524.70 ± 271.10 pg/L) and procollagen type 1 N-terminal propeptide (941.12 ± 161.39 µg/L) than those at TOCI-8 (845.71 ± 478.55 pg/L (p < 0.001) and 370.08 ± 197.04 µg/L (p < 0.001), respectively). CONCLUSION AIS girls had decreased cortical bone density and bone mechanical strength with elevated BTMs at PHV. Coupling of PHV with decreased cortical and FEA parameters could provide the link to the previously reported observation that low BMD could contribute as one of the prognostic factors for curve progression that mostly occurs during PHV in AIS.
Collapse
Affiliation(s)
- K G Yang
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - W Y W Lee
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A L H Hung
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - V W Y Hung
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - M F Tang
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - T F Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A P S Kong
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J C Y Cheng
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - T P Lam
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
8
|
Yun‐Ning Cheung E, Pik‐Shan Kong A, Siu‐Him Lau E, Yee‐Kwan Chow E, On‐Yan Luk A, Ching‐Wan Ma R, Ping Lam T, Yuk‐Wai Lee W, Chun‐Yiu Cheng J, Ebeling PR, Chung‐Ngor Chan J. Association of hip fractures with cardiometabolic-renal risk factors in Southern Chinese patients with type 2 diabetes - the Hong Kong Diabetes Register. J Diabetes Investig 2021; 12:1739-1748. [PMID: 33605046 PMCID: PMC8409844 DOI: 10.1111/jdi.13529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/14/2021] [Accepted: 02/16/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Diabetes and bone health are closely related. We examined the incidence and risk factors of hip fractures in Chinese patients with type 2 diabetes (T2D). MATERIALS AND METHODS In this prospective cohort, we consecutively enrolled 22,325 adults with T2D above the age of 40 years in the Hong Kong Diabetes Register between 1994 and 2015 with crude hip fracture incidence rate censored in 2017. RESULTS At baseline, the mean age of this cohort was 60.9 ± 10.5 years (mean duration of diabetes 6 years, 52.4% male). During a mean ± standard deviation (SD) follow-up period of 8.7 ± 5.2 years with 193,553 person-years, 603 patients were hospitalized due to hip fractures with an incidence (95% confidence interval, CI) of 315.1 (290.4-341.3) per 100,000 person-years. On multivariable analysis with competing death risk adjusted, the independent hazard ratios (95% CI) for hip fractures in T2D were 2.01 (1.61-2.51) for female sex, 1.08 (1.07-1.09) for age, 0.93 (0.90-0.95) for body mass index, 1.52 (1.25-1.85) for albuminuria and 1.12 (1.02-1.23) for low density lipoprotein-cholesterol. In men, the 30-day, 1-year and 5-year post-hip fracture mortality rate (95% CI) were 5.8 (2.4-9.1) %, 29.2 (22.3-35.5) % and 65.9 (57.3-72.8) % respectively. The corresponding rates in women were 3.4 (1.6-5.1) %, 18.6 (14.7-22.4) %, and 46.8 (40.9-52.1) %. CONCLUSIONS Southern Chinese patients with T2D have a high risk of hip fracture associated with suboptimal cardiometabolic-renal risk factors and a high post-fracture mortality rate. The effects of improving modifiable risk factors on bone health warrants further evaluation.
Collapse
Affiliation(s)
- Elaine Yun‐Ning Cheung
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongHong Kong
| | - Alice Pik‐Shan Kong
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongHong Kong
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong
| | - Eric Siu‐Him Lau
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong
| | - Elaine Yee‐Kwan Chow
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongHong Kong
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong
| | - Andrea On‐Yan Luk
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongHong Kong
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong
| | - Ronald Ching‐Wan Ma
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongHong Kong
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong
| | - Tsz Ping Lam
- SH Ho Scoliosis Research LaboratoryDepartment of Orthopaedics and TraumatologyJoint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing UniversityThe Chinese University of Hong KongPrince of Wales HospitalShatinChina
| | - Wayne Yuk‐Wai Lee
- SH Ho Scoliosis Research LaboratoryDepartment of Orthopaedics and TraumatologyJoint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing UniversityThe Chinese University of Hong KongPrince of Wales HospitalShatinChina
| | - Jack Chun‐Yiu Cheng
- SH Ho Scoliosis Research LaboratoryDepartment of Orthopaedics and TraumatologyJoint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing UniversityThe Chinese University of Hong KongPrince of Wales HospitalShatinChina
| | - Peter R Ebeling
- Department of Medicine and School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVictoriaAustralia
| | - Juliana Chung‐Ngor Chan
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongHong Kong
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong
| |
Collapse
|
9
|
Yang G, Lee WYW, Hung ALH, Tang MF, Li X, Kong APS, Leung TF, Yung PSH, To KKW, Cheng JCY, Lam TP. Association of serum 25(OH)Vit-D levels with risk of pediatric fractures: a systematic review and meta-analysis. Osteoporos Int 2021; 32:1287-1300. [PMID: 33704541 DOI: 10.1007/s00198-020-05814-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/30/2020] [Indexed: 12/22/2022]
Abstract
UNLABELLED The association between the risk of fractures and suboptimal vitamin D (Vit-D) status remains controversial in children. This meta-analysis suggested that serum 25(OH)Vit-D levels were lower in pediatric cases with fractures. 25-hydroxyvitamin D (25(OH)Vit-D) levels less than 50 nmol/L were associated with increased fracture risk in children. INTRODUCTION This study aimed to assess the association between serum 25(OH)Vit-D and the risk of fractures in children, and to explore the sources of heterogeneity and investigate their impact on results. METHODS Systematic review and meta-analysis were conducted for observational studies comparing serum 25(OH)Vit-D levels between fracture and non-fracture pediatric cases. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS Analysis on 17 case-control and 6 cross-sectional studies (2929 fracture cases and 5000 controls) suggested that 25(OH)Vit-D was lower in fracture cases than in controls (pooled mean difference (MD) = - 3.51 nmol/L; 95% confidence interval (CI): - 5.60 to - 1.42) with a heterogeneity (I2) of 73.9%. The sensitivity analysis which merged the case-control studies that had a NOS score ≥ 4 showed a pooled MD of - 4.35 nmol/L (95% CI: - 6.64 to - 2.06) with a heterogeneity (I2) of 35.9%. Pooled odds ratio of fracture in subjects with 25(OH)Vit-D ≤ 50 nmol/L compared to subjects with 25(OH)Vit-D > 50 nmol/L was 1.29 (95% CI: 1.10 to 1.53; I2 < 1%). CONCLUSION This study indicated that serum 25(OH)Vit-D levels were lower in pediatric patients with fractures. 25(OH)Vit-D ≤ 50 nmol/L was associated with increased fracture risk in children.
Collapse
Affiliation(s)
- G Yang
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - W Y W Lee
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A L H Hung
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - M F Tang
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - X Li
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A P S Kong
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - T F Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - P S H Yung
- JC Sports Medicine and Health Sciences Centre, Lui Che Woo Institute of Innovative Medicine, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K K W To
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong SAR, China
- Joint Research Laboratory of Promoting Globalization of Traditional Chinese Medicines between Shanghai Institute of Materia Medica, Chinese Academy of Sciences and The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J C Y Cheng
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - T P Lam
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
10
|
Lam TP, Yang G, Pang H, Yip B, Lee W, Hung A, Tang N, To K, Qiu Y, Cheng J. A six years longitudinal cohort study on the changes in bone density and bone quality up to peak bone mass in adolescent idiopathic scoliosis (AIS) with and without 2 years of Calcium and Vit-D supplementation. Stud Health Technol Inform 2021; 280:31-34. [PMID: 34190056 DOI: 10.3233/shti210429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) is associated with osteopenia which could persist into adulthood affecting attainment of Peak Bone Mass thus resulting in osteoporosis in late adulthood. We previously reported a randomized double-blinded placebo-controlled trial(the Cal study) showing significant bone health improvement with 2-year calcium(Ca)+Vit-D supplementation for AIS girls. This study addressed the important issue whether bone health improvement from the initial 2-year Ca+Vit-D supplementation could persist as subjects approached towards Peak Bone Mass at 6-year ie after 4-year of supplement discontinuation. This was an extension of the Cal study on AIS girls (11-14 years old, mean age=12.9 years, Tanner stage<IV) with femoral neck aBMD Z-score<0 and Cobb angle≥15∘. 330 subjects were randomized to Group1(placebo), Group2(600mgCa+400-IU-Vit-D3/day) or Group3(600mgCa+800-IU-Vit-D3/day) for 2-year supplementation after which supplementation was stopped. Investigations at baseline, 2-year and 6-year included High-resolution Peripheral Quantitative Computed Tomography(HR-pQCT) at distal radius and Dual Energy X-ray Absorptiometry(DXA) at both hips. 270(81.8%) subjects completed 2-year supplementation when changes in left femoral neck aBMD, trabecular vBMD, Trabecular BV/TV, Trabecular Number and Trabecular Separation indicated significant bone health improvement with Ca+Vit-D supplementation(p<0.05). At 6-year(mean age=19.2 years), no between-group difference on bone parameters was noted except increase in Cortical Thickness being greater only in Group3 than in Group1. After 4-year supplement discontinuation, the treatment effect from the initial 2-year supplementation mostly dissipated indicating the need of continued supplementation in AIS girls to sustain therapeutic improvement on bone health as subjects approach towards Peak Bone Mass.
Collapse
Affiliation(s)
- T P Lam
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - G Yang
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - H Pang
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Bhk Yip
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wyw Lee
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alh Hung
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Nls Tang
- Department of Chemical Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kkw To
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Y Qiu
- Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jcy Cheng
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
11
|
Sarwark JF, Castelein RM, Lam TP, Aubin CE, Maqsood A, Moldovan F, Cheng J. Elucidating the inherent features of IS to better understand idiopathic scoliosis etiology and progression. J Orthop 2021; 26:126-129. [PMID: 34404968 PMCID: PMC8350329 DOI: 10.1016/j.jor.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022] Open
Abstract
Idiopathic Scoliosis (IS) is a relatively common condition and is estimated to affect as many as 3 % of youth aged 10-17 years (in the United States an estimated approximately 1.4 million otherwise healthy individuals). A clear understanding of the etiology will better direct optimization of evaluation, treatments and therapies, especially early treatments with less invasive methods. A mechanistic explanation of factors combining to initiate and then cause progression of this common condition-- in otherwise healthy pre-teenage and teenage patients--will be discussed. A recent well-designed structured systematic review states that 'strong evidence is lacking for a consistent pattern of occurrence and any abnormality', in other words there is no strong evidence for 'other associated diagnoses' in IS. And so, certain important inherent factors of IS merit greater discussion. Inherent, or intrinsic factors include: a natural susceptibility to develop a lateral and rotational deformity in the immature rapidly growing erect human spine, inherent torsion associated at the induction of deformity, biomechanics related to curve progression, and anthropology/bipedal gait. We know more today about factors related to the condition and its etiology than we have previously. Across multiple disciplines, a mechanistic approach to understanding the etiopathogenesis of IS, allows a reasonable 'theory' for IS etiology and its progression. We will discuss these inherent intrinsic factors in order to further add to our understanding of the theoretical etiopathogenesis. A better understanding of the etiology (and progression) may better direct ways to optimize evaluation, treatments and therapies, especially early treatments with less invasive methods.
