Seasonal vitamin D levels and lupus low disease activity state in systemic lupus erythematosus.

BACKGROUND: Seasonal variation and sunlight exposure can impact serum vitamin D levels, potentially influencing lupus symptoms. We investigated seasonal vitamin D levels and their correlation with clinical manifestations and disease activity in systemic lupus erythematosus (SLE). METHODS: Serum 25(OH) vitamin D3 (25(OH)D3) levels were categorised as deficient (25(OH)D3 < 10 ng/mL), insufficient (10-30 ng/mL) and sufficiency (>30 ng/mL) in participants analysed in winter (n = 407) and summer (n = 377). Logistic regression analysis was performed to assess the impact of vitamin D levels on achieving a lupus low disease activity state (LLDAS), stratified by season. RESULTS: The mean serum 25(OH)D3 levels differed significantly between the winter and summer measurement groups (22.4 vs. 24.2 ng/mL; p = .018). The prevalences of vitamin D deficiency, insufficiency and sufficiency in the winter group were 12.8%, 66.6% and 20.6%, respectively, compared with 4.5%, 67.9% and 27.6% in the summer group. Achieving LLDAS was highest in the vitamin D sufficiency group (winter: 56.6%, summer: 55%) and lowest in the vitamin D deficiency group (winter: 15.4%, summer: 13.6%), with significant differences (all p < .001). Multivariate analysis identified SLE disease activity index ≤4, normal anti-double-stranded DNA and vitamin D sufficiency as significant factors for achieving LLDAS in both seasons. CONCLUSIONS: Sufficient vitamin D levels are important for achieving LLDAS in patients with SLE during winter and summer. Therefore, physicians should pay attention to the adequacy of vitamin D levels and consider recommending vitamin D supplementation for patients with vitamin D insufficiency.

Effects of intensive care unit quality assessment on changes in medical staff in medical institutions and in-hospital mortality.

BACKGROUND: Quality assessments are being introduced in many countries to improve the quality of care and maintain acceptable quality levels. In South Korea, various quality assessments are being conducted to improve the quality of care, but there is insufficient evidence on intensive care units (ICUs). This study aims to evaluate the impact of ICU quality assessments on the structural indicators in medical institutions and the resulting in-hospital mortality of patients. METHODS: This study used data collected in the 2nd and 3rd ICU quality assessments in 2017 and 2019. A total of 72,879 patients admitted to ICUs were included during this period, with 265 institutions that received both assessments. As for structural indicators, changes in medical personnel and equipment were assessed, and in-hospital deaths were evaluated as patient outcomes. To evaluate the association between medical staff and in-hospital mortality, a generalized estimating equation model was performed considering both hospital and patient variables. RESULTS: Compared to the second quality evaluation, the number of intensivist physicians and experienced nurses increased in the third quality evaluation; however, there was still a gap in the workforce depending on the type of medical institution. Among all ICU patients admitted during the evaluation period, 12.0% of patients died in the hospital. In-hospital mortality decreased at the 3rd assessment, and hospitals employing intensivist physicians were associated with reduced in-hospital deaths. In addition, an increase in the number of experienced nurses was associated with a decrease in in-hospital mortality, while an increase in the nurse-to-bed ratio increased mortality. CONCLUSIONS: ICU quality assessments improved overall structural indicators, but the gap between medical institutions has not improved and interventions are required to bridge this gap. In addition, it is important to maintain skilled medical personnel to bring about better results for patients, and various efforts should be considered. This requires continuous monitoring and further research on long-term effects.

Naphthalene diimide-based random terpolymers with axisymmetric and asymmetric electron acceptors for controllable morphology and enhanced fill factors in all-polymer solar cells.

