Correlations between subjective treatment responses and plantar pressure parameters of metatarsal pad treatment in metatarsalgia patients: a prospective study

BACKGROUND: Metatarsalgia is related to repetitive high-pressure loading under the metatarsal head (MH) that causes pain. The high pressure under the MH can be reduced by adequately applying metatarsal pads (MPs). Plantar pressure measurements may provide a method to objectively evaluate pressure loading under the MH. However, it is still unclear if the decrease in plantar pressure under the MH after MP treatment is associated with subjective improvement. This study aims to explore the correlations between subjective pain improvement and outcome rating, and the plantar pressure parameters in metatarsalgia patients treated using MPs. METHODS: Thirteen patients (a total of 18 feet) with secondary metatarsalgia were included in this study. Teardrop-shaped MPs made of polyurethane foam were applied just proximal to the second MH by an experienced physiatrist. Insole plantar pressure was measured under the second MH before and after MP application. Visual analog scale (VAS) scores of pain were obtained from all subjects before and after 2 weeks of MP treatment. The subjects rated using four-point subjective outcome scales. The Wilcoxon signed-rank test was used to analyze the difference between the plantar pressure parameters and VAS scores before and after treatment. The Kruskal-Wallis test was applied to compare the plantar pressure parameters in each outcome group. Pearson's correlation was applied to analyze the correlation between the changes in plantar pressure parameters and VAS scores. Statistical significance was set as p < 0.05. RESULTS: MP application decreased the maximal peak pressure (MPP) and pressure-time integral (PTI) under the second MH and also statistically improved subjective pain scores. However, neither the pre-treatment values of the MPP and PTI shift in the position of the MPP after treatment, nor the age, gender and body mass index (BMI) of the subjects were statistically correlated with subjective improvement. Declines in the PTI and MPP values after MP application were statistically correlated with the improvement in VAS scores (r = 0.77, R(2 )= 0.59, p < 0.001; r = 0.60, R(2 )= 0.36, p = 0.009). CONCLUSION: We found that the successful decline in the PTI and MPP under the second MH after MP application was correlated to subjective pain improvement. This study provides a strategy for the further design and application of MPs for metatarsalgia treatment

Pleural Effusion after Percutaneous Radiofrequency Ablation for Hepatic Malignancies

AbstractBackground and AimsRadiofrequency ablation (RFA) can play an important role in the treatment of primary or metastatic liver tumors. Currently, percutaneous RFA is generally regarded as a safe, effective, and minimally invasive procedure. This study aimed to evaluate the presence and course of pleural effusion after monopolar RFA.MethodsFrom October 2008 to July 2013, a total of 54 patients (28 male and 26 female, mean age 65.2) treated with monopolar RFA were included in our study. 47 patients were diagnosed with hepatocellular carcinoma, 4 patients with hepatic metastasis, and 3 patients had other diagnoses. There were a total of 115 sessions of treatment and 199 liver tumors to be treated (1.73 ± 1.02 tumors treated per session). The tumor size ranged from 0.8 cm to 5.0 cm (mean 2.31 cm, standard deviation 1.04 cm). Thereafter, a follow-up ultrasound was performed within 24 hours subsequent to ablation to evaluate the presence of pleural effusion. The degree of pleural effusion was assessed by chest X-ray.ResultsFifteen (13.0%) treatment sessions in 14 patients showed right-sided pleural effusion after ablations. One patient had a large amount of effusion, while other patients manifested a minimal to small amount of effusion. There were 5 patients that experienced delayed resolution of pleural effusion; one patient (0.87%) had a minimal amount of pleural effusion even after one month. Overall, there was no pneumothorax, or periprocedural morality. Age, gender, tumor numbers, tumor sizes, and complete ablation of target tumors were similar among groups presenting with or without pleural effusion. Tumor locations associated with S78 segments abutting the diaphragm or right lobe of the liver were not associated with development of pleural effusion. Only the duration of ablation time had a marginal trend toward significance (p = 0.051).ConclusionsThe transient appearance of right-sided pleural effusion after percutaneous RFA for hepatic malignancies was not infrequent. However, refractory pleural effusion was rare

