Efficacy and Postoperative Complication Rates of Different Surgical Approaches for Calcaneal Fractures: A Network Meta-analysis.

Context: Calcaneal fractures (CFs) are the most common kind of tarsal fracture. The choice of surgical approach is a key element in the management of CFs, but the best method remains in dispute. Also, no single approach is appropriate for all kinds of CFs. Objective: The study intended to evaluate the relationship between six surgical approaches for clinical treatment of CFs and prevention of postoperative complications, to provide an evidence-based approach for treatment. Design: The research team performed a meta-analysis using the data from a previously published review and updating that data through a new narrative review. The team performed a systematic search in PubMed, Embase, the Cochrane Library, and the Chinese National Knowledge Internet (CNKI) from inception until January 2022, with no language restrictions. The search used the following keywords for the search: calcaneus, heel bone, surgical wounds, surgical incisions, prospective trials, prospective trials, and randomized controlled trials. Outcome Measures: The research team compared the complication rates, American Orthopedic Foot and Ankle Society (AOFAS) scores, and Bohler's angles for the six surgical approaches, which were: (1) the extensive lateral approach (ELA), (2) the sinus tarsi approach (STA), (3) the horizontal arc approach (HAA), (4) the longitudinal approach (LA), (5) the oblique lateral incision (OLI), and (6) the modified incision (MI)). The team summarized the results using a random effects model. Results: The research team analyzed the data from 19 RCTs with 1521 participants. They all were randomized controlled trials (RCTs). The complication rates were available for 18 studies, which included 1474 participants. The rates were significantly lower: (1) for HAA compared to ELA, [OR=-2.03; 95% CrI: [-3.63, -0.43)]; (2) for LA compared to ELA (OR=-1.83; 95% CrI: [-2.83, -0.84]); and (3) for STA compared to ELA (OR=- 1.22; 95% CrI: [-1.67, -0.78]). Of the 19 studies, 11 RCTs, with 942 participants, used the AOFAS scale. The probabilities for the surface under the cumulative ranking curve (SUCRA) indicated that OLI (0.694 ) >LA (0.596) >HAA (0.51) >STA (0.477) >ELA (0.224). In addition, ELA had the worst SUCRA (0.224). Of the 19 studies, 15 RCTs, with 1376 participants, used the Bohler angle as an outcome measure. The probability of SUCRA for the surgical approaches indicated that LA (0.723) >ELA (0.667) >STA (0.468) >HAA (0.373) >MI (0.27). Conclusions: The meta-analysis provides an evidence-based approach to the clinical treatment of CFs for six surgical approaches. HAA had the best outcomes, and ELA had the worst.

Inferior Vena Cava Volume Is an Independent Predictor of Massive Transfusion in Patients With Trauma.

OBJECTIVES: Early adequate resuscitation of patients with trauma is crucial in preventing shock and early mortality. Thus, we aimed to determine the performance of the inferior vena cava (IVC) volume and other risk factors and scores in predicting massive transfusion and mortality. METHODS: We included all patients with trauma who underwent computed tomography (CT) scan of the torso, which included the abdominal area, in our emergency department (ED) from January 2014 to January 2017. We calculated the 3-dimensional IVC volume from the left renal vein to the IVC bifurcation. The primary outcome was the performance of IVC volume in predicting massive transfusion, and the secondary outcome was the performance of IVC volume in predicting 24-hour and 30-day in-hospital mortality. RESULTS: Among the 236 patients with trauma, 7.6% received massive transfusions. The IVC volume and revised trauma score (RTS) were independent predictors of massive transfusion (adjusted odds ratio [OR]: 0.79 vs 1.86, 95% confidence interval [CI], 0.71-0.89 vs 1.4-2.47, respectively). Both parameters showed the good area under the curve (AUC) for the prediction of massive transfusion (adjusted AUC: 0.83 and 0.82, 95% CI, 0.74-0.92 vs 0.72-0.93, respectively). Patients with a large IVC volume (fourth quartile) were less likely to receive massive transfusion than those with a small IVC volume (first quartile, ≥28.29 mL: 0% vs <15.08 mL: 20.3%, OR: 0.13, 95% CI, 0.03-0.66). CONCLUSIONS: The volume of IVC measured on CT scan and RTS are independent predictors of massive transfusion in patients with trauma in the ED.

