Contemporary and Future Development of 3D Printing Technology in the Field of Assistive Technology, Orthotics and Prosthetics.

3D printing is considered as a helpful technology that facilitates innovative assistive technology, orthotics, and prosthetics development. This technology could likely contribute to positive treatment outcomes. It could also mitigate the challenges encountered when using the traditional methods. Our team's research in the application of 3D printing in prosthetics, orthotics and biomedical technology has shown beneficial results in its use. This article gives a general description on application of CAD/CAM, digitalization and 3d printing in this industry followed by short description of two spinal-related projects conducted in our research team. Technological and clinical challenges on utilization of this technology have been listed. Finally, this manuscript provides recommendation for broader applications and developments of the aforementioned technology through interdisciplinary practices. A glimpse into the future of 3D printing in the healthcare industry shows that this industry is poised to continue having a significant impact in this sector. It should be emphasized that assistive technology, orthotics, and prosthetics require a human touch and connection, and no digital tool or technology can replace such requirements. Indeed, multi-disciplinary collaboration is the key to the success of applications of 3D printing.

Performance of the Roche/Snibe electrochemiluminescent anti-SARS-COV-2 spike assays compared to the Roche/Abbott IgG nucleocapsid and Abbott IgM spike assays.

INTRODUCTION: We evaluated the Roche Elecsys Anti-SARS-CoV-2 and Snibe SARS-CoV-2 S-RBD IgG spike chemiluminescent immunoassays and compared them to existing Roche/Abbott nucleocapsid and Abbott IgM spike assays. METHODS: We enrolled 184 SARS-CoV-2 RT-PCR positive samples and 215 controls (172 pre-pandemic, and 43 cross-reactivity) to evaluate the Roche spike antibody (anti-SARS-CoV-2-S) assay. For the Snibe evaluation, we included 119 RT-PCR positive samples and 249 controls (200 pre-pandemice, 49 cross-reactivity). 98 cases had been tested on three spike assays (Roche total antibody, Snibe IgG and Abbott IgM). RESULTS: The Roche anti-SARS-CoV-2-S assay had a CV of 0.5% (0.82U/mL) and 2.3% (8.72U/mL) and was linear from 1.16 to 240U/mL. The Snibe assay was linear from 6.43 to 77.7AU/mL, CV of 5.5% (0.43AU/mL) and 8.8% (0.18AU/mL). The Snibe spike assay was significantly more sensitive than the Abbott IgG assay at 0-6 days POS (35.2% vs 3.6%, mean difference 29.6%, 95% CI 17.5 to 41.8, p < 0.0001). Optimized LORs significantly improved the sensitivity of the Roche spike (48.1%-56.7%) and both nucleocapsid assays (Roche 43.3%-65.5%, Abbott 3.6%-18.5%) in early disease. CONCLUSION: Although both spike assays showed higher sensitivity than their nucleocapsid counterparts, lower, optimized LORs provided the most significant improvements to sensitivity.

Preliminary results of a pilot study on the safety and efficacy of balloon dilatation of the Eustachian tube for nasopharyngeal cancer patients with chronic Eustachian tube dysfunction post irradiation.

OBJECTIVE: Eustachian tube dysfunction is a known complication following radiotherapy to the head and neck region. Unfortunately, treatment options are limited, with significant associated morbidity. Balloon Eustachian tube dilatation has been used successfully to treat Eustachian tube dysfunction; hence, this study aimed to determine the safety and efficacy of this method in treating Eustachian tube dysfunction in post-radiotherapy patients with nasopharyngeal carcinoma. METHOD: This interventional cohort pilot study on patients with Eustachian tube dysfunction compared those with nasopharyngeal carcinoma to patients without. Outcome assessment was based on tympanometry type and Eustachian Tube Dysfunction Questionnaire score. RESULTS: A total of 14 ears (12 patients) were tested. Only 14 per cent of the nasopharyngeal carcinoma cohort showed improvement, while 71 per cent of the non-nasopharyngeal carcinoma group were successfully treated. No significant adverse effect was reported in any patient during this study. CONCLUSION: Balloon Eustachian tube dilatation was not shown to be beneficial for post-radiotherapy Eustachian tube dysfunction in nasopharyngeal carcinoma patients in the preliminary stages of this pilot study.