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ABSTRACT. Objective. To examine (1) the risk of death from cardiovascular disease (CVD) and from all causes in patients with gout who do not undergo urate-lowering therapy (ULT), and (2) the effect of ULT on mortality risk in patients with gout. Methods. In this prospective case-matched cohort study, 40,623 Taiwanese individuals aged ≥ 17 years were followed for 6.5 years. Mortality rate was compared between 1189 patients with gout who did not receive ULT and reference subjects (no gout, no ULT) matched for age, sex, and the index date of gout diagnosis (1:3 patients with gout/reference subjects), and between 764 patients with gout who received ULT and 764 patients with gout who did not receive ULT matched 1-to-1 based on their propensity score and the index date of ULT prescription

Effects of an irregular bedtime schedule on sleep quality, daytime sleepiness, and fatigue among university students in Taiwan

<p>Abstract</p> <p>Background</p> <p>An irregular bedtime schedule is a prevalent problem in young adults, and could be a factor detrimentally affecting sleep quality. The goal of the present study was to explore the association between an irregular bedtime schedule and sleep quality, daytime sleepiness, and fatigue among undergraduate students in Taiwan.</p> <p>Methods</p> <p>A total of 160 students underwent a semi-structured interview and completed a survey comprising 4 parts: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and a rating of irregular bedtime frequency. Participants were grouped into 3 groups in terms of irregular bedtime frequency: low, intermediate, or high according to their 2-week sleep log. To screen for psychological disorders or distress that may have affected responses on the sleep assessment measures, the Chinese health questionnaire-12 (CHQ-12) was also administered.</p> <p>Results</p> <p>We found an increase in bedtime schedule irregularity to be significantly associated with a decrease in average sleep time per day (Spearman r = -0.22, p = 0.05). Multivariate regression analysis revealed that irregular bedtime frequency and average sleep time per day were correlated with PSQI scores, but not with ESS or FSS scores. A significant positive correlation between irregular bedtime frequency and PSQI scores was evident in the intermediate (partial r = 0.18, p = 0.02) and high (partial r = 0.15, p = 0.05) frequency groups as compared to low frequency group.</p> <p>Conclusion</p> <p>The results of our study suggest a high prevalence of both an irregular bedtime schedule and insufficient sleep among university students in Taiwan. Students with an irregular bedtime schedule may experience poor sleep quality. We suggest further research that explores the mechanisms involved in an irregular bedtime schedule and the effectiveness of interventions for improving this condition.</p

A Prospective Study of Hyperuricemia on outy Arthritis and Mortality of Cardiovascular Disease

