Search

Background Necrotizing fasciitis following venomous snakebites is uncommon. The purpose of this study was to describe the initial clinical features of necrotizing fasciitis after snakebites, and to identify the risk factors for patients with cellulitis who later developed necrotizing fasciitis. Methods Sixteen patients with surgically confirmed necrotizing fasciitis and 25 patients diagnosed with cellulitis following snakebites were retrospectively reviewed over a 6-year period. Differences in patient characteristics, clinical presentations, snake species and laboratory data were compared between the necrotizing fasciitis and the cellulitis groups. Results None of the 41 patients died after being bitten by a snake. Twenty-nine patients (70.7%) were bitten by a cobra. Enterococcus species and Morganella morganii were the most common pathogens identified in wound cultures. Relative to the cellulitis group, the necrotizing fasciitis group had significantly higher rates of hemorrhagic bullae ( p =0.000), patients with underlying chronic disease ( p =0.019), white blood cell counts ( p =0.035), segmented white cell counts ( p =0.02), and days of hospitalization ( p =0.001). Conclusions Victims of venomous snakebites should be admitted for close monitoring of secondary wound infections. The risk factors of developing necrotizing fasciitis from cellulitis following snakebites were associated with chronic underlying diseases and leukocytosis (total white blood-cell counts ≥10000cells/mm 3 and ≥80% of segmented leukocyte forms). Physicians should be alert to a worsening wound condition after a snakebite, and surgical interventions should be performed for established necrotizing fasciitis with the empirical use of third-generation cephalosporins plus other regimens.

// Liang-Tseng Kuo 1, 2, , Su-Ju Lin 3 , Chi-Lung Chen 1 , Pei-An Yu 1 , Wei-Hsiu Hsu 1, 4, * and Tien-Hsing Chen 5, * 1 Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan 2 Chang Gung University of Science and Technology, Chiayi, Taiwan 3 Division of Nephrology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan 4 College of Medicine, Chang Gung University, Taoyuan, Taiwan 5 Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan * These authors have contributed equally to this work Correspondence to: Wei-Hsiu Hsu, email: 7572@cgmh.org.tw Tien-Hsing Chen, email: skyheart0826@gmail.com Keywords: total knee arthroplasty; diabetes mellitus; chronic kidney disease; mortality; periprosthetic joint infection Received: August 16, 2017 Accepted: September 24, 2017 Published: October 31, 2017 ABSTRACT Diabetes and chronic kidney disease (CKD) are associated with a higher rate of complications in patients undergoing total knee arthroplasty (TKA). The purpose of this study was to determine the effects of CKD and diabetes in patients after TKA. Diabetic patients who received unilateral primary TKA between January 2008 and December 2011 were enrolled. The follow-up period was more than 6 months. The primary outcome was a TKA-related infection and the secondary outcome was all-cause mortality. The study cohort included 13844 patients who were followed for a mean period of 2 years, of whom 1459 (10.5%) had CKD. The patients with CKD were older than those without CKD (71.6 versus 70.3 years, P

Background: There is no consensus regarding the best treatment approach for middle-aged patients with anterior cruciate ligament (ACL) injuries. Chronic ACL-deficient knees are often associated with instability as well as secondary meniscal and cartilage lesions. ACL reconstruction (ACLR) has achieved satisfactory outcomes in younger patients; however, the effectiveness and safety of ACLR in middle-aged patients remain uncertain. Purpose: To compare the patient-reported functional scores, arthrometric outcomes, and complications of primary ACLR between older (≥50 years) and younger (Study Design: Systematic review; Level of evidence, 3. Methods: We conducted a systematic review of cohort studies that compared the clinical outcomes of ACLR between patients aged ≥50 years and those aged Results: This study included 4 retrospective cohort studies with a total of 287 participants (129 in the older group and 158 in the younger group). All included studies reported significant improvements in clinical outcomes in both groups after ACLR. No significant differences were noted in the improvement of International Knee Documentation Committee (IKDC) scores (mean difference [MD], 0.20 [95% CI, −2.65 to 3.05]; P = .89) and Lysholm scores (MD, −1.98 [95% CI, −6.93 to 2.98]; P = .43) between the 2 groups. No significant differences were observed in anteroposterior stability or risk of complications between the groups. Conclusion: ACLR may be performed in middle-aged patients (≥50 years) without concern for inferior clinical and arthrometric results compared with younger patients (

Background Vibrio cholerae non-O1 is a virulent pathogen that causes significant morbidity and mortality in humans. Herein, we report a case of corneal ulcer caused by this pathogen. Case presentation A 59-year-old fisherman with no systemic history was struck in the right eye by a marine shrimp and developed keratitis. Corneal scrapping culture revealed the presence of the V. cholerae non-O1, and its identification was confirmed by Analytical Profile Index 20E system and polymerase chain reaction. He was successfully treated with topical levofloxacin (0.3%) and fortified amikacin (12.5 mg/mL) for 2 weeks. The visual acuity recovered to 20/25 after treatment without complications. Conclusions This is the first case report of keratitis caused by V. cholerae non-O1 strain. Ocular injury by marine creatures and contaminated seawater can contribute to severe corneal ulcer. Early diagnosis can be achieved by meticulous history taking and a comprehensive laboratory workup. Simultaneously, an effective antibiotic therapy can lead to a positive outcome.

To prevent scoliosis development at early stage of growth in elementary school students, we assessed how body posture-namely the school bag carrying method and head position-can affect the morphology of the spinal column...

BackgroundChronic inflammation is known to be associated with both rotator cuff tears (RCTs) and depression. However, no epidemiological studies with a longitudinal follow-up have been performed to prove this association. We aimed to investigate whether depressed patients had an elevated risk of RCT and subsequent repair surgery compared with those without depression.MethodsThis retrospective cohort study comprised of patients diagnosed with depression between 2000 and 2010 (depression cohort) and patients without depression (non-depression cohort, 1:2 age and sex matched). The risk of RCT and rotator cuff repair surgery were determined during a 13-year follow-up (2000-2013) between these two cohorts.ResultsThis study included 26,868 patients with depression and 53,736 patients without depression. The incidence of RCT was 648 and 438 per 100,000 person-years in the depression and non-depression cohorts, respectively. The adjusted hazard ratio (HR) was 1.46 (95% confidence interval [CI], 1.36-1.57) for depressed patients. The incidence of rotator cuff repair surgery was 28 and 18 per 100,000 person-years in the depression and non-depression cohorts, respectively. Depressed patients also had a significantly increased risk of subsequent rotator cuff repair surgery (adjusted HR = 1.46; 95% CI, 1.04-2.06).ConclusionThe present study showed that depression was associated with an increased risk of rotator cuff tear and rotator cuff repair surgery.