A purpose-design computational method for estimation of plane of maximum curvature in Adolescent Idiopathic Scoliosis.

Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional (3D) deformity, and the plane of maximum curvature (PMC) is proposed to reflect these clinical features, which refers to a vertical plane presenting the maximum projected spinal curvature and its parameters include the PMC Cobb and orientation (angle between PMC and sagittal planes). This study aimed to develop a computational method (CM) for PMC estimation. Twenty-nine patients with AIS and computed tomography (CT) images were recruited. For CT, PMC was determined by rotating a vertical plane about its vertical axis with 5° increment until the maximum Cobb angle was measured. For CM, PMC was estimated via identifying the eight points (the corner points of the superior and inferior endplates of the upper and lower end-vertebrae respectively) in the coronal and lateral CT images. Two experienced raters repeated the PMC estimation three times with one-week interval. The intra-class correlation coefficient (ICC) and Bland-Altman method were used for statistical analysis. Twenty-seven right thoracic curves (RTs) (mean Cobb: 46.1°±12.4°) and 23 left thoracolumbar/lumbar (LTLs/LLs) (mean Cobb: 30.6°±11.1°) were analysed. The intra- and inter-rater ICC values were >0.91 and 0.84 in RTs and LTLs/LLs, respectively. The PMCs obtained from the CM and CT were showed good agreement was also observed between the PMCs obtained from the two methods according to ICC (>0.90) and Bland-Altman method assessments. This purpose-design computational method could provide reliable and valid estimation of PMCs for AIS, which has potential to be used as an alternative for 3D assessment.

Evaluation of an Electrochemiluminescent SARS-CoV-2 Antibody Assay.

BACKGROUND: Little is known about the performance of the Roche novel severe acute respiratory syndrome coronavirus 2 antibody (anti-SARS-CoV-2) assay. We provide an extensive evaluation of this fully automated assay on Cobas e801/e602 immunoassay analyzers. METHODS: We assessed the linearity, precision, and throughput of the Roche anti-SARS-CoV-2 assay. Sensitivity was calculated from 349 SARS-CoV-2 polymerase chain reaction (PCR) positive samples; specificity was determined from 715 coronavirus disease 2019 (COVID-19)-naive samples. We examined cross-reactivity against other antibody positive samples [syphilis, rheumatoid factor (RF), antinuclear antibody (ANA), double-stranded DNA (ds-DNA), influenza, dengue, hepatitis B (HBV), hepatitis C (HCV)] and the anti-SARS-CoV-2 kinetics. RESULTS: The assay cut-off index (COI) was linear up to 90.8. The interassay precision was 2.9% for a negative control (COI = 0.1) and 5.1% for a positive control (COI = 3.0). Assay time is 18 min and results are available 1 min later; throughput for 300 samples was 76 min. Only 1 case positive for HBsAg tested falsely positive; specificity was 99.9%. The assay has a sensitivity of 97.1% 14 days after PCR positivity (POS) and 100% at ≥21 days POS; 48.2% of cases had anti-SARS-CoV-2 within 6 days POS. In 11 patients in whom serum was available prior to a positive antibody signal (COI ≥1.0) the interval between the last negative and first positive COI (time to "seroconversion") on average is 3 days (range 1-6 days) and 4 more days (range 1-7) for the anti-SARS-CoV-2 to plateau. CONCLUSION: The Roche anti-SARS-CoV-2 assay shows excellent performance with minimal cross-reactivity from other viral and confounding antibodies. Antibody development and seroconversion appears quite early.

Risk of needing completion thyroidectomy for low-risk papillary thyroid cancers treated by lobectomy.