Collapse
Affiliation(s)
- John F. Sarwark
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave. Box 69, Chicago, IL, 60611, USA
| | - Rene M. Castelein
- Universitair Medisch Centrum Utrecht T.a.v. Staf Orthopedie, HP G05.228, Heidelgerglaan 100, 584, CX Utrecht, the Netherlands
| | - Tsz Ping Lam
- The Chinese University of Hong Kong, Room 74034, 5th Floor, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong SAR, China
| | - Carl E. Aubin
- Polytechnique Montréal, P.O. Box 6079, Downtown Station, Montréal, Quebec, H3T 3A7, Canada
| | - Ayesha Maqsood
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave. Box 69, Chicago, IL, 60611, USA
| | - Florina Moldovan
- Université de Montréal, 3175 Cote Sainte-Catherine, Bloc 17, Room 2.17.026, Montréal, Quebec, H3T 1C5, Canada
| | - Jack Cheng
- The Chinese University of Hong Kong, Room 74034, 5th Floor, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong SAR, China
| |
Collapse
|
12
|
Lam TP, Ng B, Hung A, Chau WW, Cheng J. 1 to 30 years post-surgical HRQOL of Adolescent Idiopathic Scoliosis (AIS) with SRS-22 - a study of 1315 patients. Stud Health Technol Inform 2021; 280:322. [PMID: 34190140 DOI: 10.3233/shti210528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- T P Lam
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Bkw Ng
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Alh Hung
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - W W Chau
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jcy Cheng
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| |
Collapse
|
13
|
Pang H, Wong YS, Yip B, Hung A, Chu W, Lai K, Zheng YP, Chung T, Sharma G, Cheng J, Lam TP. Using ultrasound for screening scoliosis to reduce unnecessary radiographic radiation - a prospective diagnostic accuracy study on 442 schoolchildren. Stud Health Technol Inform 2021; 280:106-108. [PMID: 34190069 DOI: 10.3233/shti210445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Scoliosis screening is important for timely initiation of brace treatment to mitigate curve progression in skeletally immature children. Scoliosis screening programs frequently include the protocol of referring children screened positive with Scoliometer and Moiré Topography for confirmatory standard radiography. Despite being highly sensitive (88%) for detecting those who require specialist referral, the screening program was found to have more than 50% false positive rate that leads to unnecessary radiation exposure. Radiation-free ultrasound has been reported to be reliable for quantitative assessment of scoliosis curves. The aim of this prospective diagnostic accuracy study was to determine the accuracy of ultrasound in determining the referral status for children initially screened positive for scoliosis. 442 schoolchildren with a mean Cobb angle of 14.0 ± 6.6° were recruited. Using x-ray as the gold standard, the sensitivity and specificity of ultrasound in predicting the correct referral status were 92.3% and 51.6% respectively. ROC curve analysis revealed an area under curve of 0.735 for ultrasound alone and 0.832 for ultrasound plus scoliometer measurement. The finding provided strong evidences on the accuracy of ultrasound in determining the referral status that could result in more than 50% reduction of unnecessary radiation exposure for children undergoing scoliosis screening.
Collapse
Affiliation(s)
- H Pang
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Y S Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Bhk Yip
- Division of Family Medicine and Primary Health Care, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Alh Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Wcw Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR, China
| | - Kkl Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, China
| | - Y P Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, China
| | - Twh Chung
- Student Health Service, Department of Health, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - G Sharma
- Student Health Service, Department of Health, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Jcy Cheng
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - T P Lam
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| |
Collapse
|
14
|
Wang Y, Feng Z, Cheng KL, Zhang J, Xu L, Lam TP, Hung A, Cheng J, Qiu Y, Lee W. Role of differentially expressed LBX1 in Adolescent Idiopathic Scoliosis (AIS) paraspinal muscle phenotypes and muscle-bone crosstalk through modulating myoblasts. Stud Health Technol Inform 2021; 280:14-17. [PMID: 34190053 DOI: 10.3233/shti210425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIS is three-dimensional spinal deformity with unclear etiopathogenesis. LBX1 is so far the only multi-centers validated AIS predisposing gene. The imbalance of posterior paraspinal muscles is an important factor in AIS etiopathogenesis. It is poorly understood how LBX1 contributes to the abnormal paraspinal muscles and onset/progression of AIS. We aimed to evaluate the expression of LBX1 in paraspinal muscles at the concave and convex side in AIS, and whether alternation of LBX1 expression could affect myoblastsactivities and potentially influence muscle-bone interaction via myokines expression. Paraspinal muscles from AIS and age- and curvature-matched congenital scoliosis (CS) patients were collected for fiber types analysis. Biopsies were also subjected to qPCR to validate expression of myogenic markers, selected myokines and LBX1. Human skeletal muscle myoblast (HSMM) was used for LBX1 loss-of-function study in vitro. Muscle fiber types analysis showed type I and type IIX/IIAX fibers proportion were significantly different between AIS concave and convex but not in two sides of CS. LBX1, myogenic markers and one myokine were significantly imbalanced in AIS but not in CS. Loss-of-function study showed knockdown of LBX1 could inhibit myogenic markers expression and myokines as well. This study provides new insight into the association between imbalanced paraspinal muscle and potential muscle-bone crosstalk in AIS patients and the biological function of predisposing gene LBX1. Further investigation with appropriate animal models is warranted to explore if asymmetric expression of LBX1 could result in distinct muscle phenotypes and bone qualities thus affect the progression of spine curvature in AIS.
Collapse
Affiliation(s)
- Y Wang
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Z Feng
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.,Spine Surgery, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - K L Cheng
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - J Zhang
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - L Xu
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.,Spine Surgery, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - T P Lam
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Alh Hung
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Jcy Cheng
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Y Qiu
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.,Spine Surgery, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Wyw Lee
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| |
Collapse
|
15
|
Lau R, Cheuk KY, Tam E, Hui S, Cheng J, Lam TP. Feasibility and effects of 6-month home-based digitally supported E-Fit program utilizing high-intensity interval exercises in girls with adolescent idiopathic scoliosis: a randomized controlled pilot study. Stud Health Technol Inform 2021; 280:195-198. [PMID: 34190086 DOI: 10.3233/shti210466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) patients have lower physical activities when compared with healthy controls, and are associated with lower bone mineral density (BMD), muscle strength and poorer quality of life (QoL). We aimed to assess the feasibility and effects of 6-month home-based digitally supported E-Fit comprised of high-intensity interval exercises for AIS patients. 40 AIS girls aged 11-14 were randomly assigned to E-Fit or control group. E-Fit group participated in an online 6-month home-based exercise program. At baseline, 6-months and 12-months follow-up, BMD using dual-energy X-ray absorptiometry, muscle functions, physical activity using Modified Baecke Questionnaire (MBQ), and QoL using Scoliosis Research Society-22 (SRS-22r) and feedback questionnaire were investigated. 14 in E-Fit and 16 in control group completed the study. Both groups had similar baseline characteristics. At 6-months, E-Fit group showed better improvement and significant interaction effect in left femoral neck bone mineral content (p=0.021) and isometric curl up test (p=0.04). Left arm lean mass showed better improvement between 6-months and 12-months follow-up (p=0.046) and whole-body areal BMD had significant interaction effect at 12-months follow-up (p=0.077). Improvement on self-image, work and sports participation were noted in E-Fit group across time. 70% of E-Fit participants were positive towards domestic application via online platform. E-Fit showed some benefits on bone health, muscle functions, physical activity and QoL measures. Current study indicated some potential physical and psychological benefits of E-Fit for AIS girls. E-Fit was feasible to conduct online at home and might have value of promoting exercise habits among relatively inactive AIS girls.
Collapse
Affiliation(s)
- Rwl Lau
- Tung Wah College, Hong Kong SAR, China.,SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K Y Cheuk
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ems Tam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ssc Hui
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jcy Cheng
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - T P Lam
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
16
|
Yeung KH, Man G, Hung A, Lam TP, Cheng J, Chu W. Morphological changes of intervertebral disc in relation with curve severity of patients with Adolescent Idiopathic Scoliosis - a T2-weighted MRI study. Stud Health Technol Inform 2021; 280:37-39. [PMID: 34190057 DOI: 10.3233/shti210431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to evaluate the morphological changes of intervertebral discs (IVD) and vertebral bodies (VB) in AIS girls according to the subgroups with different curve severity by magnetic resonance imaging (MRI). This study included 33 age-matched female controls and 76 AIS girls with a right-sided thoracic curvature. Wedge angle, height ratio and distance ratio of VB and IVD were measured on the best midline coronal and sagittal planes from reformatted MRI spine. Volumes of VB, IVD and nucleus pulposus (NP) were evaluated on volumetric images. One-way ANOVA with Bonferroni correction was used. There was significant difference in wedge angle and height ratio of VB and IVD between AIS and controls. In severe-AIS, the position of NP was significantly shifted to the convexity when compared with non-severe AIS and controls. Whereas, the volume of IVD and NP in severe-AIS was found to be significantly smaller. On top of coronal wedging of VB and IVD, there was significantly reduced volume of IVD and NP in severe-AIS patients, despite T2 signal of IVD was preserved. The current findings indicate that early mechanical effects on the discs and vertebrae in adolescent scoliotic spine is evident on quantitative imaging. Importantly, these patients may be vulnerable to disc degeneration if no operative treatment is prescribed.
Collapse
Affiliation(s)
- K H Yeung
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Gcw Man
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Alh Hung
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - T P Lam
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jcy Cheng
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wcw Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| |
Collapse
|
17
|
Yeung KH, Man GCW, Skalli W, Hu Z, Hung VWY, Hung ALH, Lam TP, Ng BKW, Cheng JCY, Vergari C, Chu WCW. Global sagittal alignment after surgery of right thoracic idiopathic scoliosis in adolescents and adults with and without thoracic hypokyphosis. Sci Rep 2021; 11:6294. [PMID: 33737666 PMCID: PMC7973511 DOI: 10.1038/s41598-021-85782-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/04/2021] [Indexed: 11/09/2022] Open
Abstract
This study aimed to characterize global sagittal alignment in adolescent idiopathic scoliosis (AIS) with normal kyphosis (NTK, kyphosis > 10°) and with thoracic hypokyphosis (THK, kyphosis < 10°), before and after posterior spinal fusion, and compare them with asymptomatic controls. 27 AIS girls and young adults with right thoracic curves were included (seventeen with age ≤ 18 years, then age > 21). Biplanar radiographies were acquired at baseline, immediate post-operatively, 1-year and 2-year follow-up, and 3D reconstruction of the spine and pelvis was performed. NTK and THK showed different global sagittal alignment, as well as differences compared to controls. AIS with THK at baseline had higher SVA/SFD (2.0 ± 2.9 vs - 0.4 ± 1.9; P < 0.05) and OD-HA (0.2 ± 1.4° vs - 1.3 ± 1.6°; P < 0.05) than controls, indicating that THK had compensated balance with unusual forward leaning posture. Immediately post-operation, SVA/SFD remained high (1.3 ± 3.0) while OD-HA reversed (- 1.2 ± 1.7°), indicating that THK patients had found partially compensated balance. After 2-yeas, both SVA/SFD (- 1.3 ± 2.1) and OD-HA (- 1.4 ± 0.9°) were normalized. The changes in global sagittal alignment and mechanism of balance are different in AIS with or without THK. As the head plays a critical role on balance during immediate and delayed post-operation, OD-HA can be complementary parameter for assessing global balance during post-operative follow-up of AIS patients with THK.
Collapse
Affiliation(s)
- Kwong Hang Yeung
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Gene Chi Wai Man
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wafa Skalli
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, Arts et Metiers ParisTech, 151, boulevard de l'hopital, 75013, Paris, France
| | - Zongshan Hu
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Vivian Wing Yin Hung
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Alec Lik Hang Hung
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Tsz Ping Lam
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Bobby Kin Wah Ng
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jack Chun Yiu Cheng
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Claudio Vergari
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, Arts et Metiers ParisTech, 151, boulevard de l'hopital, 75013, Paris, France.
