Research of Global Tilt and Functional Independence: Insights into Spinal Health of Older Women.

Spinal alignment intricately influences functional independence, particularly in older women with osteopenia experiencing mild neck and back pain. This study elucidates the interplay between spinal alignment, bone mineral density (BMD), and muscle strength in elderly women presenting with mild neck and back pain. Focusing on a cohort of 189 older women, we examined the associations among global tilt (GT), coronal and sagittal alignment, BMD, grip strength, and functional independence as gauged by the Barthel index. Our findings indicate significant associations between functional capacity and grip strength, bone density, GT, and pelvic tilt (PT). Elderly women with a Barthel Index above 80 demonstrated higher grip strength and better bone quality, reflected by less negative average T scores. These individuals also exhibited lower values of GT and PT, suggesting a better sagittal alignment compared to those with a Barthel index of 80 or below. The results highlight that deviations in GT and PT are significantly associated with decreased functional independence. These insights emphasize the importance of maintaining optimal spinal alignment and muscle strength to support functional independence in elderly women. This study underscores the potential for targeted interventions that improve postural stability and manage pain effectively in this vulnerable population.

Correlations between Sagittal Parameters and Functional Scores in 65-Year-Old Osteoporotic Females with Vertebral Body Fracture under Low-Energy Mechanism.

Background: Vertebral compression fractures (VCFs) are the most common fragility fractures associated with low-energy injury mechanisms in postmenopausal women with osteoporosis. No clear consensus is currently available on the optimal timing for surgical intervention in specific cases. Methods: This study examined the correlations between sagittal parameters, functional scores, and the appropriate timing for surgical intervention during the recovery stage in patients with osteoporosis with thoracolumbar (TL) vertebral body fractures. A total of 161 women aged ≥ 65 years with osteoporosis were included in the study. Spinal sagittal parameters from standing plain films and functional outcomes as the Oswestry disability index (ODI) and the visual analogue scale (VAS) were collected. Results: We found that TL junction Cobb angle was significantly correlated with ODI > 30 (p < 0.001) and VAS > 6 (p < 0.001) and the discriminative values for predicting ODI > 30 and VAS > 6 were a TL kyphotic angle of 14.5° and 13.5°, respectively. Among women aged ≥ 65 years with osteoporosis, the back pain and functional impairment observed within 6 months following a compression fracture are associated with a greater TL kyphosis angle. Conclusions: This suggests that a more proactive approach may be necessary when addressing the conditions of these patients.

Effect of Osteoporosis Treatments on Osteoarthritis Progression in Postmenopausal Women: A Review of the Literature.

PURPOSE OF REVIEW: The purpose of this literature review was to determine if medications used to treat osteoporosis are also effective for treating osteoarthritis (OA). RECENT FINDINGS: A total of 40 relevant articles were identified. Studies were categorized into those (1) discussing estrogen and selective estrogen receptor modulators (SERMs), (2) bisphosphonates, (3) parathyroid hormone (PTH) analogs, and (4) denosumab, and (5) prior review articles. A large amount of evidence suggests that estrogen and SERMs are effective at reducing OA symptoms and disease progression. Evidence suggests that bisphosphonates, the most common medications used to treat osteoporosis, can reduce OA symptoms and disease progression. In vivo studies suggest that PTH analogs may improve the cartilage destruction associated with OA; however, few human trials have examined its use for OA. Denosumab is approved to treat osteoporosis, bone metastases, and certain types of breast cancer, but little study has been done with respect to its effect on OA. The current evidence indicates that medications used to treat osteoporosis are also effective for treating OA. Estrogen, SERMs, and bisphosphonates have the most potential as OA therapies. Less is known regarding the effectiveness of PTH analogs and denosumab in OA, and more research is needed.

Five-Year Outcomes of Continuous Treatment with Zoledronic Acid Versus Denosumab in Older Men with High Fracture Risk: Risk Factor Analysis of Bone Density Improvement and Incidence of New Fracture.

