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Aim Gout is a common complication in kidney transplant recipients. This study evaluated the association between kidney transplant recipients and the long-term risk of incident gout. Method For this age-matched and sex-matched retrospective cohort study, the Catastrophic Illness Certificate Database and the National Health Insurance Research Database were combined between 1997 and 2010. The study included 5917 patients with kidney transplants and 23 668 matched kidney transplant-free subjects. Hazard ratio (HR) for risk of incident gout was calculated using the Cox proportional hazards regression. Results In this study, of the 5917 kidney transplant recipients, 521 (8.8%) had gout. The kidney transplant group had a higher risk of incident gout than those in the matched kidney transplant-free group (adjusted HR = 1.55, 95% confidence intervals [CI] = 1.36-1.77), particularly within 3 years following kidney transplant recipients (adjusted HR = 2.61, 95% CI = 2.13-3.20). We observed that at the >3 to 6 years and the >6 to 9 years follow-up, patients with kidney transplant did not have a significant association with risk of incident gout (adjusted HR = 0.92, P = 0.4806 and adjusted HR = 1.26, P = 0.1901, respectively). Conclusion These findings revealed that risk of incident gout increased within 3 years following kidney transplant recipients and the individual's long-term risk of incident gout between kidney transplant recipients and the general population remained similar.

Osteoporosis and its associated fragility fractures are becoming a severe burden in the healthcare system globally. In the Asian-Pacific (AP) region, the rapidly increasing in aging population is the main reason accounting for the burden. Moreover, the paucity of quality care for osteoporosis continues to be an ongoing challenge. The Fracture Liaison Service (FLS) is a program promoted by International Osteoporosis Foundation (IOF) with a goal to improve quality of postfracture care and prevention of secondary fractures. In this review article, we would like to introduce the Taiwan FLS network. The first 2 programs were initiated in 2014 at the National Taiwan University Hospital and its affiliated Bei-Hu branch. Since then, the Taiwan FLS program has continued to grow exponentially. Through FLS workshops promoted by the Taiwanese Osteoporosis Association (TOA), program mentors have been able to share their valuable knowledge and clinical experience in order to promote establishments of additional programs. With 22 FLS sites including 11 successfully accredited on the best practice map, Taiwan remains as one of the highest FLS coverage countries in the AP region, and was also granted the IOF Best Secondary Fracture Prevention Promotion award in 2017. Despite challenges faced by the TOA, we strive to promote more FLS sites in Taiwan with a main goal of ameliorating further health burden in managing osteoporotic patients. Keywords: Asia-Pacific region, Taiwan, Fracture Liaison Service, Best Practice Framework, Osteoporosis

Resume Objectif La consommation d’alcool est fortement associee a l’hyperuricemie, qui peut etre responsable de la goutte. Cette etude a evalue le risque de goutte chez des patients presentant des maladies liees a l’alcool et un syndrome de dependance a l’alcool. Methodes Nous avons realise une etude de cohorte sur la population nationale dans la base de donnees de recherche nationale d’assurance maladie de Taiwan (NHIRD) afin d’evaluer le risque et l’incidence de la goutte chez les patients presentant des maladies liees a l’alcool et un syndrome de dependance a l’alcool (selon la definition de la classification internationale des maladies, neuvieme revision). Nous avons identifie dans ces dossiers 11 675 cas de maladies liees a l’alcool entre 1998 et 2008. Le groupe temoin comptait 23 350 sujets sans maladie liee a l’alcool apparies par score de propension (1 patient:2 temoins) selon l’âge, la tranche d’âge et le sexe. Resultats Les resultats ont montre que les maladies liees a l’alcool etaient significativement associees au risque de goutte ( hazard ratio ajuste 1,88 ; p p p ≤ 0,0182). Conclusion Les medecins devraient etre informes de l’association entre syndrome de dependance a l’alcool et survenue de goutte, et des evaluations et mesures de la consommation d’alcool visant a prevenir la dependance devraient etre mises en place dans le cadre des soins integres aux patients goutteux.

Alcohol intake is strongly associated with hyperuricemia, which may cause gout. This study evaluated the risk of gout in patients with alcohol-related diseases and alcohol dependence syndrome.We used the Taiwan National Health Insurance Research Database (NHIRD) to conduct a nationwide population-based cohort study to assess the risk of gout and gout incidence in patients with alcohol-related diseases and alcohol dependence syndrome (as defined by the International Classification of Diseases, Ninth Revision). In the NHIRD records from 1998 to 2008, we identified 11,675 cases of alcohol-related diseases. The control group comprised 23,350 cases without alcohol-related diseases propensity score-matched (1 case: 2 controls) for age, age group, and sex.The results revealed that alcohol-related diseases were significantly associated with gout risk (adjusted hazard ratio 1.88; P0.0001). Of the alcohol-related disease cases, 34.1% of the patients had alcohol dependence syndrome (males 34.8%; females 32.4%), and alcohol dependence was independently associated with gout occurrence (relative risk [RR] 2.01; P0.0001). Severe alcohol-dependent patients (who were also the heavy benzodiazepines users), were associated with an increased risk of gout (RR 1.71 to 4.21, P≤0.0182).Physicians should be aware of the association between alcohol dependence syndrome and gout occurrence, and alcohol use assessment and measures to prevent alcohol dependence should be implemented in the integrative care for patients with gout.