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| |
Collapse
|
18
|
Cheng JCY, Moreau A, Lee WYW, Lam TP, Yip BHK, Choy RKW. MicroRNA and its link to osteoblasts in adolescent idiopathic scoliosis: abridged secondary publication. Hong Kong Med J 2020; 26 Suppl 7:10-12. [PMID: 33229610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Affiliation(s)
- J C Y Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - A Moreau
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - W Y W Lee
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - T P Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - B H K Yip
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - R K W Choy
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
19
|
Li X, Leung CHY, Gao T, Chung VCH, FWP Y, Wong SYS, Lam TP, Cheng JCY, Yip BHK. The use of mindfulness-based intervention to improve bracing compliance for AIS patients. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Despite good bracing compliance is crucial to prevent curve progression among braced AIS patients, only few interventions were suggested to improve bracing compliance. This study examined the effect of MBI on bracing compliance for AIS patients.
Methods
116 eligible AIS patients were randomized and 86 participants were enrolled in intervention. Patients in the MBI group joint weekly sessions, which is an adapted version of mindfulness-based stress reduction (MBSR) program, for 8 weeks. Control group consisted of an 8-week PE intervention that is recommended according to the SOSORT 2011 guideline. The primary outcome is the 6-month post-intervention bracing compliance. The secondary outcomes include quality of life and psychosocial measurements. Primary analysis was ANCOVA with treatment as covariate. Trend analysis was conducted using Linear Mixed effect model.
Results
At the end of intervention, intention-to-treat analysis improved bracing compliance by1.24h/day and 0.08h/day for MBI and PE respectively. MBI group presented an increase in emotional regulation than baseline (ERQ-CCA) (1.92, p = 0.01), especially in Cognitive reappraisal sub-scale (1.00, p = 0.05). Bracing Specific Quality of Life (SRS-22) reduced significantly in both groups, but MBI group decreased less (MBI: -3.08, p = 0.00, PE -4.47, p = 0.00). Effect at six months for compliance progressed negatively but favoured MBI group (MBI: -1.16, p = 0.13, PE: -1.84, p = 0.06) although there was no significant difference between groups (p = 0.78). The Perception of stress (PSS) decreased significantly in PE group (-3,53, p = 0.01) rather than MBI (1.53, p = 0.22), however the between-group difference isn't significant (p = 0.62).
Conclusions
It is alarming that patients in both interventions group progressed with poorer compliance and worsen QoL. These progressions were less severe in the MBI group than in the PE group, but the differences did not reach statistical significant.
Key messages
Both groups decreased in compliance and QoL but MBI group reduced less. MBI wasn't more effective in improving participants’ compliance and other measurements.
Collapse
Affiliation(s)
- X Li
- School of Public Health, CUHK, Hongkong, China
| | - C H Y Leung
- School of Public Health, CUHK, Hongkong, China
| | - T Gao
- School of Public Health, CUHK, Hongkong, China
| | - V C H Chung
- School of Public Health, CUHK, Hongkong, China
| | - Yu FWP
- Department of Orthopaedics and Traumatology, CUHK, Hongkong, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, CUHK, Hongkong, China
- Joint Scoliosis Research Center of the Chinese University of, CUHK, Hongkong, China
| | - S Y S Wong
- School of Public Health, CUHK, Hongkong, China
| | - T P Lam
- Department of Orthopaedics and Traumatology, CUHK, Hongkong, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, CUHK, Hongkong, China
- Joint Scoliosis Research Center of the Chinese University of, CUHK, Hongkong, China
| | - J C Y Cheng
- Department of Orthopaedics and Traumatology, CUHK, Hongkong, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, CUHK, Hongkong, China
- Joint Scoliosis Research Center of the Chinese University of, CUHK, Hongkong, China
| | - B H K Yip
- School of Public Health, CUHK, Hongkong, China
| |
Collapse
|
20
|
Yeung KH, Man GCW, Lam TP, Ng BKW, Cheng JCY, Chu WCW. Accuracy on the preoperative assessment of patients with adolescent idiopathic scoliosis using biplanar low-dose stereoradiography: a comparison with computed tomography. BMC Musculoskelet Disord 2020; 21:558. [PMID: 32811481 PMCID: PMC7433123 DOI: 10.1186/s12891-020-03561-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/03/2020] [Indexed: 01/26/2023] Open
Abstract
Background Although computed tomography (CT) is commonly used to diagnose the scoliotic spine in patients with adolescent idiopathic scoliosis (AIS) preoperatively, it is limited by the high radiation and prone scanning position. Recently, a new biplanar stereoradiography (EOS) was used to image the scoliotic spine in an upright posture with significantly less radiation in non-severe AIS subjects. However, its reliability to assess preoperative AIS patients remains unreported. Hence, the purpose of this study is to compare the scoliotic curvature between prone (CT) and upright positions (EOS) in preoperative AIS patients. Methods Thirty-three pre-operative AIS patients (mean age:18.4 ± 4.2) were recruited. EOS was used to scan the whole thoracic spine at upright position. Whereas on the same day, a conventional CT scan was used to evaluate the spine in prone position. The three-dimensional reconstruction of EOS and CT of the spine were then generated. Using previous validated techniques, multiple scoliotic parameters in both modalities were determined. The agreement between the two modalities was compared using the Bland-Altman test, whereas the correlation was assessed by the intraclass correlation coefficient (ICC). Results The mean ICC (prone and upright) of intra-rater/inter-rater reliabilities for the measured parameters were 0.985,0.961/0.969,0.903, respectively. Thoracic Cobb angles, intervertebral wedging and lumbar lordosis correlated significantly between upright EOS imaging radiographs (62.9 ± 9.3°,6.4 ± 2.9° and 48.8 ± 12.4°) and prone CT (47.3 ± 10.0°,5.8 ± 2.7° and 27.9 ± 11.4°; P < 0.001). The apical vertebral wedging and apical intervertebral disc wedging showed a good correlation among the two modalities (upright, 6.5 ± 3.5° and 6.4 ± 2.9°; prone, 6.5 ± 3.6° and 5.8 ± 2.7°; R2 ≥ 0.94; P < 0.01). Similarly, there was significant correlation in apical intervertebral rotation (R2 = 0.834; P < 0.01) between the prone CT (3.4 ± 3.0°) and upright EOS (3.8 ± 3.2°). In addition, the Cobb angle was significantly larger in upright EOS (62.9 ± 9.3°) than in prone CT (47.3 ± 10.0°, P < 0.01) position. There was significant underestimation on scoliotic severity in the prone position when compared with upright position. Conclusions Importantly, the image acquisition and reconstruction from EOS can better provide accurate three-dimensional spinal representations of the scoliotic curvature in preoperative AIS patients. Moreover, our findings suggested that scoliotic curvatures in preoperative AIS patients can be largely represented by both imaging modalities despite the difference in body positioning.
Collapse
Affiliation(s)
- Kwong Hang Yeung
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Gene Chi Wai Man
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tsz Ping Lam
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Bobby Kin Wah Ng
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jack Chun Yiu Cheng
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
| |
Collapse
|
21
|
Li X, Hung VWY, Yu FWP, Hung ALH, Ng BKW, Cheng JCY, Lam TP, Yip BHK. Persistent low-normal bone mineral density in adolescent idiopathic scoliosis with different curve severity: A longitudinal study from presentation to beyond skeletal maturity and peak bone mass. Bone 2020; 133:115217. [PMID: 31891787 DOI: 10.1016/j.bone.2019.115217] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Low bone mineral status has been reported in patients first presented with adolescent idiopathic scoliosis (AIS). We aimed to study whether low-normal bone mineral density (BMD) is persistent among AIS girls during puberty and at peak bone mass, and whether if such persistence is associated with curve severity and differed from healthy controls. METHOD This prospective longitudinal study comprised 550 AIS girls and 194 healthy control subjects followed from 1997 till 2016. Low-normal BMD was defined as z-standardized bone mineral density (z-BMD) of bilateral femoral neck ≤ -1. Markov Chain 2-stages analysis was conducted to investigate the low-normal BMD transition rate. Linear mixed-effects model and Bland-Altman plot were used to investigate whether low-normal BMD is persistent among a subgroup of AIS patients that reached peak bone mass. RESULTS The average z-BMD were comparable between AIS cohort and controls at 11 years old (-0.532 vs -0.602), but at 19 years old z-BMD worsened among AIS subjects (-0.860) while controls z-BMD improved (-0.455). During growth period until skeletal maturity, persistence of low-normal BMD was high in both cohorts (>80%) and the AIS group with severe curve presented 100% persistence. Subgroup analysis revealed that z-BMD of AIS patients at skeletal maturity and peak bone mass were highly correlated (r2 = 0.905) and with good agreement. CONCLUSION AIS patients had poorer BMD that is associated with curve severity and more likely to persist beyond peripubertal period and at peak bone mass when compared to controls.
Collapse
Affiliation(s)
- Xue Li
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Vivian Wing Yin Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Fiona Wai Ping Yu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Alec Lik Hang Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Bobby Kin Wah Ng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Jack Chun Yiu Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Tsz Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Benjamin Hon Kei Yip
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| |
Collapse
|
22
|
Man GCW, Tam EMS, Wong YS, Hung VWY, Hu Z, Lam TP, Liu Z, Cheung WH, Ng TB, Zhu Z, Qiu Y, Cheng JCY. Abnormal Osteoblastic Response to Leptin in Patients with Adolescent Idiopathic Scoliosis. Sci Rep 2019; 9:17128. [PMID: 31748652 PMCID: PMC6868007 DOI: 10.1038/s41598-019-53757-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/04/2019] [Indexed: 11/09/2022] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional structural deformity of the spine with unknown etiology. Although leptin has been postulated as one of the etiologic factors in AIS, its effects on osteoblastic activity remain unknown. Herein, we conducted this study to investigate whether there are abnormal functional responses to leptin and abnormal expression of leptin receptor in AIS osteoblasts. In vitro assays were performed with osteoblasts isolated from 12 severe AIS girls and 6 non-AIS controls. The osteoblasts were exposed to different concentrations of leptin (0, 10, 100, 1000 ng/mL). The effects of leptin on cell proliferation, differentiation and mineralization were determined. Protein expressions of leptin receptor (LEP-R) under basal and osteogenic conditions were also evaluated by Western blot. Our results showed that leptin significantly stimulated osteoblasts from non-AIS subjects to proliferate, differentiate and mineralized. However, in the AIS group, the stimulatory effects of leptin on cell proliferation, differentiation, and mineralization were not observed. In addition, no statistically significant difference in the expression of leptin receptor under both basal and osteogenic conditions was found between AIS and control group. In conclusion, these findings might help to explain the low bone mass and deranged bone quality that is clinically associated with AIS girls.