Denosumab and zoledronic acid are both effective and easily administrable injectable anti-osteoporotic medications for postmenopausal women. This study investigated the treatment efficacy of these agents in older male patients with low a bone mass and history of fragility fracture. A cohort of 175 male patients receiving continuous zoledronic acid treatment and a cohort of 366 male patients receiving continuous denosumab treatment at our medical center between 2015 and 2020 were included, and we analyzed the efficacy of treatment by the improvement in bone mineral density (BMD) and the new-onset low-energy fracture rate after 5 years of continuous medication. BMD significantly improved after 5 years of medication, and >90% of patients were satisfied with their treatment medication. BMD improved more with denosumab than with zoledronic acid, especially in patients with T-scores higher than -2.5. Smoking, alcohol abuse, diabetes, and inflammatory polyarthritis were associated with poor improvements in BMD. The incidence rate of new fragile fracture was 4.4% and old age was significantly associated with the incidence rate of new fracture. In summary, our study revealed that denosumab and zoledronic acid both significantly increased BMD among older male patients with high fragility fracture rates over a 5-year follow-up period. Early medical treatment and lifestyle adjustment were crucial for improving quality of life.

Incidence of Acute Upper Gastrointestinal Bleeding and Related Risk Factors among Elderly Patients Undergoing Surgery for Major Limb Fractures: An Analytical Cohort Study.

(1) Background: Upper gastrointestinal bleeding (UGIB), a major postoperative complication after surgical fixation of major limb fractures, can be fatal but is often neglected. This study determined the incidence rates of and related risk factors for perioperative UGIB among older patients with major upper limb fractures but without a history of peptic ulcer disease (PUD). (2) Methods: We collected the data of patients aged more than 65 years who underwent surgery for major limb fracture between 1 January 2001 and 31 December 2017, from Taiwan's National Health Insurance Research Database and excluded those with a history of UGIB and PUD before the date of surgery. The primary outcome was the incidence of UGIB requiring panendoscopy during hospitalization. A multiple logistic regression model was used to identify the independent predictors of UGIB, with adjustment for confounding factors. The final model included variables that were either statistically significant in univariate analyses or deemed clinically important. (3) Results: The incidence of UGIB was 2.8% among patients with major limb fractures. Male sex, older age, major lower limb fracture, and a history of chronic renal disease were significant risk factors for the increased incidence of perioperative UGIB. (4) Conclusions: Patients with major limb fractures who underwent surgery exhibited a higher rate of stress ulceration with UGIB, even when they had no history of PUD. Perioperative preventive protocols (e.g., protocols for the administration of proton-pump inhibitors) may be necessary for patients with these major risk factors.

[Storing Complementary Therapy Knowledge to Expand Nursing Roles].