Aims We evaluated the association between type 2 diabetes and gout by a retrospective cohort study. Methods Data of 17,259 male and 18,318 female patients with type 2 diabetes were retrieved for the 1998–2010 period. These patients were matched to a comparison group (n = 34,518 and n = 36,636, respectively) in a 1:2 ratio by age and region. Results We found that patients with type 2 diabetes after adjustment for hyperlipidemia and hypertension had a lower risk of incident gout than the matched population (incidence rate ratio, men: 0.39 [95% CI: 0.36–0.42]; women: 0.78 [0.72–0.84]). Specifically, type 2 diabetes alone without hyperlipidemia and hypertension was associated with a reduced risk of incident gout in men (adjusted relative risk [RR]: 0.29, 95% CI: 0.22–0.39), but not in women (0.86, 95% CI: 0.55–1.36). We found that insulin users with hyperlipidemia and hypertension associated with risk of incident gout and no sex-specific differences were noted (adjusted RR, men: 1.28 [95% CI: 1.11–1.48]; women: 1.32 [95% CI: 1.14–1.53]). Specifically, insulin users alone without hyperlipidemia and hypertension were not statistically significantly associated with gout risk (P ≥ .0954). Conclusions The results of this study indicated that hyperlipidemia and hypertension modified the association between type 2 diabetes and gout.

Osteoporosis is a major health issue. By 2050, a greater than 2-fold increase in patients number with hip fractures will occur in Asia representing 50% of all hip fractures worldwide. For the Asia-Pacific (AP) region, more efforts on controlling osteoporosis and the subsequent fractures are crucial. Bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA) is commonly used to diagnose osteoporosis and monitor osteoporosis treatment. However, the inconvenience, cost, limited availability of DXA and the delay in detection of BMD changes after treatment initiation support an important role for bone turnover markers (BTMs), as short-term tools to monitor therapy. With regards to low adherence rates of medical treatment of osteoporosis, the experts reached consensus on the use of BTMs for both raising awareness and short-term monitoring of osteoporosis treatment in the AP region. The experts endorse the use of BTMs, especially serum C-terminal telopeptide of type 1 collagen (CTX) and serum procollagen type 1 N propeptide (P1NP), as short-term monitoring tools to help clinicians assess the responses to osteoporosis therapies and appropriately adjust treatment regimens earlier than BMD. Either the absolute values or the degree of change from baseline in BTMs can be used to monitor the potential efficacy of osteoporosis therapies. The use of BTMs can be incorporated in osteoporosis care programs, such as fracture liaison service (FLS), to improve patient adherence and treatment outcomes. Encouraging sufficient reimbursement from health care systems may facilitate widespread use of BTMs in clinical practice in the AP region.

In this article the name of the sixth author, E. Michael Lewiecki was rendered incorrectly. The publisher regrets this error and apologizes for the inconvenience caused.

This retrospective cohort study evaluated the association between gout and the risk of benign prostatic hyperplasia among men by using data from Taiwan’s National Health Insurance Research Database. Population-based representative insurance (outpatient and inpatient) claims data of 29,269 patients with gout and 29,269 matched patients without gout (1:1 ratio) for the period of 1997–2010 in Taiwan were identified. The association between gout and benign prostatic hyperplasia was evaluated using the Cox proportional hazards model. The associations of age by gout and gout phenotypes with benign prostatic hyperplasia risk were estimated. Patients with gout had a higher incidence rate of benign prostatic hyperplasia than those in the matched gout-free group (19.62 vs. 10.11 events per 1000 person-years). Compared with the gout-free group, the adjusted hazard ratios (HRs) (95% confidence intervals (CIs)) for benign prostatic hyperplasia were 1.30 (1.24–1.36). The gout-to-benign prostatic hyperplasia association was modified by age (Pinteraction 60 years (adjusted HR 1.07, P = 0.063). Compared with gouty tophi, a higher risk of benign prostatic hyperplasia was noted in gouty nephropathy (adjusted HR 1.30, 95% CI 1.12–1.50). Our results suggest that male gout is positively related to benign prostatic hyperplasia, particularly in young gout patients and those with gouty nephropathy.

The Fracture Liaison Service (FLS) Consensus Meeting endorsed by the International Osteoporosis Foundation (IOF), Asian Federation of Osteoporosis Societies (AFOS), and Asia Pacific Osteoporosis Foundation (APOF) was hosted by the Taiwanese Osteoporosis Association on October 14, 2017. International and domestic experts reviewed the 13 Best Practice Framework (BPF) standards and concluded that all standards were generally applicable in the Asia-Pacific region and needed only minor modifications to fit the healthcare settings in the region. To review and generate consensus on best practices of fracture liaison service (FLS) in the Asia-Pacific (AP) region. In October 2017, the Taiwanese Osteoporosis Association (TOA) invited experts from the AP region (n = 23), the Capture the Fracture Steering Committee (n = 2), and the USA (n = 1) to join the AP region FLS Consensus Meeting in Taipei. After two rounds of consensus generation, the recommendations on the 13 Best Practice Framework (BPF) standards were reported and reviewed by the attendees. Experts unable to attend the on-site meeting reviewed the draft, made suggestions, and approved the final version. Because the number of FLSs in the region is rapidly increasing, experts agreed that it was timely to establish consensus on benchmark quality standards for FLSs in the region. They also agreed that the 13 BPF standards and the 3 levels of standards were generally applicable, but that some clarifications were necessary. They suggested, for example, that patient and family education be incorporated into the current standards and that communication with the public to promote FLSs be increased. The consensus on the 13 BPF standards reviewed in this meeting was that they were generally applicable and required only a few advanced clarifications to increase the quality of FLSs in the region.