All-polymer solar cells (all-PSCs), based on p-type polymer donors and n-type acceptors as the active layer, offer exceptional promise because of excellent thermal stability, superior film formation, and good mechanical stress as a unique bulk heterojunction (BHJ) solar cell combination. Therefore, tuning the molecular composition between polymers is crucial for optimizing power conversion efficiency (PCE) in these all-PSC systems. In this study, we synthesized a series of naphthalene diimide (NDI)-based random terpolymers P(NDI-BDD10), P(NDI-TPD10), P(NDI-TT10), and P(NDI-2FQ10) with axisymmetric (BDD, TPD) and asymmetric (TT, 2FQ) electron acceptors. Compared with the blend morphology of PBDB-T:N2200, their diverse effects due to the addition of trace amounts of axisymmetric and asymmetric components were comprehensively investigated using physical and surface analyses and structural simulations. Consequently, most of our polymer acceptors demonstrated improved fill factors (FFs) in the optimal morphology. P(NDI-BDD10)-based devices achieved the highest PCE of 6.80% and FF of 69.1%, while the architecturally most asymmetric P(NDI-TT10)-based devices reached the lowest PCE of 4.52% despite an enhanced FF of 65.4%. As a result, the appropriate molecular arrangement is crucial for obtaining the desired morphology and improved PCE. Our findings give novel molecular design insight into the distinctions between axisymmetric and asymmetric electron acceptors and seem significant for achieving improved morphological features and efficiency.

The effect of fragmented cancer care and change in nurse staffing grade on cancer patient mortality.

BACKGROUND: Continuity of patient care ensures timely and appropriate care and is associated with better patient outcomes among cancer patients. However, the impact of nurse staffing grade changes on patient outcomes remains unknown. AIMS: This retrospective cohort study aimed to evaluate the effect of fragmented care and changes in nurse staffing grade on the survival of colorectal cancer patients who underwent surgery. METHODS: This study included 2228 newly diagnosed colorectal cancer patients. Fragmented care was defined as the receipt of treatment in multiple hospitals and was divided into three categories based on changes in nurse staffing grade. Five-year survival rates were used to evaluate the effect of fragmented care and nurse staffing grade on outcomes of cancer patients. Survival analysis was performed by adjusting for covariates using the Cox proportional hazards model for 5-year mortality. RESULTS: Approximately 18.5% of patients died within 5 years; the mortality rate during cancer treatment was higher in patients who received fragmented care, especially in those transferred to hospitals with fewer nurses. Patients who received fragmented care had shorter survival times, and those transferred to hospitals with fewer nurses had higher risks of 5-year mortality (hazard ratio: 1.625; 95% CI: [1.095, 2.412]). Transfers to hospitals with fewer nurses were associated with increased mortality rates in low-income patients, hospitals located in metropolitan and rural areas, and high-severity groups. LINKING EVIDENCE TO ACTION: Receipt of fragmented care and change in nurse staffing grade due to patients' transfer to different hospitals were associated with increased mortality rates in cancer patients, thus underlining the importance of ensuring continuity and quality of care. Patients from rural areas, from low-income families, and with high disease severity may have better outcomes if they receive treatment in well-staffed hospitals.

Lipid-lowering drug adherence and combination therapy effects on gastrointestinal cancer in patients with dyslipidemia without diabetes: a retrospective cohort study in South Korea.

BACKGROUND: In aging populations, the number of people with high cholesterol levels is increasing. Appropriate management of high cholesterol levels with drugs such as statins may prevent secondary diseases. Despite many studies on the effects of statins on various types of cancer, the effectiveness of lipid-lowering therapy in preventing cancer remains controversial. This study aimed to evaluate its long-term effect on developing gastrointestinal (GI) cancer in patients with dyslipidemia. METHODS: This study used the National Health Insurance Sampling (NHIS) cohort data (2002-2015), which included patients with dyslipidemia without diabetes, and measured patients' adherence to lipid-lowering therapy using the medication possession ratio. We used the Cox proportional hazard ratio (HR) to identify the association between the continuity of lipid-lowering therapy and the risk of GI cancer. We also evaluated the association between a combination of lipid-lowering drugs and a reduced risk of GI cancer. RESULTS: A total of 49,351 patients were diagnosed with dyslipidemia, of which 579 were diagnosed with GI cancer. Patients with higher adherence to lipid-lowering therapy had a significantly reduced risk of GI cancer compared to patients without drugs, and high adherence was associated with a reduced incidence of all types of GI cancer. Specifically, the combination of statins and ezetimibe or fibrates appears to reduce GI cancer risk effectively. Overall, the continuity of lipid-lowering therapy had a protective effect on GI cancer in middle-aged and elderly patients with dyslipidemia compared to non-users. CONCLUSIONS: Our findings suggest that the continuity of lipid-lowering therapy is vital in patients with dyslipidemia. In addition, for individuals vulnerable to GI cancer, combination therapy may be associated with more effective protection against GI cancer. Healthcare providers need patient education and monitoring to improve drug adherence in patients with dyslipidemia.