研究目的：尿酸與痛風發生頻率的相關性，已有確切的流行病學文獻支持。同時也有研究進一步報告指出具有痛風的病史，較有冠心病更易於導致心血管疾病的死亡。所以學者乃由尿酸與痛風之間的強烈相關性，進而揣測尿酸與心血管疾病之間的可能相關性。雖然目前這種相關性在高危險族群中，已較為確立，但是尿酸在一般人群中是否是一個心血管疾病的危險因子，仍具爭議。外雖然目前教科書上對於高尿酸血症與痛風的診斷，已使用明確的血尿酸濃度切點，但是有關尿酸濃度與痛風發作的關係的診斷學數據，卻尚未有大型人群調查資料可資佐證。以本研究(1)旨在決定不同血尿酸濃度預估痛風發作危險的可行性，期望能更適切的定義痛風疾病診斷的尿酸篩檢濃度，並建立未來痛風疾病的預防與治療目標指引。(2)評估一般民眾的血尿酸濃度、高尿酸血症(血尿酸濃度大於7 mg/dl)，與全死亡率以及各種不同心血管疾病死亡的因果時序相關性。究方法：這是一個前瞻性的世代研究，使用台灣美兆健診中心的資料(1)研究十八歲以上體檢病人，尿酸與痛風之間的相關性。(2)研究三十五歲以上體檢病人中，尿酸與心血管疾病的相關性。前者(1)的追蹤結果是根據台灣的健保資料檔，並定義痛風為（甲）至少兩次的一般科醫師或風濕科專科醫師的診斷登記為屬於痛風的ICD或A碼。（乙）同時候的醫師處方也開立有秋水仙與降尿酸的藥物。以此針對血尿酸濃度的增加來評估痛風發作的相關危險性。後者(2)的追蹤結果是根據台灣的國家死亡登記檔，比較血尿酸濃度的增加對於全死亡率、及各種心血管死亡率的相關危險性。本研究分別得到中央研究院與中國醫藥大學的人體試驗委員會同意，並使用COX比例危害迴歸模型，以及統計軟體SAS 9.01版 (SAS Institute, Cary, NC)作為分析工具。究結果：本研究從1994年到96年的原始美兆健診中心的資料檔案共取得146,900筆(男性67,954筆，女性 78,946筆) 的資料，經過排除不適當的資料，得到研究（1）共有132,556筆大於十八歲的參加者資料(男性60,181筆，女性 72,375筆)進入分析，平均追蹤時間為7.31年，其間共有1,606 筆(男性1,341筆，女性265筆) 的痛風診斷。經估計痛風的標準年發生率為每千人有1.69 人年。經採用接受操作特徵曲線（ROC curve）方式推測得血尿酸濃度對於痛風預測最高敏感度與特定度的極限值估計，男性為7.5 mg/dl，女性為6.0 mg/dl。並採用人口可歸因危險百分比分析，顯示血尿酸濃度在6 mg/dl 以上可以解釋85.4%的男性痛風，與血尿酸濃度在4.5 mg/dl以上可以解釋85.2%的女性痛風。究（2）則有90,393筆大於三十五歲參加者(男性67,954筆，女性 78,946筆)的資料進入分析，平均追蹤時間為8.2年，共有5,427個死亡，其中包括心血管疾病死亡1,151人(21.2%)。藉由比例危害迴歸模型以及進一步校正相關干擾因子如：年齡、性別、身體質量比、高膽固醇症、高三酸甘油酯症、糖尿病、高血壓、抽菸與喝酒等，來估計血尿酸對心血管疾病的危險風險比。結果發現高尿酸血症與全死亡率、心血管疾病、與缺血性腦中風死亡率的危險風險比分別是1.16 (p &lt;0.001)、1.39 (p &lt;0.001)、與1.35 (p =0.02)。這種相關危險性不僅出現在高血壓(1.44, p &lt;0.001)或糖尿病(1.64, p &lt;0.001)等高危險群中，即連低風險的族群中，尿酸對全死亡率、及心血管死亡率的危險風險比也分別是1.24 (p =0.02)與1.48 (p =0.16)。究結論：我們在此前瞻性人群調查研究中發現，在不同性別的血尿酸濃度，對於痛風的發作預測，可能有不同的篩檢與預防極限值。並且在本研究中我們也發現高尿酸血症不僅在台灣的一般民眾中是全死亡率、以及心血管疾病、缺血性中風死亡率的一個獨立危險因子，這同時也獨立影響及於高危險族群，與潛在的低風險的族群。這個發現在臨床上應用的可行價值仍須待進一步的探討與研究。Objective. The association between the serum uric acid (sUA) level and the frequency of gout attack has been documented in epidemiologic reports. Gout was reported as a predisposing factor for cardiovascular disease (CVD) mortality. A relationship between sUA and CVD was thus speculated due to a strong association between sUA and gout. Although this association in high-risk groups has been documented, in general population it was yet undetermined. Besides, while we understand a definition of sUA level on hyperuricemia and gout diagnosis has been documented in the textbook, the prospective research to report a risk threshold of sUA for the occurrence of gout is still limited. Therefore the objectives of this study were aimed (1) to determine the risk of gout in relation to sUA levels and to find an optimal control level for gout prevention, and (2) to assess the temporal association between sUA level, hyperuricemia (sUA level &gt;7 mg/dl), and mortality of all-cause and CVD in the general population.ethods. A prospective cohort study of the association between sUA and gout on &gt;18 years old participants, and of the association between sUA and mortality on &gt;35 years old subjects, was conducted using data from the MJ Health Screening Centers in Taiwan. The formal sub-study used outcome follow-up data from the National Health Insurance and the latter from the National Mortality Registry in Taiwan. In the formal, criteria for gout diagnosis consisted of (1) A-code or ICD-code of gout assigned during at least two visits to physicians or rheumatologists, and (2) simultaneous prescription of colchicine and urate-lowering drugs. Likewise, the risk of gout was estimated with respect to sUA levels. In the latter sub-study, mortality from all causes, total and respective CVD were compared according to increasing sUA levels. Cox proportional hazard model was used for analysis in both sub-studies which were approved either by the Institutional Review Board of Academia Sinica, Taipei, Taiwan, or by the Institutional Review Board of the China Medical University Hospital. The statistical software SAS version 9.01 (SAS Institute, Cary, NC) was used for analysis.esults. Data from 146,900 participants (67,954 men and 78,946 women) of MJ Health Screening Center from 1994 to 1996 were retrieved for analysis. In the formal sub-study on gout, there were a total of 132,556 individuals (60,181 men and 72,375 women) included in the analysis, with a mean follow-up of 7.31 years. Among them, 1,606 (1,341 men and 265 women) were diagnosed with gout. The standardized overall annual incidence of gout was 1.69 cases per 1,000 person-years. Using the receiver operating characteristic plot method to maximize sensitivity and specificity for predicting gout, the most appropriate sUA thresholds were 7.5 mg/dl for men and 6.0 mg/dl for women. Population-attributable risk analysis revealed that 85.4% of male and 85.2% of female incident gout were attributable to sUA levelsTable of Contents 試委員會審定書…………………………………………II謝…………………………………………………………III文摘要……………………………………………………IV文摘要……………………………………………………VIIhapter 1、BACKGROUND AND SIGNIFICANCE…………….……..1-1. Hyperuricemia………………..…….……….………….………….....1-2. Gout……....................................................................….