Incorporating complementary therapy into nursing care is common in clinical practice. Complementary therapy is a non-pharmacological approach used to help address symptoms that cannot be alleviated entirely by medication. These complementary therapies often serve specific purposes, and nurses are the ideal candidates to administer them due to their patient care expertise. However, before applying any complementary therapy, it is essential to understand the potential medical safety, ethical, and legal considerations involved in the therapeutic process. Furthermore, administrators should strengthen their knowledge and implementation of these therapies to ensure safety during use. Complementary therapy facilitates the management of symptoms that are not manageable by medication alone. For example, aromatherapy and light therapy are employed in clinical settings to alleviate anxiety, depression, insomnia, and pain (Farrar & Farrar, 2020; Fong et al., 2023), while acupuncture, acupressure, and qigong are utilized to relieve pain in cancer patients (Behzadmehr et al., 2020). Although complementary therapy is gradually gaining acceptance in clinical practice for mitigating patient discomfort, it has yet to achieve widespread adoption, with the culture within healthcare institutions and the attitudes of healthcare professionals being significant factors influencing adoption willingness. Research findings indicate that the primary factor influencing the use of complementary therapy by nurses is lack of relevant knowledge (Siedlecki, 2021). Elements of complementary therapy have been incorporated into the blueprint of the National Council Licensure Examination - Registered Nurse in Western countries. Thus, nursing education programs in the United States are now required to integrate complementary therapy into their curricula (Helms, 2006). The above emphasizes the importance of equipping nursing professionals with crucial knowledge and skills related to complementary therapy. When integrated appropriately and safely into patient care, complementary therapy not only enhances the quality and status of nursing but also demonstrates the irreplaceable role of nurses in assisting patients manage symptoms that are not fully manageable by medication alone. As modern medical technology and treatment modalities continue to grow in complexity, nursing professionals must maintain an open-minded perspective and be willing to adapt to and learn the diverse knowledge and skills required in today's era of interdisciplinary. Implementing complementary therapy requires relevant healthcare knowledge for symptom relief as well as familiarity with the related principles and skills. Complementary therapy often involves more extended contact with the recipients of care, making it safer and more appropriate when administered by nursing professionals who have received medical training. In this column, three articles discuss common complementary therapeutic practices such as aromatherapy, the non-invasive Chinese medicine meridian-and-acupoint intervention, and light therapy. Each article introduces the principles of these therapies and their application in nursing. It is hoped that the information provided on these three complementary therapies will help nursing professionals find reference points for expanding and strengthening their interdisciplinary nursing practices. Thus, the inherent advantages of the nursing profession may be leveraged to further enhance and implement the professional nursing process and to maximize the roles and capabilities of the nursing profession.

L-Glutamine is better for treatment than prevention in exhaustive exercise.

Introduction: Glutamine is known as the richest nonessential amino acid in the human body. The intake of glutamine is not only beneficial to nutrition but also reported to enhance inflammation reducing bioactivity in exercise. Although studies have demonstrated that glutamine is beneficial for exercise, the optimal intake timing remains unclear. This study examined whether the effects of glutamine on tissue damage and physiology differ between intake timings. Methods: Rats were divided into without L-glutamine supplementation (vehicle), with L-glutamine before exhaustive exercise (prevention), and with L-glutamine after exhaustive exercise (treatment) groups. Exhaustive exercise was induced by treadmill running and L-glutamine was given by oral feeding. The exhaustive exercise began at a speed of 10 miles/min and increased in increments of 1 mile/min, to a maximum running speed of 15 miles/min with no incline. The blood samples were collected before exhaustive exercise, 12 h and 24 h after exercise to compare the creatine kinase isozyme MM (CK-MM), red blood cell count and platelet count. The animals were euthanized on 24 h after exercise, and tissue samples were collected for pathological examination and scored the severity of organ injury from 0 to 4. Results: The CK-MM was elevated gradually after exercise in the vehicle group; however, CK-MM was decreased after L-glutamine supplementation in the treatment group. The treatment group had higher red blood cell count and platelet count than the vehicle and prevention group after exercise. In addition, the treatment group had less tissue injury in the cardiac muscles, and kidneys than prevention group. Conclusion: The therapeutic effect of L-glutamine after exhaustive exercise was more effective than preventive before exercise.

Tramadol May Increase Risk of Hip Fracture in Older Adults with Post-Traumatic Osteoarthritis.

