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Background: Roughly 30% of patients with chronic lateral ankle instability (CLAI) have long-lasting painful instability requiring surgical intervention. Ligament reconstruction with the traditional open method and using tendon allografts can provide sufficient mechanical stability for severe CLAI. Arthroscopic ligament reconstruction with tendon allograft has recently been introduced to treat CLAI. Purpose: In this study, we describe an arthroscopic ligament reconstruction procedure involving the use of the tendon allograft for patients with CLAI, and we compare the efficacy of this procedure with open ligament reconstruction with tendon allograft. Study Design: Cohort study; Level of evidence, 3. Methods: We enrolled 10 patients (4 men and 6 women) with CLAI (mean age, 37.3 years; range, 16-57 years) who underwent arthroscopic ligament reconstruction with tendon allografting between November 2017 and June 2019. The control group consisted of 10 patients who received open tendon allograft reconstruction. Preoperative and 2-year postoperative functional outcomes were evaluated using the American Orthopaedic Foot & Ankle Society ankle-hindfoot scale (AOFAS), Karlsson Ankle Functional Score (KAFS), pain visual analog scale (VAS), 12-Item Short Form Health Survey (SF-12), and Tegner activity score (TAS). Results: The mean operative time was 118 and 110 minutes in the arthroscopic and open groups, respectively. At 2-year follow-up, scores on the AOFAS improved significantly compared with preoperatively, from 71.3 to 96.4 ( P = .006) in the arthroscopic group, and from 68.6 to 96.7 ( P = .005) in the open group. The postoperative AOFAS, VAS, KAFS, and SF-12 scores did not differ significantly between the 2 groups; however, the TAS score was significantly higher in the arthroscopic reconstruction group compared with in the open group (7 vs 6.1, respectively; P = .01). Conclusion: Arthroscopic ligament reconstruction with tendon allografting resulted in sufficient ankle stability and no donor-site morbidity. This procedure can yield similar functional outcomes to open reconstruction technique and may be an option for the management of CLAI.

Background: People with dementia are a high-risk group for hip fractures. Although the increased risk of hip fractures associated with antipsychotic drugs (APD) is found in older populations, little is known about the risk for people with dementia living in Asia. We aimed to investigate the association between hip fractures and the characteristics of APD use in patients with dementia. Methods: A nested case-control analysis was conducted on a nationwide cohort in Taiwan. People with diagnoses of dementia during 2003–2012 were identified. Conditional logistic regression analysis was performed, and adjusted odds ratios (aORs) were calculated with a 95% confidence interval (CI) to estimate the risk of hip fractures. Results: APD use was associated with an increased risk of hip fractures in patients with dementia, current use or combined use of first and second generations of APDs had even higher risks. Regarding the duration of APD use, a U-shape curve of hip fracture risk was noted, and the risk peaked during 0–15 days and &gt, 215 days of exposure (aOR = 1.46, 95% CI 1.37–1.57, aOR = 1.47, 95% CI 1.37–1.58, respectively). Considering the doses of APDs, the hip fracture risk was significantly increased with all four levels of the cumulative doses and average daily doses and peaked in the group with the highest average daily dose. Conclusions: The findings suggest that caution must be taken when initiating APD use in patients with dementia, even in a small dose, and mixed types of APD prescriptions should be administered with care. Furthermore, frequent evaluation of the possibility of tapering or withdrawal of the medication is necessary, as the risk does not attenuate after long-term use.

Tarsal navicular osteonecrosis in adults is a rare condition with unclear etiology, and the optimal treatment has not been established. Here we report a case of tarsal navicular osteonecrosis with a complete course of treatment and comprehensive imaging studies starting at an early stage. A 37-year-old female diagnosed with tarsal navicular osteonecrosis was first treated with percutaneous decompression, but her symptoms persisted postoperatively. The tarsal navicular showed no further collapse, but follow-up magnetic resonance imaging (MRI) at 6 months postoperatively revealed persistent osteonecrotic changes. Debridement of the necrotic bone with preservation of the cortical shell and bone substitute packing for the defect (light bulb procedure) were performed. The symptoms resolved by 3 months postoperatively, and the patient could return to work. At a 6-year follow-up visit, the patient was free of symptoms, and MRI showed remodeling of the tarsal navicular without further collapse.

