Associations between body composition and vertebral fracture risk in postmenopausal women.

INTRODUCTION: Osteoporosis is a metabolic bone disease with low bone mineral density (BMD) and high incidence of vertebral fractures (VFs). Postmenopausal women with osteoporosis have decreased total fat and lean mass. This study aimed to investigate the associations between body composition and VF risk and explore the potential predictor of VF risk in postmenopausal women. METHODS: Enrolled 731 postmenopausal women were referred by various departments and outpatient clinics to assess vertebral status between October 2016 and November 2017. The main measures were total body lean mass, fat mass, and BMD. Patients were divided into osteopenia, osteoporosis, and normal groups based on T-scores. Logistic regression analyses were performed to evaluate associations between body composition parameters and VF. RESULTS: VF was significantly associated with increased age, lower height, and lighter weight in all participants, and higher BMI was observed in VF participants. Participants in the osteoporosis group were older and had lower height, weight, and BMD than those in normal and osteopenia groups. Femoral and total hip T-scores as well as T-scores for lumbar spine were significantly lower in participants with VF than in non-VF participants. Percentage of bone mass was also significantly lower in VF participants compared to that of non-VF participants. Women with increased BMD and lower bone mass had reduced odds for VF occurrence. Bone mass was significantly able to identify VF occurrence. CONCLUSIONS: Body composition analysis discerns differences in the bone status of postmenopausal women with and without VF. The cutoff value of the bone mass might be used effectively as an indicator of risk for VF occurrence.

[Progress in the application of pedicled autologous tissue in the repair of urethrorectal fistula].

The treatment of urethrorectal fistula remains challenging due to its rarity and complexity. The traditional operation mainly uses simple fistula repair, but the recurrence rate is high and the effect is poor. In recent years, a number of clinical retrospective studies have proved the feasibility of placing various kinds of pedicled tissue flap between the rectum and urethra, and its application has provided a new solution for the treatment of urethral rectal fistula, and achieved satisfactory results. Compared with traditional fistula repair, pedicled tissue flap has sufficient tissue thickness and clear blood supply, which makes up for the thin tissue and poor blood supply of urethral anastomosis and rectal fistula in traditional surgery, and significantly reduces the postoperative recurrence rate of urethral rectal fistula. On the other hand, there are differences in surgical approaches due to the different etiology, location, size of fistula mouth, and doctors' preferences. The anatomy and blood supply of all kinds of autologous pedicled tissue flaps also determine their clinical application. As a common disease of urology and colorectal surgery, the multidisciplinary collaboration of consultation and treatment has brought more options for the management of urethral rectal fistula. Based on this, in this paper, the application of various pedicled autologous tissues in the repair of urethrorectal fistula is reviewed, and different types of tissues are classified according to the surgical approach. The anatomy, blood supply, clinical application, indications, advantages and disadvantages of commonly used autogenous pedicled tissue are discussed in order to provide some reference for the repair of urethrorectal fistula.

Additively manufactured biomedical Ti-Nb-Ta-Zr lattices with tunable Young's modulus: Mechanical property, biocompatibility, and proteomics analysis.

Some ß-Ti alloys, such as Ti-Nb-Ta-Zr (TNTZ) alloys, exhibit a low Young's modulus and excellent biocompatibility. These alloys are promising new generation biomedical implant materials. Selective laser melting (SLM) can further enable customer-specific manufacturing of ß-Ti alloys to satisfy the ever-increasing need for enhanced biomedical products. In this study, we quantitatively determined the relationships between porosity, yield strength, and Young's modulus of SLM-prepared TNTZ lattices. The study constitutes a critical step toward understanding the behavior of the lattice and eventually enables tuning the Young's modulus to match that of human bones. Fatigue properties were also investigated on as-printed lattices in terms of the stress limit. The biocompatibility study included a routine evaluation of the relative cell growth rate and a proteomics analysis using a common mouse fibroblast cell line, L929. The results indicated that the as-printed TNTZ samples exhibited evidence of protein proliferation of the L929 cells, particularly P06733, and that those proteins are responsible for biological processes and molecular functions. They in turn may have promoted cell regeneration, cell motility, and protein binding, which at least partially explains the good biocompatibility of the as-printed TNTZ at the protein level. The study highlights the promising applications of additively manufactured TNTZ as a bone-replacing material from mechanical and biocompatibility perspectives.

