Background/Aims: Chronic hepatitis C (CHC) patients who failed antiviral therapy are at increased risk for hepatocellular carcinoma (HCC). This study assessed the potential role of metformin and statins, medications for diabetes mellitus (DM) and hyperlipidemia (HLP), in reducing HCC risk among these patients. Methods: We included CHC patients from the T-COACH study who failed antiviral therapy. We tracked the onset of HCC 1.5 years post-therapy by linking to Taiwan’s cancer registry data from 2003 to 2019. We accounted for death and liver transplantation as competing risks and employed Gray’s cumulative incidence and Cox subdistribution hazards models to analyze HCC development. Results: Out of 2,779 patients, 480 (17.3%) developed HCC post-therapy. DM patients not using metformin had a 51% increased risk of HCC compared to non-DM patients, while HLP patients on statins had a 50% reduced risk compared to those without HLP. The 5-year HCC incidence was significantly higher for metformin non-users (16.5%) versus non-DM patients (11.3%; adjusted sub-distribution hazard ratio [aSHR]=1.51; P=0.007) and metformin users (3.1%; aSHR=1.59; P=0.022). Statin use in HLP patients correlated with a lower HCC risk (3.8%) compared to non-HLP patients (12.5%; aSHR=0.50; P<0.001). Notably, the increased HCC risk associated with non-use of metformin was primarily seen in non-cirrhotic patients, whereas statins decreased HCC risk in both cirrhotic and non-cirrhotic patients. Conclusions Metformin and statins may have a chemopreventive effect against HCC in CHC patients who failed antiviral therapy. These results support the need for personalized preventive strategies in managing HCC risk.

OBJECTIVE: To investigate the complications of tourniquet in the clinical application of lower tibiofibular fracture. METHODS: From June 2018 to September 2019, 33 cases of closed lower tibiofibular fractures (AO type 43A) were treated with plates and screws and were divided into two groups according to whether pueumatic tourniquet was used:16 cases in the observation group, 13 males and 3 females, aged 18 to 69 (38.8±17.0) years, the operation time after injury was (6.9±1.7) days, and tourniquet was not used during operation. There were 17 cases in the control group, 13 males and 4 females, aged from 21 to 71 (43.8±12.4) years, the operation time after injury was (6.5±1.0) days, automatic pneumatic tourniquetwas routinely used in the operation. The operation time, blood loss, postoperative swelling, pain and other complications were compared between two groups. RESULTS: Total of 33 patients were followed up for an average of 15 months. There was no significant difference in operation time and blood loss between two groups ( CONCLUSION The fracture of lower tibiofibular segment is superficial and easy to be exposed and fixed during operation. In order to avoid tourniquet complications, it is not recommended to use air bag tourniquet routinely or minimize the application time of tourniquet.
Adolescent ; Adult ; Aged ; Female ; Fracture Fixation, Internal ; Fractures, Bone/surgery* ; Humans ; Male ; Middle Aged ; Operative Time ; Retrospective Studies ; Tourniquets ; Treatment Outcome ; Young Adult

Objective To use World Health Organization Family International Classifications (WHO-FICs) to explore the framework and approaches of development and research of guidelines of rehabilitation at levels of policies, community and services.Methods The important documents and tools of rehabilitation at international level, including United Nations Convention on the Rights of Persons with Disabilities, WHO World Report on Disability, Community-based Rehabilitation Guideline, Rehabilitation in Health Service System, and International Classification of Diseases (ICD), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Intervention (ICHI) of WHO-FICs, had been discussed.Results The framework, classifications, diagnosis and description of diseases and functioning, coding, intervention and functioning evaluation based on ICD-11, ICF and ICHI-β-2 had been established for development and implementation of rehabilitation guidelines and Cochrane rehabilitation.Conclusion The framework and systematic approaches of ontology, classification, terminology, coding, diagnosis and description of diseases and functioning, interventions and evaluations for the development and implementation of rehabilitation guidelines had been developed.