…….3-3. Inter-relations among Hyperuricemia, Gout, Metabolic Syndrome and Cardiovascular Diseases……...............................................….…7-4. Cohort Studies…………………………………………………..…….16-5. Unresolved Questions...................................................................................19hapter 2、 OBJECTIVES..………………………………………………….......26hapter 3、PATIENTS AND METHODS……………………………………….. 27-1.Study design…………………………………………………………….27-2.Data collection and variables of interest………………………28-3. Follow-up and end-points…………………………………………29-4. Statistical analysis…………………………………………….30hapter 4、RESULTS……………..……………………………………………….33art I Study of Association between Serum Uric Acid and Gouty arthritis…………………………………………………………………..33-1-1. Baseline characteristics and comorbidities.……..………….…..33-1-2. Age, gender, serum uric acid and incident gout.……..…………34-1-3. Diagnostic characteristics of serum uric acid level in predicting incident gout. ……………………………………………………….…35-1-4. Population-attributable risk of incident gout at various levels of serum uric acid.………..……………………………………………….36art II Study of Association between Serum Uric Acid and Cardiovascular Mortality………………..……………………….…….37-2-1 Participant characteristics…………………..…………..…….…...37-2-2. Effect of hyperuricemia in all patients……………………….….37-2-3. Effect of hyperuricemia in high-risk (patients with hypertension and diabetes) and low-risk subgroups…………….………..…….….38-2-4 Sex Effect.…………………………………………………….39hapter 5、DISCUSSION…………...…………………………………..………….41art I. Study of Association between Serum Uric Acid and Gouty Arthritis………………………………..………….………………..……41art II Study of Association between Serum Uric Acid and Cardiovascular Mortality…..……..…….……………………………..46hapter 6、CONCLUSIONS……………………………………………..…..……50ables、able 1、Causes of hyperuricemia…………………………………………22able 2、 Summary of most recent prospective cohort studies examining the association between serum uric acid and cardiovascular outcomes among high-risk patients.…..........….…23able 3、 Summary of most recent prospective cohort studies that showed no association between sUA and cardiovascular outcomes in the general population...........................................................…24able 4、Summary of most recent prospective cohort studies that showed a positive association between serum uric acid and cardiovascular outcomes in the general population...................…25able 5. Baseline characteristics of the participants in the MJ Health Screening Center, stratified by gender (N=132,556)……………......…..52able 6. Baseline characteristics of MJ participants who developed gout versus those who did not……………………………………………...………...53able 7. Relative risks of each metabolic risk factor on the occurrence of gouty arthritis, stratified by genders……………………………………...……..54able 8. Baseline characteristics of the participants in the MJ ealth Screening Center, stratified by gender.............................................................55able 9. Risk of hyperuricemia or per unit increase in SUA on mortality of all-cause, and various types of cardiovascular diseases. (n = 89,469)…..............................................................................................................56igure、igure 1, Relationship between incidence (per 1,000 person-years) of gout and serum uric acid levels by gender and by age. Incidence estimates and 95% confidence intervals are provided…………….…..57igure 2, Hazard ratios of gout attack comparing higher serum uric acid quartiles to the lowest quartile, stratified by gender. There are 1,606 (1,341 men and 265 women) gout events occurred in 132,556 participants (60,181 men and 72,375 women). ……………....………..58igure 3, Sensitivity, specificity, predictive values, and population- attributable risk by various levels of baseline serum uric acid Abbreviation: SEN: sensitivity; SPE: specificity; PPV: positive predictive value; NPV: negative predictive value; PAR: population attributable risk……………………………………………………...…………..59igure 4. Survivorship from total cardiovascular disease (CVD) mortality, stratified by increasing serum uric acid levels from a mean (SD) of 8.2 (1.3) years follow-up of the MJ health examinees….....................................................................................................…60igure 5. Hazard ratios (HRs) of hyperuricemia (serum uric acid &gt;7 mg/dl) on mortality from (A), cardiovascular disease (1,151 events) and (B), all-causes (5,427 events), for all examinees (n = 90,393) and for patients with hypertension (n = 29,421) and diabetes (n = 7,899)…................................................................................................................61igure 6. Respective cardiovascular disease (CVD) mortality rates (A and B) and hazard ratios (C and D) according to serum uric acid (sUA) level quartiles (A and C) and ordered sUA categories (B and D) in both sexes..............................................................................................................62EFERENCES…………..…………………………………...……………6