Objective Comorbidity is an important concern for chronic gout patients. We evaluated the relationship between comorbidity profiles and gout in Taiwan aborigines and Taiwanese Han. Methods We used the claims data from the Taiwan national health insurance database for 2004 to 2006. Physician-diagnosed gout and comorbidities were coded using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Total sampling from Pingtung County of southern Taiwan included 37,482 aborigines (gout cases, n = 3906 and controls, n = 33,576) and 37,451 Han (gout cases, n = 1115 and controls, n = 36,336). Results In 2006, the gout prevalences were 10.42% and 2.98% (prevalence ratio [PR] = 3.50) in the aborigines and Han general populations, respectively. The prevalences of uric acid nephrolithiasis and tophi were higher in aborigines (0.42% and 0.30%, respectively) than in Han (0.09% and 0.04%, respectively). When stratified by comorbidity status, the prevalences of gout were 4.49% and 27.34% in aborigines and 1.52% and 9.44% in Han (approximate PR = 3.00). Similarly, the prevalence ratios of gout in the comorbidity group, compared with the non-comorbidity group, were 6.09 in aborigines and 6.23 in Han. Multivariate odds ratios [ORs] showed that hypercholesterolemia, hyperglyceridemia, essential hypertension and renal insufficiency were the common comorbidities of gout (OR ≥ 1.63); heart failure exerted a significant effect only in aborigines (OR = 1.55). For five comorbidity factors, patients with multiple comorbidities had higher gout prevalence (maximum OR = 12.90). Conclusion Gout prevalence was higher in aborigines, both with and without comorbidities, than in Han. The comorbid diseases and comorbidity aggregations showed a substantial association with gout occurrence in both ethnicities.

Purpose Carpal tunnel syndrome (CTS) is a common diagnosis occurring in the workplace when people experience hand or wrist symptoms and difficulty performing activities. This study aimed to investigate the psychometric properties of the Chinese version of the Boston Carpal Tunnel Questionnaire (BCTQ) used to evaluate patients with CTS. Methods A convenience sample of patients with CTS was recruited from two hospitals. The Symptom Severity Scale (SSS) and Functional Status Scale (FSS) of the BCTQ were used to assess symptoms and functional status. Test–retest reliability within 1 week was evaluated (n = 51). Construct validity was assessed by examining the relationship between the BCTQ and other well known measures (n = 99). Responsiveness of the scale was examined pre- and post-operatively for patients undergoing carpal tunnel surgery (n = 23). Results High reliability was demonstrated through intraclass correlation coefficients of 0.81 and 0.83 for SSS and FSS, respectively. The minimal detectable change was 0.86 and 0.75 for SSS and FSS, respectively. Convergent validity was supported by high correlation of both scales with Disability of the Arm, Shoulder and Hand (|rho| = 0.63, 0.75 for SSS and FSS), and moderate to high correlation with the subscales of the Short-Form 36 for SSS(|rho| = 0.72 for Body Pain) and FSS (|rho| = 0.48 for Physical Function). Responsiveness was confirmed by moderate to high standardized response means for SSS (1.03) and FSS (0.62). Conclusion The Chinese BCTQ is a reliable, valid and responsive disease-specific measure for assessment of symptoms and functional status in patients with CTS.

Various results of the previous literature related to surgical effect on pulmonary function of spinal muscular atrophy (SMA) patients might be due to different SMA type, different fusion level and technique. The aim of this study was to determine the value of scoliosis surgery for SMA type II patients with regard to pulmonary function, under the same fusion level, fusion technique and average long-term follow-up. Ten SMA II patients who underwent spinal correction procedures from 1993 to 2010 were identified. Data on clinical features and pulmonary function, including forced vital capacity (FVC) and forced expiratory volume in 1st second (FEV1), were collected. The data on pulmonary function were divided into preoperative, postoperative short-term (0–5 years), mid-term (5–10 years), and long-term (>10 years). Statistical comparisons were made using the Wilcoxon test for pulmonary function and body weight analysis. Questions were answered by parents on how surgery influenced the frequency of respiratory infection and the ability to sit at school. The average length of postoperative pulmonary function follow-up was 12.3 years (range 4.9–15.9 years). There was no significant difference in FVC or FEV1 between preoperative and each postoperative period. However, a significant decline from mid-term to long-term was observed (p = 0.028). Body weight increased significantly in all postoperative periods and was moderately correlated to pulmonary function (r = 0.526 for FVC). The answers to the questionnaire revealed that 80% of the patients had obvious improvement in the frequency of respiratory infection and 100% were tolerable sitting at school. Surgical correction for scoliosis in SMA II patients results in pulmonary function being maintained during long-term follow-up. In addition, the advantages of surgery also include body weight gain, better sitting tolerance, and reduced frequency of respiratory infection.