Periprosthetic joint infections (PJIs) caused by Staphylococcus aureus infection are difficult to treat due to antibiotic resistance. It is known that the biofilms from methicillin-resistant S. aureus (MRSA) promote expansion of myeloid-derived suppressor cells (MDSCs) to suppress T-cell proliferation and benefit bacterial infections. This study finds that GMI, a fungal immunomodulatory peptide isolated from Ganoderma microsporum, suppresses MDSC expansion to promote the proliferation of cytotoxic T cells. The enhancement is likely attributed to increased expression of IL-6 and TNF-α and reduction in ROS expression. Similar beneficial effects of GMI on the suppression of MDSC expansion and IL-6 expression are also observed in the whole blood and reduces the accumulation of MDSCs in the infected bone region in a mouse PJI infection model. This study shows that GMI is potentially useful for treating S. aureus-induced PJIs.

The study explored how to best use scaffolds for supporting students’ inquiry practices in computer-supported learning environments. We designed a series of inquiry units assisted with three versions of written inquiry prompts (generic and context-specific); that is, three scaffold-fading conditions: implicit, explicit, and fading. We then examined how the three scaffold-fading conditions influenced students’ conceptual understanding, understanding of scientific inquiry, and inquiry abilities. Three grade-10 classes (N = 105) participated in this study; they were randomly assigned to and taught in the three conditions. Data-collection procedures included a pretest–posttest approach and in-depth observations of the target students. The findings showed that after these inquiry units, all of the students exhibited significant learning gains in conceptual knowledge and performed better inquiry abilities regardless of which condition was used. The explicit and fading conditions were more effective in e...

Background Anterior cruciate ligament (ACL) injury is one of the most common injuries of the area surrounding the knee. Muscle strength deficiency is observed following an ACL injury. Determining differences in muscle strength and gait between patients with acute and chronic ACL injury will provide crucial information for assessments and treatment plans. Methods We evaluated 60 patients with ACL rupture. Patients were classified into acute and chronic groups. We compared measurements of anthropometric parameters, muscle strength, gait and functional questionnaire. Findings The muscle strength of both knee extensors and flexors was higher in the chronic group than in the acute group. The muscle strength index for extensors was 57% in the acute group and 73% in the chronic group. However, the hamstring-to-quadriceps ratio for peak torque of the injured leg in the acute and chronic groups was similarly high at 98% and 101%, respectively. In gait, asymmetry in the hip and knee was observed in the acute group but not in the chronic group. The Knee Injury and Osteoarthritis Outcome Scores (KOOS) for symptoms, pain, activities of daily living, sports and recreational activities were higher in the chronic group than in the acute group. Interpretation Compared with the acute group, the gait of the chronic group is more symmetrical, and the score of KOOS is also higher. The muscle training protocols could be strategically planned according to these differences. Patients with ACL injury are characterized high hamstrings-to quadriceps peak torque ratio.

Background The demand for total knee arthroplasty is increasing worldwide. Optimising results and meeting patients’ expectations are more challenging than before, because the length of hospitalisation has markedly reduced and the standard care processes have been accelerated. We incorporated an interactive patient infotainment system into the standard clinical pathway for total knee arthroplasty in the hope of improving patients’ length of stay. Objectives To analyse whether incorporation of an interactive infotainment system reduced the length of stay and improved the quality of medical care (in terms of number of medical orders and emergency room returns). Design A prospective, quasi-randomised controlled trial . Participants and Setting Data of 86 patients hospitalised for a unilateral total knee arthroplasty at a medical centre in Taiwan were analysed. Methods From January 2017 to July 2017, 86 patients who underwent unilateral total knee arthroplasty and were cared for under a standard clinical pathway were included. The study group (41 patients) had access to electronic programs and video demonstrations related to health literacy, physical therapy, home care and precautions following total knee arthroplasty via a patient infotainment system, while the control group (45 patients) did not. Hospital course, quality indices, in-hospital medical costs, returns to the emergency room and readmission at 30 or 90 days were analysed and compared between the two groups of patients. Results The study group had a shorter length of stay (4.4vs.4.8 days, mean differences [MD] = -0.37, 95% CI -0.71 to -0.03, p = 0.026) and fewer medical orders (109 vs 111 orders, MD= -1.86, 95% confidence intervals (CI) -3.58 to -0.15, p = 0.047) as compared with the control group. The incidences of emergency room return and readmission to the hospital at 30 or 90 days were comparable between the two groups. No difference in the total medical cost was found between the two groups, with only the cost of laboratory tests in the study group being significantly lower than that in the control group ( $144 vs. $163, MD = -21.7, 95% CI -41.0 to -2.25 , p = 0.007). Conclusions The incorporation of a patient infotainment system into the standard clinical pathway for total knee arthroplasty can efficiently reduce the length of hospital stay and maintain the quality of medical care. Further studies on improvement of patient medical literacy with the help of the infotainment system would be of interest in order to improve clinical practice and patient satisfaction. Registration number NCT03788798 Tweetable abstract A patient infotainment system can reduce hospital stay and maintain medical quality for total knee arthroplasty

Background The aim of this study is to compare perioperative outcomes, readmission, and mortality after hemiarthroplasty for hip fractures in diabetic patients with different renal function statuses. Methods In this retrospective population-based cohort study, diabetic patients who received primary hemiarthroplasty for hip fracture between January 1997 and December 2013 were identified from the Taiwan National Health Insurance Research Database. Primary outcomes were perioperative outcomes including infection and revision. Secondary outcomes were all-cause readmission and mortality. Results A total of 29,535 diabetic patients were included: 8270 patients had chronic kidney disease (CKD group), 1311 patients underwent permanent dialysis (dialysis group), and 19,954 patients did not have CKD (non-CKD group). During a mean follow-up of 4.5 years, these 3 groups had comparable risks of any infection, including superficial and deep infection. Dialysis patients had a significantly higher risk of revision than did CKD and non-CKD patients (subdistribution hazard ratio 1.65, 95% confidence interval 1.16-2.36; subdistribution hazard ratio 1.57, 95% confidence interval 1.10-2.24, respectively). Compared with the non-CKD group, the dialysis group had significantly higher risks of readmission and mortality at all time points, namely 3 months after surgery, 1 year after surgery, and the final follow-up. The CKD group also had higher risks of readmission and mortality than did the non-CKD group at all time points. Conclusion CKD is associated with poor outcomes following hemiarthroplasty for fragility hip fracture. CKD patients may have higher risks of surgical complications including revision than non-CKD patients, and they have significantly elevated risks of readmission and mortality.

