Biomechanical comparisons of F.E.R.I. techniques with different type of intramedullary screws fixation for Jones fractures.

Introduction: Jones fractures frequently fail to unite, and adequate fixation stability is crucial. This study aimed to elucidate the biomechanical stability of various intramedullary screw fixation constructs. Methods: Jones fracture model over the proximal 5th metatarsal of artificial bone was created in all specimens. Six groups were divided based on varied screw constructs with different screw lengths, either 30 or 40 mm, including cannulated screws-C30 and C40 groups, one high-resistance suture combined with intramedullary cannulated screws (F.E.R.I. technique)-CF30 and CF40 groups, and second-generation headless compression screws (SG-HCS) -HL30 and HL40 groups. Mechanical testing was conducted sequentially, and the maximal force (N) and stiffness (N/mm) of all constructs were recorded. Results: The maximal force (N) at 1.0 mm downward displacement in C30, C40, CF30, CF40, HL30, and HL40 groups were 0.56 ± 0.02, 0.49 ± 0.02, 0.65 ± 0.02, 0.49 ± 0.01, 0.68 ± 0.02, and 0.73 ± 0.02, respectively, and the stiffness (N/mm) in subgroups were 0.49 ± 0.01, 0.43 ± 0.01, 0.67 ± 0.01, 0.42 ± 0.01, 0.61 ± 0.01, and 0.58 ± 0.02, respectively. SG-HCS subgroups exhibited greater maximal force and stiffness than conventional cannulated screws. Screws of 30 mm in length demonstrated better stability than all 40 mm-length screws in each subgroup. In C30 fixation, the stiffness and maximum force endured increased by 1.16 and 1.12 times, respectively, compared with the C40 fixation method. There were no significant differences between CF30 and SG-HCS groups. Only the F.E.R.I technique combined with the 4.5 mm cannulated screw of 30 mm in length increased the biomechanical stability for Jones fractures. Discussion: These biomechanical findings help clinicians decide on better screw fixation options for greater stability in Jones fractures, especially when large-diameter screws are limited in use. However, this biomechanical testing of intramedullary screw fixation on Jones fracture model lacks clinical validation and no comparisons to extramedullary plate fixations. Moving forward, additional clinical and biomechanical research is necessary to validate our findings.

The status of binocular visual functions among Taiwan high-tech industry engineers and its correlation with computer vision symptom.

To analyze the status of binocular visual functions, the relationship between binocular visual function and computer vision-related symptoms in the high-tech industry group. The study sample was comprised of 33 participants aged between 20 and 40 years of age. After completing basic information and the Computer Vision Symptom Scale (CVSS-17) questionnaire, the participants underwent a comprehensive examination of binocular visual function. All data were statistically analyzed with SPSS V26.0 software. The value of the binocular vision function of the Taiwan high-tech industry group was significantly different compared with the Scheiman and Morgan standard value. Study subjects were generally found to exhibit larger exophoric at distance, which in turn might lead to a lower ability to maintain binocular fusion to a single image, or recover from fusional disruption at distance. Subjects also experienced accommodation and convergence problems at near at the same time. Age, gender, and refractive errors had no significant impact on CVSS-17 scores, only the duration of computer usage showed a significant effect, particularly for internal symptom factor (ISF) dimensions. In addition, the interaction between the ISF and external symptom factor resulted in more severe visual symptoms. Long-term use of electronic devices may lead to an imbalance in binocular vision function, thereby increasing or exacerbating visual symptoms. If the use of electronic devices is an unchangeable trend, interventions in prescription, visual training or the visual design of electronic products become worthwhile topics for development.

The compensatory hypertrophy of transferred flexor hallucis longus tendon for insertional Achilles tendinopathy: a retrospective MRI study.