Taiwanese aborigines have a high prevalence of hyperuricemia and gout. Uric acid levels and urate excretion have correlated with dopamine-induced glomerular filtration response. MAOs represent one of the major renal dopamine metabolic pathways. We aimed to identify the monoamine oxidase A (MAOA, Xp11.3) gene variants and MAO-A enzyme activity associated with gout risk. This study was to investigate the association between gout and the MAOA single-nucleotide polymorphisms (SNPs) rs5953210, rs2283725, and rs1137070 as well as between gout and the COMT SNPs rs4680 Val158Met for 374 gout cases and 604 controls. MAO-A activity was also measured. All three MAOA SNPs were significantly associated with gout. A synonymous MAOA SNP, rs1137070 Asp470Asp, located in exon 14, was associated with the risk of having gout (P = 4.0 x 10(-5), adjusted odds ratio 1.46, 95% confidence intervals [CI]: 1.11-1.91). We also showed that, when compared to individuals with the MAOA GAT haplotype, carriers of the AGC haplotype had a 1.67-fold (95% CI: 1.28-2.17) higher risk of gout. Moreover, we found that MAOA enzyme activity correlated positively with hyperuricemia and gout (P for trend = 2.00 x 10(-3) vs. normal control). We also found that MAOA enzyme activity by rs1137070 allele was associated with hyperuricemia and gout (P for trend = 1.53 x 10(-6) vs. wild-type allele). Thus, our results show that some MAOA alleles, which have a higher enzyme activity, predispose to the development of gout.

Objective To study the associations of gout, tophi and uric acid levels with the gout-related SLC2A9 (solute carrier family 2, member 9) single nucleotide polymorphisms (SNPs) between two different racial groups. Methods Eight SLC2A9 SNPs were genotyped in 109 subjects with gout and 191 control subjects from Han Chinese men in Taiwan and 69 subjects with gout and 168 control subjects from the Solomon Islands. Results Non-synonymous SLC2A9 rs3733591 Arg265His was associated with risk for gout and tophaceous gout in Han Chinese subjects (p=0.0012 and p=0.0044). The genetic effect of this SNP on tophaceous gout was replicated in Solomon Islanders (p=0.0184). Patients with SLC2A9 Arg265His risk C-allele consistently had a higher risk for tophi (OR 2.05–2.15) than non-tophi (OR 0.91–1.62). SNP rs3733591 described 3.68% and 5.98% of the total variability in uric acid levels for Chinese and Solomon Island subjects, respectively. Conclusion Non-synonymous SNP rs3733591 variant within the SLC2A9 gene from two geographically diverse populations served as an important genetic checkpoint for tophaceous gout and increased uric acid levels.

Many single nucleotide polymorphisms (SNPs) have been found to be associated with breast cancer, but their SNP interactions are seldom addressed. In this study, we focused on the joint effect for SNP combinations of seven CXCL12-related genes involved in major cancer-related pathways. SNP genotyping was determined by PCR-restriction fragment length polymorphism (RFLP) in this study (case = 220, control = 334). Different numbers of combinational SNPs with genotypes called the SNP barcodes from different chromosomes were used to evaluate their joint effect on breast cancer risk. Except for vascular endothelial growth factor (VEGF) rs3025039-CT, none of these SNPs were found to individually contribute to breast cancer risk. However, for two combined SNPs, the proportion of subjects with breast cancer was significantly low in the SNP barcode with CC-GG genotypes in rs2228014-1801157 (CXCR4-CXCL12) compared to those with non-CC-GG genotypes. Similarly, the SNP barcode of rs12812942-rs2228014-rs3025039 (CD4-CXCR4-VEGF) and rs12812942-rs3136685-rs2228014-rs1801157 (CD4- CCR7-CXCR4-CXCL12) with specific genotype patterns (AT-CC-CC and AT-AG-CC-GG) among three and four combinational SNPs were significantly low in breast cancer occurrence. More SNP combinations larger than five SNPs were also addressed, and these showed similar effects. After controlling for age, and comparing their corresponding non-SNP barcodes, the estimated odds ratios for breast cancer ranged between 0.20 and 0.71 for specific SNP barcodes with two to seven SNPs. In conclusion, we have associated the potential combined CXCL12-related SNPs with genotypes that were protective against breast cancer, and that may contribute to identification of a low-risk population for the development of breast cancer.

Polymer, ceramic and metal are wildly applied in orthopedic and dental materials. However, most metal including titanium, titanium alloy and 316L stainless steel do not posses bioactivities to bond with bone tissue. For improving this weakness, we incubated titanium wire and 316L stainless steel fiber into the simulated body fluid (SBF) after alkaline and thermal treatments to form a bone-like apatite layer on it. With the reaction, the coating was formed on the surface of metal and it can induce apatite nucleus appear on the surface. The surface appearance was observed and the chemical constitution of bone-like apatite was examined. As the result show, when the titanium wire and 316L stainless steel fiber treated with 5 M NaOH aqueous solution, subsequently heated at 400 °C and soaked into SBF at a temperature of 80 °C increase the possibility of nucleation of considerable quantities of bone-like hydroxyapatite. We also found the main components of both the HA structures were Ca and P, and the percentage Ca/P were 1.69 and 1.1, which is similar to that of a natural bone.

Apatite (HA) layer can be formed on the surface of titanium using the electrochemical deposit method. In the present study, we found the current and loading time strongly affected the granule size and quantity of HA. When a low current was applied, needle-like HA was formed and irregular granules were seen at a higher current. We also found the main components of both the HA structures were Ca and P, and the percentage Ca/P was 1.69, which is similar to that of a natural bone.