To investigate whether epinephrine in irrigation fluid improves visual clarity in arthroscopic shoulder surgery. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared the surgical outcomes of patients who did and did not receive epinephrine during arthroscopic shoulder surgery. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for relevant RCTs. We used the Cochrane Collaboration’s tool to assess the risk of bias and adopted random-effects model meta-analysis to combine data. We used the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology to evaluate the overall quality of the body of the retrieved evidence. The primary outcome was visual clarity. The secondary outcomes were operative time, amount of irrigation fluid, the need for increased pump pressure, and adverse cardiovascular events. This study included three RCTs with a total of 238 participants (124 in the epinephrine group and 114 in the non-epinephrine group). The use of epinephrine in irrigation fluid for shoulder arthroscopy achieved better visual clarity (standardized mean difference, 1.01; 95% confidence interval [CI] 0.63 to 1.39; p

Appendix 1. Database search strategy. (DOC 211 kb)

Background: Osteonecrosis of the femoral head can lead to destruction of the hip joint and disabling arthritis in young adults, if left untreated. Among the salvage procedures, core decompression combined with bone graft substitutes is a viable option for joint preservation. The purpose of this study was to review the outcomes of using synthetic bone graft substitute (calcium sulfate and calcium phosphate) for the treatment of late-stage osteonecrosis of the femoral head. Methods: From November 2008 to May 2009, 19 hips in 18 patients with osteonecrosis of the femoral head [6 hips in Association Research Circulation Osseous (ARCO) stage IIC and 13 hips in stage IIIA] were treated with core decompression combined with PRO-DENSE ™ (Injectable Regenerative Graft). The average age of the patients at the time of surgery was 48 years (range 25-67 years). Twelve patients (13 hips) overused alcohol, four patients (4 hips) were idiopathic, one patient (1 hip) used corticosteroids, and one patient (1 hip) was post-traumatic. The clinical failure was defined as conversion to total hip arthroplasty or progression in head collapse. Results: At the conclusion of the study, 3 in the 6 stage IIC hips and 8 in the 13 stage IIIA hips were converted to total hip arthroplasty in an average of 8.5 months (range 4-30 months) postoperatively. Advanced collapse of the femoral head awaiting for total hip arthroplasty was observed in the other six hips. Of the 19 hips, only 2 hips (10.5%) survived without further collapse in the 5-year follow-up. This resulted in 89.5% failure rate with early resorption of the grafting in an average of 5.3 months. Conclusions: Core decompression combined with an injectable calcium sulfate and calcium phosphate composite graft (PRO-DENSE) were associated high failure rates in the early postoperative period. It is not recommended for the treatment of ARCO stage IIC and IIIA osteonecrosis of the femoral head.

Background To assess the effects of tourniquet use in arthroscopic anterior cruciate ligament (ACL) reconstruction surgery. Methods We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) that compared surgical outcomes following tourniquet use against non-tourniquet use during ACL reconstruction surgery. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE for relevant RCTs. We used the Cochrane Collaboration’s tool to assess the risk of bias of included RCTs, and performed a random-effects meta-analysis in calculating the pooled risk estimates. The primary outcomes was postoperative pain measured by visual analogue scale, verbal rating scale, or required morphine dose. The secondary outcomes were blood loss in drainage, operative time, muscle strength, and calf and thigh girth. Results We included 5 RCTs with 226 participants (116 in the tourniquet group and 110 in the non-tourniquet group). Postoperative pain and morphine doses were not significantly different between the two groups. Compared to the non-tourniquet group, the tourniquet group had a significantly increased blood loss in the drain (mean difference: 94.40 ml; 95% CI 3.65–185.14; P = 0.04). No significant differences in the operative time and muscle strength were found between the two groups. Tourniquet use was associated with a greater decrease in thigh girth but not in calf girth. Conclusions The current evidence shows that compared to tourniquet use, ACL reconstruction surgery without tourniquet does not appear to have any major disadvantages and does not prolong operation time. There might be less drain blood loss associated with tourniquet use, though drains are no longer routinely used in ACL reconstruction surgery.

This study presents a series of three experiments that focus on how distributed scaffolding influences learners’ conceptual understanding and reasoning from combined levels of triangulation, at the interactive level (discourses within a focus group) and the collective level (class). Three inquiry lessons on plate tectonics (LPT) were designed, implemented and redesigned to explore how students responded to the scaffoldings provided. The results show that the goal-oriented version (LPT3) was significantly more effective at helping students develop an understanding of plate tectonics and evidence-based reasoning than the teacher-led (LPT1) and deconstructed (LPT2) versions (χ 2 = 11.56, p < 0.003). In LPT3, we can identify three key features of the scaffolding: an advanced organizer, deconstruction of complex tasks, and reflection on the whole inquiry cycle at the end of class time. In addition, LPT3 took much less teaching time. In other words, it appears to be effective and efficient, most likely due to synergies between teacher facilitation and lesson scaffolds. The empirical results clarify the functions of the design model proposed for distributed scaffolding: navigating inquiry, structuring tasks, supporting communication, and fostering reflection. Future studies should more closely evaluate the scaffolding system as a whole and synergies between different types of scaffolds for advancing learning.

A witch's hat-shaped structural allograft can restore bone stock over acetabular medial wall during revision total hip arthroplasty, which may be of importance for future re-revisions. However, long-term results are unclear. A retrospective review of 104 consecutive hips in 96 patients was performed to determine survivorship and functions. The minimum follow-up was 10 years. Nine patients required re-revision for cup aseptic loosening with a mean time to revision of 4.5 years. Kaplan-Meier survivorship was 89.4% at the endpoint. Radiographic evaluation revealed sixteen instances of minor medial wall graft absorption without significant cup migration. The mean modified Harris Hip Scores were 36 preoperatively and 86 at last follow-up. Revision acetabular surgery using a witch's hat-shaped allograft to restore acetabular medial wall provides an excellent alternative.

Purpose: The prevalence of myopia in school-age children and rural area in Taiwan has increased dramatically. The aim of this study was to explore the associated factors of myopia in rural ado-lescents. Methods: A cross sectional design with a rural junior high student was invited to partici-pate in this study. The relationship between refraction error (RE), spectacle fitting condition, and ocular alignment was determined by stereoacuity. The RE was determined using autorefractor. The ocular alignment was evaluated by cover-uncover test. Stereoacuity was measured by Titmus test. The examination about spectacle fitting included the lens power, lens transparency, pupil distance, frame size, and distortion of the frame. Multiple linear regression was used to determine the effect of the spectacle suitability and ocular alignment on the RE and stereoacuity. Results: The prevalence of myopia was 78% in a total of 338 adolescents, and the incidence of high myopia (≤-6 Diopter, D) accounted for 10.2%. Participant worn poor-fitting spectacles were found with more myopia (-3.95D vs -3.42D, p = 0.02). The exophoria or exotropia significantly increased RE (p < 0.01). The eye position was significantly associated with decreased steroacuity function (p = 0.03). Head position demonstrated to have a significant relationship with stereoacuity (p = 0.03). Conclusions: Good-fitting spectacles provided a good visual function and were associated with less RE condition. Exotrope showed a significant correlation with myopia and stereoacuity. The health care providers should be aware of the ocular alignment in myopic suffers.