Collapse
Affiliation(s)
- Gene Chi-Wai Man
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, SAR, China.,The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Hong Kong, SAR, China
| | - Elisa Man-Shan Tam
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, SAR, China.,The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Hong Kong, SAR, China
| | - Yi Shun Wong
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, SAR, China.,The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Hong Kong, SAR, China
| | - Vivian Wing-Ying Hung
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, SAR, China.,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China.,The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Hong Kong, SAR, China
| | - Zongshan Hu
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, SAR, China.,The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Hong Kong, SAR, China
| | - Tsz Ping Lam
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, SAR, China.,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China.,The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Hong Kong, SAR, China
| | - Zhen Liu
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China.,The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Hong Kong, SAR, China
| | - Wing Hoi Cheung
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, SAR, China.,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Tzi Bun Ng
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Zezhang Zhu
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China.,The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Hong Kong, SAR, China
| | - Yong Qiu
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China.,The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Hong Kong, SAR, China
| | - Jack Chun-Yiu Cheng
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, SAR, China. .,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China. .,The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Hong Kong, SAR, China.
| |
Collapse
|
23
|
Lam TP, Lo TL, Chao DVK, Lam KF, Lam WW, Sun KS. Consultation pattern of Hong Kong primary care attenders for psychological distress. Hong Kong Med J 2019; 25 Suppl 2:18-20. [PMID: 30674703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- T P Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong
| | - T L Lo
- Department of Family Medicine and Primary Care, The University of Hong Kong
- Kwai Chung Hospital
| | - D V K Chao
- Department of Family Medicine and Primary Care, The University of Hong Kong
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital
| | - K F Lam
- Department of Statistics and Actuarial Science, The University of Hong Kong
| | - W W Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong
| | - K S Sun
- Department of Family Medicine and Primary Care, The University of Hong Kong
| |
Collapse
|
24
|
Chan AMW, Au WWY, Chao DVK, Choi K, Choi KW, Choi SMY, Chow Y, Fan CYM, Ho PL, Hui EMT, Kwong KH, Kwong BYS, Lam TP, Lam ETK, Lau KW, Lui L, Ng KHL, Wong MCS, Wong TY, Yeung CF, You JHS, Yung RWH. Antibiotic management of acute pharyngitis in primary care. Hong Kong Med J 2019; 25:58-63. [PMID: 30713150 DOI: 10.12809/hkmj187544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The Centre for Health Protection of the Department of Health has convened the Advisory Group on Antibiotic Stewardship Programme in Primary Care (the Advisory Group) to formulate guidance notes and strategies for optimising judicious use of antibiotics and enhancing the Antibiotic Stewardship Programme in Primary Care. Acute pharyngitis is one of the most common conditions among out-patients in primary care in Hong Kong. Practical recommendations on the diagnosis and antibiotic treatment of acute streptococcal pharyngitis are made by the Advisory Group based on the best available clinical evidence, local prevalence of pathogens and associated antibiotic susceptibility profiles, and common local practice.
Collapse
Affiliation(s)
| | - A M W Chan
- Hong Kong College of Family Physicians, Hong Kong
| | - W W Y Au
- Infection Control Branch, Centre for Health Protection, Department of Health, Hong Kong
| | - D V K Chao
- Department of Family Medicine and Primary Health Care, United Christian Hospital, Hospital Authority, Hong Kong
| | - K Choi
- Hong Kong Medical Association, Hong Kong
| | - K W Choi
- Hong Kong Society for Infectious Diseases, Hong Kong
| | - S M Y Choi
- Primary Care Office, Department of Health, Hong Kong
| | - Y Chow
- Quality HealthCare Medical Services Limited, Hong Kong
| | - C Y M Fan
- Professional Development and Quality Assurance, Department of Health, Hong Kong
| | - P L Ho
- IMPACT Editorial Board, Reducing bacterial resistance with IMPACT, 5th edition, Hong Kong
| | - E M T Hui
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong
| | - K H Kwong
- Human Health Holdings Limited, Hong Kong
| | - B Y S Kwong
- Chief Pharmacist's Office, Hospital Authority, Hong Kong
| | - T P Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - E T K Lam
- Centre for Health Protection Infection Control Branch, Department of Health, Hong Kong
| | - K W Lau
- Centre for Health Protection Infection Control Branch, Department of Health, Hong Kong
| | - L Lui
- Centre for Health Protection Infection Control Branch, Department of Health, Hong Kong
| | - K H L Ng
- Centre for Health Protection Infection Control Branch, Department of Health, Hong Kong
| | - M C S Wong
- Hong Kong Academy of Medicine, Hong Kong
| | - T Y Wong
- Centre for Health Protection Infection Control Branch, Department of Health, Hong Kong
| | | | - J H S You
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong
| | - R W H Yung
- Hong Kong Sanatorium & Hospital, Hong Kong
| |
Collapse
|
25
|
Cheuk KY, Wang XF, Wang J, Zhang Z, Yu FWP, Tam EMS, Hung VWY, Lee WYW, Ghasem-Zadeh A, Zebaze R, Zhu TY, Guo XE, Cheng JCY, Lam TP, Seeman E. Sexual Dimorphism in Cortical and Trabecular Bone Microstructure Appears During Puberty in Chinese Children. J Bone Miner Res 2018; 33:1948-1955. [PMID: 30001459 DOI: 10.1002/jbmr.3551] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/28/2018] [Accepted: 07/07/2018] [Indexed: 01/21/2023]
Abstract
Distal forearm fractures during growth are more common in males than females. Because metaphyseal cortical bone is formed by coalescence of trabeculae emerging from the periphery of the growth plate, we hypothesized that the later onset of puberty in males produces a longer delay in trabecular bone formation and coalescence, which leaves a transient phase of high cortical porosity, low matrix mineral density, and high trabecular density relative to females. We quantified the nondominant distal radial microstructure using high-resolution peripheral quantitative computed tomography in 214 healthy Chinese boys and 219 Chinese girls aged between 7 and 17 years living in Hong Kong. Measurements of 110 slices (9.02 mm) were acquired 5 mm proximal to the growth plate of the nondominant distal radius. Porosity was measured using StrAx1.0 (Straxcorp, Melbourne, VIC, Australia) and trabecular plate and rod structure were measured using individual trabecula segmentation (ITS). Mechanical properties were estimated using finite element analysis (FEA). Results were adjusted for age, total bone cross-sectional area (CSA), dietary calcium intake, and physical activity. In boys, total bone CSA was 17.2% to 22.9% larger throughout puberty, cortical/total bone CSA was 5.1% smaller in Tanner stage 2 only, cortical porosity was 9.4% to 17.5% higher, and matrix mineral density was 1.0% to 2.5% lower in Tanner stage 2 to 5, than girls. Boys had higher trabecular rod BV/TV in Tanner stage 3 and 4, but higher trabecular plate BV/TV and plate to rod ratio in Tanner stage 5, than girls. Boys had 17.0% lower apparent modulus than girls in Tanner stage 2. A transient phase of higher porosity due to dissociation between bone mineral accrual and linear growth may contribute to higher distal radial bone fragility in Chinese boys compared to girls. © 2018 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Ka Yee Cheuk
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China.,SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiao-Fang Wang
- Department of Endocrinology, Austin Health, University of Melbourne, Heidelberg, VIC, Australia.,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Ji Wang
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Zhendong Zhang
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Fiona Wai Ping Yu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China.,SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, China.,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Elisa Man Shan Tam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China.,SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, China
| | - Vivian Wing Yin Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China.,SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, China.,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wayne Yuk Wai Lee
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China.,SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, China
| | - Ali Ghasem-Zadeh
- Department of Endocrinology, Austin Health, University of Melbourne, Heidelberg, VIC, Australia.,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Roger Zebaze
- Department of Endocrinology, Austin Health, University of Melbourne, Heidelberg, VIC, Australia.,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Tracy Y Zhu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China.,SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - X Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Jack Chun Yiu Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China.,SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, China.,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Tsz Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China.,SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, China.,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ego Seeman
- Department of Endocrinology, Austin Health, University of Melbourne, Heidelberg, VIC, Australia.,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| |
Collapse
|
26
|
Yip BHK, Li X, Leung CHY, Gao T, Chung VCH, Yu FWP, Lam TP, Cheng JCY, Wong SYS. Trial Protocol: The use of mindfulness-based intervention for improving bracing compliance for adolescent idiopathic scoliosis patients: protocol for a randomised, controlled trial. J Physiother 2018; 64:193. [PMID: 29907335 DOI: 10.1016/j.jphys.2018.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/13/2018] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Adolescent idiopathic scoliosis (AIS) is the most prevalent deforming orthopaedic condition; it causes significant disability when spinal curves progress beyond 45deg. Bracing is the primary treatment prescribed for adolescents with an immature skeleton who have spinal curves between 25 and 45deg. New evidence suggests that compliance with bracing significantly decreases the progression of high-risk curves to the threshold for surgery. Nonetheless, bracing is a stressful experience. Therefore, interventions that mediate health-related quality of life for AIS patients are of great interest. In the past few decades, numerous studies have documented the benefits of mindfulness training on chronic pain, stress management, anxiety and emotional disorders. Mindfulness might additionally provide AIS patients with psychosocial support. RESEARCH QUESTIONS This study will investigate the effects of a mindfulness-based intervention on bracing compliance and quality of life among AIS patients with poor bracing compliance. The study also plans to evaluate if the mindfulness-based intervention effect is sustained after the intervention period. The potential mechanism by which mindfulness affects bracing compliance will be explored. DESIGN Single-blind, two-arm, randomised, controlled trial. PARTICIPANTS AND SETTING The study will recruit 120 AIS patients aged between 10 and 15 years with non-satisfactory bracing compliance. Patients who have previously practised or are currently practising meditation or mindful yoga or who cannot finish the whole intervention will be excluded. The study will take place at the Jockey Club School of Public Health and Primary Care building. INTERVENTION Patients in the mindfulness-based intervention group will join weekly sessions for 8 weeks. This program is a short version of a mindfulness-based stress relaxation program to address the specific issues of AIS patients. Two to three experienced instructors will deliver the program. CONTROL Control group patients will participate in an 8-week physiotherapy exercise program as recommended in the International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) 2011 guideline. MEASUREMENTS The primary outcome is the 6-month post-intervention total score of bracing compliance. Secondary measures are non-bracing-specific quality of life, bracing-specific quality of life, self-compassion, emotional regulation, mindful awareness and acceptance, self-efficacy, perception of stress, and general measure of health outcome. PROCEDURE 120 participants will be assigned to either an intervention or control arm by simple randomisation, and the randomisation result will only be revealed once participants have confirmed availability to attend intervention classes. Clinicians of the scoliosis clinic and research staff will be blinded to the treatment allocation. ANALYSIS ANCOVA will be conducted to compare the effect of mindfulness-based intervention versus physiotherapy exercise on the outcome measures. To investigate significant change over time, linear mixed models analyses will be conducted following the intention-to-treat principle. The R-package lavaan will be used to conduct structural equation modelling to study the potential mechanism of mindfulness. DISCUSSION/SIGNIFICANCE This will be the first psychosocial intervention study conducted on braced AIS patients with the aim of improving patients' bracing compliance and quality of life. The results from this study will potentially carry significant impact on future AIS treatment by emphasising psychosocial care for braced AIS patients.