Purpose Carpal tunnel syndrome (CTS) is one of the most common hand problems and a major cause of work disability. The purpose of this study was to use confirmatory factor analysis (CFA) to assess the factor structure of the Boston Carpal Tunnel Questionnaire (BCTQ) in patients with CTS. Methods One hundred and twenty-three patients with CTS were recruited from two hospitals. Each patient completed the functional status scale and the symptom severity scale of the BCTQ. CFA was used to assess the model fit between the data and pre-established theoretical measurement models. Results CFA showed that all three-factor models were better than the original two-factor model. Among the three-factor models, the simplified model, with 11 items assessing daytime pain, nocturnal numbness/tingling, and hand function was the best, for the model fit the data better than did the other models. Specifically, the Comparative Indices were larger than 0.95 (Tucker–Lewis Index and Comparative Fit Index values), and the Absolute Fit Indices and information-theoretic measures were the smallest. Moreover, all factor loadings were significant and high in magnitude (ranging from 0.66 to 0.99), the composite reliabilities exceeded 0.60 (ranging from 0.78 to 0.94), and the average variance extracted exceeded 0.50 (ranging from 0.61 to 0.89). Conclusion The simplified model showed the highest reliability and validity, and the factor structure was the simplest/clearest one. The simplified model is recommended for clinical use due to its convenience and precision for assessing the problems of patients with CTS.

Fibrodysplasia ossificans progressiva (FOP) is a rare congenital disease with autosomal dominant transmission characterized by the presence of malformations of the big toes and of postnatal progressive heterotopic endochondral osteogenesis. We report the case of 3-year-old girl with dysplasia of the first metatarsal bones and progressive heterotopic ossificans of the right thigh due to previous diphtheria-tetanus-pertussis immunizations and several inappropriate surgical interventions. Direct sequence analysis identified a 617G-A nucleotide mutation in the patient but not in her parents or brother. Pedigree analysis suggests that a de novo mutation in the ACVR1 gene is responsible for the disease in this family. This is the first report of the results of a mutation analysis in a sporadic case of FOP in a Taiwanese patient.

Metals have been widely applied in orthopedic and dental materials. However, most metals, such as titanium, titanium alloy, and 316L stainless steel, have poor bioactivity to bond with bone tissue. To improve this disadvantage, we incubated titanium filaments with simulated body fluid (SBF). As a result, a sodium titanate coating with apatite nucleation was formed on the surface of the filaments. After treated with 5 M NaOH aqueous solution, heated at 400 °C, and soaked into SBF at a temperature of 80 °C, nucleation of bone-like hydroxyapatite on the filaments were increased.

Seven patients who presented with complicated acute finger injuries were treated successfully with local transpositional adipofascial flaps. This is a one-stage procedure with advantages of simplicity and rapidity. This flap is thin with good pliability and provides a very versatile and reliable covering for soft-tissue defects of the fingers. Full-thickness skin grafts were applied to the raw surface of the adipofascial flaps in all patients. All cases had excellent wound healing and restored full range of motion. This procedure facilitates early wound healing and early range of motion for finger joints; it also reduces wound pain, minimizes scar formation, and eliminates the need for second-stage surgery.

Defects in the head and neck resulting from ablation of oral cancer frequently lead to disabling functional and cosmetic deformities. Rehabilitation of patients with oral cancer can be an emotionally and technically challenging endeavor. Selection of the donor tissue is clearly dependent upon the defect that is to be reconstructed. The donor tissue should be of sufficient bulk and pliability to facilitate reestablishing contour and function. Regional flap and free flap have been the mainstays of reconstruction for surgical defects after ablation of oral cancer. The records of 77 patients in whom 49 deltopectoral (DP) flaps and 28 free radial forearm flaps (FRFF) were used were analyzed. The success rate of the DP flap was 89.8% and of the FRFF was 96.4%. The minor complication rate at the transplant site (fistula, dehiscence, hematoma) for the DP flaps was 22.4% and for the FRFFs was 14.3%. Overall complication rate at the transplant site for DP flaps was 32.7% and for the FRFFs was 17.9%. The incidence of partial loss of the donor-site skin graft was 4.1% for the DP flaps and 10.7% for the FRFFs. Overall complication rate at the donor site for DP flaps was 10.2% and for the FRFFs was 39.3%. DP flaps had better aesthetic and functional results at the donor site, than FRFFs. However, the DP flap is a staged procedure and results in prolonged hospitalization. In contrast to FRFF, performing a DP flap avoids the difficult technique of microanastomosis, and therefore reduces the donor-site complication rate and the operation time. Therefore, free flaps can not be routinely substituted for regional flaps, but they represent better reconstructive alternatives for specific and selected patients.

Free tissue transfer using microvascular anastomosis has been established as an accepted maxillofacial reconstructive procedure. The free radial forearm flap (FRFF) has become a workhorse flap as a means of reconstructing surgical defects in the head and neck region. Since 1992, we have carried out 38 FRFF transfers in 37 patients for reconstruction after head and neck cancer ablative surgery. We present our clinical experience with head and neck reconstruction using the FRFF and the morbidity of the donor sites. Of the 38 FRFFs, 35 FRFFs were performed successfully. The survival rate of FRFF was 92%. Donor site complications included partial loss of skin graft in 4 donor sites (11%), abnormal sensations in 10 (26%), poor appearance in 3 (8%), and reduced grip strength in 4 (11%). Therefore, we believe that, because of the reliability, functional characteristics, and low donor site morbidity, the FRFF is a useful and versatile flap for reconstruction of head and neck defects.