Disparities in healthcare expenditures according to economic status in cancer patients undergoing end-of-life care.

BACKGROUNDS: A desire for better outcome influences cancer patients' willingness to pay. Whilst cancer-related costs are known to have a u-shaped distribution, the actual level of healthcare utilized by patients may vary depending on income and ability to pay. This study examined patterns of healthcare expenditures in the last year of life in patients with gastric, colorectal, lung, and liver cancer and analyzed whether differences exist in the level of end-of-life costs for cancer care according to economic status. METHODS: This study is a retrospective cohort study which used data from the Korean National Elderly Sampled Cohort, 2002 to 2015. End-of-life was defined as 1 year before death. Economic status was classified into three categorical variables according to the level of insurance premium (quantiles). The relationship between the dependent and independent variables were analyzed using multiple gamma regression based on the generalized estimated equation (GEE) model. RESULTS: This study included 3083 cancer patients, in which total healthcare expenditure was highest in the high-income group. End-of-life costs increased the most in the last 3 months of life. Compared to individuals in the 'middle' economic status group, those in the 'high' economic status group (RR 1.095, 95% CI 1.044-1.149) were likely to spend higher amounts. The percentage of individuals visiting a general hospital was highest in the 'high' economic status group, followed by the 'middle' and 'low' economic status groups. CONCLUSION: Healthcare costs for cancer care increased at end-of-life in Korea. Patients of higher economic status tended to spender higher amounts of end-of-life costs for cancer care. Further in-depth studies are needed considering that end-of-life medical costs constitute a large proportion of overall expenditures. This study offers insight by showing that expenditures for cancer care tend to increase noticeably in the last 3 months of life and that differences exist in the amount spent according economic status.

Association of institutional transition of cancer care with mortality in elderly patients with lung cancer: a retrospective cohort study using national claim data.

BACKGROUND: Although survival based outcomes of lung cancer patients have been well developed, institutional transition of cancer care, that is, when patients transfer from primary visiting hospitals to other hospitals, and mortality have not yet been explored using a large-scale representative population-based sample. METHODS: Data from the Korean National Elderly Sampled Cohort survey were used to identify patients with lung cancer who were diagnosed during 2005-2013 and followed up with for at least 1 year after diagnosis (3738 patients with lung cancer aged over 60 years). First, the authors examined the distribution of the study population by mortality, and Kaplan-Meier survival curves/log-rank test were used to compare mortality based on institutional transition of cancer care. Survival analysis using the Cox proportional hazard model was conducted after controlling for all other variables. RESULTS: Results showed that 1-year mortality was higher in patients who underwent institutional transition of cancer care during 30 days after diagnosis (44.2% vs. 39.7%, p = .027); however, this was not associated with 5-year mortality. The Cox proportional hazard model showed that patients who underwent institutional transition of cancer care during 30 days after diagnosis exhibited statistically significant associations with high mortality for 1 year and 5 years (1-year mortality, Hazard ratio [HR]: 1.279, p = .001; 5-year mortality, HR: 1.158, p = .002). CONCLUSION: This study found that institutional transition of cancer care was associated with higher mortality among elderly patients with lung cancer. Future consideration should also be given to the limitation of patients' choice when opting for institutional transition of care since there are currently no control mechanisms in this regard. Results of this study merit health policymakers' attention.

Health-related quality of life among cancer patients and survivors and its relationship with current employment status.