Tramadol, an analgesic widely used for arthritic pain, is known to have adverse effects. This study investigated the association between the long-term use of tramadol for pain control and subsequent hip fractures in patients aged 60 years or older with posttraumatic osteoarthritis. This population-based retrospective cohort study included patients with posttraumatic osteoarthritis who received tramadol for pain control for more than 90 days within a 1-year period. A control cohort was enrolled using propensity score matching. The primary outcome was a new diagnosis of hip fracture requiring surgery. In total, 3093 patients were classified into each cohort. Tramadol use was identified as a risk factor for hip fracture (adjusted hazard ratio (aHR): 1.41; 95% confidence interval (CI): 1.09-1.82; p = 0.008), especially among patients aged 60-70 years (aHR: 2.11; 95% CI: 1.29-3.47; p = 0.003) and among male patients (aHR: 1.83; 95% CI: 1.24-2.70; p = 0.002). This is the first cohort study focusing on the association between long-term tramadol use and hip fracture among older adults with posttraumatic osteoarthritis. Tramadol, as a long-term pain control analgesic for older adults with posttraumatic osteoarthritis, may increase the risk of hip fracture, especially among male patients and those aged 60-70 years.

Clam Extract Decreases Nasal Symptoms and Improves Sleep Quality after Septoturbinoplasty.

Context: Nasal septal deviation (NSD) causes nasal blockage, which results in lower sleep quality among patients. A high percentage of patients still suffer from nasal symptoms as a result of the inflammatory response that occurs with septoturbinoplasty. Freshwater clams are a common food with an anti-inflammatory effect and have been used for promoting liver function for patients in China. Objectives: The study intended to evaluate the effects of clam extract (CE) in reducing inflammatory response, alleviating nasal blockage, and improving sleep quality for NSD patients after septoturbinoplasty. Design: The study was a randomized, controlled pilot that used a prospective design. Setting: The study took place at the Cheng Hsin General Hospital in Taipei, Taiwan. Participants: Participants were 52 patients with NSD at a clinic at the hospital. Intervention: Patients were randomly assigned to 2 groups: (1) an intervention group that received CE capsules and (2) a control group that received empty capsules that were identical in appearance to the CE capsules. Participants received the treatments 3 times a day for 2 weeks after septoturbinoplasty. Outcome Measures: Participants were assessed for nasal-symptom severity, wound inflammation, serum concentration of tumor necrosis factor alpha (TNF-α), and sleep quality. All outcome measures were undertaken at baseline, on various days during the study depending on the measure, and postintervention on day 14 for wound assessment and sleep quality. Results: After the septoturbinoplasty, the intervention group had lower nasal-symptom severity, wound inflammatory response, TNF-α concentration, and sleep disruption than those in the control group (P < .05). Conclusions: After septoturbinoplasty, CE can reduce nasal-symptom severity and inflammatory response and also improve patients' sleep quality. The anti-inflammatory effects of CE indicate that it can be considered to be an adjuvant therapy to improve sleep quality after surgery.

Reasons for Altering Bladder Management and Satisfaction with Current Bladder Management in Chronic Spinal Cord Injury Patients.

Patients with spinal cord injury (SCI) often require bladder management. However, patients routinely change their bladder management for better satisfaction. The reasons for altering a bladder management method in SCI patients remain insufficiently understood. The purposes of this study are to assess current satisfaction with bladder management and the reasons for changing bladder management in SCI patients. A prospective cross-sectional survey with a convenience sampling method was used. The study was conducted from January 2018 to December 2019. The inclusion criteria included an age ≥18 years and a diagnosis of SCI more than one year previously. The questionnaires were self-administered and collected from eligible patients during a free clinic service. A total of 515 SCI participants were enrolled. Two hundred and eighty-three (55.0%) participants had experienced changing their bladder management. The most used method of current bladder management was self-voiding. About 84.7% of participants reported being satisfied with their current bladder management. Bladder management changes were most often made due to frequent urinary tract infections. Furthermore, the participants dissatisfied with their management had more urological complications. This study indicates that appropriate bladder management can improve the subjective satisfaction of patients. For long-term care, preventing urinary tract infections is a helpful strategy for patients' satisfaction with bladder management.

The Incidence of Acute Respiratory Infection Was Higher in the Older Adults with Lower Limb Fracture Who Receive Spinal Anesthesia Than Those Who Receive General Anesthesia.