Background and Objectives Surgical treatment of high-grade giant cell tumors (GCT) of bones with an intralesional excision or a wide excision still poses a dilemma between eradicating the tumor and saving the extremity's function. Our study evaluates the possibility of managing high grade GCT with an intralesional curettage combined with adjuvant therapies, instead of a wide excision, to better avoid limb salvage procedures with endoprostheses. Methods According to the grading system of Campanacci et al., twenty-four patients with grade III giant cell bone tumors were treated between May 1983 and Aug 2001 period. We analyzed the differences in local recurrence rates, functional results, and complications between wide excision and curettage with adjuvant therapy in management of the patients diagnosed with primary lesions after a mean follow-up period of 7.5 years (range: 2.1–20.3 years). Results Fourteen patients underwent the curettage procedure with adjuvant therapy and reconstruction with bone grafts. In the curettage group, two patients had local recurrences and three patients had fracture complications. None of the nine patients receiving wide excisions had experienced local recurrence at the time of their most recent follow-up examination. Using the Musculoskeletal Tumor Society system to evaluate average function, the results were 25.56 points for the wide excision group and 25.64 points for the curettage group, respectively. Conclusions Our results suggest that surgical curettage with various adjuvant modalities might be considered as the first choice for treatment of high-grade GCTs in weight-bearing areas, especially in young patients, to avoid unnecessary endoprosthesis. J. Surg. Oncol. 2005;92:46–51. © 2005 Wiley-Liss, Inc.

The 2-year survival rate for high-grade osteosarcoma was 46.9% before the introduction of National Health Insurance (NHI) in Taiwan on March 1, 1995, but increased to 73.8% after the implementation of NHI. The 5-year survival rate also increased, from 37.5% to 63.6%. Between May 1990 and May 2001, 74 patients with high-grade osteosarcoma were treated at our hospital. Median age was 17 years (range, 7-63 years). Inadequate surgical margins, poor histologic response to chemotherapy, advanced stage of disease, and incomplete treatment were strongly associated with poor prognosis. Before NHI, 10 patients had incomplete treatment, mainly because of unaffordable medical fees. After NHI, only three patients had incomplete treatment, due to personal reasons. Patient survival improved dramatically with advances in multiagent chemotherapy, but it was the NHI that enabled patients to complete expensive treatment courses, including preoperative neoadjuvant chemotherapy, limb-salvage surgery, and postoperative adjuvant chemotherapy. The NHI also improved the accessibility of medical care, with more patients presenting in the early stages of disease and, as a result, it not only improved survival rate but also increased the number of patients undergoing limb-salvage surgery. We concluded that the NHI significantly improved the survival rate for patients with osteosarcoma in Taiwan.

Gorham disease is a so-called massive idiopathic osteolysis or vanishing bone disorder. Massive osteolysis remains an enigmatic condition that involves various skeletal locations and is caused by endothelial proliferation. The diagnosis is difficult and is established via the association of clinical, radiologic and histologic pictures. Treatment modalities yield variable results. We report a case of vanishing bone in the elbow joint and carpal bones following trauma. This 13-year-old boy complained of severe restricted motion and deformity of the right elbow. We managed the problem using arthroplasty with close-wedge osteotomy on the lateral condyle of the humerus.

Previous reports have suggested that polymorphism in the vitamin D receptor (VDR) gene is associated with sporadic breast cancer, but there is controversy among different authors and ethnic groups. The purpose of this study was to determine whether polymorphism in the VDR gene might also influence breast cancer risk in Taiwan, a country with a low incidence of breast cancer.Polymorphisms in the end of the VDR gene were genotyped for 34 Taiwanese women with sporadic breast cancer, 46 with benign breast tumors and 169 cancer-free female cohort controls.The ApaI, TaqI, and BsmI polymorphisms in the 3' end of the VDR gene were associated with breast cancer risk, with a trend for increasing risk with increased numbers of BsmI B alleles and ApaI AA genotypes. When the allele frequencies of BsmI polymorphism were compared among the three populations, a significant difference was observed (chi2 = 13.684, df = 4, p = 0.0084). The OR of the Aa genotype was 0.333 (95% CI = 0.1 14-0.978) and that of the aa genotype was 0.515 (95% CI = 0.190-1.398). These data indicate that the AA genotype may be associated with an increased risk of breast cancer, while the Aa genotype tends to be associated with decreased risk. The TaqI polymorphism was not associated with breast cancer risk in this study.These results suggest that polymorphic variation in or near the 3' end of the VDR gene may influence breast cancer risk in Taiwanese women and justifies further investigation of the role of VDR for sporadic breast cancer in low-incidence areas. These findings also should help when designing targeted therapy.

Tendons are frequently injured by direct trauma. Tendon adhesions were a common sequel of tendon repair and are one of the most challenging problems in hand surgery. The concept of “controlled motion” gradually replaced “total immobilization” in the treatment of flexor tendon injuries and today represents a standard of care for all primary repaired flexor tendon injury. Use of controlled motion splints during the early stages of stages of tendon recovery in crease tendon gliding. However, how best to achieve passive motion and the effect of passive motion on tendon gliding have remained controversial subjects. Based on a series of recent experiments, the concept of “dynamic synergistic wrist motion splint” was established and evaluated. It was found that this synergistic wrist motion increases the tendon excursion due to eliminating the laxity and buckling of tendon in the regions between pulleys without introduce excessive amount of tension. The purpose of this study is to design and fabricate a dynamic splint based on this concept and define the nature coordinated motion between the wrist and finger joints due to the passive tension of the muscles in vivo. Parametric analysis will be conducted to achieve an optimum design with the consideration of anatomic constraints. Clinical trial of using such dynamic splint will be evaluated in the future.