Background: Low-risk differentiated thyroid cancers may, according to the American Thyroid Association (ATA) 2015 guidelines, be managed initially with lobectomy. However, definitive risk categorization requires pathological assessment of the specimen, resulting in completion thyroidectomy being recommended when discordance between preoperative and postoperative staging occurs. This study sought to establish the expected rate of completion thyroidectomy in patients with papillary thyroid cancer (PTC) treated by lobectomy. Methods: Patients with PTC treated over 5 years (2013-2017 inclusive) and meeting the ATA criteria for lobectomy were identified from the prospectively developed database of a high-volume, university department of endocrine surgery. Concordance between the ATA initial and final recommendation, and the putative rate of completion thyroidectomy were calculated. Multivariable analysis was used to assess preoperative factors as predictors of the need for total thyroidectomy. Results: Of 275 patients with PTC who met ATA preoperative criteria for lobectomy there was concordance between this and the final recommendation in 158 (57·5 per cent) and discordance in 117 (43·5 per cent). Most common reasons for discordance were: angioinvasion (30·8 per cent), local invasion (23·9 per cent) or both (20·5 per cent). Four patients (1·5 per cent) had permanent hypoparathyroidism. On multivariable analysis, age, sex, tumour size and family history did not independently predict the final treatment required. Conclusion: Although many patients may be treated adequately with lobectomy, just under half would require completion thyroidectomy. Further work is needed on preoperative risk stratification but, before this, total thyroidectomy remains the treatment of choice for low-risk 1-4-cm PTC in the hands of high-volume thyroid surgeons who can demonstrate low complication rates.

Influence of Urban Green Space and Facility Accessibility on Exercise and Healthy Diet in Hong Kong.

Background A cross-sectional study using a convenience sampling method was conducted to understand how green space and accessibility of common public open spaces in compact urban areas affect physical activity and healthy diets of residents. Methods A total of 554 residents completed a structured questionnaire on quality of life, physical activity level and healthy eating practice. Particularly, categories of physical activity and durations were obtained by using the short form Chinese International Physical Activity Questionnaire (IPAQ-C), then the Metabolic Equivalent of Task (MET)-minutes/week was calculated using the formulae (walking minutes × walking days × 3.3) + (moderate-intensity activity minutes × moderate days × 4.0) + (vigorous-intensity activity minutes × vigorous-intensity days × 8.0). The percentage of green space was calculated based on a spatial buffer with a 500 m radius from participants' geocoded addresses using a SPOT ('Satellite Pour l'Observation de la Terre' in French) satellite image-derived vegetation dataset. Parks, promenade and sports facilities were examples of open spaces. Results The sampled population who lived with green space averaged 10.11% ± 7.95% (ranged 1.56-32.90%), with the majority (90%) performing physical activities at medium and high levels. MET-minutes/week was significantly associated (Pearson r = 0.092; p < 0.05) with the green space percentage. Relatively active residents commonly used open spaces within the district for performing exercise, in particular, parks and promenades were mostly used by older residents, while sports facilities by the younger groups at age 25-44 and <25 years. Conclusions Current findings suggested promotion of exercise could be achieved by the design or redesign of built environment to include more parks accessible to the residents with the increase of vegetation.

Study of main and cross-over effects on pressure relief among body mass index (BMI), body position and supporting material properties.

Pressure ulcers influence people with limited mobility who must spend a long time lying or sitting because these positions create high interfacial pressure between the body and supporting materials. Supporting materials, such as mattresses and cushions, are designed to prevent pressure ulcers by increasing the contact area, reducing the interfacial pressure or reducing the contact time. Foam is the most common supporting material for relieving pressure because it is cheap and easy to change its shape to fit the contour of the body. Past studies showed that BMI, body position and supporting material properties have an impact on relieving pressure; however, there is no study of the main and cross-over effects among these parameters. This study aims to investigate the main and cross-over effects among BMI, body position and supporting material properties on pressure relieving performance using univariate ANOVA and correlation analysis. It was found that body position and foam density were the main effect and BMI and body position, and body position and foam density were the cross-over effects on pressure relief. It was also found that low density Polyurethane (PU) foam of less than 4 cm in thickness as well as the appropriate K2 and K3 moduli are best suited for pressure relief. The actual value of foam thickness and the appropriate K2 and K3 moduli are subject to BMI values and body position. The significance of the outcomes from this study is that it will aid in optimizing the design of supporting materials with varied BMI values and body positions to greatly reduce pressure ulcers for ailing patients.