Flexor hallucis longus (FHL) transfer is an effective surgery in treating insertional Achilles tendinopathy (IAT). However, limited data exist regarding the post-surgery changes in the transferred FHL. The study aimed to compare the sequential changes and hypertrophy of FHL after isolated FHL transfer (FHLT). We retrospectively enrolled patients who underwent isolated FHLT for insertional Achilles pathology from 2015 to 2020 and divided them into two groups based on whether reattachment of the residue Achilles stump to the FHL was performed or not. We recorded demographic characteristics, MRI parameters, and functional outcome. We also analyzed the correlation between the collected data and FHL hypertrophy. Results revealed no significant differences in most MRI parameters of FHL and functional outcomes between the groups. However, the fat distribution within the FHL showed significant reduction and notable 20.2% hypertrophy after FHLT. Interestingly, the hypertrophy of the FHL was significantly more pronounced in the non-reattached group. Furthermore, we observed a positive correlation between the follow-up period and FHL hypertrophy. In conclusion, the FHL demonstrated significant enlargement over time following FHLT. The compensatory hypertrophy of the transferred FHL was particularly evident and the cumulative incidences of FHL enlargement over time were higher in the non-reattached groupcompared to reattached group. However, both reattachment and non-reattachment of Achilles stump on FHL transfer for insertional Achilles tendinopathy carried similar postoperative functional outcomes.

Exploring the feasibility of using long-term stored newborn dried blood spots to identify metabolic features for congenital heart disease screening.

Congenital heart disease (CHD) represents a significant contributor to both morbidity and mortality in neonates and children. There's currently no analogous dried blood spot (DBS) screening for CHD immediately after birth. This study was set to assess the feasibility of using DBS to identify reliable metabolite biomarkers with clinical relevance, with the aim to screen and classify CHD utilizing the DBS. We assembled a cohort of DBS datasets from the California Department of Public Health (CDPH) Biobank, encompassing both normal controls and three pre-defined CHD categories. A DBS-based quantitative metabolomics method was developed using liquid chromatography with tandem mass spectrometry (LC-MS/MS). We conducted a correlation analysis comparing the absolute quantitated metabolite concentration in DBS against the CDPH NBS records to verify the reliability of metabolic profiling. For hydrophilic and hydrophobic metabolites, we executed significant pathway and metabolite analyses respectively. Logistic and LightGBM models were established to aid in CHD discrimination and classification. Consistent and reliable quantification of metabolites were demonstrated in DBS samples stored for up to 15 years. We discerned dysregulated metabolic pathways in CHD patients, including deviations in lipid and energy metabolism, as well as oxidative stress pathways. Furthermore, we identified three metabolites and twelve metabolites as potential biomarkers for CHD assessment and subtypes classifying. This study is the first to confirm the feasibility of validating metabolite profiling results using long-term stored DBS samples. Our findings highlight the potential clinical applications of our DBS-based methods for CHD screening and subtype classification.

Comparative Biomechanical Analysis of Unilateral, Bilateral, and Lateral Pedicle Screw Implantation in Oblique Lumbar Interbody Fusion: A Finite Element Study.

Oblique lumbar interbody fusion (OLIF) can be combined with different screw instrumentations. The standard screw instrumentation is bilateral pedicle screw fixation (BPSF). However, the operation is time consuming because a lateral recumbent position must be adopted for OLIF during surgery before a prone position is adopted for BPSF. This study aimed to employ a finite element analysis to investigate the biomechanical effects of OLIF combined with BPSF, unilateral pedicle screw fixation (UPSF), or lateral pedicle screw fixation (LPSF). In this study, three lumbar vertebra finite element models for OLIF surgery with three different fixation methods were developed. The finite element models were assigned six loading conditions (flexion, extension, right lateral bending, left lateral bending, right axial rotation, and left axial rotation), and the total deformation and von Mises stress distribution of the finite element models were observed. The study results showed unremarkable differences in total deformation among different groups (the maximum difference range is approximately 0.6248% to 1.3227%), and that flexion has larger total deformation (5.3604 mm to 5.4011 mm). The groups exhibited different endplate stress because of different movements, but these differences were not large (the maximum difference range between each group is approximately 0.455% to 5.0102%). Using UPSF fixation may lead to higher cage stress (411.08 MPa); however, the stress produced on the endplate was comparable to that in the other two groups. Therefore, the length of surgery can be shortened when unilateral back screws are used for UPSF. In addition, the total deformation and endplate stress of UPSF did not differ much from that of BPSF. Hence, combining OLIF with UPSF can save time and enhance stability, which is comparable to a standard BPSF surgery; thus, this method can be considered by spine surgeons.

Optimizing Spinal Fusion Cage Design to Improve Bone Substitute Filling on Varying Disc Heights: A 3D Printing Study.