INTRODUCTION: Health-related quality of life (HRQoL) is an important end point to measure in cancer patients and survivors. This study investigated whether differences in HRQOL exist between cancer patients, cancer survivors, and the general population, in addition to how employment status interplays in this relationship. METHODS: Data were from the 2019 Korea National Health & Nutrition Examination. HRQoL was measured using the HRQoL Instrument with 8 Items (HINT-8) index, which encompasses physical, mental, social, and health-related aspects. All variables were entered simultaneously into the fully adjusted model. Multiple regression analysis was used to evaluate the association between HRQoL in cancer patients and cancer survivors compared to the general population. An interaction analysis was conducted based on current employment status. RESULTS: A total of 3805 cancer patients, 109 cancer survivors, and 3609 individuals of the general population were included in this study. The HRQoL scores of cancer patients (ß: - 0.0221, p-value: 0.0218) were poorer compared to the general population with statistical significance. In contrast, the HRQoL scores of cancer survivors did not show statistically significant differences. The interaction term between cancer status and economic activity status was statistically significant for cancer patients * unemployed (ß: - 0.0557, p-value: 0.0020). CONCLUSION: Cancer patients had lower HRQoL than the general population. Additionally, the interaction analysis reveals that unemployed cancer patients have poorer HRQoL scores than the employed general population. The results reveal that cancer patients are vulnerable to decreases in HRQoL, in particular those who are currently unemployed.

The association between nurse staffing level and length of stay in general ward and intensive care unit in Korea.

BACKGROUND: Although many studies investigating the relationship between nurse staffing and quality of care have been published, the appropriate nurse-to-patient ratio with patient severity considered remains poorly understood. The aim of this study was to evaluate the impact of nurse staffing levels on length of stay (LOS) in the intensive care unit (ICU) and general ward. METHODS: This study used a retrospective cohort study. The nurse staffing level was classified into nine grades for ICU based on a nurse-to-bed ratio, and eight grades for general wards based on a nurse-to-patient ratio. A generalized estimating equation model was used to evaluate the associations between the nurse staffing level and LOS. Subgroup analysis was conducted to assess these associations according to patient nursing needs at each hospital type. RESULTS: This study included 13,135 ICU patients and 263,818 patients admitted to the general ward. In the ICU, the level of nurse staffing (based on the nurse-to-bed ratio) in grade 4 and above (grade 2: <0.63, grade 3: <0.77, grade 4: <0.88) was significantly associated with reduced LOS compared to grade 7 (<1.25). In the general ward, the level of nurse staffing in grade 4 and above was linked to reduced LOS compared to grade 7. CONCLUSION: The results of this study show that an appropriate nurse-to-patient ratio is associated with a shorter LOS. In particular, hospitals with a higher proportion of severely ill patients require a larger staff of nurses, making it necessary to develop standards for determining nurse staffing level with patient severity taken into account.

Regional and income disparities in treatment and drug adherence of patients with dyslipidemia: a retrospective cohort study in South Korea, 2003-2015.

BACKGROUNDS: Health disparities represent a major public health problem that needs to be addressed, and a variety of factors, including geographical location and income, can contribute to these disparities. Although previous studies have suggested that health differs by region and income, evidence on the difference in treatment rate is relatively insufficient. To identify differences in prescription rates by region and income in patients with dyslipidemia. METHODS: Using data from the National Health Insurance Service senior cohort, we included older adults who were diagnosed with dyslipidemia in Korea from 2003 to 2015. Overall prescription rate was determined for patients with dyslipidemia. In addition, medication possession ratio and a defined daily dose were analyzed in patients who were prescribed statins. A generalized estimating equation Poisson model was used to assess differences in prescription rates. RESULTS: Patients living in rural areas (Chungcheong-do, Jeolla-do, and Gyeongsang-do) had a significantly higher prescription rate than those in metropolitan cities. Unlike the prescription rate, the drug adherence was significantly higher in Seoul, Gyeonggi-do, and Gangwon-do but lower in Jeolla-do and Gyeongsang-do than in metropolitan cities. Patients with low income had lower prescription rates than those with high income, but this difference was not statistically significant. CONCLUSION: Our findings demonstrate differences in the treatment rates of patients with dyslipidemia by region and income. Appropriate interventions are needed in vulnerable regions and groups to increase the treatment rate for patients with dyslipidemia.