Danshen (Salvia miltiorrhiza) protects ovariectomized rats fed with high-saturated fat-sucrose diet from bone loss.

Dietary patterns may interfere with the efficacy of herbal intervention. Our results demonstrated the protective effects of Salvia miltiorrhiza aqueous extract (SMA) on bone metabolism were influenced by levels of dietary fat and sucrose in ovariectomized (OVX) rats through its actions on attenuating lipid deposition and oxidative stress in rats. INTRODUCTION: Salvia miltiorrhiza (SM), also known as Danshen, has been tested as an osteoporosis treatment in a series of small, short human trials that generally report improvements in bone property. However, dietary patterns may interfere with the effects of herbal intervention. We hypothesized that dietary fat and sucrose levels could influence the effects of SM supplementation on bone in estrogen-deficient animals. METHODS: Six-month-old Sprague-Dawley sham or OVX rats were fed either a low-saturated fat-sucrose (LFS, a diet that was similar in composition to normal rat chow) or a high-fat-sucrose (HFS) diet and OVX rats were treated (8 rats/group) with SM aqueous extract (SMA, 600 mg/kg/day), 17ß-estradiol (1 mg/kg/day), or vehicle for 12 weeks. RESULTS: SMA significantly improved bone properties as revealed by the increase in trabecular bone mineral density and decrease in trabecular separation at proximal metaphysis of the tibia (PT) in HFS-fed OVX rats, but not in LFS-fed OVX rats. SMA greatly reduced lipid deposition and malondialdehyde levels, improved the activities of superoxide dismutase, catalase, and glutathione peroxidase in the livers of HFS-fed OVX rats. SMA could directly improve the proliferation and differentiation in vitro in an H2O2-induced preosteoblast cell model by attenuating cellular reactive oxygen species levels. CONCLUSIONS: The protective effects of SMA on bone metabolism were influenced by dietary fat and sucrose levels in OVX rats. The ability of SMA to reduce bone loss in HFS-fed OVX rats was associated with the attenuation of lipid deposition and oxidative stress levels.

A Case-Control Study of Body Composition, Prevalence, and Curve Severity of the Patients With Adolescent Idiopathic Scoliosis in the East Part of China.

OBJECTIVE: The purpose of the study is to investigate the characteristics of prevalence and curve severity in patients with adolescent idiopathic scoliosis (AIS) and the body composition alterations between the patients with AIS and healthy controls. METHODS: Information on the study sample was obtained from a screening database. The AIS cohort was paired with an age- and gender-matched healthy cohort. The stratification of BMI and curve severity was conducted according to the criteria developed by the US Centers for Disease Control and Prevention and the Scoliosis Research Society. The prevalence and curve severity of the patients with AIS were investigated. Multigroup comparison of body composition parameters was conducted according to BMI between the patients with AIS and healthy controls. RESULTS: A total of 1,202 patients with AIS and an age- and gender-matched cohort were recruited from local schools. The underweight cases had the highest prevalence of AIS and significantly higher Cobb angle compared with the other three BMI subgroups. Although the patients with AIS had lower body weight, body fat mass, percentage of body fat, and fat-free mass compared with healthy controls, converse results were observed in the underweight cases after stratification according to BMI. CONCLUSION: Based on the sporadic body composition of the patients with AIS observed in the current study, it is predictable that the pathophysiological alterations may be different before and after the onset of scoliosis. Well-designed human or animal studies for underweight patients would be helpful to reveal the mechanisms of pathophysiological alterations and better predict the development of AIS.

Observational evidence of a long-term increase in precipitation due to urbanization effects and its implications for sustainable urban living.