A different approach to assess resident phacoemulsification learning curve: analysis of both completion and complication rates.

PURPOSE: To assess phacoemulsification learning curve by analysing residents' surgical completion and complication rates. METHODS: This prospective study included 226 cases of phacoemulsification performed by 11 senior residents under a single supervisor during a 27-month period. Both completion and complication rates were collected to assess their surgical results. 'Short-term completion rate (STCR)', the frequency of the surgeries completed exclusively by the residents during every five consecutive cases, was used in the evaluation of the learning curve parameter. RESULTS: These residents could complete phacoemulsification independently in 101 surgeries (44.7%). Intraoperative complications occurred in 62 cases (27.4%), of which 11 cases were complicated with vitreous loss (4.9%). By tracing different residents' individual STCRs, we found that the learning curve for phacoemulsification surgery to be of an exponential pattern, and the first STCR of 60% to be a good representation of the exponential point. Before the residents' first STCR of 60%, their average completion rate was only 16.7% and complication rate was as high as 39.2%. While after that point, the average completion rate accelerated to 76.4% and complication rate decreased to 14.2%. CONCLUSION: The learning curve of phacoemulsification is of an exponential pattern and the trainees' STCR can be a useful parameter to evaluate their surgical performance.

Hospital-based allogenic bone bank--10-year experience.

Bone banking in a hospital provides resources of allogenic bone grafts. However, they may transmit infection from donor to recipient. We found few reports discussing the infection rate and monitoring processes associated with bone banks. The discard rate using the screening test was 18.5% (309/1674) in this series. The leading cause was hepatitis B antigen (HBsAg) positive donor serum (67%), followed by Venereal Disease Research Laboratory (VDRL) positive donor serum (15%), and anti-hepatitis C virus (HCV) positive donor serum (12%). The overall infection rate in the recipients was 1.3% (17/1365). Among 1353 implanted allografts, 22 cases (1.6%) had a positive swab culture result after thawing. Only four out of these 22 cases (18.2%) developed infection. However, the wound cultures of the infected recipients were different from the swab culture of thawing allografts except in one case. Among the 1331 recipients with sterile allograft bones, 13 (1%) were found to have infection. In conclusion, our bone bank operates under a strict monitoring system which results in a low infection rate. The recipient's status, the aseptic technique and environment during operation is likely to be more critical in prevention of allograft-related infection.

Ultrasound examination of patellar tendon after harvest for anterior cruciate ligament reconstruction.

BACKGROUND AND PURPOSE: Reconstruction of ruptured anterior cruciate ligament (ACL) using the middle-third of the patellar tendon has become an established procedure. However, current studies of donor site morbidity have reported discrepant results. This study used ultrasound imaging to evaluate morphologic changes in the patellar tendon after harvest for ACL reconstruction. METHODS: Twenty-nine patients who had undergone successful ACL reconstruction with patellar tendon graft more than 1 year previously were enrolled in the study. Ultrasound imaging was used to compare the width, thickness, and tissue reaction of patellar tendons between the operated and contralateral sides. RESULTS: The operated side was 4.8% wider on average than the contralateral side (p < 0.05). The operated side was also 58.3% thicker on average (p < 0.0001), with irregular margins and heterogenous echogenecity. CONCLUSION: The donor site of the patellar tendon was significantly wider and thicker and was heterogenous when examined on sonogram more than 1 year postoperatively.

Anterior tibia spine fracture in children: follow-up evaluation by biomechanical studies.

BACKGROUND: The treatment of anterior tibial spine (ATS) fracture in children is in controversy. Previous studies have shown that most of the children who sustained ATS fractures have objective evidence of the anterior cruciate ligament (ACL) laxity at follow-up, but detailed biomechanical analysis of the knee joint has seldom been performed. METHODS: Eight ATS fractures in children at a mean age of 12 years were treated from 1989 to 1994. Two were of Meyer's classification type I, 3 were of type II, and 3 were of type III. The treatment varied from casting to open reduction & internal fixation (ORIF) by pulling through suture or biofix absorbable screw. Patients were followed with radiological, clinical and biomechanical analysis. KT 1000 knee arthrometer was used to evaluate the laxity of ACL. Cybex isokinetic machine was used to evaluate knee extensor and flexor strength. RESULTS: During an average follow-up period of 47 months, all fractures showed to unite well on X-ray except 1 untreated type I fracture who had malunion. Only one had subjective complaint of instability, but 3 had clinical signs of instability. Objective evidence of laxity, determined by KT-1000 arthrometer, was noted in 4 patients. Decreased muscle strength, determined by Cybex isokinetic machine, was more prominent in hamstrings than in quadriceps. CONCLUSIONS: Patients with milder ATS fracture (type I & II), if treated inappropriately, may still result in ACL laxity and knee muscle strength deficiency. Type III ATS fractures, if treated well by ORIF, tend to recover nearly normal ACL function and muscle strength.