Danthron inhibits the migration and invasion of human brain glioblastoma multiforme cells through the inhibition of mRNA expression of focal adhesion kinase, Rho kinases-1 and metalloproteinase-9.

In this study, we investigated the effect of danthron on the cell migration and invasion of human brain glioblastoma multiforme GBM 8401 cells in vitro. The changes of migration and invasion of GBM 8401 cells after treatment with danthron were detected by cell migration assay and cell invasion assay. The levels of mRNA gene expression associated with cell migration and invasion were detected by real-time PCR. Results indicated that human brain glioblastoma multiforme GBM 8401 cells treated with danthron in vitro migrated and invaded less than cells treated with phosphate-buffered saline (PBS) (control). Western blotting showed that danthron inhibited the protein levels of FAK, MMP-7, MMP-9 and uPA in GBM 8401 cells. Real-time PCR assay also showed that danthron inhibited the mRNA expression of matrix metalloproteinase-9 (MMP-9), FAK and ROCK-1 of GBM 8401 cells. These results showed that danthron inhibited invasion and migration of GBM 8401 cells by downregulating mRNA expression associated with these processes, resulting in reduced metastasis. Thus, danthron may be considered a therapeutic agent that can inhibit primary tumor growth and prevent metastasis.

HGF increases cisplatin resistance via down-regulation of AIF in lung cancer cells.

Our previous study had shown that advanced stages of lung adenocarcinomas (ADC) was frequently associated with overexpression of hepatocyte growth factor (HGF), which has multipotent and anti-apoptotic activities. In this study, we examined the effect of HGF on gene expression of apoptosis-inducing factor (AIF) and cisplatin sensitivity in lung ADC cells. Expression of AIF was determined by immunocytochemistry and confocal immunofluorescence microscopy. Our data show that addition of HGF suppressed AIF expression and increased cisplatin resistance. The effect could be through HGF receptor and its downstream effector, focal adhesion kinase (FAK). Interestingly, knockout of FAK gene increased AIF expression and drug sensitivity. Re-introduction of FAK gene, on the other hand, restored drug resistance. These results suggested that HGF might induce cisplatin resistance via c-Met to activate FAK and down-regulate AIF expression.

Analysis of drug-drug interactions (DDIs) in nursing homes in Central Taiwan.

With the progressive aging of the population, the long-term nursing care and drug safety for the elderly are gradually gaining attention. In Taiwan, nursing homes are the main institutes helping society or families take care of elderly people suffering from diseases. The aim of this study was to assess the prescribed medications of nursing home residents, the occurrence of DDIs and the association between the number of drugs and DDIs with a view to reinforce drug safety for the elderly. The findings of this study showed that the mean number of medications per resident was 5.74+/-2.4. Of the 323 samples, 81 (25.1%) had experienced DDIs, 63 (64.95%) were of moderate and 7 (7.2%) of major severity. The findings also showed that the number of potential DDIs increased as the number of medications used per residents increased. The residents with nine or more medications tended to have more DDIs, in comparison to those with one or two medications. The odds ratio (OR) was 11.389, which had reached statistical significance in difference. Therefore, to reduce potential DDIs, the number of medications for the senior people with chronic diseases should be properly controlled.

Berberine induces apoptosis in human HSC-3 oral cancer cells via simultaneous activation of the death receptor-mediated and mitochondrial pathway.