Although projected precipitation increases in East Asia due to future climate change have aroused concern, less attention has been paid by the scientific community and public to the potential long-term increase in precipitation due to rapid urbanization. A ten-year precipitation dataset was analysed for both a rapidly urbanized megacity and nearby suburban/rural stations in southern China. Rapid urbanization in the megacity was evident from satellite observations. A statistically significant, long-term, increasing trend of precipitation existed only at the megacity station (45.6mm per decade) and not at the other stations. The increase was attributed to thermal and dynamical modifications of the tropospheric boundary layer related to urbanization, which was confirmed by the results of our WRF-SLUCM simulations. The results also suggested that a long-term regional increase in precipitation, caused by greenhouse gas-induced climate change, for instance, was not evident within the study period. The urbanization-induced increase was found to be higher than the precipitation increase (18.3mm per decade) expected from future climate change. The direct climate impacts due to rapid urbanization is highlighted with strong implications for urban sustainable development and the planning of effective adaptation strategies for issues such as coastal defenses, mosquito-borne disease spread and heat stress mortality.

Renin inhibitor aliskiren exerts beneficial effect on trabecular bone by regulating skeletal renin-angiotensin system and kallikrein-kinin system in ovariectomized mice.

SUMMARY: The skeletal renin-angiotensin system contributes to the development of osteoporosis. The renin inhibitor aliskiren exhibited beneficial effects on trabecular bone of osteoporotic mice, and this action might be mediated through angiotensin and bradykinin receptor pathways. This study implies the potential application of renin inhibitor in the management for postmenopausal osteoporosis. INTRODUCTION: The skeletal renin-angiotensin system plays key role in the pathological process of osteoporosis. The present study is designed to elucidate the effect of renin inhibitor aliskiren on trabecular bone and its potential action mechanism in ovariectomized (OVX) mice. METHODS: The OVX mice were treated with low dose (5 mg/kg) or high dose (25 mg/kg) of aliskiren or its vehicle for 8 weeks. The bone turnover markers were measured by ELISA. The structural parameters of trabecular bone at lumbar vertebra (LV) and distal femoral metaphysis were measured by micro-CT. The expression of messenger RNA (mRNA) and protein was studied by RT-PCR and immunoblotting, respectively. RESULTS: Aliskiren treatment reduced urinary excretion of calcium and serum level of tartrate-resistant acid phosphatase in OVX mice. The treatment with aliskiren significantly increased bone volume (BV/TV) and connectivity density (Conn.D) of trabecular bone at LV-2 and LV-5 as well as dramatically enhanced BV/TV, Conn.D, bone mineral density (BMD/BV) and decreased bone surface (BS/BV) at the distal femoral end. Aliskiren significantly down-regulated the expression of angiotensinogen, angiotensin II (Ang II), Ang II type 1 receptor, bradykinin receptor (BR)-1, and osteocytic-specific gene sclerostin as well as the osteoclast-specific genes, including carbonic anhydrase II, matrix metalloproteinase-9, and cathepsin K. CONCLUSIONS: This study revealed that renin inhibitor aliskiren exhibited the beneficial effects on trabecular bone of ovariectomy-induced osteoporotic mice, and the underlying mechanism for this action might be mediated through Ang II and BR signaling pathways in bone.

Reliability and Validity Study of Clinical Ultrasound Imaging on Lateral Curvature of Adolescent Idiopathic Scoliosis.