Exercise Pills for Drug Addiction: Forced Moderate Endurance Exercise Inhibits Methamphetamine-Induced Hyperactivity through the Striatal Glutamatergic Signaling Pathway in Male Sprague Dawley Rats.

Physical exercise reduces the extent, duration, and frequency of drug use in drug addicts during the drug initiation phase, as well as during prolonged addiction, withdrawal, and recurrence. However, information about exercise-induced neurobiological changes is limited. This study aimed to investigate the effects of forced moderate endurance exercise training on methamphetamine (METH)-induced behavior and the associated neurobiological changes. Male Sprague Dawley rats were subjected to the administration of METH (1 mg/kg/day, i.p.) and/or forced moderate endurance exercise (treadmill running, 21 m/min, 60 min/day) for 2 weeks. Over the two weeks, endurance exercise training significantly reduced METH-induced hyperactivity. METH and/or exercise treatment increased striatal dopamine (DA) levels, decreased p(Thr308)-Akt expression, and increased p(Tyr216)-GSK-3ß expression. However, the phosphorylation levels of Ser9-GSK-3ß were significantly increased in the exercise group. METH administration significantly increased the expression of NMDAr1, CaMKK2, MAPKs, and PP1 in the striatum, and exercise treatment significantly decreased the expression of these molecules. Therefore, it is apparent that endurance exercise inhibited the METH-induced hyperactivity due to the decrease in GSK-3ß activation by the regulation of the striatal glutamate signaling pathway.

Effects of a mandatory DRG payment system in South Korea: Analysis of multi-year nationwide hospital claims data.

BACKGROUND: In 2002, a voluntary diagnosis-related groups (DRGs) payment system was introduced in South Korea for seven disease groups, and participation in the DRGs was mandated for all hospitals beginning in 2013. The primary aim of this study was to compare results reflective of patient care between voluntary participation hospitals (VPHs) and mandatory participation hospitals (MPHs) governed by either the DRGs or fee-for-service (FFS) payment system. METHODS: We collected DRGs and FFS inpatient records (n=3,038,006) from the Health Insurance Review and Assessment for the period of July 2011 to July 2014 and compared length-of-stay, total medical costs, shifting services to an outpatient setting, and readmission rates according to payment system, time of DRGs implementation, and hospital type. We analyzed the effects of mandatory introduction in DRGs payment system on results for patient care and used generalized estimating equations with difference-in-difference methodology. RESULTS: Most notably, patients at MPHs had significantly shorter LOS and lower readmission rates than VPH patients after mandatory introduction of the DRGs. Shifting services to an outpatient setting was similar between the groups. CONCLUSIONS: Our findings suggest that the DRGs payment policy in Korea has decreased LOS and readmission rates. These findings support the continued implementation and enlargement of the DRGs payment system for other diseases in South Korea, given its potential for curbing unnecessary resource usage encouraged by FFS. If the Korean government deliberates on expansion of the DRGs to include other diseases with higher rates of complications, policymakers need to monitor deterioration of health care quality caused by fixed pricing.

2D Nanosheets and Their Composite Membranes for Water, Gas, and Ion Separation.

Two-dimensional nanosheets have shown great potential for separation applications because of their exceptional molecular transport properties. Nanosheet materials such as graphene oxides, metal-organic frameworks, and covalent organic frameworks display unique, precise, and fast molecular transport through nanopores and/or nanochannels. However, the dimensional instability of nanosheets in harsh environments diminishes the membrane performance and hinders their long-term operation in various applications such as gas separation, water desalination, and ion separation. Recent progress in nanosheet membranes has included modification by crosslinking and functionalization that has improved the stability of the membranes, their separation functionality, and the scalability of membrane formation while the membranes' excellent molecular transport properties are retained. These improvements have enhanced the potential of nanosheet membranes in practical applications such as separation processes.