INTRODUCTION: Acute respiratory infection (ARI) can significantly reduce postoperative quality of life and impair the recovery of older adult patients with lower-limb fractures, and its relationship with methods of anesthesia remains inconclusive. Using data from the National Health Insurance Research Database (NHIRD) of Taiwan, this study examined the data of patients who received surgical management for lower-limb fractures and compared those who underwent general anesthesia (GA) with those who underwent regional anesthesia (RA) in terms of their incidence of acute upper and lower respiratory infection during the one-month postoperative period. The study also identified related risk factors. MATERIAL AND METHODS: Approximately two million patients were randomly sampled from the NHIRD registry. We identified and enrolled patients with lower-limb fractures who were over 60 years old and underwent GA or RA during surgeries conducted between 2010 and 2017. We divided these patients into two groups for further analysis. The outcome of this study was the development of ARI during the one-month postoperative period. RESULTS: In total, 45,032 patients (GA group, 19,580 patients; RA group, 25,452 patients) with a mean age of 75.0 ± 8.9 years were included in our study. The incidence of postoperative ARI within one month of surgery was 8.0% (1562 patients) in the GA group and 9.5% (2412 patients) in the RA group, revealing a significant difference. The significant risk factors for the incidence of ARI were the application of RA for surgery, older age, hypertension, liver disease, and chronic obstructive pulmonary disease (COPD). A subgroup analysis revealed that the RA method was associated with a significantly higher ARI incidence relative to the GA method among patients aged between 60 and 80 years, among male patients, among the patients with or without any comorbidity and among the patients without COPD. CONCLUSION: The incidence of postoperative ARI within one month of surgery was higher among older patients with lower-limb fractures who received RA for surgery than among those who received GA for surgery. The other major risk factors for ARI were older age, hypertension, liver disease, and COPD. Therefore, we should focus on patients with a high risk of developing ARI, especially during the COVID-19 pandemic.

Correlation between the Control of Blood Glucose Level and HbA1C and the Incidence of Surgical Site Infection after Emergent Surgery for the Lower Limb Fracture among Type II DM Patients Aged More Than 50 Years Old.

This is the first study focusing on perioperative blood glycemic monitoring for the incidence of surgical site infection (SSI) among patients with type II DM (T2DM) during the 1-year follow-up after emergent orthopedic surgery. We retrospectively collected the data of 604 patients who had received surgery for unilateral lower limb traumatic fracture from January 2011 to January 2021, including 215 men and 389 women with a mean age of 71.21 and a mean BMI of 25.26. In total, 84 (13.9%) of them developed SSI during the 1-year follow-up. Higher preoperative and postoperative -3-month hemoglobin A1c (HbA1c) and AC blood glucose and the presence of rheumatoid arthritis were all associated with increased rates of SSI. The thresholds for predicting SSI were the following: (1) preoperative HbA1c > 7.850% (area under curve [AUC] = 0.793); (2) postoperative HbA1c > 6.650% (AUC = 0.648); (3) preoperative AC blood glucose > 130.50 mg/dL (AUC = 0.773); and (4) postoperative AC blood glucose > 148.5 mg/dL (AUC = 0.709) by receiver-operating characteristic curve method. These findings may provide a useful control guideline for patients with T2DM older than 50 years old and who received surgery for a lower limb fracture in the prevention of postoperative SSI.

The Short-Term Changes of the Sagittal Spinal Alignments After Acute Vertebral Compression Fracture Receiving Vertebroplasty and Their Relationship With the Change of Bathel Index in the Elderly.