It remains unclear if computer-assisted surgery (CAS) technique actually improves the clinical outcomes of total knee arthroplasty (TKA) and decreases the failure rate. The purpose of this retrospective study was to compare the functional results of TKA in a series of patients who underwent staged bilateral TKAs with CAS TKA in 1 knee and conventional TKA in the contralateral knee. From January 1997 to December 2010, we collected 60 patients who were randomly assigned to receive CAS TKA in 1 limb and conventional TKA in the other. The Brainlab Vector Vision navigation system was used for CAS TKA, and the DePuy press-fit condylar sigma guide system was used for conventional TKA. Patients were assessed before surgery, 3 months and 1 year after surgery, and annually thereafter. IKS criteria were used for radiographic evaluation. Clinical and functional evaluation using the scoring system of hospital for special surgery (HSS), international knee society (IKS), Western Ontario and McMaster University osteoarthritis index (WOMAC), and short form-36 (SF-36) were obtained on each knee, before surgery, and at each follow-up visit. Pertinent statistical methods were adopted for data analysis. Fifty-six patients were available for analysis and 44 of the patients were female. The mean duration of follow-up was 8.1 years. Less blood loss (P = .007) and longer operation time were noted for CAS TKAs when compared with conventional TKAs. Precise alignment and fewer outliers of the lower limb and prosthetic component positions were found for CAS TKAs (P

Osteoporosis and osteopenia prevailed in postmenopausal women and predisposed to osteoporotic fractures that increase mortality, morbidity, and the cost of social care. Here, we investigated the effect of 24 weeks of aerobic dancing on the bone miner density, physical fitness and health-related quality of life (HRQoL) in postmenopausal women with osteopenia. Total 80 participants (control [CON]: 40; exercise [EX]: 40) were included in the final analysis. The EX group underwent a 24-week aerobic dance intervention. Bone mineral density (BMD), physical fitness, and SF-36 questionnaire were assessed at baseline and 24-weeks. The BMD change in the femoral neck at the 24-weeks were significantly different between the 2 groups (CON: −1.3 ± 2.7%, EX: 3.1 ± 4.6%, P = .001). Grip strength, sidestep and physical functional domain of HRQoL in the EX group were significantly improved compared to the CON. The results were suggested 24-week aerobic dance intervention could result in the lower the incidence of bone fracture through increasing BMD and decreasing fall risk for postmenopausal women.

Chronic kidney disease (CKD) affects many physiologic systems, including bone quality, nutrition, and cardiovascular condition. Femoral neck fractures in patients on dialysis are associated with frequent complications and a high risk of mortality. However, the effect of CKD on clinical outcomes of patients with hip fractures treated with osteosynthesis remains unclear.One hundred and thirty patients with 130 femoral neck fractures treated with internal fixation were divided into two groups and the data were then analyzed. Group 1 consisted of 98 patients (98 hip fractures) with normal renal function (estimated glomerular filtration rate, or eGFR, ≥60 ml/min/1.73 m(2)). Group 2 was composed of 32 patients (32 hip fractures) with CKD (eGFR60 ml/min/1.73 m(2)) without dialysis. Clinical outcomes as well as early and late complications were recorded for each group. Survivorship analysis was performed, and the mortality and complication rates for the groups were then compared.In Group 1, 32 complications (32.6%) occurred in 98 hips, including 5 cases of nonunion and 16 cases of osteonecrosis. In Group 2, 24 complications (75%) developed in 32 hips; these included 8 cases of nonunion and 3 cases of osteonecrosis. The mean duration of follow-up was 32 months. The overall mortality rate was 11.5%. No difference was noted in early, late, or overall mortality rate between two groups. Patient with CKD had a higher nonunion rate (OR = 5.9, P = 0.023). Meanwhile, CKD and displaced fracture pattern were independent predictors for revision surgery (OR = 3.0, P = 0.032; OR = 6.9, P = 0.001, respectively).Osteosynthesis is a safe and effective treatment for femoral neck fractures; however, patients with femoral neck fracture and CKD have a higher risk of nonunion and subsequent surgical revision.Prognostic studies, Level III.

Basal metabolic rate (BMR) reflects a combination of cardiopulmonary function and lean body mass resulting from regular physical activity. Though many studies have examined the relationships between bone mineral density (BMD) and body composition, little is known regarding the relationship between BMD and BMR.The purpose of this study was to investigate the relationship between BMR, anthropometric parameters, body composition and BMD in postmenopausal women in Taiwan.Two hundred and eighty-nine women between the ages of 40 and 80 years were included in this cross-sectional study. The following parameters were assessed: height, body weight, total body fat (TBF), BMR, waist-to-hip ratio, grip strength, and back strength. Differences in all variables between osteoporotic and non-osteoporotic women (categorized according to decades in age) were calculated using a one-way analysis of variance (ANOVA) and a Bonferroni post-hoc test. Multiple linear regression with a backward stepwise approach was performed to evaluate the relationship between these measurements and BMD.Among women over 50 years of age, those who were non-osteoporotic had higher BMR, BMI, and body fat by comparison to their osteoporotic counterparts (p0.05 for all). Multiple linear regression revealed that BMR and body fat significantly predicted BMD of the femoral neck (adjusted beta coefficients of 0.304 and 0.190, respectively; p0.05 for both). BMR and body fat also predicted an increased vertebral BMD (adjusted beta coefficients of 0.310 and 0.141, respectively; p0.05 for both).BMR is closely associated with BMD in elderly persons, and may be a novel target for interventions aimed at preventing the age-related decline in BMD.

The gray-level histogram of ultrasound is a promising tool for scanning the hypoechogenic appearance of supraspinatus tendinopathy, and the aim of this study was to test the hypothesis that the gray-level value of the supraspinatus tendon in the painful shoulder has a lower value on B-mode images even though in different ultrasound devices. Sixty-seven patients who had unilateral shoulder pain with rotator cuff tendinopathy underwent bilateral shoulder ultrasonography, and we compared the mean gray-level values of painful shoulders and contralateral shoulders without any pain in each patient using two ultrasound devices. The echogenicity ratio (symptomatic/asymptomatic side) of two ultrasound devices was compared. A significant difference existed between the symptomatic shoulder and contralateral asymptomatic shoulder (p