The success of spinal fusion surgery relies on the precise placement of bone grafts and minimizing scatter. This study aims to optimize cage design and bone substitute filling methods to enhance surgical outcomes. A 3D printed lumbar spine model was utilized to implant 3D printed cages of different heights (8 mm, 10 mm, 12 mm, and 14 mm) filled with BICERA® Bone Graft Substitute mixed with saline. Two filling methods, SG cage (side hole for grafting group, a specially designed innovative cage with side hole, post-implantation filling) and FP cage (finger-packing group, pre-implantation finger packing, traditional cage), were compared based on the weight of the implanted bone substitute. The results showed a significantly higher amount of bone substitute implanted in the SG cage group compared to the FP cage group. The quantity of bone substitute filled in the SG cage group increased with the height of the cage. However, in the FP cage group, no significant difference was observed between the 12 mm and 14 mm subgroups. Utilizing oblique lumbar interbody fusion cages with side holes for bone substitute filling after implantation offers several advantages. It reduces scatter and increases the amount of implanted bone substitute. Additionally, it effectively addresses the challenge of insufficient fusion surface area caused by gaps between the cage and endplates. The use of cages with side holes facilitates greater bone substitute implantation, ultimately enhancing the success of fusion. This study provides valuable insights for future advancements in oblique lumbar interbody fusion cage design, highlighting the effectiveness of using cages with side holes for bone substitute filling after implantation.

Customized designed notch filters and applied effects on glare and contrast sensitivity in patients with dry eye syndrome.

PURPOSE: Glare visual acuity and contrast sensitivity are important indicators of visual quality. Studies have shown that the glare visual acuity and contrast sensitivity in dry eye patients tend to degenerate, further affecting their quality of life. The objective of this study was to investigate the effect of notch filters on glare VA and contrast sensitivity in patients with dry eye or with dry eye syndrome. METHOD: 36 subjects in the 20‒65 age group were diagnosed as having dry eye disease or perceived dry eye syndromes themselves who were included after the initial screening with the OSDI questionnaire, and one was subsequently excluded as they had undergone retinal detachment surgery. Finally, 35 subjects (14 male and 21 female) with a mean age of 40.66 ± 15.62 years participated in this study. All subjects wore their habitual prescriptions and four different filter lenses (namely 480, 620, dual 480 & 620 notch filter, and FL-41 tinted lens), and measured the parameters of glare visual acuity and contrast sensitivity using CSV-1000 and sine wave contrast test (SWCT), respectively. Student t-test and Repeated measurement analysis (R-ANOVA) were utilized by using SPSS 26.0 software. RESULTS: A dual-wavelength 480 & 620 nm optical notch filter had a significant anti-glare effect decreasing glare disabilities or discomfort, and leading to better visual quality, the same effect was also shown on a 480 nm notch filter lens. All participants showed a significant difference among the baseline, three notch filters (480 nm, 620 nm, dual-wavelength 480 & 620 nm), and FL-41 tinted lens were used on SWCT_A (1.5 cpd, F = 3.054, p = 0.019) and SWCT_E (18 cpd, F = 2.840, p = 0.049); but did not show statistical different on SWCT_B (3 cpd, F = 0.333, p = 0.771), SWCT_C (6 cpd, F = 1.779, p = 0.159), and SWCT_D (12 cpd, F = 1.447, p = 0.228). The baseline showed the best visual performance on CS at a low spatial frequency (SWCT_A, 1.5 cpd), any filter might reduce the contrast sensitivity at low spatial frequencies in the clinical trial, whereas 480 nm notch filter showed the best effectiveness on CS at a high spatial frequency (SWCT_E, 18 cpd), the FL-41 lens that also filters out the 480 nm band does not achieve the same effect. Moreover, patients with dry eye or those older than 40 years old preferred optical multilayer notch filters to FL-41 tinted lenses. CONCLUSION: The 480- & 620-nm dual-wavelength and 480-nm single-wavelength notch filters have the best effect on the glare visual acuity and contrast sensitivity (CS) at high spatial frequencies in dry eye patients. The 620-nm notch filter performs better in CS at low and mid-low spatial frequencies; the FL-41 tinted lens performs poorly for glare VA and CS spatial frequencies examination. Patients with glare disabilities or CS disturbance at high spatial frequencies may choose a 480-nm notch filter lens, and patients who have CS disturbance at low spatial frequencies may consider a 620-nm notch filter for the prescription.