Sleep Quality Independently Affects Health-related Quality of Life and Cognitive Function in Korean Female Patients with Rheumatoid Arthritis: a Case-control Study.

BACKGROUND: This study aimed to address sleep quality in patients with rheumatoid arthritis (RA) and to determine how it affects health-related quality of life (HRQoL) and cognitive function. METHODS: One hundred and twenty-three patients with RA and 76 healthy controls were enrolled in this study. Sleep quality was assessed using the Korean version of the Pittsburgh Sleep Quality Index (PSQI). Cognitive function and HRQoL was evaluated by a Korean-Montreal Cognitive Assessment (MoCA-K) and 36-item Short-Form Health Survey (SF-36), respectively. Other clinical, demographic, and laboratory data were obtained from retrospective medical chart review. RESULTS: More patients in the RA group reported poor sleep quality (PSQI > 5) than in the control group (61% [75/123] vs. 39.5% [30/76]; P = 0.003). Total PSQI was also significantly higher in the RA group (median [interquartile range], 7 [5-11] vs. 5 [3-6.75]; P = 0.001). Total PSQI score negatively correlated with MoCA-K score (Spearman's rho (r) = -0.223; P = 0.003) with a physical component summary (PCS) of SF-36 (r = -0.221; P = 0.003) and a mental component summary (MCS) of SF-36 (r = -0.341; P < 0.001), which means that poor sleep quality was associated with poor cognitive function and low HRQoL. CONCLUSION: The findings of this study suggest that poor sleep quality is an independent risk factor for low HRQoL and cognitive dysfunction. Efforts to improve the sleep quality of RA patients seem to be an important aspect of integrative treatment for RA.

Spontaneous spinal epidural hematoma of the thoracic spine after herbal medicine: a case report.

BACKGROUND: Spontaneous spinal epidural hematoma (SSEH) is an uncommon disease, but it can lead to acute cord compression with disabling consequences. Identifiable reasons for spontaneous hemorrhage are vascular malformations and bleeding disorders. However, SSEH after taking herbal medicines has not been described yet. CASE PRESENTATION: A 60-year-old female experienced sudden back pain combined with numbness and weakness in the lower limbs for several hours with no trauma, drug use, family history or any disease history. Her deep tendon reflexes were normoactive, and Babinski was negative. An emergent MRI showed a spinal epidural hematoma extending from T3 to T5. She was taken to surgery after immediate clinical and laboratory evaluations had been completed. Emergency decompression with laminectomy was performed and the patient recovered immediately after the surgery. Additional history taken from the patient at outpatient clinic after discharge revealed that she had been continuously taking herbal medicine containing black garlic for 8 weeks. CONCLUSION: To our knowledge, no report has been previously issued on SSEH after taking herbal medicines. Although contradictory evidence is present on bleeding risks with herbal uses, we believe that it's reasonable to ascertain if patients with SSEP are taking herbal medication before or during spinal surgery.

Functionalized Boron Nitride Nanosheets: A Thermally Rearranged Polymer Nanocomposite Membrane for Hydrogen Separation.

Amino functionalized boron nitride nanosheets (FBN) were incorporated into a crosslinked, thermally rearranged polyimide (XTR) to fabricate FBN-XTR nanocomposite membrane. The FBN-XTR membrane exhibited a small decrease in H2 permeability but demonstrated a remarkably increased H2 gas selectivity over other gases, compared with XTR. The XTR membrane heat-treated at 425 °C had a H2 permeability of 210 Barrers and a H2 /CH4 separation factor of 24.1, whereas the nanocomposite membrane with 1 wt % FBN exhibited a H2 permeability of 110 Barrers and H2 /CH4 separation factor of 275, an order of magnitude greater. At 1 wt % FBN loading, the FBN-XTR membrane showed three times higher tensile strength and 60 % higher elongation than pristine XTR membrane. In addition, FBN-XTR was found to be able to be readily processed into thin-film membranes for practical H2 separation applications.