Plantar fasciopathy (PF) is the most common cause of heel pain. Extracorporeal shockwave therapy (ESWT) improves the gait pattern in patients with PF. However, the effects of ESWT on the biomechanics of the ankle in these patients remains unclear. Sixteen participants were included in the present study. Of the 16 participants, 8 patients with PF were assigned to receive extracorporeal shockwave therapy, and 8 healthy participants served as an external control group. ESWT was applied to the PF group for 1500 pulses at an energy flux of 0.26 mJ/mm2 every 3 weeks for 3 sessions. The biomechanics of the ankle joints were then assessed using an isokinetic dynamometer, and a health-related quality of life questionnaire was administered at baseline and at the final follow-up session 12 weeks after the initial treatment. Passive stiffness was calculated and compared between the foot affected with PF, the opposite foot, and both feet of those in the healthy control group. The Kruskal-Wallis 1-way analysis of variance with repeated measures was performed, and statistical significance was considered present at the 5% (p ≤ .05) level. Ankle dorsiflexion in the affected limb increased from 14° ± 3° to 17° ± 2° after ESWT (p

Purpose No reports have been published on synchronous multifocal necrotizing fasciitis (SMNF), a multifocal presence of necrotizing fasciitis in different extremities. We evaluated the clinical characteristics and outcomes of SMNF. Methods Eighteen patients (14 men, 4 women; mean age: 59 years) diagnosed with SMNF of the extremities between January 2004 to December 2012 were enrolled and evaluated. Results Vibrio species were the most commonly (78%; n = 14) isolated; others were two cases (11%) of Aeromonas spp., one case (6%) of group A β-hemolytic streptococcus, and one case of coagulase-negative staphylococcus. SMNF was in the bilateral lower limbs (72%; n = 13), bilateral upper limbs (17%; n = 3), and one patient with one upper and one lower limb (11%). Non-surviving patients had more bilateral lower limb involvement and thrombocytopenia. Conclusions Most patients with SMNF were male and had bilateral lower limb and marine Gram-negative bacteria involvement. The mortality of SMNF remained extremely high in patients with involvement of bilateral lower limb and initial thrombocytopenia.

Most perianal abscesses originate from infected anal glands at the base of the anal crypts. Most abscesses below are usually drained through perianal incision and can be treated successfully. However, when perianal abscesses extend to the high intrapelvic cavity, it may be inadequate treatment through a single route incision through a perianal approach. The aim of this technical note is to show that combined anterior ilioinguinal and perianal incisions may provide optimal surgical field and multiple drainages. Here, we report a 56-year-old male patient with perianal-originating parapsoas abscesses. Residual abscess still remained after initial perianal incision and drainage after 1-month treatment. We presented combined anterior ilioinguinal and perianal incision technique methods for proper drainage in this complicated case. No recurrent or residual abscess remained after 2 weeks of operation. So, combined anterior ilioinguinal incision is feasible for high-located perianal abscess.

Summary Background Necrotizing fasciitis is a true surgical emergency. This study was undertaken to determine whether clinical indicators could be used to initiate early surgery, and to compare the characteristics observed on initial examination of necrotizing fasciitis in patients who died and those who survived. Methods We retrospectively reviewed the medical records of 143 patients with surgically confirmed necrotizing fasciitis of the extremities over a period of 3.5 years at a tertiary hospital of southwest Taiwan. Differences in mortality, patient characteristics, laboratory findings, and hospital course were compared between patients who died and those who survived, and between patients with Gram-positive infections and those with Gram-negative infections. Results A patient with a fungal infection died. Nine of the 58 patients in the Gram-positive group (15.5%) and 12 of the 60 cases in the Gram-negative group (20%) died. Hence a total of 22 patients died, giving a mortality rate of 15.4%. Hypotension, lower counts of total and segmented leukocytes, higher counts of banded leukocytes, and lower levels of serum albumin were significantly associated with mortality. Monomicrobial infections had a stake of 70.6%, and Vibrio spp were the predominant causative agents (26.6%). Conclusions Hypotensive shock, severe hypoalbuminemia, and increased counts of banded leukocytes can be considered the clinical and laboratory risk indicators to initiate early surgery and to predict mortality for all types of necrotizing fasciitis. The clinical characteristics of Gram-negative infections were more fulminant than those of Gram-positive infections.

The value of computer-assisted surgery in total knee arthroplasty for arthritic knees continues to be debated. We hypothesized that the usefulness of computer assistance is related to the magnitude of the deviation from the preoperative mechanical axis and that computer-assisted surgery may be beneficial under certain circumstances.Patients with bilateral knee osteoarthritis and genu varus deformity who were to have staged bilateral total knee arthroplasty were enrolled. The patients randomly underwent computer-assisted total knee arthroplasty in one knee and conventional total knee arthroplasty in the contralateral knee. The two methods were compared for accuracy of placement of the components and lower extremity alignment after total knee arthroplasty as determined by six radiographic parameters.One hundred and thirteen patients (226 knees) met the inclusion criteria. For patients with a preoperative mechanical axis deviation of10° and those with a deviation of 10° to 14.9° in both knees, the postoperative radiographic parameters did not differ significantly between the two techniques. In patients with a preoperative mechanical axis deviation of20°, the reconstructed mechanical axes were significantly closer to normal in the computer-assisted total knee arthroplasty group. Significant results were also noted in the anatomical axes, femoral valgus angle, and femoral flexion angle. Furthermore, a higher percentage of knees in which computer-assisted surgery was used had restoration of the mechanical axis within 3° of neutral.Computer-assisted surgery was a valuable adjunct for obtaining proper alignment during total knee arthroplasty in patients with knee osteoarthritis with severe varus deformity. Conventional total knee arthroplasty was as effective as computer-assisted total knee arthroplasty for obtaining proper alignment in patients with a minor to moderate deformity.

We conducted a retrospective study to investigate the effect of femoral bowing on the placement of components in total knee replacement (TKR), with regard to its effect on reestablishing the correct mechanical axis, as we hypothesised that computer-assisted total knee replacement (CAS-TKR) would produce more accurate alignment than conventional TKR. Between January 2006 and December 2009, 212 patients (306 knees) underwent TKR. The conventional TKR was compared with CAS-TKR for accuracy of placement of the components and post-operative alignment, as determined by five radiological measurements. There were significant differences in the reconstructed mechanical axes between the bowed and the non-bowed group after conventional TKR (176.2° (sd 3.4) vs 179.3° (sd 2.1), p < 0.001). For patients with significant femoral bowing, the reconstructed mechanical axes were significantly closer to normal in the CAS group than in the conventional group (179.2° (sd 1.9) vs 176.2° (sd 3.4), p < 0.001). Femoral bowing resulted in inaccuracy when a conventional technique was used. CAS-TKR provides an effective method of restoring the mechanical axis in the presence of significant femoral bowing.