Background: The purpose of this study is to investigate the clinical and radiological results of a sliding oblique metatarsal osteotomy (SOMO) to correct bunionette deformity. Methods: We retrospectively reviewed 44 patients (51 feet, left/right: 29/22) from December 2010 to December 2018 who underwent SOMO and compared radiographic measurements and clinical outcome scores preoperatively and postoperatively. Radiographic measurements included 4th and 5th intermetatarsal angle (IMA), metatarsophalangeal angle (MTPA), and lateral deviation angle (LDA). Clinical outcome measurements included The American Orthopedic Foot and Ankle Society (AOFAS) score for lesser metatarsophalangeal procedures and visual analog scale (VAS) pain score. The mean follow-up period was 26.6 months (minimum 18 months). Based on Coughlin and Fallat classification, all cases were separated into four subtypes: 6 type I, 10 type II, 12 type III, 23 type IV cases included.) Results: All radiographic parameters significantly improved after SOMO procedure (IMA/MTPA/LDA, p value < 0.001). Clinical scores also showed a significant improvement in AOFAS and VAS scores (p value < 0.001). In terms of subgroup based on each type, both radiographic measurements and clinical scores revealed significant improvements in each subgroup (p value < 0.05), except LDA of type I subgroup (p value = 0.09). Three cases reported pin-tract infection but recovered with good healing after removal of the K-wire and a prescription of oral antibiotic. Conclusion: The SOMO procedure may be considered as a reliable and simple treatment for most types of bunionette deformity with satisfactory outcomes and no severe complications. Level of Evidence: Level IV, case series.

Blind Spot Detection (BSD) is an important technique for ADAS. We propose a BSD algorithm using Gabor filtering and optical flow to detect vehicles in the blind spot region for both day-time and night-time applications. For the day-time scene, the Gabor filtering is used to detect the vehicles, inside lane line, and outside lane line. After detection, the optical flow information calculated according to Horn-Schunck method is used to judge the motion of the vehicle candidates and filter the mistake-judgement. For the night-time scene, we try to find the head-light of the approaching cars. First, we perform binarization on the image first, find the center of gravity of the light-area, classify the light-area into 2 groups and judge it as a vehicle or not. The proposed BSD system achieves 93.58% recall and 95.83% precision in day time scene and 90.22% recall and 92.76% precision in night time scene. The algorithm can achieve performance of 89 fps on Intel Core I7 and 50 fps on Renesas R-Car M2 under 640×480 resolution.

Prior studies show that self-motions early after a fracture surgery can effectively reduce the tissue viscosity. However, due to the postoperative pain and unawareness of the postoperative limitations, a patient prefers to take medication to alleviate pain while complicated rehabilitation exercises can only be implemented under the limited intervention of a therapist, resulting in the patient's lack of interactive feedback on a daily basis and a failure of self-motions to miss the timing of rehabilitation. Additionally, an assessment for the patient's amount of movements is usually carried out by questioning a caregiver by the medical staff during a clinical interview to organize the patient's self-report because an oral statement is more subjective and difficult to quantify the patient's amount and quality of movements, which may lead to the compiling results that can not be compared or referenced to, and may become a blind spot in the record in the current health care system. This study is intended to develop a lower limb fracture postoperative-guided interactive rehabilitation training system for the hip, knee and ankle joints, and establish a method of motion analysis and a method of motion performance assessment in conjunction with the wireless sensor technology and animation techniques, providing an objective assessment from the caregiver and learning the patient's rehabilitation status with a simple and easy recording means. Additionally, with the design of interactive feedback, the improved postoperative rehabilitations are tried to increase the participant’s interest in self-management of health and facilitate to keep tracking the rehabilitation information. The medical evidences show that a guided rehabilitation system can enhance the patient's motive and willingness to be committed to a rehabilitation training as well as increase Quality and Amount of the exercise activity during the training process.