BACKGROUND: Non-ionizing radiation imaging assessment has been advocated for the patients with adolescent idiopathic scoliosis (AIS). As one of the radiation-free methods, ultrasound imaging has gained growing attention in scoliosis assessment over the past decade. The center of laminae (COL) method has been proposed to measure the spinal curvature in the coronal plane of ultrasound image. However, the reliability and validity of this ultrasound method have not been validated in the clinical setting. OBJECTIVES: To evaluate the reliability and validity of clinical ultrasound imaging on lateral curvature measurements of AIS with their corresponding magnetic resonance imaging (MRI) measurements. METHODS: Thirty curves (ranged 10.2°-68.2°) from sixteen patients with AIS were eligible for this study. The ultrasound scan was performed using a 3-D ultrasound unit within the same morning of MRI examination. Two researchers were involved in data collection of these two examinations. The COL method was used to measure the coronal curvature in ultrasound image, compared with the Cobb method in MRI. The intra- and inter-rater reliability of the COL method was evaluated by intra-class correlation coefficient (ICC). The validity of this method was analyzed by paired Student's t-test, Bland-Altman statistics and Pearson correlation coefficient. The level of significance was set as 0.05. RESULTS: The COL method showed high intra- and inter-rater reliabilities (both with ICC (2, K) >0.9, p<0.05) to measure the coronal curvature. Compared with Cobb method, COL method showed no significant difference (p<0.05) when measuring coronal curvature. Furthermore, Bland-Altman method demonstrated an agreement between these two methods, and Pearson's correlation coefficient (r) was high (r>0.9, p<0.05). CONCLUSION: The ultrasound imaging could provide a reliable and valid measurement of spinal curvature in the coronal plane using the COL method. Further research is needed to validate the proposed ultrasound measurement in larger clinical trial and to optimize the ultrasound scanning and measuring procedure.

Cyanine fluorophores for cellular protection against ROS in stimulated macrophages and two-photon ROS detection.

We report the first example of a novel two-photon active, biocompatible, and macrophage cell-membrane permeable carbazole-based cyanine fluorophore for the detection of three biologically important ROS, namely, ˙OH, O2(-) and OCl(-) in solution. This versatile probe shows cellular protection not only in stimulated macrophages from phorbol-12-myristate-13-acetate-induced morphological changes but also lipopolysaccharide-induced cytotoxicity by quenching with the O2(-) and OCl(-) production, respectively. Such protection could be visualized by a distinct change in the fluorescence intensity of the probe.

Time-dependent response of scoliotic curvature to orthotic intervention: when should a radiograph be obtained after putting on or taking off a spinal orthosis?

STUDY DESIGN: A prospective study; 2-group design. OBJECTIVE: This study aims to assess the time response of scoliotic spines to orthotic intervention using clinical ultrasound. SUMMARY OF BACKGROUND DATA: Patients with moderate adolescent idiopathic scoliosis are generally advised orthotic treatment. However, the time to reach maximum correction after donning spinal orthosis or the time to return to pretreatment curvature after doffing spinal orthosis is not fully understood. METHOD: Subjects were divided into 2 groups, the don-orthosis group and the doff-orthosis group where the time reaching maximum correction and the time returning to pretreatment curvature were investigated accordingly. To avoid excessive radiation exposure via obtaining repeated radiographs, a validated method of estimating Cobb angle using radiation-free clinical ultrasound was applied at an interval of every 30 minutes up to 180 minutes. The spinal flexibility (estimated from supine radiographs) and body mass index were collected from the subjects for analyses. RESULT: Nine female patients with adolescent idiopathic scoliosis were recruited. There was no immediate change in the Cobb angles. A change of more than 5° could be observed in both groups only after 30 minutes and maximum change was found at/after 120 minutes. In the doff-orthosis group, the subject with the lowest body mass index took the longest time to increase more than 5° after doffing spinal orthosis. In the don-orthosis group, the subject with the highest body mass index took the longest time to achieve curve correction more than 5°. CONCLUSION: This investigation demonstrated that there is a time lag between application of spinal orthosis and its effect on scoliotic curvature. This is likely due to the low-stiff and viscoelastic properties of the spine. The clinical relevance of this study is that for patients with scoliosis undergoing orthotic treatment, radiograph should not be obtained within 2 hours of putting on or taking off spinal orthosis because it may not show the maximum effect. LEVEL OF EVIDENCE: 4.

Novel T-cell inhibiting peptides delay the onset of Type 1 diabetes in non-obese diabetic mice.