Heat shock factor 1 (HSF1) specifically potentiates c-MYC-mediated transcription independently of the canonical heat shock response.

Despite its pivotal roles in biology, how the transcriptional activity of c-MYC is tuned quantitatively remains poorly defined. Here, we show that heat shock factor 1 (HSF1), the master transcriptional regulator of the heat shock response, acts as a prime modifier of the c-MYC-mediated transcription. HSF1 deficiency diminishes c-MYC DNA binding and dampens its transcriptional activity genome wide. Mechanistically, c-MYC, MAX, and HSF1 assemble into a transcription factor complex on genomic DNAs, and surprisingly, the DNA binding of HSF1 is dispensable. Instead, HSF1 physically recruits the histone acetyltransferase general control nonderepressible 5 (GCN5), promoting histone acetylation and augmenting c-MYC transcriptional activity. Thus, we find that HSF1 specifically potentiates the c-MYC-mediated transcription, discrete from its canonical role in countering proteotoxic stress. Importantly, this mechanism of action engenders two distinct c-MYC activation states, primary and advanced, which may be important to accommodate diverse physiological and pathological conditions.

Herbs for lochia discharge used among postpartum women in Taiwan.

ETHNOPHARMACOLOGICAL RELEVANCE: In the traditional Taiwanese culture of "postpartum confinement", the term "lochia discharge" is a synonym for assisting postpartum uterine involution. Postpartum women in Taiwan consult traditional Chinese medicine (TCM) pharmacies to obtain various TCM formulations that facilitate lochia discharge. AIM OF THE STUDY: As an ethnopharmacy study, we aimed to conduct field investigations to explore the herbal composition of TCM formulations for lochia discharge provided by TCM pharmacies in Taiwan and to identify the pharmaceutical implications of these TCM formulations. MATERIALS AND METHODS: Through stratified sampling, we collected 98 formulations for postpartum lochia discharge from TCM pharmacies, which used a total of 60 medicinal materials. RESULTS: The most common plant families of the medicinal materials found in Taiwanese lochia discharge formulations were Fabaceae and Lauraceae. Abiding by the TCM theory of nature and flavor, most drugs were warm in nature and sweet in flavor, and predominantly focused on the traditional functions of qi tonifying and blood activating. Correlation and network analyses of the medicinal components of lochia discharge formulations identified 11 core herbs, which, in the order of most to least frequently used, include Angelica sinensis, Ligusticum striatum, Glycyrrhiza uralensis, Zingiber officinale, Prunus persica, Eucommia ulmoides, Leonurus japonicus, Lycium chinense, Hedysarum polybotrys, Rehmannia glutinosa, and Paeonia lactiflora. These 11 herbs formed a total of 136 drug combinations in the 98 formulations, with 2-7 herbs in each combination. In addition, in the center of the network were A. sinensis and L. striatum, which jointly appeared in 92.8% of the formulations analyzed. CONCLUSIONS: To our knowledge, this is the first study to systematically review lochia discharge formulations in Taiwan. The results of this study could provide an important basis for subsequent research in the clinical efficacy of Taiwanese lochia discharge formulations and the pharmacological mechanisms of their herbal components.

Proteotoxic stress response in atherosclerotic cardiovascular disease: Emerging role of heat shock factor 1.

Atherosclerosis is a major risk factor for cardiovascular diseases. Hypercholesterolemia has been both clinically and experimentally linked to cardiovascular disease and is involved in the initiation of atherosclerosis. Heat shock factor 1 (HSF1) is involved in the control of atherosclerosis. HSF1 is a critical transcriptional factor of the proteotoxic stress response that regulates the production of heat shock proteins (HSPs) and other important activities such as lipid metabolism. Recently, HSF1 is reported to directly interact with and inhibit AMP-activated protein kinase (AMPK) to promote lipogenesis and cholesterol synthesis. This review highlights roles of HSF1 and HSPs in critical metabolic pathways of atherosclerosis, including lipogenesis and proteome homeostasis.

Development and Testing of the Smart Healthcare Prototype System through COVID-19 Patient Innovation.