Intrafamilial transmission of hepatitis C virus in hemodialysis patients.

The prevalence of hepatitis C virus (HCV) infection in chronic hemodialysis patients ranges from 20 to 50% and these patients may serve as a reservoir of infection for their household contacts. The aim of this study was to investigate the prevalence of anti-HCV in hemodialysis patients and their families, and to evaluate possible routes of infection. One hundred eighty-six family members of 84 hemodialysis patients and 529 healthy adults were enrolled. The family members consisted of 50 spouses, 96 children, 11 parents, 29 siblings, and other relatives living together with the patients. Serum samples were collected for testing anti-HCV. Exposure to risk factors was obtained by a questionnaire and an interview. The results showed that prevalence of anti-HCV in hemodialysis patients was 44%, whereas in family members it was 5.4%, not significantly different from that of age-matched healthy adults (standardized morbidity rate = 1.51, P = 0.390). The anti-HCV rate in family members tended to increase with age, and a spouse of an infected hemodialysis patient had a higher risk of HCV infection than other family members (15% vs. 2.6%, odds ratio 6.6, P = 0.058). Except for the age factor, no difference was found between seropositive and seronegative family members with respect to risk factors such as blood transfusion, surgery, frequent injections, dental procedures, or acupuncture. It was concluded that, although the anti-HCV positivity of hemodialysis patients is high, the risk of HCV infection for their family members is not higher than that of the general population. Among family members, spouses of seropositive hemodialysis patients have the highest risk of HCV infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Continuous ambulatory peritoneal dialysis in the elderly: a seven-year experience.

This is a retrospective comparison of the status among the elderly (> or = 60 years, 23 patients) and younger patients (< 60 years, 31 cases) who initiated continuous ambulatory peritoneal dialysis (CAPD) between January 1986 and December 1992 at the National Taiwan University Hospital. The distribution of underlying renal diseases differed in the two groups with diabetes (56%) as the most common disease in the elderly, in contrast to glomerulonephritis (60%) in the younger patients. Haemodialysis intolerance and patient preference were the main reasons leading to the use of CAPD in both groups. Social rehabilitation status was poorer in the elderly group. The difference in cumulative risk of the first peritonitis episode and the technique failure rate were not statistically significant. The major causes of mortality were of vascular origin in both groups. In conclusion, similarities in the technique failure rate and the cumulative risk of peritonitis imply that CAPD is an acceptable alternative long-term dialysis therapy for geriatric patients.

Measurement of Chinese lumbar pedicles: with special reference to transpedicular screw fixation.