Identification of Resting-State Network Functional Connectivity and Brain Structural Signatures in Fibromyalgia Using a Machine Learning Approach

Abnormal resting-state functional connectivity (rs-FC) and brain structure have emerged as pathological hallmarks of fibromyalgia (FM). This study investigated and compared the accuracy of network rs-FC and brain structural features in identifying FM with a machine learning (ML) approach. Twenty-six FM patients and thirty healthy controls were recruited. Clinical presentation was measured by questionnaires. After MRI acquisitions, network rs-FC z-score and network-based gray matter volume matrices were exacted and preprocessed. The performance of feature selection and classification methods was measured. Correlation analyses between predictive features in final models and clinical data were performed. The combination of the recursive feature elimination (RFE) selection method and support vector machine (rs-FC data) or logistic regression (structural data), after permutation importance feature selection, showed high performance in distinguishing FM patients from pain-free controls, in which the rs-FC ML model outperformed the structural ML model (accuracy: 0.91 vs. 0.86, AUC: 0.93 vs. 0.88). The combined rs-FC and structural ML model showed the best performance (accuracy: 0.95, AUC: 0.95). Additionally, several rs-FC features in the final ML model correlated with FM&rsquo;s clinical data. In conclusion, ML models based on rs-FC and brain structural MRI features could effectively differentiate FM patients from pain-free subjects

Risk factors for 14-day rehospitalization following trauma with new traumatic spinal cord injury diagnosis: A 10-year nationwide study in Taiwan.

Fourteen-day rehospitalization with new traumatic spinal cord injury (tSCI) diagnosis is used as an indicator for the diagnostic quality of the first hospitalization. In this nationwide population-based cohort study, we identified risk factors for this indicator.We conducted a nested case-control study by using the data of patients who received a first hospitalization for trauma between 2001 and 2011. The data were retrieved from Taiwan's National Health Insurance Research Database. Variables including demographic and trauma characteristics were compared between patients diagnosed with tSCI at the first hospitalization and those receiving a 14-day rehospitalization with new tSCI diagnosis.Of the 23 617 tSCI patients, 997 had 14-day rehospitalization with new tSCI diagnosis (incidence rate, 4.22%). The risk of 14-day rehospitalization with new tSCI diagnosis was significantly lower in patients with severe (injury severity score [ISS] = 16-24; odds ratio [OR], 0.17; 95% confidence interval [CI], 0.13-0.21) and profound (ISS > 24; OR, 0.11; 95% CI, 0.07-0.18) injuries. Interhospital transfer (OR, 8.20; 95% CI, 6.48-10.38) was a significant risk factor, along with injuries at the thoracic (OR, 1.62; 95% CI, 1.21-2.18), lumbar (OR, 1.30; 95% CI, 1.02-1.65), and multiple (OR, 3.23; 95% CI, 1.86-5.61) levels. Brain (OR, 2.82), chest (OR, 2.99), and abdominal (OR, 2.74) injuries were also identified as risk factors. In addition, the risk was higher in patients treated at the orthopedic department (OR, 2.26; 95% CI, 1.78-2.87) and those of other surgical disciplines (OR, 1.89; 95% CI, 1.57-2.28) than in those treated at the neurosurgery department.Delayed tSCI diagnoses are not uncommon, particularly among trauma patients with ISSs < 16 or those who are transferred from lower-level hospitals. Further validation and implementation of evidence-based decision rules is essential for improving the diagnostic quality of traumatic thoracolumbar SCI