AIM:To analyze the changes of retinal hemodynamics in patients with diabetic retinopathy (DR) by color Doppler ultrasonography.METHODS:Totally 96 patients (96 eyes) with diabetes mellitus (DM) treated in our hospital from June 2014 to May 2017 were selected and divided into A,B,C three groups.Group A consisted of 32 DM patients (32 eyes),Group B with 32 cases (32 eyes) of non-proliferative diabetic retinopathy (NPDR),Group C 32 cases (32 eyes)of proliferative diabetic retinopathy(PDR),and 30 healthy volunteers (30 eyes) were set as control group.All patients' the central retinal artery (CRA),posterior ciliary artery (PCA),ophthalmic artery (OA) hemodynamic changes were detected by color Doppler ultrasound.And the relation of HbA1c and FBG with diabetic lesion degree were studied.RESULTS:The hemodynamic indexes of CRA,PCA and OA in each group were statistically significant (P＜0.05).The difference of PSV of CRA,PCA and OA in Group A and control group was not statistically significant (P＞0.05).The PSV and EDV of CRA,PCA and OA in Group C were the lowest,and the RI was the highest,which had a significant difference between Group A and B (P＜0.05).HbA1c and FBG in each group showed statistical significance (P＜0.05).Course of disease in Group A and Group C only showed significantly different (P＜0.05).CONCLUSION:Color Doppler ultrasound monitoring changes of CRA,PCA,OA hemodynamics in diabetic patients can bring us more understand in retinal blood flow,and play a vital role in prevention and treatment of diabetic retinopathy.

OBJECTIVETo explore the effect of a self-made guiding needle of steel wire in guiding the wire through the tibial tunnel for the treatment of avulsion fractures of tibial posterior cruciate ligament with open reduction and wire fixation.

METHODSFrom February 2011 to June 2014, a total of 22 patients with avulsion fractures of tibial posterior cruciate ligament underwent surgical treatments were analyzed, including 14 males and 8 females with an average age of 35.6 years old (ranged, 17 to 63 years old). According to Meyers classification, 9 patients were classified as type II, 13 patients were classified as type III. All the patients underwent open reduction and wire fixation with medial knee "L" shape approach. A wire guiding needle was used to guide the wire through the tibial tunnel during operation.

RESULTSWith the assistance of wire guidance needles, wires passed through the tibial tunnel rapidly during the operation in all the 22 patients. All the patients were followed up, X-ray imagings 6 months after operation showed the fractures healed well. The average follow-up time in all patients was 6 months (ranged, 6 to 12 months). The averaged Lysholm knee score in 22 knee was 92.7 +/- 3.4. All patients' posterior drawer test were negative.

CONCLUSIONSelf-made wire guiding needle can simplify the operation procedures in which the wires pass through the tibial tunnel, shorten the operation time, reduce the surgical trauma and complications, and be worthy of clinical application.

Adolescent ; Adult ; Bone Wires ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Posterior Cruciate Ligament ; injuries ; surgery ; Tibia ; injuries ; surgery ; Tibial Fractures ; surgery ; Young Adult

OBJECTIVETo investigate the association of maternal body composition and dietary intake with the risk of gestational diabetes mellitus (GDM).

METHODSA total 154 GDM subjects and 981 controls were enrolled in a prospective cohort study in 11 hospitals from May 20, 2012 to December 31, 2013. Bioelectrical impedance analysis and dietary surveys were used to determine body composition and to evaluate the intake of nutrients in subjects at 21-24 weeks' gestation (WG). Logistic regression analysis was applied to explore the relationships of maternal body composition and dietary intake with the risk of GDM morbidity.

RESULTSAge, pre-pregnant body weight (BW), and body mass index (BMI) were associated with increased risk of GDM. Fat mass (FM), fat mass percentage (FMP), extracellular water (ECW), BMI, BW, energy, protein, fat, and carbohydrates at 21-24 WG were associated with an increased risk of GDM. In contrast, fat free mass (FFM), muscular mass (MM), and intracellular water (ICW) were associated with a decreased risk of GDM.

CONCLUSIONMaternal body composition and dietary intake during the second trimester of pregnancy were associated with the risk of GDM morbidity.

Adult ; Asian Continental Ancestry Group ; Body Composition ; Body Mass Index ; Cohort Studies ; Diabetes, Gestational ; epidemiology ; Diet ; Diet Surveys ; Feeding Behavior ; Female ; Humans ; Pregnancy ; Pregnancy Trimester, Second ; Risk Factors

OBJECTIVEThis study was aimed to investigate the effects of carbon monoxide releasing molecule (CORM-2), a novel carbon monoxide carrier, on the reendothelialization of carotid artery in rat endothelial denudation model.

METHODSMale rats subjected to carotid artery balloon injury were treated with CORM-2, inactive CORM-2 (iCORM-2) or dimethyl sulfoxide (DMSO). The reendothelialization capacity was evaluated by Evans Blue dye and the immunostaining with anti-CD31 antibody. The number of circulating endothelial progenitor cells (EPCs) was detected by flow cytometry. The proliferation, migration, and adhesion of human umbilical vein endothelial cells (HUVECs) were assessed by using [3H]thymidine, Boyden chamber and human fibronectin respectively. The expressions of protein were detected by using western blot analysis.