Evidence has accumulated that berberine is able to induce cell cycle arrest and apoptosis in many human cancer cell lines. However, there is no available information on the effects of berberine on human oral squamous cell carcinoma. In this study, the effects of berberine on cell growth, apoptosis and cell cycle regulation in human oral squamous carcinoma HSC-3 cells were examined. Berberine induced dose- and time-dependent irreversible inhibition of cell growth and cellular DNA synthesis. This was also confirmed by phase-contrast microscopy which showed that berberine induced morphological changes in HSC-3 cells. Propidium iodide/annexin V staining for flow cytometric analysis showed that berberine-induced apoptosis correlated with caspase-3 activation. Flow cytometric studies of the cell cycle distribution showed that berberine induced mainly G0/G1-phase arrest. Flow cytometric examinations also showed that berberine induced reactive oxygen species (ROS) and Ca2+ production, as well as the dysfunction of mitochondrial membrane potential (MMP), which were correlated with apoptosis. In conclusion, our data support that berberine initially induces an endoplasmic reticulum stress response based on ROS and Ca2+ production which is followed by dysfunctions of the mitochondria, resulting in apoptosis of these oral cancer HSC-3 cells. Prolonged exposure of the HSC-3 cells to berberine causes increased apoptosis through reduced levels of MMP, release of cytochrome c and activation of caspase-3.

Factors influencing the intention to utilize out-of-pocket health checkup services: A sample of citizens from 12 townships of Taichung County in Taiwan.

BACKGROUND: Taiwan started its National Health Insurance (NHI) system in 1995. However, until now, most cancer screening tests and preventive care have been out-of-pocket (OOP) medical items excluded from the coverage of NHI. The aim of this study was to explore the factors influencing an individual's intention to utilize OOP health checkups. METHODS: A cross-sectional research method was adopted in this study. Based on the theory of planned behavior, a questionnaire was developed and used to survey purposively sampled residents (n = 940) from 12 randomly selected townships in Taichung County, Taiwan, from August to September 2006. Descriptive statics and linear regression were conducted to analyze the collected data. RESULTS: Our results showed that result evaluation (beta = 0.092), behavioral beliefs (beta = 0.088), behavioral norms of people with experience in utilizing OOP health checkups (beta = 0.116), perceived convenience (beta = 0.273), and worry about illness and perceived health (beta = 0.110) were important factors influencing the intention to utilize OOP health checkups. Age, education and acceptable health checkup charges were also related. CONCLUSION: Reinforcing disease- and health checkup-related knowledge may positively influence an individual's intention to utilize OOP health checkups. In addition, improving perceived convenience and reducing disease-screening barriers can intensify the individual's intention to use OOP health checkups. The influence of age, education level and OOP checkup charges should also be taken into consideration when related policies are formulated.

Concurrent use of corticosteroids with licorice-containing TCM preparations in Taiwan: a National Health Insurance Database study.

OBJECTIVES: This study used a nationwide population-based dataset from the 1997-2003 National Health Insurance claims to explore the prevalence, frequency, and relative risk of concurrent use of systemic corticosteroids with licorice-containing Traditional Chinese Medicine (TCM) preparations that might possibly result in drug-herb interactions. DESIGN: This study was based on the complete datasets of Western medicine and TCM outpatient reimbursement claims from 1997 to 2003 contained in the National Health Insurance Research Database of Taiwan. According to the date and duration of prescriptions, the patients who concurrently used systemic corticosteroids with licorice-containing TCM preparations were derived for statistical analysis. SETTING: This study was set in Taiwan. OUTCOME MEASURES: Descriptive statistics were used to analyze the demographics of patients who used corticosteroids with licorice-containing TCM preparations concurrently, including age, gender, and the frequency and percentage of major diseases in International Classification of Diseases, 9th version, Clinical Modification (ICD-9-CM) categories. The relative risk of potential corticosteroid-herb interaction was also analyzed with respect to different characteristics of the patients (age, sexuality etc.). RESULTS: The prevalence of concurrent use of systemic corticosteroids with licorice-containing TCM preparations through prescriptions from different Chinese medicine and Western medicine physicians was 1.495%. Among the major disease categories, ICD-9-CM codes 280-289 had the highest prevalence rate of 3.803%. CONCLUSIONS: Potential risk of corticosteroid-licorice interactions may happen, even through formal medical services. In the future, such educational propagations should be reinforced. Furthermore, an alert device that includes well-recognized drug-herb interactions should be built into every hospital's computer system to remind physicians to be cautious on drug safety.

Factors influencing the purchasing behavior of TCM outpatients in Taiwan.