Percutaneous Subtrochanteric Osteotomy for Painful Dislocated Hips in Patients With Cerebral Palsy.

BACKGROUND: Treatment of a painful, chronically dislocated hip in nonambulatory children with cerebral palsy (CP) is challenging and controversial. Although many surgical options have been described, there is limited information, including patient-centered outcomes, following treatment. The purpose of our study was to evaluate the effect of a percutaneous subtrochanteric valgus osteotomy (SVO) using external fixation (EF) on hip abduction, radiographic parameters, and quality of life (QOL) measures in such patients. METHODS: Fifteen nonambulatory patients (8 male, 7 female) with CP with 19 chronically dislocated hips underwent SVO using EF and adductor tenotomy at an average age of 14.3 years (range, 10.7 to 26.8 y). Changes in hip abduction and radiographic angular correction following surgery were assessed. Caregivers completed 2 surveys detailing differences in the patient's QOL measures, including severity and duration of pain and ease of nursing care, and the modified Child Health Index of Life with Disabilities (CPCHILD). RESULTS: Caregivers of 11 patients completed both surveys at an average follow-up of 50 months (range, 17 to 119 mo) after fixator removal. There was improvement in pain, sitting tolerance, ease of transfers, and perineal care in the majority (9/11) of patients. The modified CPCHILD (possible score, 10 to 50) improved from 27.2 to 16.23 (P=0.05). Hip abduction improved from -7 degrees (range, -32 to 5 degrees) to 24 degrees (range, 0 to 40 degrees) (P<0.0001). The average valgus osteotomy correction was 48.2 degrees (range, 2.2 to 93.2 degrees). The pelvic femoral shaft angle improved from -15.2 degrees (range, -47.7 to 7.4 degrees) to 15.4 degrees (-44.3 to 44.6 degrees). There was some correlation of both, change in hip abduction (R=0.55) and osteotomy angle (R=0.60), with improvement in QOL measures. There were 3 major complications (20%) in 15 patients. CONCLUSIONS: On the basis of preliminary results, percutaneous SVO stabilized with EF improves QOL in the majority of nonambulatory CP patients despite untoward events and is a viable alternative to open osteotomy with internal fixation. More robust comparative studies are needed to further assess the optimal salvage technique in this patient population. LEVEL OF EVIDENCE: Level IV.

Is Parathyroid Hormone A Viable Solution For Nonunion? A Systematic Review And Pooled Analysis.

We conducted a systematic review and pooled analysis of published studies to evaluate the clinical results of parathyroid hormone (PTH) in the treatment of nonunion and delayed union and assess whether there are any adverse effects of PTH. Four electronic databases (PubMed, Web of Science, EMBASE, and Cochrane library) were searched from 1950 to 2016. A total of 24 patients from 13 published studies were identified. The mean age of the patients was 57 years (range, 19-91 years). Mean duration of nonunion after initial treatment (surgical or conservative) was 8.4 months (range, 3-36 months). PTH was given to the patients for 1.5 months to 10 months (mean, 5.3 months) for various types of fractures. The union rates after using PTH was 96%. Mean time to union after PTH therapy was 7.3 months (range, 3-15 months). No patients reported any side effects during the entire period of PTH treatment. Our study has helped to further elucidate the outcomes of PTH therapy in the treatment of nonunion. We believe that PTH is a viable option that is a promising, safe, and effective anabolic treatment for delayed union and nonunion.

Obese children experience more extremity fractures than nonobese children and are significantly more likely to die from traumatic injuries.

UNLABELLED: Two of the most prevalent problems children facing worldwide are injuries and obesity. We conducted a systematic review of published studies that evaluated the effects of obesity on children with traumatic injuries. Six studies published between 2006 and 2014 were identified, comprising a total of 4594 children: 867 were obese and 3727 were not. Obese children were 25% more likely to have extremity fractures than nonobese children (p = 0.003), and their mortality rate was significantly higher at 4.7% versus 2.8% (p = 0.026). CONCLUSION: Our review showed that obese children were more likely to have extremity fractures and die of traumatic injuries than nonobese children.