Collapse
Affiliation(s)
- Benjamin Hon Kei Yip
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong
| | - Xue Li
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong
| | - Christine Hiu Yan Leung
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong
| | - Ting Gao
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong
| | - Vincent Chi Ho Chung
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong
| | - Fiona Wai Ping Yu
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University; Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Tsz Ping Lam
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University; Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Jack Chun Yiu Cheng
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University; Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Samuel Yeung Shan Wong
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong
| |
Collapse
|
27
|
Xue C, Shi L, Hui SCN, Wang D, Lam TP, Ip CB, Ng BKW, Cheng JCY, Chu WCW. Altered White Matter Microstructure in the Corpus Callosum and Its Cerebral Interhemispheric Tracts in Adolescent Idiopathic Scoliosis: Diffusion Tensor Imaging Analysis. AJNR Am J Neuroradiol 2018; 39:1177-1184. [PMID: 29674416 DOI: 10.3174/ajnr.a5634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Neural system was one of the important contributors to the etiopathogenesis of adolescent idiopathic scoliosis; additionally, the morphology of corpus callosum interconnecting both hemispheres of the brain was found to be altered morphologically. Our aim was to evaluate and compare the microstructural changes of the corpus callosum and its interhemispheric white matter fiber tracts interconnecting both cerebral hemispheres in patients with adolescent idiopathic scoliosis and matched controls using diffusion tensor imaging. MATERIALS AND METHODS Brain DTI was performed in 69 patients with adolescent idiopathic scoliosis (female, right thoracic/thoracolumbar curve) and 40 age-matched controls without adolescent idiopathic scoliosis (female). 2D and 3D segmentation of the corpus callosum were performed using a region-growing method, and the corpus callosum was further divided into 6 regions, including the rostrum, genu, anterior and posterior midbodies, isthmus, and splenium. The laterality index was calculated to quantify the asymmetry of the corpus callosum. Interhemispheric fiber tractography were performed using the Brodmann atlas. RESULTS 2D ROI analysis revealed reduced fractional anisotropy in the genu and splenium (P = .075 and P = .024, respectively). Consistently reduced fractional anisotropy on the left sides of the genu and splenium was also found in 3D ROI analysis (P = .03 and P = .012, respectively). The laterality index analysis revealed a pseudo-right lateralization of the corpus callosum in adolescent idiopathic scoliosis. Interhemispheric fibers via the splenium interconnecting Brodmann 3, 1, and 2; Brodmann 17; and Brodmann 18 (corresponding to the primary somatosensory cortex and primary and secondary visual cortices) were also found to have reduced fractional anisotropy (P ≤ .05). CONCLUSIONS Reduced fractional anisotropy was found in the genu and splenium of the corpus callosum and corresponding interhemispheric fiber tracts interconnecting the somatosensory and visual cortices via the splenium. Our results are suggestive of altered white matter microstructure within the brain of those with adolescent idiopathic scoliosis, which could be related to abnormal brain maturation during adolescence in adolescent idiopathic scoliosis and could possibly explain the previously documented somatosensory function impairment and visuo-oculomotor dysfunction in this condition.
Collapse
Affiliation(s)
- C Xue
- From the Departments of Imaging and Interventional Radiology (C.X., L.S., S.C.N.H., D.W., C.-B.I., W.C.W.C.)
| | - L Shi
- From the Departments of Imaging and Interventional Radiology (C.X., L.S., S.C.N.H., D.W., C.-B.I., W.C.W.C.)
| | - S C N Hui
- From the Departments of Imaging and Interventional Radiology (C.X., L.S., S.C.N.H., D.W., C.-B.I., W.C.W.C.)
| | - D Wang
- From the Departments of Imaging and Interventional Radiology (C.X., L.S., S.C.N.H., D.W., C.-B.I., W.C.W.C.)
| | - T P Lam
- Orthopedics and Traumatology (T.P.L., B.K.W.N., J.C.Y.C.), Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - C-B Ip
- From the Departments of Imaging and Interventional Radiology (C.X., L.S., S.C.N.H., D.W., C.-B.I., W.C.W.C.)
| | - B K W Ng
- Orthopedics and Traumatology (T.P.L., B.K.W.N., J.C.Y.C.), Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - J C Y Cheng
- Orthopedics and Traumatology (T.P.L., B.K.W.N., J.C.Y.C.), Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - W C W Chu
- From the Departments of Imaging and Interventional Radiology (C.X., L.S., S.C.N.H., D.W., C.-B.I., W.C.W.C.)
| |
Collapse
|
28
|
Bagheri A, Liu XC, Tassone C, Thometz J, Chaloupka A, Tarima S, Cohen L, Simic M, Dennis S, Refshauge K, Pappas E, Parent EC, Pietrosanu M, Redford E, Schmidt S, Hill D, Moreau M, Hedden D, Adeeb S, Lou E, Brink RC, Schlösser TPC, Colo D, Vincken KL, van Stralen M, Hui SCN, Chu WCW, Cheng JCY, Castelein RM, Kechagias V, Grivas TB, Vlasis K, Michas K, Grivas TB, Kechagias V, Vlasis K, Michas K, Tam EMS, Yu FWP, Hung VWY, Shi L, Qin L, Ng BKW, Chu WCW, Griffith J, Cheng JCY, Lam TP, Xue C, Shi L, Hui SCN, Lam TP, Ng BKW, Cheng JCY, Chu WCW, Hui SCN, Pialasse JP, Wong JYH, Lam TP, Ng BKW, Cheng JCY, Chu WCW, Vo QN, Le LH, Lou EHM, Zheng R, Hill DL, Moreau MJ, Hedden DM, Mahood JK, Southon S, Lou E, Brignol A, Cheriet F, Miron MC, Laporte C, Qiu Y, Liu H, Liu Z, Zhu ZZ, Qian BP, Liu X, Rizza R, Thometz J, Rosol D, Tassone C, Tarima S, North P, Zaina F, Pesenti F, Negrini S, Persani L, Capodaglio P, Polli N, Yip BHK, Yu FWP, Hung VWY, Lam TP, Qin L, Ng BKW, Cheng JCY, Zhang J, Lee WYW, Chen H, Tam EMS, Man GC, Lam TP, Ng BKW, Qiu Y, Cheng JCY, Liu H, Liu Z, Zhu Z, Qian BP, Qiu Y, Harasymczuk P, Andrusiewicz M, Janusz P, Biecek P, Kotwicki T, Kotwicka M, Lee JS, Shin JK, Goh TS, Son SM, Chen H, Lee WYW, Zhang J, Tam EMS, Man GCW, Lam TP, Ng BKW, Qiu Y, Cheng JCY, Schwartz M, Gilday S, Bylski-Austrow DI, Glos DL, Schultz L, O’Hara S, Jain VV, Sturm PF, Wang X, Crandall DG, Parent S, Larson N, Labelle H, Aubin CE, Fard NB, Southon S, Moreau M, Hedden D, Duke K, Southon S, Lukenchuk L, Kerslake M, Huynh G, Chorney J, Tsui B, Tobert D, Bakarania P, Berdishevsky H, Grimes K, Matsumoto H, Hyman J, Roye B, Roye D, Vitale M, Black J, Bradley M, Drake S, Glynn D, Maude E, Berdishevsky H, Lindgren A, Bakarania P, Grimes K, Matsumoto H, Feinberg N, Bloom Z, Roye D, Vitale M, Dupuis S, Fortin C, Caouette C, Aubin CÉ, Gur G, Yakut Y, Jevtić N, Schreiber S, Hennes A, Pantović M, de Mauroy JC, Barral F, Pourret S, de Mauroy JC, Barral F, Pourret S, Aulisa AG, Guzzanti V, Galli M, Falciglia F, Aulisa L, Bernard JC, Deceuninck J, Berthonnaud E, Rougelot A, Pickering ME, Chaleat-Valayer E, Webb R, Bettany-Saltikov J, Neil B, Zaina F, Poggio M, Donzelli S, Lusini M, Minnella S, Negrini S, de Mauroy JC, Barral F, Hoang A, Mao S, Shi B, Qian B, Zhu Z, Sun X, Qiu Y, Cobetto N, Aubin CÉ, Parent S, Barch S, Turgeon I, Labelle H, Raihan HMA, Kumar DT, Khasnabis C, Equbal A, Chakraborty AK, Biswas A, Gur G, Dilek B, Ayhan C, Simsek E, Aras O, Aksoy S, Yakut Y, Lou E, Hill D, Zheng R, Donauer A, Tilburn M, Raso J, Morau M, Hedden D, Chen H, Man-Sang W, Cohen L, Kobayashi S, Simic M, Dennis S, Refshauge K, Pappas E, Aslanzadeh F, Parent EC, MacIntosh B, Maragkoudakis EG, Grivas TB, Gelalis ID, Mazioti C, Tsilimidos G, Burwell RG, Zheng Y, Wu XJ, Dang YN, Sun N, Yang Y, Wang T, He CQ, Wong MS, Donzelli S, Martinez G, Negrini A, Zaina F, Negrini S, Matsumoto H, Feinberg N, Shirley M, Swindell H, Bloom Z, Roye DP, Akbarnia BA, Garg S, Sanders JO, Skaggs DL, Smith JT, Vitale MG, Rizza R, Liu X, Thometz J, Lou E, Hill D, Donauer A, Tilburn M, Hedden D, Moreau M, Healy A, Farmer S, Chockalingam N, Aulisa AG, Guzzanti V, Galli M, Pizzetti P, Aulisa L, Maruyama T, Kobayashi Y, Nakao Y, Liu H, Qian BP, Qiu Y, Mao SH, Wang B, Yu Y, Zhu Z, Berdishevsky H, Lindgren AM, Bakarania P, Grimes K, Makhni MC, Shillingford J, Vitale MG, Black J, Maude E, Turland A, Glynn D, Caronni A, Sciumè L, Donzelli S, Zaina F, Negrini S, Schreiber S, Parent EC, Moez EK, Hedden DM, Hill DL, Moreau M, Lou E, Watkins EM, Southon SC, Parent EC, Schreiber S, Moez EK, Sloan P, Hedden D, Moreau M, Hill D, Southon S, Watkins E, Parent EC, Ghaneei M, Adeeb S, Schreiber S, Moreau M, Hedden D, Hill D, Southon S, Karavidas N, Dritsa D, Bettany-Saltikov J, Hanchard N, Kim D, Kim J, Sbihli A, Parent E, Levey L, Holowka M, Davis L, Dolan LA, Weinstein SL, Larson JE, Meyer MA, Boody B, Sarwark JF, Schreiber S, Parent EC, Hedden DM, Hill DL, Thometz J, Liu X, Rizza R, Tassone C, Liu X, Gundlach B, Tarima S, Grant A, Kalyan R, Hekal W, Honeyman C, Cook T, Murray S, Pitruzzella M, Donzelli S, Zaina F, Negrini S, de Mauroy JC, Barral F, Pourret S, de Mauroy JC, Barral F, Pourret S, Grimes K, Feinberg N, Hope J, Berdishevsky H, Bakarania P, Matsumoto H, Swindell H, Yoshimachi J, Roye D, Vitale M, Touchette J, St-Jean A, Brousseau D, Marcotte L, Théroux J, Doucet C, Lin Y, Wong MS, MacMahon J, MacMahon E, Boyette J, Stikeleather L, Lebel A, Lebel VA, Pancholi-Parekh CA, Stolze L, Selthafner M, Hong K, Liu X, Thometz J, Tassone C, Morrison PR, Hanke TA, Knott P, Krumdick ND, Chockalingam N, Shannon T, Davenhill R, Needham R, Jasani V, Ahmed EN, St-Jean A, Touchette J, Drake S, Brousseau D, Marcotte L, Théroux J, Doucet C, Aulisa AG, Guzzanti V, Gordano M, Mastantuoni G, Aulisa L, Chandrinos M, Grivas TB, Kechagias V, Głowka P, Gaweł D, Kasprzak B, Nowak M, Morzyński M, Kotwicki T, Deceuninck J, Bernard JC, Lecante C, Berthonnaud E, Fortin C, Aubin-Fournier JF, Bettany-Saltikov J, Parent EC, Feldman DE, Bernard JC, Liu Z, Zhang W, Hu Z, Zhu W, Jin M, Han X, Qiu Y, Cheng JCY, Zhu Z, Liu Z, Guo J, Wu T, Qian B, Zhu Z, Zhu F, Jiang J, Qiu Y, Han X, Liu Z, Liu H, Qiu Y, Guo J, Yan H, Sun X, Cheng JCY, Zhu Z, Di Felice F, Zaina F, Pitruzzella M, Donzelli S, Negrini S, Needham RA, Chatzistergos P, Chockalingam N, Brink RC, Schlösser TPC, Colo D, Vincken KL, van Stralen M, Hui SCN, Chu WCW, Cheng JCY, Castelein RM, Bylski-Austrow DI, Glos DL, Jain VV, Reynolds JE, Sturm PF, Wall EJ, Igoumenou VG, Megaloikonomos PD, Tsiavos K, Panagopoulos GN, Mavrogenis AF, Grivas TB, Soultanis K, Papagelopoulos PJ, Fard NB, Duke K, Chan A, Parent EC, Lou E, Lee JS, Shin JK, Goh TS, Son SM, Kobayashi S, Togawa D, Hasegawa T, Yamato Y, Oe S, Banno T, Mihara Y, Matsuyama Y. 13th International Conference on Conservative Management of Spinal Deformities and First Joint Meeting of the International Research Society on Spinal Deformities and the Society on Scoliosis Orthopaedic and Rehabilitation Treatment – SOSORT-IRSSD 2016 meeting. Scoliosis 2017. [PMCID: PMC5461518 DOI: 10.1186/s13013-017-0124-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
29
|
Cheung TF, Cheuk KY, Yu FWP, Hung VWY, Ho CS, Zhu TY, Ng BKW, Lee KM, Qin L, Ho SSY, Wong GWK, Cheng JCY, Lam TP. Prevalence of vitamin D insufficiency among adolescents and its correlation with bone parameters using high-resolution peripheral quantitative computed tomography. Osteoporos Int 2016; 27:2477-88. [PMID: 27010646 DOI: 10.1007/s00198-016-3552-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/23/2016] [Indexed: 12/25/2022]
Abstract
UNLABELLED Vitamin D deficiency and insufficiency are highly prevalent among adolescents in Hong Kong, which is a sub-tropical city with ample sunshine. Vitamin D level is significantly correlated with key bone density and bone quality parameters. Further interventional studies are warranted to define the role of vitamin D supplementation for improvement of bone health among adolescents. INTRODUCTION The relationship between bone quality parameters and vitamin D (Vit-D) status remains undefined among adolescents. The aims of this study were to evaluate Vit-D status and its association with both bone density and bone quality parameters among adolescents. METHODS Three hundred thirty-three girls and 230 boys (12-16 years old) with normal health were recruited in summer and winter separately from local schools. Serum 25(OH) Vit-D level, bone density and quality parameters by Dual Energy X-ray Absorptiometry (DXA) and High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT), dietary calcium intake, and physical activity level were assessed. RESULTS Sixty-four point seven percent and 11.4 % of subjects were insufficient [25 ≤ 25(OH)Vit-D ≤ 50 nmol/L] and deficient [25(OH)Vit-D < 25 nmol/L] in Vit-D, respectively. The mean level of serum 25(OH)Vit-D in summer was significantly higher than that in winter (44.7 ± 13.6 and 35.9 ± 12.6 nmol/L, respectively) without obvious gender difference. In girls, areal bone mineral density (aBMD) and bone mineral content (BMC) of bilateral femoral necks, cortical area, cortical thickness, total volumetric bone mineral density (vBMD), and trabecular thickness were significantly correlated with 25(OH)Vit-D levels. In boys, aBMD of bilateral femoral necks, BMC of the dominant femoral neck, cortical area, cortical thickness, total vBMD, trabecular vBMD, BV/TV, and trabecular separation were significantly correlated with 25(OH)Vit-D levels. CONCLUSION Vit-D insufficiency was highly prevalent among adolescents in Hong Kong with significant correlation between Vit-D levels and key bone density and bone quality parameters being detected in this study. Given that this is a cross-sectional study and causality relationship cannot be inferred, further interventional studies investigating the role of Vit-D supplementation on improving bone health among adolescents are warranted.