Summary: The consistent relationship between congenital muscular torticollis and dysplasia of the hip is now widely accepted. However, the coexistence rate of these two disorders has been reported with variations from 0 to 20%. To obtain a more accurate coexistence rate, ultrasound scanner was used as the diagnostic tool for both of these disorders. Sixty-three children (30 boys and 33 girls) younger than 6 months who had undergone ultrasound scanning of both bilateral sternocleidomastoid muscle and bilateral hips were included in this study. Forty-seven children were confirmed to have muscular torticollis, and the remaining 16 cases were diagnosed as postural torticollis. Only these 47 cases were included for analysis of the coexistence rate. Eight children were found with dysplasia of the hips associated with muscular torticollis, which included Graf's type IIa for four hips, type IIb for two hips, type IIIa for one hip, and type IIIb for one hip. From the results of the present ultrasonographic study, the coexistence rate of congenital muscular torticollis and dysplasia of the hip was concluded to be 17%. If only those dysplastic hips (type IIb, IIIa, IIIb) that required treatment were included, the coexistence rate would be lowered to 8.5%.

Tendons are frequently injured by direct trauma. Tendon adhesions are a common factor compromising the results of tendon repair and to this day represent one of the most challenging problems in hand surgery. Use of controlled motion splints during the early stages of tendon recovery increases tendon gliding. Thus, a variety of controlled motion splints have been developed. This paper introduces a new controlled motion splint called the Synergistic Wrist Motion Splint (SWIMS). The "seqential quadratic programming method" was used to optimize Yang's synertistic model of the wrist/hand system, with the results being embodied in a practical controlled motion splint. Derivation of the model is discussed in detail. The dimensions of a patient's hand are input into a general formula to generate a specific SWIMS configuration for the patient. Five prototype SWIMS splints were produced and tested on 5 normal subjects. A three-dimensional motion analysis system was employed to measure the relative motion between the wrist and finger joints due to passive muscle tension for the prototype SWIMS splints, and the results are compared with the mathematical simulation or model.

Objective We investigated the association between gout and the risk of type 2 diabetes mellitus. Methods Population-based representative insurance (outpatient and inpatient) claims data of 29,765 patients with gout and 59,530 controls without gout (1:2 case:control ratio) between 1998 and 2010 in Taiwan were identified. The association between gout and type 2 diabetes was evaluated using the Cox proportional hazards model. Moreover, the combined effects of sex and incident gout on the risk of type 2 diabetes were estimated. Results In total, 3940 patients (13.24%) with gout and 6334 controls (10.64%) developed type 2 diabetes in the follow-up period. Multivariate analyses revealed a significant association between gout and type 2 diabetes. Compared with the control group, the adjusted hazard ratios (95% confidence intervals) for type 2 diabetes were 1.62 (1.54-1.70) in men, 1.97 (1.81-2.14) in women, and 1.70 (1.62-1.77) overall. The multiplicative interaction was β = 0.18 and P = .0001, suggesting a positive interaction between sex and incident gout. Moreover, compared with men without gout, a significantly higher risk of type 2 diabetes was noted in women without gout (adjusted relative risk [95% confidence interval], 1.17 [1.10-1.24]), men with gout (1.11 [1.06-1.16]), and women with gout (1.47 [1.37-1.57]) ( P for interaction = .0058). Conclusions Gout is a strong and independent risk factor for type 2 diabetes, and female patients with gout are at a higher risk of type 2 diabetes than are male patients with gout.

This report presents a case of hydrochloric acid injection in the inguinal area in a suicide attempt, resulting in total occlusion of the external iliac artery, requiring disarticulation of the hip. To the authors' best knowledge, it has not been previously reported in the English medical literature. The accelerated destructive activity of these irritant chemicals and deep tissue damages are emphasized. Early and aggressive debridement with copious saline irrigation and circumspect monitoring are recommended.

Fractures of the posteromedial tibial plateau are rare and their treatment is not well established. Between January 2004 and December 2008, eight patients with fractures of the posteromedial tibia plateau were identified. All patients were treated with fracture reduction using an anterior approach. After a mean follow-up of 21 months, the average range of knee motion was 0-123 degrees of flexion. Seven patients had been injured in motor-scooter accidents, in which the protective front plate of the scooter had hit the knee while it was in the 90 degrees -flexion position. At the final follow-up, 87.5% (7/8) patients had satisfactory reductions of the articular surface, and all patients had acceptable alignments. There were no neural or vascular injuries following surgery, and no superficial or deep infections. The average Hospital for Special Surgery Knee Score was 89. In conclusion, fracture reduction using the anterior approach is associated with fewer complications than the posterior approach, and good functional recovery can be expected.

icrosurgical techniques are widely used in reconstructive urgery, as they enable the surgeon to anastomoes small vesels and nerves (typically 1 mm) successfully. A surgical icroscope is the best aid to practising anastomotic skill, but t is both bulky and costly. A binocular loupe is inexpensive, nd is as successful as a microscope in free tissue transfer.1–3 owever, if a surgeon wears a binocular loupe for hours it ill cause physical and mental fatigue as does a microscope. any of these problems are faced by surgeons having to be ompletely still while using these eyepieces, particularly for igh magnification. Over recent years, digital camcorders have proved to be n advancement in technology for macro-magnification, and ould be an alternative to the microscope in the learning of icrosurgical skills. First it is necessary to investigate the relations among he magnification, the working distance, the depth of focus, nd diameter of the operative field. The surgical microscope rovides a 200–400 mm working distance and allows the sureon to operate instruments in a less than 20 mm operative eld without interference. The digital camcorder provides xceptional viewing clarity with improved resolution in the iquid crystal display (LCD) screen. The 2.7–3.5 in.-wide creen can rotate for multiple viewing angles, and provides harp, detailed images for monitoring. Because of the limited agnification, a close-up lens is needed to magnify the object. There are many inexpensive, high-quality, close-up lenses hat are capable of producing excellent images without loss f sharpness. Using a close-up lens (Canon 250D or 500D)