Introduction: Fragility vertebral compression fractures (VCFs) are of major concern due to aging populations worldwide, which may occur after a fall from standing or due to severe osteoporosis, impacting greatly the life quality of the elderly. This study thus determined the factors independently associated with poor functional recovery from a new VCF and changes in sagittal spinal alignment after vertebroplasty in elderly patients with osteoporosis. Materials and Methods: The data were collected from patients older than 70 years and diagnosed with a new VCF. Logistic regression analysis was performed to determine factors independently associated with function and radiographic status. Results: We enrolled 8 male and 34 female patients with a mean age of 80.74 ± 8.31 years between January and July 2020. Compared with preoperative data, post-vertebroplasty lumbar sagittal alignments and functional scores improved significantly, and function recovered gradually over 12 weeks. Climbing stairs was the most influential performance indicator at the beginning of the recovery process. At each postoperative follow-up, changes in the C7-sacrum sagittal vertical axis exhibited an influence on functional recovery. Male patients were better able to move from a chair to a bed at the 2-week postoperative follow-up, and positive changes in the spino-sacral angle led to improved function in terms of stair climbing at the 6-week postoperative follow-up. Conclusions: Vertebroplasty seemed to be effective for functional recovery related to sagittal spinal alignment improvement of the elderly with VCFs during postoperative 12 weeks, which may be a critical stage for the recovery for their life activities. The recovery rate for stair climbing after vertebroplasty was slower than for the other functional performance indicators in our study. In addition, if a patient was unable to demonstrate a marked improvement in sagittal alignment, they were likely to have ongoing impaired function and a poor prognosis after surgery.

A novel method of skin graft fixation using adhesive hydrofiber foam.

OBJECTIVE: Conventional skin graft fixation uses a tie-over bolus dressing with splint fixation. However, splints are highly uncomfortable and contribute considerably to medical waste. Previous study has shown positive results using hydrofiber for skin graft fixation. The aim of this study was to assess the effectiveness of using adhesive hydrofiber foam for skin graft fixation. METHOD: In this retrospective study, patients reconstructed with split-thickness skin graft that was fixated only with adhesive hydrofiber foam from April 2017 until April 2019 were included. RESULTS: A total of 44 patients took part, of whom 32 were male and 12 female, with a mean age of 56±19 years. The mean operative time was 77.5±91 minutes. The average defect size was 42±37cm2. The mean skin graft take was 97±5%. The mean length of hospital admission after skin grafting until discharge was 8.5±9.2 days. Excluding those patients undergoing other procedures at the same time as the skin graft gave a total of 34 patients. Their mean operative time was 32±20 minutes, and mean length of hospital stay after skin grafting was 4.0±4.7 days. CONCLUSION: Adhesive hydrofiber foam for skin graft fixation was technically very easy to apply, resulting in a waterproof, non-bulky, secure dressing. Splints were not required. Patients were allowed to mobilise. This method resulted in increased patient comfort and decreased medical waste. From these findings, we believe that this is an extremely simple and effective method of skin graft fixation.

Stromal-vascular fraction and adipose-derived stem cell therapies improve cartilage regeneration in osteoarthritis-induced rats.

This study aimed to evaluate the effects of the stromal vascular fraction (SVF) and adipose-derived stem cells (ADSCs) on cartilage injury in an osteoarthritis (OA) rat model. Sodium iodoacetate (3 mg/50 µL) was used to induce OA in the left knee joint of rats. On day 14 after OA induction, 50 µL of SVF (5 × 106cells), ADSCs (1 × 106 cells), or 0.9% normal saline (NS) was injected into the left knee-joint cavity of each group. The macroscopic view and histological sections revealed that the articular cartilage in the NS group was damaged, inflamed, uneven and thin, and had hyperchromatic cell infiltration. Notably, the cartilage surface had recovered to nearly normal and appeared smooth and bright on day 14 in the SVF and ADSC groups. Additionally, the white blood cell counts in the SVF and ADSC groups were higher than those in the NS group on day 14. Plasma IL-1ß levels on days 7 and 14 were reduced in the SVF and ADSC groups. These results indicated that both SVF and ADSC treatments may assist in articular cartilage regeneration after cartilage injury. Cell therapy may benefit patients with OA. However, clinical trials with humans are required before the application of SVF and ADSC treatments in patients with OA.