Since the outbreak of the novel coronavirus disease 2019 (COVID-19), the epidemic has gradually slowed down in various countries and people's lives have gradually returned to normal. To monitor the spread of the epidemic, studies discussing the design of related healthcare information systems have been increasing recently. However, these studies might not consider the aspect of user-centric design when developing healthcare information systems. This study examined these innovative technology applications and rapidly built prototype systems for smart healthcare through a systematic literature review and a study of patient innovation. The design guidelines for the Smart Healthcare System (SHS) were then compiled through an expert review process. This will provide a reference for future research and similar healthcare information system development.

Using the deformity index of vital structures to predict outcome of patients with large vestibular schwannomas after Gamma Knife radiosurgery.

PURPOSE: Microsurgery is the mainstay of treatment for large vestibular schwannomas (VS), but the benefits of radiosurgery remain incompletely defined. Here, we aim to use automated volumetric analysis software to quantify the degree of brain stem deformity to predict long-term outcomes of patients with large VS following GKRS. METHODS: Between 2003 and 2020, 39 patients with large VS (volume > 8 cc) undergoing GKRS with a margin dose of 10-12 Gy were analyzed. The reconstruction 3D MRI was used to evaluate the extent of deformity for predicting the long-term outcome of patients. RESULTS: Their mean tumor volume was 13.7 ± 6.3 cc, and their mean follow-up after GKRS was 86.7 ± 65.3 months. Favorable clinical outcome was observed in 26 (66.7%) patients, while 13 (33.3%) patients had treatment failure. Patients with small tumor volumes, low vital structure deformity indice [(TV/(BSV + CerV) and (TV + EV)/(BSV + CerV)], and long distance of tumor to the central line were more likely to have favorable clinical outcome after GKRS. Significant prognostic value was with tumor shrinkage ratio (< 50%) were CV, CV/TV, TV/CerV, (TV + EV)/(BSV + CerV), and the distance of tumor to the central line. In cox regression, favorable clinical outcome was correlated with the Charlson comorbidity index and cochlear dosage (both p < 0.05). In multivariant analysis, tumor regression was highly correlated with the CV/TV ratio (p < 0.001). CONCLUSIONS: The brainstem deformity ratio is likely a useful index to assess the clinical and tumor regression outcomes. Clinical outcomes are multifactorial and the tumor regression was highly correlated with the ratio of cystic components.

Routine binocular examination of young Taiwanese adults as a predictor of visual behavior performance.

BACKGROUND: Morgan and Scheiman's Optometric Extension Program (OEP) expected binocular vision findings have longstanding use in optometry. With technological advances, the demands and standards of binocular function have changed. This study aimed to investigate which binocular visual functions can effectively predict visual behavior performance. METHODS: Participants aged 15-24 years were recruited from two colleges and two universities. After completing the CSMU-Visual Behavioral Performance questionnaire (CSMU-VBP, with four components: near work, visual perception, visual comfort, and whole-body balance), participants were divided into symptomatic and asymptomatic groups based on questionnaire findings (cutoff: < 12 vs. ≥ 12 symptoms). Then a 24-step binocular visual examination was undertaken. Data were analyzed with one-sample, Student's, and paired t-tests. Additionally, receiver operating characteristic analysis was used to determine the predictors of binocular visual function required for near work, visual perception, visual comfort, and body balance dimensions. RESULTS: Among 308 participants, 43 (14%) and 265 (86%) were symptomatic and asymptomatic, respectively. Among the 46 participants with abnormal binocular vision, 36 (78%) reported that they had no obvious symptoms. The commonest dysfunctions were accommodative excess and convergence excess. Most of the binocular visual findings significantly diverged from traditional normal values: amplitude of accommodation, as well as base-in prism to break and recovery points at distance were higher than traditional normal values, whereas others were lower than traditional normal values. Total CSMU-VBP scores indicated that the asymptomatic and symptomatic groups had significant differences in DBO recovery (t = 2.334, p = 0.020) and BAF (t = 1.984, p = 0.048). Receiver operating characteristic curve analysis yielded the following binocular visual functional cutoff points: near work (DBO blur < 7, DBO recovery < 5.5), visual perception (MAF < 10.5, BAF < 10.25), visual comfort (DLP < - 2.25, DBI break > 11.5, NBI blur > 15, NBI break > 17.5, NBI recovery > 13, NPC < 5.75), and body balance (NFD_H > - 0.5, gradient AC/A [minus] > 2.25, NPC < 4.75). CONCLUSIONS: The mean values of binocular visual function among young Taiwanese adults were statistically different from traditional normative values. Further research is required to confirm whether these findings reflect impaired binocular vision or stringent criteria. Assessments of binocular visual function, especially binocular accommodation sensitivity, are crucial in routine optometric examination.