The aim of this study was to investigate the effectiveness of immunomodulatory peptides in preventing the spontaneous onset of Type 1 diabetes in NOD mice. Two such peptides, CP and C1, were injected intraperitoneally in NOD mice three times a week starting at two different time points, nine weeks and 11 weeks of age, and blood sugar levels monitored for the development of diabetes. CP was shown to be effective in delaying the onset of diabetes compared to control (P = 0.006). The timing of peptide administration was crucial since delay in treatment did not prevent the onset of diabetes (nine weeks versus 11 weeks of age). C1 was effective in delaying the onset of Type 1 diabetes with borderline significance when given at week 11 (P = 0.05). These findings confirm the efficacy of these peptides in the prevention and possible treatment for Type 1 diabetes and thereby create new opportunities for genetic manipulation.

Elevated undercarboxylated and reduced carboxylated osteocalcin are associated with metabolic syndrome in middle age Asian females.

Accumulating data suggest that bone plays a role in energy metabolism through decarboxylation of osteocalcin. Thus, we aimed to study the association of circulating under--carboxylated osteocalcin (UC-OCN) and car-boxylated osteocalcin (C-OCN) with metabolic syndrome in middle aged Asian population.In this cross-sectional study, 131 middle aged Asian subjects were recruited. Circulating UC-OCN, C-OCN and parameters of metabolic phenotype were measured.Circulating UC-OCN was increased in subjects with metabolic syndrome (8.1±7.2 ng/ml vs. 5.9±4.6 ng/ml, p=0.036). In contrast, C-OCN showed a non-significant trend towards reduction in subjects with metabolic syndrome (3.6±2.2 ng/ml vs. 4.3±1.8 ng/ml, p=0.057). Further analysis revealed that changes in both UC-OCN and C-OCN occurred primarily among females with metabolic syndrome. Interestingly, neither forms of OCN differed significantly between individuals with and without metabolic syndrome in males. Logistic regression revealed that UC-OCN was independently associated with metabolic syndrome after adjusting for multiple covariates. However, association between metabolic syndrome and C-OCN was dependent on gender (i. e., amongst females only) in the fully adjusted regression model.Variation in OCN (including its sub-species) was associated with variation in metabolic parameters amongst Asian adults. Circulating UC-OCN was increased while C-OCN was decreased in treatment-naïve females with metabolic syndrome. Our preliminary observations further supported a potential link between bone and energy metabolism in humans.

The effect of pressure pad location of spinal orthosis on the treatment of adolescent idiopathic scoliosis (AIS).

Patient with moderate AIS is usually prescribed with spinal orthosis aiming to mechanically support and prevent the spine from further deterioration. In the conventional fitting method, pre-brace X-ray is the main reference, thus, the pressure pad of spinal orthosis may not be accurately located to the strategic areas because the spinal deformities could change 3-dimensionally once pressure pad is applied. A high correlation (r > 0.98) between Cobb's angle and spinous process angle (SPA) was found in the recent studies. With the advancements of 3D clinical ultrasound (3D CUS), tracing SPA along a scoliotic spine becomes possible and this can be used to estimate Cobb's angle. This study aimed to evaluate the effect of pressure pad location of spinal orthosis in the treatment of AIS and 3D CUS was used to trace SPA for estimation of Cobb's angle. The in-brace X-rays were assessed for confirmation of treatment effectiveness. The subjects were divided into ultrasound-guided fitting group A (n=21) and conventional fitting group B (n=22). In the group A, pressure pads were tested at 5 locations - the prescribed location as in the conventional fitting (referred to the pre-brace X-ray), and 1 cm and 2 cm above and below the prescribed location, and 3D CUS was applied to trace the SPA in these 5 pad locations, and the pad location with the lowest estimated Cobb's angle was selected in the final fitting. The assessments of in-brace X-rays showed that the mean Cobb's angle of group A decreased from 28.9° (pre-brace) to 18.6° (immediate in-brace) while the mean Cobb's angle of group B decreased from 27.1° (pre-brace) to 22.5° (immediate in-brace). There was a significant difference (p < 0.05) in the correction of Cobb's angle between the two groups. The results showed that accurate pressure pad location does play an important role in the reduction of Cobb's angle and 3D CUS can be considered as a non-invasive and effective assessment tool to improve orthotic treatment of AIS.