Aim To assess whether disruption of the posterior cortex of intracapsular femoral fractures leads to an increased incidence of complications following closed reduction and internal fixation by multiple cannulated screws in young adults. Methods A total of 146 consecutive adult patients with 146 femoral neck fractures were treated by closed reduction and internal fixation with parallel cannulated screw in inverted triangle or diamond configurations. All enrolled patients were divided into three groups: those with a non-displaced femoral neck fracture (Garden types I or II), those with a displaced femoral neck fracture (Garden types III or IV) but no posterior cortex disruption and those with a displaced femoral neck fracture (Garden types III or IV) and a disrupted posterior cortex. Results Based on an average follow-up of 4.76 years (range, 2–6 years), displaced femoral neck fractures with a disrupted posterior cortex demonstrated an increased risk for avascular necrosis of the femoral head, shortening, redisplacement and conversion of prosthetic replacement as compared with those fractures without posterior cortex disruption (p = 0.002, 0.016, 0.001 and Conclusions As compared with a femoral neck fracture with an intact posterior cortex, a displaced femoral neck fracture with a disrupted posterior cortex increases the risk for avascular necrosis, redisplacement and shortening and raises the likelihood that prosthetic replacement will be needed. Orthopaedic surgeons should be aware of this prognostic factor.

A case of Stevens–Johnson syndrome in a healthy 58-year-old woman who underwent cataract surgery under topical anesthesia is reported. General skin erosions developed 2 hours after surgery. The patient's family doctor diagnosed that she was allergic to seafood. One month later, she underwent phacoemulsification surgery in the other eye. After surgery, she developed Stevens–Johnson syndrome with general skin lesions, erythema nodosa, genital mucosa erosion, oral ulcers, gastritis, and conjunctiva edema. The symptoms subsided 2 weeks later after immunotherapy. Although nonpreserved anesthesia (2% lidocaine) has seldom been reported to cause allergic reactions via the intravenous or the intramuscular route, it is possible that an intracameral injection of 0.2% lidocaine during cataract surgery can induce Stevens–Johnson syndrome. Careful evaluation of the patient's history and proper treatment were recommended to prevent additional complications.

IntroductionBone marrow-stimulating (BMS) techniques during arthroscopic rotator cuff repair surgery theoretically enhance the biological component for healing and hence improve tendon healing, but their efficacy remains unproven. The purpose of this review is to determine the effects and associated harms of BMS in arthroscopic rotator cuff repair surgery.Methods and analysisWe will perform a systematic review and meta-analysis of randomised-controlled trials (RCTs) and retrospective cohort studies (RCS) that compare outcomes following BMS use against no use of BMS during arthroscopic rotator cuff repair surgery. We will search the databases including the Cochrane Central Register of Controlled Trials, Medline and Embase, and clinical trial registries for relevant studies. We will include studies published from start of indexing until 23 August 2018. Two reviewers will independently assess the eligibility for studies. For each included trial, we will conduct duplicate independent data extraction and risk of bias assessment. We will use the Cochrane Collaboration tool to assess the risk of bias of included RCTs, while we will use the Risk Of Bias In Non-randomised Studies - of Interventions tool to evaluate the risk of bias of RCS. We will perform a random-effects meta-analysis in calculating the pooled risk estimates when appropriate. We will assess the overall quality of the data for each individual outcome using the Grading of Recommendations, Assessments, Development and Evaluation approach. The primary outcomes are tendon healing rate, overall pain and shoulder functions. The secondary outcomes are the proportion of participants with adverse events related to interventions, the range of motion and the proportion of participants with return to previous activities.Ethics and disseminationWe will report this review according to the guidance of the PRISMA statement. The results of this review will be disseminated through conference presentations and publications in peer-reviewed journals.PROSPERO registration numberCRD42018087161.

This prospective study analyzed computer-assisted surgery (CAS) navigation and conventional instrumentation in bilateral total knee arthroplasty. Sixty patients underwent CAS navigation in 1 knee and conventional instrumentation in the contralateral knee randomly. The target zone resided in the reconstructed mechanical axis within a range of 3° varus or valgus. The reconstructed mechanical axes in the CAS navigation group were significantly closer to planned axes than those in the conventional group. Average blood loss in the CAS navigation group was lower, whereas mean tourniquet time was longer than in the conventional group. No surgery-related complications existed in either group. The results indicate that, despite longer operative time, CAS navigation total knee arthroplasty is a safe procedure and outperforms conventional technique in accuracy of leg axes.

Background: Vibrio and Aeromonas species, which can cause necrotizing fasciitis and primary septicemia, are members of the Vibrionaceae family and thrive in aquatic environments. Because the clinical symptoms and signs of necrotizing fasciitis and sepsis caused by these two bacteria are similar, the purposes of this study were to describe the clinical characteristics of Vibrio vulnificus and Aeromonas infections, to analyze the risk factors for death, and to compare the effects of surgical treatment on the outcome. Methods: The cases of thirty-two patients with necrotizing soft-tissue infections and sepsis caused by Vibrio vulnificus (seventeen patients) and Aeromonas species (fifteen patients) were retrospectively reviewed over a four-year period. Surgical debridement or immediate limb amputation was initially performed in all patients. Demographic data, underlying diseases, laboratory results, and clinical outcome were analyzed for each patient in both groups. Results: Six patients in the Vibrio vulnificus group and four patients in the Aeromonas group died. The patients who died had significantly lower serum albumin levels than did the patients who survived (p < 0.05). The patients with a combination of hepatic dysfunction and diabetes mellitus had a higher mortality rate than those with either hepatic disease or diabetes mellitus alone (p < 0.05). The patients with Vibrio vulnificus infections had a significantly lower systolic blood pressure at presentation (p = 0.006). The patients with Aeromonas infections who died had significantly lower white blood-cell counts (p = 0.03) with significantly fewer numbers of segmented white blood cells than those who died in the Vibrio vulnificus group (p = 0.01). Conclusions: The contact history of patients with a rapid onset of cellulitis can alert clinicians to a differential diagnosis of soft-tissue infection with Vibrio vulnificus (contact with seawater or raw seafood) or Aeromonas species (contact with fresh or brackish water, soil, or wood). Early fasciotomy and culture-directed antimicrobial therapy should be aggressively performed in those patients with hypotensive shock, leukopenia, severe hypoalbuminemia, and underlying chronic illness, especially a combination of hepatic dysfunction and diabetes mellitus. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

Background: Pediatric headache is a multifactorial disease and may lead to substantial levels of disability. However, the ophthalmological factors in pediatric headache remained unclear. This study aimed to investigate the contribution of ophthalmological factors in pediatric headache in Taiwan. Design: Retrospective, population based, cross-sectional study. Participants: 2727 children, between age of 7 to15, in Yu-Lin and Chia-Yi counties, Taiwan, during the health promotion examination were included during 2012~2014. Methods: General health examinations, including body weight, body height, visual acuity, and skeletal development, were recorded. Headache was assessed by questionnaire. The ocular alignment was measured by cover-and-uncover test. Ocular height, and head position were measured utilizing photographs of children in front of the modified Amsler grid. Main outcome measures: The risk factors for pediatric headache were analyzed using univariate and multivariate comparisons. Results: The prevalence of headache increased from 5.2% at the age of 7-9 group to 9.3% at the age of 10-12 group, and became 17.9% at the age of 13-15 group. Girls have a higher prevalence rate than boys (1.4:1). Headache was not associated with body height, body weight, or sleep duration. Head-roll and asymmetric ocular height were the significant predictors for the headache (p