Collapse
Affiliation(s)
- T F Cheung
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China
| | - K Y Cheuk
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China
| | - F W P Yu
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China
| | - V W Y Hung
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China
| | - C S Ho
- Department of Chemical Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - T Y Zhu
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China
| | - B K W Ng
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China
| | - K M Lee
- Lee Hysan Clinical Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - L Qin
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China
| | - S S Y Ho
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - G W K Wong
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - J C Y Cheng
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China
- SH Ho Scoliosis Research Laboratory, Sha Tin, Hong Kong, China
| | - T P Lam
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China.
- SH Ho Scoliosis Research Laboratory, Sha Tin, Hong Kong, China.
| |
Collapse
|
30
|
Shi B, Mao S, Xu L, Sun X, Liu Z, Zhu Z, Lam TP, Cheng JC, Ng B, Qiu Y. Factors favoring regain of the lost vertical spinal height through posterior spinal fusion in adolescent idiopathic scoliosis. Sci Rep 2016; 6:29115. [PMID: 27373798 PMCID: PMC4931422 DOI: 10.1038/srep29115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/10/2016] [Indexed: 11/09/2022] Open
Abstract
Height gain is a common beneficial consequence following correction surgery in adolescent idiopathic scoliosis (AIS), yet little is known concerning factors favoring regain of the lost vertical spinal height (SH) through posterior spinal fusion. A consecutive series of AIS patients from February 2013 to August 2015 were reviewed. Surgical changes in SH (ΔSH), as well as the multiple coronal and sagittal deformity parameters were measured and correlated. Factors associated with ΔSH were identified through Pearson correlation analysis and multivariate regression analysis. A total of 172 single curve and 104 double curve patients were reviewed. The ΔSH averaged 2.5 ± 0.9 cm in single curve group and 2.9 ± 1.0 cm in double curve group. The multivariate regression analysis revealed the following pre-operative variables contributed significantly to ΔSH: pre-op Cobb angle, pre-op TK (single curve group only), pre-op GK (double curve group only) and pre-op LL (double curve group only) (p < 0.05). Thus change in height (in cm) = 0.044 × (pre-op Cobb angle) + 0.012 × (pre-op TK) (Single curve, adjusted R(2) = 0.549) or 0.923 + 0.021 × (pre-op Cobb angle1) + 0.028 × (pre-op Cobb angle2) + 0.015 × (pre-op GK)-0.012 × (pre-op LL) (Double curve, adjusted R(2) = 0.563). Severer pre-operative coronal Cobb angle and greater sagittal curves were beneficial factors favoring more contribution to the surgical lengthening effect in vertical spinal height in AIS.
Collapse
Affiliation(s)
- Benlong Shi
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong &Nanjing University, Nanjing, China
| | - Saihu Mao
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong &Nanjing University, Nanjing, China
| | - Leilei Xu
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong &Nanjing University, Nanjing, China
| | - Xu Sun
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong &Nanjing University, Nanjing, China
| | - Zhen Liu
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong &Nanjing University, Nanjing, China
| | - Zezhang Zhu
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong &Nanjing University, Nanjing, China
| | - Tsz Ping Lam
- Joint Scoliosis Research Center of the Chinese University of Hong Kong &Nanjing University, Nanjing, China.,Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China
| | - Jack Cy Cheng
- Joint Scoliosis Research Center of the Chinese University of Hong Kong &Nanjing University, Nanjing, China.,Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China
| | - Bobby Ng
- Joint Scoliosis Research Center of the Chinese University of Hong Kong &Nanjing University, Nanjing, China.,Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China
| | - Yong Qiu
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong &Nanjing University, Nanjing, China
| |
Collapse
|
31
|
Shi B, Guo J, Mao S, Wang Z, Yu FWP, Lee KM, Ng BKW, Zhu Z, Qiu Y, Cheng JCY, Lam TP. Curve Progression in Adolescent Idiopathic Scoliosis With a Minimum of 2 Years' Follow-up After Completed Brace Weaning With Reference to the SRS Standardized Criteria. Spine Deform 2016; 4:200-205. [PMID: 27927503 DOI: 10.1016/j.jspd.2015.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/16/2015] [Accepted: 12/13/2015] [Indexed: 01/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES To investigate curve evolution after brace weaning in adolescent idiopathic scoliosis (AIS) with reference to the Scoliosis Research Society (SRS) criteria. SUMMARY OF BACKGROUND DATA Previous studies mainly focused on curve evolution during bracing in AIS. However, curve progression after brace weaning was not well addressed. METHODS Braced AIS girls followed up for at least 2 years after brace weaning were reviewed. All patients had radiographs at initial visit, brace weaning, 6 months, 1 year, and 2 years after brace weaning, and last follow-up. Curve progression after brace weaning was separately defined as increase in Cobb angle >5 degrees and curve magnitude >45 degrees. The predictors for curve progression were identified using the independent t test. RESULTS 200 AIS girls were reviewed. The average duration of follow-up after brace weaning was 51.4 ± 25.6 months. Compared with brace weaning, at 6 months, 1 year, 2 years and last follow-up after brace weaning, 50 (25.0%), 60 (30.0%), 93 (46.5%), and 87 (43.5%) patients, respectively, had curve progression >5 degrees; 0 (0%), 0 (0%), 2 (1%), and 2 (1%) patients, respectively, had surgery recommended; among those with Cobb angle ≤40 degrees at brace weaning, 7 (4.0%), 11 (6.3%), 16 (9.2%), and 18 (10.3%) patients, respectively, had Cobb angle >45 degrees; the mean progression magnitudes were 2.6 ± 5.8, 3.5 ± 5.8, 5.1 ± 6.5, and 5.4 ± 7.4 degrees, respectively; and the mean progression rates were 0.34 ± 0.83, 0.16 ± 0.56, 0.13 ± 0.39, and 0.006 ± 0.28 degrees/month, respectively. Cobb angle at brace weaning was associated with increase in Cobb angle >5 degrees (p = .033) and curve magnitude >45 degrees (p < .001) after brace weaning. CONCLUSIONS Curve progression after brace weaning is observed in 43.5% AIS patients. The highest risk occurs within 6 months after brace weaning whereas Cobb angle remains stable after 2 years' follow-up. High Cobb angle at brace weaning indicates high risk of curve progression after brace weaning. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Benlong Shi
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Jing Guo
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Saihu Mao
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Zhiwei Wang
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Fiona W P Yu
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Kwong Man Lee
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Bobby K W Ng
- Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Zezhang Zhu
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Yong Qiu
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Jack C Y Cheng
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Tsz Ping Lam
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China.
| |
Collapse
|
32
|
Lam TP, Lam KF, Ho PL, Yung RWH. Knowledge, attitude, and behaviour toward antibiotics among Hong Kong people: local-born versus immigrants. Hong Kong Med J 2015; 21 Suppl 7:S41-S47. [PMID: 26908273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- T P Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong
| | - K F Lam
- Department of Statistics & Actuarial Science, The University of Hong Kong
| | - P L Ho
- Department of Microbiology, The University of Hong Kong
| | | |
Collapse
|
33
|
Ng BKW, Chau WW, Hui ACN, Cheng PY, Wong CY, Wang B, Cheng JCY, Lam TP. HRQoL assessment by SRS-30 for Chinese patients with surgery for Adolescent Idiopathic Scoliosis (AIS). Scoliosis 2015. [PMCID: PMC4341157 DOI: 10.1186/1748-7161-10-s1-p31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
34
|
Cheuk KY, Lam TP, Zhang IJJ, Wang ZW, Hung VWY, Ng BKW, Mak AFT, Cheng JCY. Abnormal bone micro-architecture and rod-plate configuration in osteopenic adolescent idiopathic scoliosis (AIS). Scoliosis 2015. [PMCID: PMC4340156 DOI: 10.1186/1748-7161-10-s1-o14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
35
|
Cheuk KY, Zhu TY, Yu FWP, Hung VWY, Lee KM, Qin L, Cheng JCY, Lam TP. Abnormal Bone Mechanical and Structural Properties in Adolescent Idiopathic Scoliosis: A Study with Finite Element Analysis and Structural Model Index. Calcif Tissue Int 2015; 97:343-52. [PMID: 26100651 DOI: 10.1007/s00223-015-0025-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/15/2015] [Indexed: 11/29/2022]
Abstract
Previous studies found adolescent idiopathic scoliosis (AIS) is associated with low bone mineral density (BMD) and abnormal bone quality, whilst the association between AIS and their bone strength is unknown. From high-resolution peripheral quantitative computed tomography-generated images, bone mechanical properties can be evaluated with finite element analysis (FEA), and trabecular rod-plate configuration related to trabecular bone strength can be quantified by structure model index (SMI). This study aimed to compare trabecular configuration and bone mechanical properties between AIS and the controls. 95 AIS girls aged 12-14 years and 97 age- and gender-matched normal controls were recruited. Bilateral femoral necks and non-dominant distal radius were scanned by dual-energy X-ray absorptiometry for areal BMD and HR-pQCT for SMI and FEA, respectively. Subjects were further classified into osteopenic and non-osteopenic group based on their areal BMD. Bone mechanical properties (stiffness, failure load and apparent modulus) were calculated using FEA. Linear regression model was used for controlling age, physical activity and calcium intake. AIS was associated with lower failure load and apparent modulus after adjusting for age, whereas AIS was associated with lower apparent modulus after adjusting for all confounders. Osteopenic AIS was associated with more rod-like trabeculae when compared with non-osteopenic AIS, whereas no difference was detected between osteopenic and non-osteopenic controls. This might be the result of abnormal regulation and modulation of bone metabolism and bone modelling and remodelling in AIS which will warrant future studies with a longitudinal design to determine the significance of micro-architectural abnormalities in AIS.