OBJECTIVES: To test the factors that influence Chinese medicine outpatients' behavior patterns in purchasing Traditional Chinese Medicine (TCM) under the National Health Insurance (NHI) system in Taiwan. METHODS: A structural questionnaire was developed and administered to randomly selected outpatients waiting for Chinese Medicine at pharmacies in two academic hospitals that offered Chinese Medicine services in central Taiwan. A total of 641 effective questionnaires were collected. SPSS 10.0 (Statistical Package for Social Sciences, SPSS Inc., Chicago, IL) was used to run descriptive analysis and one-way analysis of variance (ANOVA). In addition, LISREL 8.30 (Analytical Package, Scientific Software International, Inc., Chicago, IL) was used to modify and analyze the relationship between the variables of the hypothetical pathway model. RESULTS: Path analysis showed that "behavioral intention" and "suffering from disease" had positive and direct influences on the outpatients' patterns of purchasing TCM. Furthermore, "usable resources" was an important factor with direct influence on behavioral intention. When there were more usable resources, the behavioral intention became stronger and indirectly influenced the purchasing behavior of TCM outpatients. In addition, one-way ANOVA showed that the purchasing behavior was significantly influenced by the number of diseases that an individual suffered. The results of the pathway model showed that "behavioral intention" and "suffering from disease" had positive and direct influence on the TCM purchasing behavior of Chinese Medicine outpatients. However, "usable resources" was an important factor with direct influence on behavioral intention. When there were more usable resources, the behavioral intention became stronger and indirectly had influence on the TCM purchasing behavior. Furthermore, the analysis result of one-way ANOVA showed that the more chronic diseases the surveyed subject suffered, the more significant the influence on purchasing behavior became. CONCLUSIONS: Under the current NHI system, patients with multiple chronic diseases are the major purchasers of TCM products not covered by NHI. Therefore, increasing the usable resources of TCM products for the patients with chronic diseases will help hospitals in developing TCM services under the current NHI system.

Infection of human papillomavirus and overexpression of dihydrodiol dehydrogenase in uterine cervical cancer.

OBJECTIVE: To determine the association of human papillomavirus (HPV) infection with the expression of dihydrodiol dehydrogenase (DDH) in uterine cervical cancer (UCC). METHODS: In situ hybridization (ISH) and immunohistochemistry were applied to examine pathological specimens of 145 patients with UCC. RESULTS: By ISH, HPV16/18 DNA was detected in 108 (74.5%) UCC cases. DDH expression determined by immunohistochemistry was detected in 81 (75%) lesions among 108 HPV-positive cases. In contrast, of 37 HPV-negative cases, DDH was only detected in 16 (43.2%) of the lesions. A significant correlation was found between DDH expression and the presence of HPV (P < 0.001), FIGO stage (P = 0.004), lymph node involvement (P < 0.001), as well as patients' survival (P = 0.002). In vitro, DDH expression was also found closely associated with HPV infection, and DDH content was proportional to cell sensitivity for cisplatin and doxorubicin. CONCLUSIONS: HPV infection provokes local inflammation, which can then induce DDH expression and drug resistance in UCC. The detailed biological relationship among HPV infection, expression of DDH and drug resistance, however, remains to be clarified.

Cigarette smoking induces overexpression of hepatocyte growth factor in type II pneumocytes and lung cancer cells.

We examined gene expression of hepatocyte growth factor (HGF) and HGF receptor (HGFR), or product of proto-oncogene c-met (c-met), in smokers and nonsmokers with adenocarcinoma (ADC) by suppression subtractive hybridization and microarray techniques. Expression of HGF and c-met was confirmed by RT-PCR. HGF content in the respective tumor mass and nontumor lung tissue was measured by ELISA. HGF in pathologic samples was localized by immunohistochemistry and in situ hybridization. Our results indicate that overexpression of HGFR was frequently detected in ADC cells, whereas overexpression of HGF was detected in alveolar type II (ATII) cells. Overexpression of HGF was correlated with cigarette smoking and tumor stages. In vitro, HGF expression was evaluated in isolated murine ATII cells and in 12 ADC cell lines, and we found that nicotine activated HGF expression in ATII cells and lung cancer cells.