BACKGROUND: There is a variety of treatment modalities for unicameral bone cysts, with variable outcomes reported in the literature. Although good initial outcomes have been reported, the success rate has often changed with longer-term follow-up. We introduce a novel, minimally invasive treatment method and compare its clinical outcomes with those of other methods of treatment of this lesion. METHODS: From February 1994 to April 2008, forty patients with a unicameral bone cyst were treated with one of four techniques: serial percutaneous steroid and autogenous bone-marrow injection (Group 1, nine patients); open curettage and grafting with a calcium sulfate bone substitute either without instrumentation (Group 2, twelve patients) or with internal instrumentation (Group 3, seven patients); or minimally invasive curettage, ethanol cauterization, disruption of the cystic boundary, insertion of a synthetic calcium sulfate bone-graft substitute, and placement of a cannulated screw to provide drainage (Group 4, twelve patients). Success was defined as radiographic evidence of a healed cyst or of a healed cyst with some defect according to the modified Neer classification, and failure was defined as a persistent or recurrent cyst that needed additional treatment. Patients who sustained a fracture during treatment were also considered to have had a failure. The outcome parameters included the radiographically determined healing rate, the time to solid union, and the total number of procedures needed. RESULTS: The follow-up time ranged from eighteen to eighty-four months. Group-4 patients had the highest radiographically determined healing rate. Healing was seen in eleven of the twelve patients in that group compared with three of the nine in Group 1, eight of the twelve in Group 2, and six of the seven in Group 3. Group-4 patients also had the shortest mean time to union: 3.7 ± 2.3 months compared with 23.4 ± 14.9, 12.2 ± 8.5, and 6.6 ± 4.3 months in Groups 1, 2, and 3, respectively. CONCLUSIONS: This new minimally invasive method achieved a favorable outcome, with a higher radiographically determined healing rate and a shorter time to union. Thus, it can be considered an option for initial treatment of unicameral bone cysts. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Treatment of Unicameral Bone Cyst. A Comparative Study of Selected Techniques” (2010;92:855-62).

Background There is a variety of treatment modalities for unicameral bone cysts, with variable outcomes reported in the literature. Although good initial outcomes have been reported, the success rate has often changed with longer-term follow-up. We introduce a novel, minimally invasive treatment method and compare its clinical outcomes with those of other methods of treatment of this lesion. Methods From February 1994 to April 2008, forty patients with a unicameral bone cyst were treated with one of four techniques: serial percutaneous steroid and autogenous bone-marrow injection (Group 1, nine patients); open curettage and grafting with a calcium sulfate bone substitute either without instrumentation (Group 2, twelve patients) or with internal instrumentation (Group 3, seven patients); or minimally invasive curettage, ethanol cauterization, disruption of the cystic boundary, insertion of a synthetic calcium sulfate bone-graft substitute, and placement of a cannulated screw to provide drainage (Group 4, twelve patients). Success was defined as radiographic evidence of a healed cyst or of a healed cyst with some defect according to the modified Neer classification, and failure was defined as a persistent or recurrent cyst that needed additional treatment. Patients who sustained a fracture during treatment were also considered to have had a failure. The outcome parameters included the radiographically determined healing rate, the time to solid union, and the total number of procedures needed. Results The follow-up time ranged from eighteen to eighty-four months. Group-4 patients had the highest radiographically determined healing rate. Healing was seen in eleven of the twelve patients in that group compared with three of the nine in Group 1, eight of the twelve in Group 2, and six of the seven in Group 3. Group-4 patients also had the shortest mean time to union: 3.7 +/- 2.3 months compared with 23.4 +/- 14.9, 12.2 +/- 8.5, and 6.6 +/- 4.3 months in Groups 1, 2, and 3, respectively. Conclusions This new minimally invasive method achieved a favorable outcome, with a higher radiographically determined healing rate and a shorter time to union. Thus, it can be considered an option for initial treatment of unicameral bone cysts.

Our study was conducted to compare radiographic alignments and functional outcomes with 2 approaches to minimal-incision total knee arthroplasty (TKA): the minimal-incision medial parapatellar (MP) approach and the quadriceps-sparing (QS) approach with side-cutting instruments. Sixty patients (80 knees) with primary osteoarthritis were randomly assigned to receive MP or QS TKA. Postoperative alignment of the femoral component was significantly less valgus, and postoperative alignment of the tibial component was significantly more varus with the QS approach than with the MP approach. One tibial outlier and 3 femoral outliers were observed with QS TKA. The overall postoperative hip-knee-ankle axis was more varus, and surgical time was longer with QS TKA. Short-term isokinetic peak muscle torque, postoperative pain, and functional outcomes did not differ between the approaches.

Background: Buccal squamous cell carcinoma (BSCC) is the most frequently occurring oral cancer in Asians due to the popularity of areca use in this area. The aim of the present study was to evaluate the survival of areca-associated BSCC associated with multiple molecular markers. Methods: Using immunohistochemistry, we evaluated the survival of a cohort of 55 patients with BSCC being followed long term, as correlated to the expression of variable markers. Results: We found that p53, p21, Rb, cyclin D1 (CCD1), MDM2, and γ-catenin were positive in 81, 60, 70, 31, 88, and 44% of patients, respectively. Subjects with −ve immunoreactivity for CCD1, and +ve immunoreactivity for MDM2 and γ-catenin had significantly better survival than subjects with the opposite immunoreactive pattern. Kaplan–Meier survival curves confirmed this association. Conclusion: The data indicate that expression of CCD1, MDM2, and γ-catenin might serve as potential prognostic markers for BSCC in areca-using patients.