Collapse
Affiliation(s)
- K Y Cheuk
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong and Nanjing, China
| | - T Y Zhu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - F W P Yu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong and Nanjing, China
- Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - V W Y Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - K M Lee
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong and Nanjing, China
- Lee Hysan Clinical Research Laboratories, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - L Qin
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - J C Y Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong and Nanjing, China
- Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - T P Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong and Nanjing, China.
- Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| |
Collapse
|
36
|
Mao S, Shi B, Xu L, Wang Z, Hung ALH, Lam TP, Yu FWP, Lee KM, Ng BKW, Cheng JCY, Zhu Z, Qiu Y. Initial Cobb angle reduction velocity following bracing as a new predictor for curve progression in adolescent idiopathic scoliosis. Eur Spine J 2015; 25:500-5. [PMID: 25906378 DOI: 10.1007/s00586-015-3937-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/06/2015] [Accepted: 04/06/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The initial correction rate (ICR) has been widely used as a predictor for curve progression in adolescent idiopathic scoliosis (AIS) undergoing bracing treatment. We proposed a new parameter, the initial Cobb angle reduction velocity (ARV), for prediction of curve progression. The purpose of this study was to identify whether the initial ARV was a more effective predictor than ICR for curve progression in AIS patients undergoing brace treatment, and to evaluate the ideal cut-off point of initial ARV for prediction of curve progression. METHODS This was a retrospective cohort study on AIS girls receiving standardized bracing treatment regularly followed up every 3-6 months. Standardized SRS criteria for bracing study were utilized in the case selection. The demographic data, maturity status and Cobb angle of each visit were recorded. The initial ARV and ICR were identified. Patients were divided into progressive (≥6°) and non-progressive (<6°) groups based on their final bracing outcome. Differences between two groups were identified and logistic regression analysis was applied to compare the predictive values of initial ARV and ICR for curve progression during bracing treatment. RESULTS Seventy-six patients were included in the non-progressive group and 19 in the progressive group. Significant differences between non-progressive and progressive groups were found in terms of initial ARV (12.8 ± 21.4°/year vs -5.4 ± 15.2°/year, P = 0.001) and ICR (12.1 ± 20.7 % vs -5.8 ± 18.0 %, P = 0.001). The logistic regression analysis revealed that age at initial visit (OR 1.742, P = 0.043) and initial ARV (OR 1.057, P = 0.002) had higher predictive values than ICR (P = 0.601) for curve progression in braced AIS girls. The ideal cut-off point of initial ARV was 10°/year (OR 8.959, P = 0.005) for the prediction of curve progression. CONCLUSIONS The initial Cobb angle reduction velocity serves as a better predictor for curve progression than initial correction rate in braced AIS patients with follow-up interval of 3-6 months. At the second visit following bracing prescription, those AIS patients with reduction velocity in Cobb angle lower than 10°/year have significantly higher risk of curve progression.
Collapse
Affiliation(s)
- Saihu Mao
- Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing, 210008, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Nanjing, China
| | - Benlong Shi
- Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing, 210008, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Nanjing, China
| | - Leilei Xu
- Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing, 210008, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Nanjing, China
| | - Zhiwei Wang
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Nanjing, China
| | - Alec Lik Hang Hung
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China
| | - Tsz Ping Lam
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Nanjing, China
| | - Fiona Wai Ping Yu
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Nanjing, China
| | - Kwong Man Lee
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China
| | - Bobby Kin Wah Ng
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China
| | - Jack Chun Yiu Cheng
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Nanjing, China
| | - Zezhang Zhu
- Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing, 210008, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Nanjing, China
| | - Yong Qiu
- Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing, 210008, China.
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Nanjing, China.
| |
Collapse
|
37
|
Abstract
OBJECTIVE To identify the factors associated with 12-month mental health service use in primary care patients with depressive symptoms. DESIGN Cross-sectional followed by 12-month cohort study. SETTING AND PARTICIPANTS 10 179 adult patients were recruited from the waiting rooms of 59 primary care clinics across Hong Kong to complete a questionnaire which screened for depression. 518 screened-positive participants formed the cohort and were telephoned at 3, 6 and 12 months to monitor mental health service use. PRIMARY AND SECONDARY OUTCOMES ▸ Help-seeking preferences; ▸ Intention to seek help from a healthcare professional; ▸ 12-month mental health service use. RESULTS At baseline, when asked who they would seek help from if they thought they were depressed, respondents preferred using friends and family (46.5%) over a psychiatrist (24.9%), psychologist (22.8%) or general practitioner (GP; 19.9%). The presence of depressive symptoms was associated with a lower intention to seek help from family and friends but had no effect on intention to seek help from a healthcare professional. Over 12 months, 24.3% of the screened-positive cohort reported receiving services from a mental health professional. Factors associated with service use included identification of depression by the GP at baseline, having a past history of depression or other mental illness, and being a public sector patient. Having a positive intention to seek professional help or more severe depressive symptoms at baseline was not associated with a greater likelihood of receiving treatment. CONCLUSIONS Mental health service use appears to be very low in this setting with only one in four primary care patients with depressive symptoms receiving treatment from a psychiatrist, GP or psychologist over a year. To help reduce the burden of illness, better detection of depressive disorders is needed especially for patients who may be undertreated such as those with no prior diagnosis of depression and those with more severe symptoms.
Collapse
Affiliation(s)
- Weng Yee Chin
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kit T Y Chan
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Cindy L K Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - T P Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Eric Y F Wan
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| |
Collapse
|
38
|
Lam TP, Ng BKW, Lee KM, Hung ALH, Tam EMS, Cheung FTF, Tsang EKL, Cheng JCY. Serum 25(OH)vitamin D level and Its correlation with bone mineral density in girls with Adolescent Idiopathic Scoliosis (AIS). Scoliosis 2015. [PMCID: PMC4341122 DOI: 10.1186/1748-7161-10-s1-o7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
39
|
Lam TP, Ng BKW, Lee KM, Wong LLN, Yu FWP, Chan SYY, Wong MS, Cheng JCY. Using your mobile phone for quantitative measurement of spinal motion: a reliability and validity study. Scoliosis 2015. [PMCID: PMC4340188 DOI: 10.1186/1748-7161-10-s1-o29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
40
|
Lam TP, Ng BKW, Yu FWP, Tsang EKL, Lee WYW, Cheung FTF, Chen HX, Cheng JCY. Serum 25(OH) vitamin d level is associated with treatment outcome of whole-body vibration (WBV) for osteopenia in girls with adolescent idiopathic scoliosis (AIS). Scoliosis 2015. [PMCID: PMC4340246 DOI: 10.1186/1748-7161-10-s1-o56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
41
|
Cheuk KY, Lam TP, Wong LLN, Hung ALH, Mak AFT, Lee KM, Ng BKW, Cheng JCY. Evaluating bone strength with finite element analysis for Adolescent Idiopathic Scoliosis (AIS): a case-control study with HR-pQCT. Scoliosis 2015. [PMCID: PMC4340170 DOI: 10.1186/1748-7161-10-s1-o20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
42
|
Man GCW, Wai MGC, Wang WWJ, Jun WWW, Yim APY, Yee YAP, Wong JH, Ho WJ, Ng TB, Bun NT, Lam TP, Ping LT, Lee SKM, Man LSK, Ng BKW, Wah NBK, Wang CC, Chiu WC, Qiu Y, Yong Q, Cheng CY, Yiu CJC. A review of pinealectomy-induced melatonin-deficient animal models for the study of etiopathogenesis of adolescent idiopathic scoliosis. Int J Mol Sci 2014; 15:16484-99. [PMID: 25238413 PMCID: PMC4200812 DOI: 10.3390/ijms150916484] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/08/2014] [Accepted: 09/10/2014] [Indexed: 11/16/2022] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is a common orthopedic disorder of unknown etiology and pathogenesis. Melatonin and melatonin pathway dysfunction has been widely suspected to play an important role in the pathogenesis. Many different types of animal models have been developed to induce experimental scoliosis mimicking the pathoanatomical features of idiopathic scoliosis in human. The scoliosis deformity was believed to be induced by pinealectomy and mediated through the resulting melatonin-deficiency. However, the lack of upright mechanical spinal loading and inherent rotational instability of the curvature render the similarity of these models to the human counterparts questionable. Different concerns have been raised challenging the scientific validity and limitations of each model. The objectives of this review follow the logical need to re-examine and compare the relevance and appropriateness of each of the animal models that have been used for studying the etiopathogenesis of adolescent idiopathic scoliosis in human in the past 15 to 20 years.