Study design Cross-cultural adaptation and cross-sectional psychometric testing in a convenience sample of patients with low back pain. Objective To translate and culturally adapt the Oswestry Disability Index version 2.1 (ODI 2.1) into a Mandarin Chinese version and to assess its reliability and validity. Summary of background data The Chinese ODI 2.1 has not been developed and validated. Methods The ODI 2.1 was translated and culturally adapted to the Chinese version. The validity of the translated Chinese version was assessed by examining the relationship between the ODI and other well-known measures. Test-retest reliability was examined in 52 of these patients, who completed a second questionnaire within 1 week. Results Internal consistency of the ODI 2.1 was excellent with Cronbach's alpha = 0.903. The intraclass correlation coefficient of test-retest reliability was 0.89. The minimal detectable change was 12.8. The convergent validity of the Chinese ODI is supported by its high correlation with other physical functional status measures (Roland Morris Disability Questionnaire and SF-36 physical functioning subscale, r = 0.76 and -0.75, respectively), and moderate correlation with other measures (Visual Analogue Scale, r = 0.68) and certain SF-36 subscales (role-physical, bodily pain, and social functioning, r range: -0.49 to -0.57). As expected, the ODI was least correlated with nonfunctional measures (SF-36 mental subscale and role-emotional subscale, r = -0.25 and -0.33, respectively). Conclusion The results of this study indicate that the Chinese version of the ODI 2.1 is a reliable and valid instrument for the measurement of functional status in patients with low back pain.

Osteoporosis is a major public health problem, mainly quantified by low BMD. Eleven polymorphisms were investigated in this study; TNFalpha-857 (rs1799724), TGFbeta1-509 (rs1800469), osteocalcin (rs1800247), TNFalpha-308 (rs1800629), PTH BstB I (rs6254), PTH Dra II (rs6256), IL-1ra (VNTR), HSP70 hom (rs2227956), HSP 70-2 (rs1061581), CTR (rs1801197), and BMP-4 (rs17563). The relationship between the combined polymorphisms in different genomic regions and BMD variation was investigated. Among the female subjects, the proportion of subjects with low BMD in low BMI group (or = 18.50) was significantly higher than that of the middle (18.51-22.99) and high (or = 23.00) BMI groups (P0.05). In post-menopausal women, there was a significant association between low BMD and genotypes ranging from 2 to approximately 7 SNPs. For two combined SNPs, the portion of subjects with low BMD was significantly higher in those with CC-AA genotypes in rs1799724-rs1800629, compared to those with non-CC-AA genotypes in post-menopausal women and the combination of all women. Similarly, part of the combined SNPs with rs1799724-rs1800629-rs6254-rs6256-IL-1ra-rs2227956-rs1801197 was significantly associated with reduced BMD. After controlling for age and BMI, post-menopausal women with certain specific SNP combination had a 3.54- to 4.68-fold increased risk for low BMD, comparing to other SNP combinations. In conclusion, our data suggest that several gene polymorphisms may be cooperatively involved in the development of osteoporosis.

Purpose Percutaneous trigger digit release has been reported as a safe, effective, and quick procedure, but most surgeons convert to an open method for residual triggering after percutaneous release. This study evaluates the safety and efficacy of repeated percutaneous release for patients who had residual triggering after the initial percutaneous release. Methods Between January 2000 and December 2002, 31 patients with a mean age of 55 years had a repeat percutaneous release to treat residual snapping or locking symptoms. Surgery was performed in the physician's office using the tip of a 19-gauge needle mounted on a 2-mL syringe. Patients received regular postoperative follow-up examinations at 1, 6, and 12 weeks after surgery, and at the last visit, they completed a questionnaire regarding the duration of pain or swelling and when were they able to return to normal work. Results Twenty-eight digits (90%) were completely free of triggering. Three digits (10%) during follow-up evaluation had residual snapping. Of these, 1 patient had repeated percutaneous release, which achieved an excellent outcome; 1 patient favored an open-release technique, and 1 patient refused further treatment. No complications were identified at the final follow-up examinations. Almost all patients returned to normal work within 3 days. Conclusions Percutaneous A1 pulley release is an effective, safe, and convenient technique for the primary trigger finger and as a secondary procedure for patients who have residual triggering after the initial surgical procedure. Type of study/level of evidence Therapeutic IV.

Background Squamous cell carcinomas and renal failure were reported the causes of death in patients with recessive dystrophic epidermolysis bullosa (RDEB). Death from colonic disease in epidermolysis bullosa (EB) is never reported. Case presentation We demonstrate a male patient with RDEB. He suffered megacolon due to fecal impaction and died from sigmoid colon perforation with peritonitis at age 35 years. Conclusion Constipation is a common clinical feature of RDEB, but fetal complications of chronic constipation are rarely reported. To the author's best knowledge, it has not been reported or recognized in the English literature previously. The aggressive assessment of constipation with fecal impaction is recommended in patients with RDEB.