Background: Anisometropia was a challenge for ophthalmologists to treat unilateral refraction condition. Failure of build-up the same clear image from two eyes together was the major cause for quitting spectacle wearing, which usually led to amblyopia in the eye with more myope. Case presentation: The two patients with anisometropia were found that the two eyeballs position were asymmetric by photography (RTV, Carl Ziess Meditec, Co). Binocular visual acuity was analyzed by using polarized lens in the both eyes for stereo-acuity in far vision (Polatest, Carl Zeiss, Germany) by following the guidelines from the Internationale Vereinigung for Binokulare Vollkorrektion (IVBV). Binocular vision was corrected by the stereoacuity in the far vision, and prism measurement was done by subjective opinion from the patient. Conclusion: Asymmetric eyeball position and size are the risk of anisometropia progression. Under the guidelines from MKH (Measuring and correcting Methodology after H.J-. Haase) for correction of associated phoria, the vision was corrected not only in the spherical and cylinder amount but also in binocular full-correction. Prism improved in binocular vision function in the far vision. By using the prismatic progressive additional lenses, the unilateral myopia progression was well controlled after followed for 4 years.

Background In many sports, female athletes have a higher incidence of anterior cruciate ligament injury than do male athletes. Among many risk factors, the lower rotatory joint stiffness of female knees has been suggested for the increased rate of anterior cruciate ligament injuries. Hypothesis In response to combined rotatory loads, female knees have significantly lower torsional joint stiffness and higher rotatory joint laxity than do male knees at low flexion angles, despite the fact that no such gender differences would be found in response to an anterior tibial load. Study Design Comparative laboratory study. Methods Joint kinematics of 82 human cadaveric knees (38 female, 44 male) in response to (1) combined rotatory loads of 10 N·m valgus and ±5 N·m internal tibial torques and (2) a 134-N anterior-posterior tibial load were measured using a robotic/universal force-moment sensor testing system. Results In response to combined rotatory loads, female knees had as much as 25% lower torsional joint stiffness (female: 0.79 N·m/deg; 95% confidence interval, 0.67-0.91; male: 1.06 N·m/deg; 95% confidence interval, 0.95-1.17) and up to 35% higher rotatory joint laxity (female: 26.2°; 95% confidence interval, 24.5°-27.9°; male: 20.5°; 95% confidence interval, 18.8°-22.2°) than did male knees (P < .05), whereas there were no gender differences in response to the anterior tibial load (P > .05). Conclusion Female knees had lower torsional joint stiffness and higher rotatory joint laxity than did male knees in response to combined rotatory loads. Clinical Relevance Larger axial rotations of female knees in response to rotatory loads may affect the distribution of forces in soft tissues and the function of muscles that provide knee stability. Control algorithms used during the biomechanical testing of cadaveric knees and computational knee models might need to be gender specific.

The purpose of this study was to evaluate the effect of the iliotibial band (ITB) on the kinematics of anterior cruciate ligament (ACL) intact and deficient knees and also on the in situ force in the ACL during a simulated pivot shift test. A combination of 10 N-m valgus and 5 N-m internal tibial torques was applied to 10 human cadaveric knees at 15 degrees, 30 degrees, 45 degrees, and 60 degrees of flexion using a robotic/universal force-moment sensor testing system. ITB forces of 0, 22, 44, and 88 N were also applied. An 88 N ITB force significantly decreased coupled anterior tibial translation of ACL deficient knees by 32%-45% at high flexion angles, but did not have a significant effect at low flexion angles. Further, an 88 N ITB force significantly decreased in situ forces in the ACL at all flexion angles by 23%-40%. These results indicate that during the pivot shift test, the ITB can improve tibial reduction at high flexion angles while not affecting subluxation at low flexion angles. Additionally, the action of the ITB as an ACL agonist suggests that its use as an ACL graft might hinder knee stability in response to rotatory load.

Wiring of patellar fractures is a common treatment. Breakage of the wires is not unusual, but the wire pieces usually remain extra-articular around the knee joint. Intra-articular migration of a wire piece is uncommon; Chen et al. reported one case which was managed by open retrieval. Arthroscopic retrieval would be better for the patient, but searching for a small foreign body in the knee joint is not an easy task, especially as hypertrophic synovial tissue usually envelops the object. For radioopaque substances, an image intensifier enables exact location. We report two cases of intra-articular wire pieces which were successfully removed with simultaneous use of arthroscopy and image intensifier.

Background. Repetitive motion of the hand has been suggested as a major factor of pathogenesis of cumulative trauma disorders (e.g., carpal tunnel syndrome). The purpose of this study was to investigate the 3D displacement of the median nerve and extrinsic finger flexor tendons (flexor digitorum superficialis; flexor digitorum profundus) as a function of flexion/extension of metacarpophalangeal joints of the index and middle fingers. Methods. Shim markers were placed on the median nerve, flexor digitorum superficialis, and flexor digitorum profundus tendons at the wrist region of seven cadaveric specimens for the purpose of digitization of tendon and nerve locations. The metacarpophalangeal joint of the index or middle finger was moved from 15° extension to 75° of flexion while the markers were digitized at increments of 15°. Marker displacements were determined in the longitudinal, radial–ulnar, and dorsal–palmar directions. Findings. Movement of metacarpophalangeal joint of the index or middle finger caused tendon and nerve displacements in the longitudinal, radial–ulnar, and dorsal–palmar directions. The longitudinal displacements of the median nerve and the flexor tendons were linearly correlated with angular movement of the metacarpophalangeal joint. The maximum longitudinal displacements of the flexor digitorum superficialis tendon, flexor digitorum profundus tendon, and median nerve were, on average, 14.7 mm, 11.9 mm, and 3.0 mm, respectively, for the index finger; and 18.4 mm, 14.5 mm, and 4.0 mm, respectively, for the middle finger. The radial–ulnar and dorsal–palmar displacements were irregular and relatively small. The maximum displacements in these transverse directions fell in the range of 1.4–5.1 mm for the median nerve and 1.9–7.3 mm for the flexor tendons. Interpretations. Finger flexor tendons and median nerve move not only concurrently, but also differentially, in all anatomical directions. Tendon and nerve movement during prolonged repetitive hand movement may cause hand disorders such as carpal tunnel syndrome.