RESULTSCORM-2 remarkably accelerated the re-endothelialization 5 d later and inhibited neointima formation 28 d later. In addition, the number of peripheral EPCs significantly increased in CORM-2-treated rats than that in iCORM-2 or DMSO-treated rats after 5 d later. In vitro experiments, CORM-2 significantly enhanced the proliferation, migration and adhesion of HUVECs. The levels of Akt, eNOS phosphorylation, and NO generation in HUVECs were also much higher in CORM-2 treated group. Blocking of PI3K/Akt/eNOS signaling pathway markedly suppressed the enhanced migration and adhesion of HUVECs induced by CORM-2.

CONCLUSIONCORM-2 could promote endothelial repair, and inhibit neointima formation after carotid artery balloon injury, which might be associated with the function changes of HUVECs regulated by PI3K/Akt/eNOS pathway.

Animals ; Carbon Monoxide ; metabolism ; pharmacology ; Carotid Artery Injuries ; drug therapy ; immunology ; metabolism ; pathology ; Carotid Artery, Common ; drug effects ; immunology ; metabolism ; pathology ; Cell Adhesion ; drug effects ; Disease Models, Animal ; Endothelial Cells ; drug effects ; immunology ; metabolism ; pathology ; Endothelium, Vascular ; drug effects ; metabolism ; pathology ; Humans ; Male ; Rats ; Rats, Sprague-Dawley

Objective To study the correlation between the changes of serum neuron specific enolase (NSE) level and psychological statuses in patients with cerebral concussion.Methods Forty patients with cerebral concussion,admitted to our hospital from January 2012 to December 2012,were chosen in our study as experimental group,and other 40 healthy controls performed physical examination in our Physical Examination Center at the same period were chosen.The serum NSE level in the two groups was determined by enzyme-linked immunosorbent assay (ELISA); Symptom Checklist 90 (SCL-90) scale was performed in 40 patients at different times after injury,and these data were compared with those from the national norm; the correlation between the changes of serum NSE level and SCL-90 scores was analyzed.Results The serum NSE level in the experimental group 1 d after the injury was obviously higher than that in the control group (P＜0.05); 3 and 7 d after the injury,the serum NSE level in the experimental group was close to normal level,which showed no significant differece as compared with that in the control group (P＞0.05).The SCL-90 scores in the experiemtal group 1,3 and 7 d after injury was signficantly higher than that of the national norm (P＜0.05).Positive corelation was noted between serum NSE level and SCL-90 scores 1 and 3 d after injury (r=0.498,P=0.001; r=0.418,P=0.007);however,negative corelation was noted btween the two 7 d after injury (r=0.213,P=0.186).Conclusion Different corelation can be noted between serum NSE level and SCL-90 scores at different time points;combined application of serum NSE level and SCL-90 scores can promote the diagnosis and treatment of patients with brain concussion.

Adult ; Antiviral Agents ; administration & dosage ; therapeutic use ; Hepatitis C ; complications ; drug therapy ; Humans ; Kidney Transplantation ; methods ; Male ; Premedication ; Renal Dialysis ; Uremia ; complications

OBJECTIVETo investigate the usability of quick exposure check (Quick Exposure Check, QEC) for the field assessment of occupational musculoskeletal disorder risk factors.

METHODIn the shipyard and automobile manufacturing plants, QEC was used to observe the operations among workers with different jobs and to assess the work loads of workers. On the basis of results, the reliability of QEC was evaluated, and the correlation between QEC scores and morbidities of musculoskeletal disorders in workers was analyzed.

RESULTSThe inter-observer reliability (ICC) was in the range from 0.737 to 1.000, and intra-observer reliability (Spearman coefficient) was from 0.605 to 1.000. The order of exposure levels to risk factors of workers engaged in different jobs (QEC scores) in the shipyard factory was plumbers > assemblers > welders; The order of exposure levels to risk factors of workers engaged in different jobs (QEC scores) in the automobile factory was welders > punching workers > machinists > casters > assemblers. In different body parts, the exposure level at back and neck parts was the highest and the exposure level at the shoulder and wrist parts was the second. The regression analysis between QEC scores of body parts and the morbidities of musculoskeletal disorders showed that there was a good correlation between exposure levels and morbidities, the coefficients (r(2)) at the shoulder, wrist, and back (static work) were 0.670, 0.740 and 0.958, respectively (P < 0.05).

CONCLUSIONThe QEC method is suitable and reliable as demonstrated by the field assessment on the exposure to risk factors in shipyard and automobile workers, and its results is correlated closely to the disease prevalence.

Adult ; Cross-Sectional Studies ; Humans ; Musculoskeletal Diseases ; epidemiology ; Occupational Diseases ; epidemiology ; Occupational Exposure ; adverse effects ; Occupational Health ; Prevalence ; Risk Assessment ; Risk Factors ; Workload ; Workplace