Biomechanical effects of different numbers and locations of screw-in clavicle hook plates.

Purpose: We sought to analyze the biomechanical effects which both different numbers and locations of screws have on three different clavicle hook plates, as well as any possible causes of sub-acromial bone erosion and peri-implant clavicular fractures. Methods: This study built thirteen groups of finite element models using three different clavicle hook plates (short plates, long plates, and posterior hook offset plates) in varying numbers and locations of the screws. The von Mises stress distribution of the clavicle and hook plate, as well as the reaction force of the acromion was evaluated. Results: The results show that inserting screws in all available screw holes on the hook plate produces a relatively large reaction force on the acromion, particularly in the axial direction of the bone plate. The fewer the screws implanted into the clavicle hook plate, the larger the area of high-stress distribution there is in the middle of the clavicle, and also, the higher the stress distribution on the clavicle hook plate. Conclusion: This study provides orthopedic physicians with the biomechanical analysis of different numbers and locations of screws in clavicle hook plates to help minimize surgical complications.

Evaluations of 3D-Printed Surgical Mask Tension Release Bands for Common COVID-19 Use with Biomechanics, Sensor Array System, and Finite Element Analysis.

A mask is one of the most basic protections to prevent the transmission of COVID-19. Surgical mask tension release bands (SMTRBs) are commonly used to ease the pain caused by prolonged mask use. However, the structural strength of SMTRBs and the effect that wearing masks with SMTRBs has on the face are unclear. Thus, this study assessed the mechanics of seven different types of 3D-printed SMTRBs. In this study, a tensile testing machine, a sensor array system, and finite element analysis were used to evaluate the mechanisms of seven SMTRBs. The tensile testing machine was applied to measure the breaking strength, elongation, stiffness, and rupture of the band. The sensor array system was used to calculate the pressure on the face when the band was used together with the mask. Finite element analysis was applied to evaluate the level of stress on the SMTRB structure when each of the seven bands was subjected to external force. The results demonstrated that thick SMTRBs put more pressure on the face but had greater structural strength. The thinner bands did not break easily; however, the mask ear loops tended to slip off more often. In addition, the size of the band hook affected the magnitude of the external force. This study provides a biomechanical reference for the future design of SMTRBs.

Correlating Ocular Physiology and Visual Function with Mild Cognitive Loss in Senior Citizens in Taiwan.

Purpose: The transition of Taiwan from an aging to a super-aging society has come with a cost as more elderly now suffer from cognitive impairment. The main purpose of our study was to investigate if early detection can be developed so that timely intervention can be instituted. We analyzed the correlation of cognitive function with ocular physiology and visual functions between senior citizens aged 60 years or older in Taiwan. Methods: Thirty-six healthy subjects were recruited for the study. Addenbrooke's cognitive examination III (ACE-III), binocular functions (including objective and subjective refraction, distance and near dissociated phoria, stereopsis, contrast sensitivity, adult developmental eye movement (ADEM), and ocular physiology (by using optical coherence tomography, OCT, and macular pigment measurement, MPS) were performed, and the data were analyzed via independent t-test, chi-square test, Pearson correlation, linear regression, and ROC (receiver operating characteristic) curve. Results: Data analysis showed that (1) patients with poor eye movement had a strong correlation with the total score and all dimensions of cognitive functions, (2) the thickness of the macula had a strong correlation with attention and memory, and (3) patients with poor eye movement and poor stereopsis in combination with thinner inferior macula appeared to have lower cognitive abilities. Discussion and Conclusions: Cognitive dysfunction is not readily identified during the early stage of cognitive decline. The use of simple and inexpensive ADEM or stereopsis test and comparing the OCT results that are popular in optometry clinics for reference can be diagnostic in identifying patients with mild cognitive impairments. With the combined use of macular pigment density or retinal thickness measurements, it was possible to effectively predict the early degradation of cognition.