Long-Term Incidence of Total Knee Arthroplasty after Open Reduction and Internal Fixation of Proximal Tibial and Distal Femoral Fractures: A Nationwide Cohort Study.

Knee fractures often require open reduction internal fixation (ORIF) for knee function recovery. More than one fifth of patients with knee fractures subsequently develop posttraumatic arthritis, and over 5% of them need total knee arthroplasty (TKA). We conducted this nationwide retrospective cohort study using the data of 2,000,000 people in the general population who received TKA and were followed up in the 17-year period 2001-2017, through random sampling of the Taiwan National Health Insurance Research Database. We matched the ORIF and non-fracture groups by a propensity score, based on age, sex, index date of surgery, and comorbidities enrolled in CCI calculated at a 1:1 ratio. The average proportion of subjects receiving TKA after ORIF for distal femoral or proximal tibial fractures was 2.0 per 1000 person-years, which was significantly higher than that in the non-fracture group. Patients aged 20-65 years and males represented a significantly higher proportion of subjects receiving TKA after ORIF than that in the non-fracture group. The proportion of subjects receiving TKA for the 20-65-year subgroup of the ORIF group was 4%, and that for the male subgroup was 1.5%; both rates increased over the 17-year follow-up period. More aggressive intraoperative and postoperative adjuvant therapies may be necessary for these subgroups.

Angelica dahurica and Rheum officinale Facilitated Diabetic Wound Healing by Elevating Vascular Endothelial Growth Factor.

Traditional Chinese medicine (TCM) provides alternative treatment choices for diabetic wounds. The aim of this study was to evaluate the effects of Angelica dahurica and Rheum officinale (ARE) on diabetic wounds and its underlying action mechanism. A total of 36 healthy male Sprague-Dawley rats were randomly divided into three groups: diabetes mellitus (DM) rats treated with ARE (DM-ARE), DM rats treated with 0.9% saline (DM-NS), and non-DM rats treated with 0.9% saline (NDM-NS). DM was induced by intraperitoneal administration of 40 mg/kg of streptozotocin after a 2-week high-fat diet feeding. After excisional skin wounds and treatments, the remaining wound area (RWA) in each group was measured. The RWA in the DM-NS group (69.60% ± 2.35%) was greater than that in the DM-ARE (55.70% ± 1.85%) and NDM-NS groups (52.50% ± 2.77%) on day 6. Besides, the DM-ARE group showed higher vascular endothelial growth factor (VEGF), higher inducible nitric oxide synthase (iNOs), higher [Formula: see text]-smooth muscle actin ([Formula: see text]-SMA), and lower nuclear factor kappa-light-chain-enhancer of activated B cell (NF-[Formula: see text]B) expression in the wound skin tissue. These results showed that treatment with ARE shifted the recovery pattern of diabetic rats to the pattern of nondiabetic rats, indicating that ARE may improve wound healing in diabetic conditions.

The incidence of mental disorder increases after hip fracture in older people: a nationwide cohort study.

BACKGROUND: People living with dementia seem to be more likely to experience delirium following hip fracture. The association between mental disorders (MD) and hip fracture remains controversial. We conducted a nationwide study to examine the prevalence of MD in geriatric patients with hip fractures undergoing surgery and conducted a related risk factor analysis. MATERIAL AND METHODS: This retrospective cohort study used data from Taiwan's National Health Insurance Research Database between 2000 and 2012 and focused on people who were older than 60 years. Patients with hip fracture undergoing surgical intervention and without hip fracture were matched at a ratio of 1:1 for age, sex, comorbidities, and index year. The incidence and hazard ratios of age, sex, and multiple comorbidities related to MD and its subgroups were calculated using Cox proportional hazards regression models. RESULTS: A total of 1408 patients in the hip fracture group and a total of 1408 patients in the control group (no fracture) were included. The overall incidence of MD for the hip fracture and control groups per 100 person-years were 0.8 and 0.5, respectively. Among MD, the incidences of transient MD, depression, and dementia were significantly higher in the hip fracture group than in the control group. CONCLUSIONS: The prevalence of newly developed MD, especially transient MD, depression, and dementia, was higher in the geriatric patients with hip fracture undergoing surgery than that in the control group. Prompt and aggressive prevention protocols and persistent follow-up of MD development is highly necessary in this aged society.