Hyperbaric oxygen therapy is a method for augmenting oxygen availability to tissues. This study investigated the effect of hyperbaric oxygen therapy on the collagenase-induced tendinopathy in the rabbit patellar tendon.In this study, 13 rabbits were treated by ultrasound-guided injection of 0.025 mL collagenase into the patellar tendon at the right knee, with the left knee serving as a control condition. The rabbits were randomly divided into two groups. After tendinopathy had been confirmed by histologic examination 3 weeks after treatment, hyperbaric oxygen therapy was initiated for group 1. The hyperbaric oxygen therapy involved 30 daily sessions of 2.5 ATA for 120 minutes starting 6 weeks after treatment. The rabbits in group 2 were put in normobaric room air. Both groups were killed 10 weeks after treatment. Histologic examinations as well as mechanical and biochemical tests were performed after the animals were killed.The ultimate tensile load in the tendon that had hyperbaric oxygen therapy was 34.8% greater than that in the control tendon 10 weeks after treatment (p0.05). Hydroxyproline concentrations increased 82.2% simultaneously in the tendons that had hyperbaric oxygen therapy, as compared with the concentrations in the control tendons (p0.05). However, no statistical difference was found between the two groups in terms of pyridinoline concentration at the 10th week (p0.05). The histologic examination demonstrated an increase in blastlike tenocytes in group 1, with more mature phenotype, more organized collagen matrix, absence of myxoid degeneration, and increased vascularity at the 10th week, as compared with the control knee.The results validate the effectiveness of hyperbaric oxygen therapy in the treatment of tendinopathy. Hyperbaric oxygen therapy may increase collagen synthesis and collagen cross-link formation during the early healing process.

Cross-coupled planar microwave filters were fabricated using YBa/sub 2/Cu/sub 3/O/sub 7-/spl delta// superconducting thin films deposited on both sides of a LaAlO/sub 3/ single crystal substrate by pulsed laser deposition. The hairpin resonator geometry allows one to miniaturize the 3-GHz filters by compacting the entire filter onto a substrate with dimensions 0.5 cm /spl times/ 1 cm. By adjusting the relative spacing among the resonators to establish adequate couplings, filters with very sharp rejection skirt and extremely small insertion loss in passband were obtained.

Dissecting popliteal cyst is an uncommon complication after total knee arthroplasty, occurring mainly as a result of either rheumatoid arthritis or a malfunctioning knee prosthesis. Its association with a failed metal-backed patellar component has not been reported since the introduction of the resurfacing of the patella with this kind of design in 1980. We present a case of a late fracture-dislocation of the metal part of the patellar component that migrated to the posterior popliteal fossa, resulting in a cystic mass formation caused by a foreign body granuloma. The patient was treated successfully with a 2-stage operation: first, revision of the total knee arthroplasty and, second, excision of the cyst. The patient had a pain-free functional knee 7 years after surgery, with no recurrence of the symptoms or the popliteal cyst.

We report on the fabrication and measurement of ultrathin a-Si solar cells with plasmonic back contacts composed of nanopattern dendritic/shrub-like Ag nanostructures that exhibit enhanced short circuit densities compared cells with flat back contacts. The morphology of the Ag nanostructure can be well controlled by the reaction time. When the proposed structure was used in the solar cell. The back-reflector of solar cell can be well designed by various Ag nanostructures and periods. A one-dimension shrub-like Ag nanostructure with spacing of 600 nm, exhibited a 14 % increase in short-circuit current density and a 20% increase in energy conversion efficiency are observed. This study indicates that the dendritic/shrub-like Ag nanostructure can be applied as a enhancing conversion configuration for ultrathin a-Si solar cells.

Abscesses involving the inguinal region are uncommon as manifestations of complex soft-tissue infections or intra-abdominal pathology, and the routes by which they cause infection are usually unclear and may be overlooked.A comprehensive review of reports in the English language literature of the clinical presentations, outcomes, and causes of abscess in the inguinal/groin area requiring surgical intervention. The cases of 33 patients, including 30 patients in 27 reports in the literature and 3 patients in the Chang Gung Memorial Hospital at Chia-Yi, were reviewed to determine the ages, positions, gender, hypothesized causes, diagnostic modalities, and clinical outcomes of abscesses in the inguinal/groin area. Clinical data, laboratory examination findings, and culture results were analyzed.Inguinal abscesses presented as tender inguinal masses that could extend from gastrointestinal, genitourinary, or retroperitoneal sites as well as being of miscellaneous origin. Most patients with such abscesses presented with fever and leukocytosis. Computed tomography provided a sensitive means for establishing the correct diagnosis and surgical plan of treatment for inguinal sbscesses. Gram-positive pathogens were associated with infections involving hip or thigh muscles and gram-negative pathogens were associated with infections involving the gastrointestinal (GI) and genitourinary (GU) tracts as well as with abscesses of the psoas muscle, Discussion: The inguinal region communicates through several routes with the peritoneal and retroperitoneal spaces as well as with the region of the thigh. The lymphatics drain from the external genitalia, inferior anal canal or perianal region, adjoining abdominal wall, and the lower extremities. Evaluation of a patient with inguinal abscess and with signs of infection should include computed tomography (CT) to elucidate the extent of infectious disease. Information obtained from CT is important in guiding the prescription of antibiotics and surgical planning for the treatment of inguinal abscesses.Computed tomography is helpful in diagnosing inguinal abscess and determining the extent of infection. In patients presenting with inguinal abscess. Early recognition of its origin can facilitate further surgical planning and possibly improve the outcome.

To investigate the impact of circuit exercise and Tai Chi exercise on body composition in middle-aged and older women.The present cohort study included 180 women (aged 45-75 years) who were divided into a circuit exercise group, Tai Chi group and control group. The exercise program consisted of 60 min of exercise three times per week for 12 weeks. The circuit exercises were carried out with intensity controlled by heart rate (60-80% of work). The Tai Chi group practiced Yang style with the same frequency, but with intensity of 50-60% of work. Blood pressure and body composition were assessed. The differences in all variables and the relative changes between baseline and 12 weeks' follow up were evaluated.The circuit exercise group showed a significant decrease in body mass index, systolic blood pressure and body fat mass, and an increase in total body muscle mass, lean body mass, bone mineral content and basal metabolic rate. The Tai Chi group showed a decrease in systolic blood pressure. Increases in the basal metabolic rate (1.3 ± 3.0%), total body muscle mass (1.8 ± 4.3%), lean body mass (1.9 ± 4.3%) and bone mineral content (1.8 ± 4.2%), and decreases in body mass index (-2.2 ± 7.8%), body fat (-6.5 ± 10.7%) and diastolic pressure (-1.2 ± 9.4%) were significantly greater in the circuit exercise group than in Tai Chi or control group.Circuit exercise for 12 weeks increases lean body mass and basal metabolic rate more effectively than Tai Chi exercise.