Prior studies show that active-motion early after a fracture surgery can effectively reduce the tissue viscosity. However, due to the postoperative pain and unawareness of the postoperative limitations, a patient prefers to take medication to alleviate pain while complicated rehabilitation exercises can only be implemented under the limited intervention of a therapist, resulting in the patient's lack of interactive feedback on a daily basis and a failure of self-motions to miss the timing of rehabilitation. This study is intended to develop a lower limb fracture postoperative-guided interactive rehabilitation training system for the hip, knee and ankle joints, and establish a method of motion analysis and a method of motion performance assessment in conjunction with the wireless sensor technology and animation techniques, providing an objective assessment from the caregiver and learning the patient's rehabilitation status with a simple and easy recording means. Additionally, with the design of interactive feedback, the improved postoperative rehabilitations are tried to increase the participant's interest in self-management of health and facilitate to keep tracking the rehabilitation information. The medical evidences show that a guided rehabilitation system can enhance the patient's motive and willingness to be committed to a rehabilitation training as well as increase Quality and Amount of the exercise activity during the training process.

Background Schizophrenia is a complex disorder with involvement of multiple genes. Methods In this study, genome-wide screening for DNA copy-number variations (CNVs) was conducted for ten pairs, a total of 20 cases, of affected siblings using oligonucleotide array-based CGH. Results We found negative symptoms were significantly more severe (p < 0.05) in the subgroup that harbored more genetic imbalance (n ≧ 13, n = number of CNV-disrupted genes) as compared with the subgroup with fewer CNVs (n ≦ 6), indicating that the degree of genetic imbalance may influence the severity of the negative symptoms of schizophrenia. Four central nervous system (CNS) related genes including CCAAT/enhancer binding protein, delta (CEBPD, 8q11.21), retinoid × receptor, alpha (RXRA, 9q34.2), LIM homeobox protein 5 (LHX5, 12q24.13) and serine/threonine kinase 11 (STK11, 19p13.3) are recurrently (incidence ≧ 16.7%) disrupted by CNVs. Two genes, PVR (poliovirus receptor) and BU678720, are concordantly deleted in one and two, respectively, pairs of co-affected siblings. However, we did not find a significant association of this BU678720 deletion and schizophrenia in a large case-control sample. Conclusions We conclude that the high genetic loading of CNVs may be the underlying cause of negative symptoms of schizophrenia, and the CNS-related genes revealed by this study warrant further investigation.

Our study was conducted to compare radiographic alignments and functional outcomes with 2 approaches to minimal-incision total knee arthroplasty (TKA): the minimal-incision medial parapatellar (MP) approach and the quadriceps-sparing (QS) approach with side-cutting instruments. Sixty patients (80 knees) with primary osteoarthritis were randomly assigned to receive MP or QS TKA. Postoperative alignment of the femoral component was significantly less valgus, and postoperative alignment of the tibial component was significantly more varus with the QS approach than with the MP approach. One tibial outlier and 3 femoral outliers were observed with QS TKA. The overall postoperative hip-knee-ankle axis was more varus, and surgical time was longer with QS TKA. Short-term isokinetic peak muscle torque, postoperative pain, and functional outcomes did not differ between the approaches.

Buccal squamous cell carcinoma (BSCC) is the most frequently occurring oral cancer in Asians due to the popularity of areca use in this area. The aim of the present study was to evaluate the survival of areca-associated BSCC associated with multiple molecular markers.Using immunohistochemistry, we evaluated the survival of a cohort of 55 patients with BSCC being followed long term, as correlated to the expression of variable markers.We found that p53, p21, Rb, cyclin D1 (CCD1), MDM2, and gamma-catenin were positive in 81, 60, 70, 31, 88, and 44% of patients, respectively. Subjects with -ve immunoreactivity for CCD1, and +ve immunoreactivity for MDM2 and gamma-catenin had significantly better survival than subjects with the opposite immunoreactive pattern. KAPLAN-meier survival curves confirmed this association.The data indicate that expression of CCD1, MDM2, and gamma-catenin might serve as potential prognostic markers for BSCC in areca-using patients.