Anterior Cervical Discectomy and Fusion Versus Conservative Treatment for Cervical Angina Conservative Treatment.

STUDY DESIGN: This study employed a retrospective study design. OBJECTIVE: This retrospective cohort study aimed to compare the outcomes of anterior cervical discectomy and fusion (ACDF), and those of conservative treatment for patients with cervical angina. SUMMARY OF BACKGROUND DATA: Cervical angina is typically characterized by intolerable and paroxysmal angina-like precordial pain, which is caused by cervical disk degeneration in patients without definitive cardiovascular abnormalities. Diagnosis is either delayed or neglected because of its various clinical manifestations. Whether conservative or surgical treatment is appropriate remains controversial because of the lack of comparative studies. MATERIALS AND METHODS: From 2009 to 2016, 163 patients with cervical angina with advanced chest pain, tightness, or palpitation were retrospectively studied. Twenty-three patients underwent ACDF, and the other 140 patients were treated nonsurgically by medication, physical therapy, collar immobilization, or stellate ganglion block. Japanese Orthopedic Association (JOA) score and 20-point autonomic nervous system (ANS) score were assessed pretreatment and posttreatment. Patients' satisfaction was assessed using the Odom criteria. RESULTS: The average age of the patients was 50 years, and most of them were females. The average follow-up was 25.5 months. The pretreatment JOA and 20-point ANS scores in the conservative and ACDF groups were 13.3 versus 11.7 (P=0.110) and 13.0 versus 13.3 (P=0.928), respectively. Generalized estimating equation analysis showed that posttreatment JOA and ANS scores at each observation interval improved significantly in the ACDF group (P<0.001). Angina-like symptoms also improved significantly in the ACDF group (P<0.001). During an average 2-year follow-up, good or excellent results were obtained in 78.2% of surgical patients and 35% of nonsurgical patients. CONCLUSIONS: Compared with conservative therapy, surgical treatment with ACDF for cervical angina provided better and more consistent relief from angina-like symptoms and overall sympathetic symptoms. LEVEL OF EVIDENCE: Level III.

Prevalence and Medical Resource of Patients with Diabetic Foot Ulcer: A Nationwide Population-Based Retrospective Cohort Study for 2001-2015 in Taiwan.

Diabetic foot ulcer (DFU) is one of the common complications of diabetes. DFU can cause a huge medical and financial burden due to infections, compromise the quality of life, and increase the mortality rate in patients. However, the consumption of medical resources for DFU is rarely mentioned. A retrospective cohort study was performed. Data were obtained from the National Health Insurance Research Database of Taiwan, and the prevalence and medical utilization data for DFU in 2001-2015 were extracted, followed by the analysis for high-risk populations. Between 2001 and 2015, there were 7511 new DFU patients. A higher proportion in these patients was male, elderly with a low education level, and low income. Between 2001 and 2015, the prevalence of DFU was 0.5-0.8%, and the number of DFU patients showed stable growth. Every year, 12.6-19.3% and 1.2-7.0% of patients underwent debridement and amputation, respectively. The hospitalization fees increased year on year. Our study showed that the DFU prevalence increased year on year, and the DFU medical expenditure increased. DFU tends to occur in males, patients with low socioeconomic status, low education level, those with multiple comorbidities, and old age. Therefore, DFU care and prevention require the entire healthcare system to jointly formulate a prevention plan.