BACKGROUND: Thorough understanding of the morphometric parameters of the lumbar pedicles is essential for transpedicular screw fixation. The purpose of this study is to establish a database for proper spinal instrumentations in Chinese patients. METHODS: A total of 764 pedicles (L2-S1) were measured from spinal computed tomography (CT) of 100 Chinese volunteers. Parameters related to transpedicular fixation include pedicle width (PW), pedicle transverse angle (PTA), pedicle angle measured from the entry point of Roy-Camille through the midpoint of the pedicle (PPA), screw insertion depths to the anterior cortex from the entry point of Roy-Camille along the line parallel to the midsagittal line (PPLP) and from the entry point of Magerl along the pedicle axis (PPLS). RESULTS: The mean age of the volunteers was 46.2 years. The average PWs from L2 to S1 were: 0.85 +/- 0.15 cm for L2, 0.92 +/- 0.22 cm for L3, 1.19 +/- 0.24 cm for L4, 1.70 +/- 0.28 cm for L5 and 2.31 +/- 0.35 cm for S1. The average PTAs from L2 to S1 were: 13.9 degrees +/- 4.9 degrees for L2, 13.4 degrees +/- 5.1 degrees for L3, 16.2 degrees +/- 5.9 degrees for L4, 27.8 degrees +/- 7.2 degrees for L5 and 44.0 degrees +/- 8.4 degrees for S1. The average PPAs from L2 to S1 were: 5.3 degrees +/- 2.4 degrees for L2, 6.3 degrees +/- 2.2 degrees for L3, 7.2 degrees +/- 2.5 degrees for L4, 10.1 degrees +/- 3.6 degrees for L5 and 17.0 degrees +/- 4.8 degrees for S1. The average PPLPs from L2 to S1 were: 5.64 +/- 0.82 cm for L2, 5.05 +/- 0.62 cm for L3, 4.99 +/- 0.89 cm for L4, 4.42 +/- 0.77 cm for L5 and 4.23 +/- 0.72 cm for S1. The average PPLSs from L2 to S1 were: 5.75 +/- 0.72 cm for L2, 5.24 +/- 0.75 cm for L3, 5.27 +/- 0.84 cm for L4, 4.88 +/- 0.72 cm for L5 and 4.99 +/- 0.72 cm for S1. CONCLUSIONS: Transpedicular screw fixation should be tailored on individual basis. Though variation exists, no sufficient evidence can be found to suggest major morphometric differences of the Chinese lumbar pedicles from the studies in the English literature.

Peritoneopericardial communication after pericardiocentesis in a patient on continuous ambulatory peritoneal dialysis with dialysis pericarditis.

A male patient aged 41 years had dialysis pericarditis with massive pericardial effusion in his 6-year on continuous ambulatory peritoneal dialysis (CAPD). Intensive hemodialysis failed to resolve the pericardial effusion. Pericardiocentesis via a subxiphoid approach was performed with placement of a pigtail catheter for drainage. A communication between peritoneal and pericardial cavities occurred, resulting in the leakage of the peritoneal dialysate into pericardial sac which was confirmed by a 99mTc radionuclide scan. The fistula healed after removal of the catheter and discontinuation of CAPD. We suggest that pericardiocentesis via a subxiphoid approach for pericardial effusion should be cautiously exercised in CAPD cases for fear of peritoneopericardial fistula.

Blood pressure response to angiotensin converting enzyme inhibitor in essential hypertension: its relation to the renin status and natriuresis during acute sodium loading.

We examined the antihypertensive response to enalapril and its relation to the changes of the renin-angiotensin-aldosterone axis (RAA) in essential hypertensive patients. The responders, whose blood pressure reduced after enalapril administration, had significant elevation of plasma renin activity after enalapril (7.5 +/- 4.0 to 31.9 +/- 10 ng/mL/h, p < 0.05). There was no significant change in the plasma renin activity of the nonresponders (3.0 +/- 1.0 to 5.6 +/- 1.9 ng/mL/h). Natriuretic response to acute salt loading was compared between the two subgroups. The natriuresis on acute salt loading of nonresponders was better than that of the responders (82.9 +/- 13.2 vs 44.5 +/- 5.7 mmol/4h, p < 0.05). These results imply that the RAA and extracellular fluid volume both contribute in different ways to the maintenance of high blood pressure in different subgroups of essential hypertension.

[Epidemiological trend in late stage of control in Malayan filariasis endemic areas with Anopheles anthropophagus as main vector].

During 1982-1990, a longitudinal observation on prevalence trend of malayan filariasis has been made in endemic areas with An. anthropophagus as the main vector. A total of 22,795 person-times of blood examination were made, and 30,439 An. anthropophagus and 10,061 An. sinensis were dissected respectively. The microfilaraemia rate dropped from 1.0% to 0.14%, and the infection rate of An. anthropophagus decreased from 0.74% to 0.09% in 3 endemic villages, while no positive case or infected vector occurred in 5 villages where microfilaraemia cases were absent since the beginning of the study. In a cross-sectional survey, 855 villages of 17 counties has been monitored for 10 years. Out of 213,934 person-times of blood examination, only 56 were positive, the average microfilaraemia rate being 0.0262%, and 94.64% of the positive had already been detected before 1986. Based on these data, it has been suggested that in endemic areas with An. anthropophagus as main vector, when the microfilaraemia rate dropped to less than 1% after control, there was no indication that the rate would upgrade during the survey period. A decline trend of the transmission of malayan filariasis, therefore, has been exhibited.