Collapse
Affiliation(s)
| | - Man Gene Chi Wai
- Department of Obstetrics and Gynaecology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China.
| | | | - Wang William Wei Jun
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China.
| | | | - Yim Annie Po Yee
- Department of Orthopaedics & Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China.
| | | | - Wong Jack Ho
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China.
| | | | - Ng Tzi Bun
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China.
| | | | - Lam Tsz Ping
- Department of Orthopaedics & Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China.
| | | | - Lee Simon Kwong Man
- Lee Hysan Clinical Research Laboratory, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China.
| | | | - Ng Bobby Kin Wah
- Department of Orthopaedics & Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China.
| | | | - Wang Chi Chiu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China.
| | | | - Qiu Yong
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China.
| | | | - Cheng Jack Chun Yiu
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong, China.
| |
Collapse
|
43
|
Wang W, Wang Z, Liu Z, Zhu Z, Zhu F, Sun X, Lam TP, Cheng JCY, Qiu Y. Are there gender differences in sagittal spinal pelvic inclination before and after the adolescent pubertal growth spurt? Eur Spine J 2014; 24:1168-74. [DOI: 10.1007/s00586-014-3563-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 09/02/2014] [Accepted: 09/04/2014] [Indexed: 11/25/2022]
|
44
|
Chun Yiu Cheng J, Lam TP, Wong MS, Guo J, Ng BKW. Answer to the letter of the editor T. Cook concerning "a prospective randomized controlled study on the treatment outcome of SpineCor brace versus rigid brace for adolescent idiopathic scoliosis with follow-up according to the SRS standardized criteria" by Jing Guo et al., Eur Spine J, doi:10.1007/s00586-013-3146-1. Eur Spine J 2014; 23:1580. [PMID: 24861699 DOI: 10.1007/s00586-014-3377-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/04/2014] [Accepted: 05/04/2014] [Indexed: 06/03/2023]
Affiliation(s)
- Jack Chun Yiu Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong,
| | | | | | | | | |
Collapse
|
45
|
Yu WS, Chan KY, Yu FWP, Ng BKW, Lee KM, Qin L, Lam TP, Cheng JCY. Bone structural and mechanical indices in Adolescent Idiopathic Scoliosis evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT). Bone 2014; 61:109-15. [PMID: 24412702 DOI: 10.1016/j.bone.2013.12.033] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 11/27/2013] [Accepted: 12/27/2013] [Indexed: 11/16/2022]
Abstract
Adolescent Idiopathic Scoliosis (AIS) is associated with systemic low bone mass. It could persist into adulthood and was shown to be an important prognostic factor for curve progression in AIS. Previous studies were confined to areal bone mineral density (aBMD) measured by Dual-energy X-ray Absorptiometry (DXA) which was a two-dimensional measurement for a three-dimensional structure. This conventional measurement was inadequate to evaluate volumetric bone density and bone quality which are important determinants for bone strength and bone health status as defined in the 2000 NIH consensus statement. High-resolution peripheral quantitative computed tomography (HR-pQCT) was therefore used in this study for three-dimensional evaluation of volumetric bone mineral density and bone micro-architecture as well as estimation of bone strength. In this study, 214 newly diagnosed AIS girls and 187 age and gender-matched normal control aged between 11 and 13years old were recruited for HR-pQCT evaluations on bone geometry, trabecular bone micro-architecture and volumetric BMD (vBMD) at the non-dominant distal radius. We demonstrated that AIS was associated with lower Cortical Bone Area, Cortical Bone vBMD, Trabecular Number and greater Trabecular Separation. With multivariate linear regression analysis and after adjustment for age, dietary calcium intake and physical activity level, the association of AIS with lower Cortical Bone vBMD, lower Trabecular Number and greater Trabecular Separation remained statistically significant. The findings of this study indicated that AIS was associated with an abnormal bone quality profile suggestive of alteration in endocortical modeling, derangement in trabecular bone structure and disturbance in bone mineralization. The cause for these changes and how they are related to the etiopathogenesis of AIS warrant further studies.
Collapse
Affiliation(s)
- Wing Sze Yu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong and Nanjing, China
| | - Ka Yan Chan
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong and Nanjing, China
| | - Fiona Wai Ping Yu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong and Nanjing, China
| | - Bobby Kin Wah Ng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong and Nanjing, China
| | - Kwong Man Lee
- Lee Hysan Clinical Research Laboratories, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong and Nanjing, China
| | - Ling Qin
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Bone Quality and Health Assessment Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Tsz Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong and Nanjing, China
| | - Jack Chun Yiu Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong and Nanjing, China.
| |
Collapse
|
46
|
Sha S, Zhu Z, Lam TP, Sun X, Qian B, Jiang J, Cheng JCY, Qiu Y. Brace treatment versus observation alone for scoliosis associated with Chiari I malformation following posterior fossa decompression: a cohort study of 54 patients. Eur Spine J 2014; 23:1224-31. [PMID: 24619608 DOI: 10.1007/s00586-014-3265-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 02/24/2014] [Accepted: 02/24/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To be deemed effective in preventing curve progression, brace treatment should show alteration of the expected natural history. Most of the reported studies on the effect of bracing on the evolution of Chiari malformation-associated scoliosis (CMS) following posterior fossa decompression (PFD) were small series with inconclusive results. The goal of this study was to investigate whether post-PFD brace treatment for CMS produces better outcomes than observation alone. METHODS The clinical and radiographic data of 21 patients treated with observation alone (Ob group) and 33 patients receiving brace treatment (Br group) were retrospectively reviewed. Evolution of scoliosis was defined as progression of Cobb angle of the primary curve of >5°, as compared with that at brace initiation. RESULTS At the latest follow-up, curve progression occurred in 10 (30 %) of Br group and 13 (62 %) of Ob group (P = .022). Overall, 8 (24 %) patients in the Br group and 9 (43 %) in the Ob group underwent further scoliosis surgery (P = .151). When analyses were restricted to the 27 braced and 17 observed patients who had reached skeletal maturity or undergone spinal fusion surgery, decreased curve progression and surgical rates were also observed in the Br group though not reaching statistical significance. Results of the survival analysis, however, demonstrated a significantly increased survival proportion in the Br group (0.63 versus 0.35, P = .014). CONCLUSIONS Compared with observation alone, bracing treatment following PFD in patients with CMS was observed to reduce the rates of curve progression and scoliosis surgery. However, patients and their parents should be informed that almost a third of patients still go on to surgery.
Collapse
Affiliation(s)
- Shifu Sha
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing, 210008, China
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Lam TP, Ng BKW, Cheung LWH, Lee KM, Qin L, Cheng JCY. Effect of whole body vibration (WBV) therapy on bone density and bone quality in osteopenic girls with adolescent idiopathic scoliosis: a randomized, controlled trial. Osteoporos Int 2013; 24:1623-36. [PMID: 23011683 DOI: 10.1007/s00198-012-2144-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 09/06/2012] [Indexed: 11/30/2022]
Abstract
UNLABELLED The aim of this randomized controlled trial was to determine whether whole body vibration (WBV) therapy was effective for treating osteopenia in adolescent idiopathic scoliosis (AIS) patients. Results showed that WBV was effective for improving areal bone mineral density (aBMD) at the femoral neck of the dominant side and lumbar spine BMC in AIS subjects. INTRODUCTION AIS is associated with osteopenia. Although WBV was shown to have skeletal anabolic effects in animal studies, its effect on AIS subjects remained unknown. The objective of this study was to determine whether WBV could improve bone mineral density (BMD) and bone quality for osteopenia in AIS subjects. METHODS This was a randomized, controlled trial recruiting 149 AIS girls between 15 and 25 years old and with bone mineral density (BMD) Z-scores <-1. They were randomly assigned to the Treatment or Control groups. The Treatment group (n = 61) stood on a low-magnitude high-frequency WBV platform 20 min/day, 5 days/week for 12 months. The Control group (n = 63) received observation alone. Bone measurement was done at baseline and at 12 months: (1) aBMD and BMC at femoral necks and lumbar spine using dual-energy X-ray absorptiometry (DXA) and (2) bone quality including bone morphometry, volumetric BMD (vBMD), and trabecular bone microarchitecture using high-resolution peripheral quantitative computed tomography (HR-pQCT) for nondominant distal radius and bilateral distal tibiae. RESULTS The Treatment group had numerically greater increases in all DXA parameters with a statistically significant difference being detected for the absolute and percentage increases in femoral neck aBMD at the dominant leg (0.015 (SD = 0.031)g/cm(2), 2.15 (SD = 4.32)%) and the absolute increase in lumbar spine BMC (1.17 (SD = 2.05)g) in the Treatment group as compared with the Control group (0.00084 (SD = 0.026)g/cm(2), 0.13 (SD = 3.62)% and 0.47 (SD = 1.88)g, respectively). WBV had no significant effect for other bone quality parameters. CONCLUSIONS WBV was effective for improving aBMD at the femoral neck of the dominant side and lumbar spine BMC in AIS subjects.
Collapse
Affiliation(s)
- T P Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
| | | | | | | | | | | |
Collapse
|
48
|
Lam TP, Hung VWY, Yeung HY, Chu WCW, Ng BKW, Lee KM, Qin L, Cheng JCY. Quantitative ultrasound for predicting curve progression in adolescent idiopathic scoliosis: a prospective cohort study of 294 cases followed-up beyond skeletal maturity. Ultrasound Med Biol 2013; 39:381-387. [PMID: 23245828 DOI: 10.1016/j.ultrasmedbio.2012.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 09/08/2012] [Accepted: 09/12/2012] [Indexed: 06/01/2023]
Abstract
Adolescent idiopathic scoliosis (AIS) is prevalent among adolescents and can carry significant morbidities. We evaluated the use of quantitative ultrasound (QUS) for predicting curve progression in patients with AIS. We recruited 294 girls with AIS at a mean age of 13.4 years, and they were prospectively followed beyond skeletal maturity for curve progression. We recorded 3 calcaneal QUS measurements at baseline, namely broadband ultrasound attenuation (BUA), velocity of sound (VOS), and stiffness index (SI). Logistic regression analysis indicated that SI, age, menarchal status, and Cobb angle were significant prognostic factors to be included in the final prediction model. The adjusted odds ratio of curve progression for Z-score of SI≦0 was 2.00 (95% CI: 1.08-3.71). The area under the ROC curve was 0.831 (95% CI: 0.785-0.877). The results of this study indicate that SI was an independent and significant prognostic factor for AIS and could be considered in addition to other prognostic factors when estimating the risk for curve progression and planning treatment for patients with AIS.
Collapse
Affiliation(s)
- Tsz Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Lam TP, Goldberg DP, Dowell AC, Fortes S, Mbatia JK, Minhas FA, Klinkman MS. Proposed new diagnoses of anxious depression and bodily stress syndrome in ICD-11-PHC: an international focus group study. Fam Pract 2013; 30:76-87. [PMID: 22843638 DOI: 10.1093/fampra/cms037] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The World Health Organization is revising the primary care classification of mental and behavioural disorders for the International Classification of Diseases (ICD-11-Primary Health Care (PHC)) aiming to reduce the disease burden associated with mental disorders among member countries. OBJECTIVE To explore the opinions of primary care professionals on proposed new diagnostic entities in draft ICD-11-PHC, namely anxious depression and bodily stress syndrome (BSS). METHODS Qualitative study with focus groups of primary health-care workers, using standard interview schedule after draft ICD-11-PHC criteria for each proposed entity was introduced to the participants. RESULTS Nine focus groups with 4-15 participants each were held at seven locations: Austria, Brazil, Hong Kong, New Zealand, Pakistan, Tanzania and United Kingdom. There was overwhelming support for the inclusion of anxious depression, which was considered to be very common in primary care settings. However, there were concerns about the 2-week duration of symptoms being too short to make a reliable diagnosis. BSS was considered to be a better term than medically unexplained symptoms but there were disagreements about the diagnostic criteria in the number of symptoms required. CONCLUSION Anxious depression is well received by primary care professionals, but BSS requires further modification. International field trials will be held to further test these new diagnoses in draft ICD-11-PHC.
Collapse
Affiliation(s)
- T P Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
| | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
OBJECTIVE To investigate the impact of a Western mental health training course for Traditional Chinese Medicine (TCM) practitioners. METHOD A combined qualitative and quantitative approach was applied to examine the changes in the TCM practitioners' clinical practice characteristics and attitudes. Focus groups and structured questionnaire surveys were conducted to compare their responses before and after the Course. RESULTS After a 10-week training course conducted by psychiatrists and family physicians, there were significant changes in confidence of the TCM practitioners for diagnosis (33% being confident before the Course vs. 76% after the Course) and management (24% vs. 55%) of common mental health problems. The causal effects of better classifications to recognition of mental health problems were explained by the qualitative responses. Proportion of TCM practitioners being confident of referring mental health patients to other healthcare professionals doubled from 25% to 50% after the Course. Nonetheless, there was no significant change in percentage of these patients being recommended to Western doctors owing to a lack of formal referral channel. CONCLUSIONS Western mental health training for TCM practitioners has positive impact on their clinical practice. However, the practical barriers in making referrals highlight the need of closer collaboration between conventional and traditional medicine.
Collapse
Affiliation(s)
- T P Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China.
| | | | | | | | | |
Collapse
|