Abstract Excluding tracheostomy, maxillomandibular advancement (MMA) is the most effective surgical treatment for obstructive sleep apnoea (OSA). However, the anticipated facial changes may prevent ...acceptance of this procedure by patients with bimaxillary protrusion, a common feature of Asian faces. We therefore developed a modified MMA technique for such cases, consisting of anterior segmental osteotomies together with standard Le Fort I and bilateral sagittal split osteotomies. A prospective study of 20 consecutive Taiwanese adults with moderate-to-severe OSA who underwent modified MMA and postsurgical orthodontics was undertaken to evaluate the efficacy with regard to OSA and the postoperative facial appearance and dental occlusion. After modified MMA, the mean apnoea–hypopnoea index decreased from 41.6 ± 19.2 n /h to 5.3 ± 4.0 n /h ( P < 0.001). All patients had a successful outcome. No patient was dissatisfied with their postoperative facial appearance. The mean Peer Assessment Rating score decreased from 21.9 ± 14.3 to 1.7 ± 1.6 ( P = 0.001). The data suggest that the modified MMA is effective in treating patients with moderate-to-severe OSA without negatively affecting facial appearance or dental occlusion. To achieve a better outcome, surgical–orthodontic integration is warranted. The surgery-first approach can achieve early improvement.
Summary
A growing elderly population is expected worldwide, and the burden of hip fractures on health care system will continue to increase. By 2035, there will be a 2.7-fold increase in the number ...of hip fractures in Taiwan. The study provides quantitative basis for the future distribution of medical resources.
Introduction
Hip fractures have long been recognized as a major public health concern. The study aimed to determine time trends in the incidence of hip fractures and to forecast the number of hip fractures expected in Taiwan up to 2035.
Methods
A nationwide survey was conducted using data from the Taiwan National Health Insurance Research Database from 2004 to 2011. A total of 141,397 hip fractures were identified, with a mean of 17,675 fractures/year. Annual incidences of hip fractures were calculated and tested for trends. Projections of the incidence rates of hip fractures and bed days associated with hip fractures were calculated using Poisson regression on the historical incidence rates in combination with population projections from 2012 to 2035.
Results
The incidence rates of hip fracture during 2004–2011 were 317 and 211 per 100,000 person-years among women and men, respectively. Over this 8-year period, the age-standardized incidence of hip fracture decreased by 13.4 % among women and 12.2 % among men. Despite the decline in the age-standardized incidence, the absolute number of hip fractures increased owing to the aging population. The number of hip fractures is expected to increase from 18,338 in 2010 to 50,421 in 2035—a 2.7-fold increase. The number of bed days for 2010 and 2035 was estimated at 161,248 and 501,995, respectively, representing a 3.1-fold increase.
Conclusions
The socioeconomic impact of hip fractures will be high in the near future. This study provides a quantitative basis for future policy decisions to serve this need.
The ultrahigh‐pressure (UHP) eclogite in the Dabie orogen preserves petrological evidence for the existence of hydrous silicate melts that formed during continental subduction‐zone metamorphism. This ...is indicated by occurrence of multiphase solid (MS) inclusions in garnet that primarily consist of K‐feldspar + quartz ± epidote/allanite. All the MS inclusions are euhedral to subhedral in morphology and surrounded with radial cracks in the host garnet. Their trace element compositions were analysed by two different approaches of laser sampling. The mass budget method was used to estimate the trace element abundances of MS inclusions from their mixtures with the host garnet. The results are compared with the direct sampling of MS inclusions, providing a first‐order approximation to the trace element composition of MS inclusions. The MS inclusions exhibit consistent enrichment of LILE, Sr and Pb, but depletion of HFSE in the primitive mantle‐normalized spidergram. Such arc‐like patterns of trace element distribution are common for continental crustal rocks. The melts have variably high K, Rb and Sr abundances, suggesting that breakdown of phengite is a basic cause for partial melting of the UHP eclogite. These MS inclusions also exhibit consistently low HFSE and Y contents, suggesting partial melting of the eclogite in the stability fields of rutile and garnet. Consequently, the trace element composition of MS inclusions provides a proxy for that of hydrous silicate melts derived from dehydration melting of the UHP eclogite during continental collision.
Abstract Background Primary liver malignancy is the leading cause of cancer death worldwide, with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) representing the majority. Combined ...HCC-CC, in contrast, accounts for less than 5% of these liver cancers and has not been clearly characterized by imaging, making diagnosis and management difficult. Materials and Methods This retrospective study investigated 32 patients with early-stage combined HCC-CC tumor who underwent hepatectomy (n = 24) or liver transplantation (n = 8). Preoperative imaging and pathologic reports were retrospectively reviewed and correlated. Survival and recurrence rates were then analyzed. Results Twelve patients with more than 50% CC component showed typical CC enhancement, whereas 17 patients with less than 50% CC component exhibited typical HCC enhancement. Those with equivocal imaging findings resulted near equal tumor component. The majority demonstrated either heterogeneous or peripheral enhancement. Considering the major tumor component, 66% of the images were consistent with histopathology. The over-all 3-year recurrent rate was 59%, with a mean time to recurrence of about 7 months. The 3-year survival rate of combined tumor after hepatectomy was 76% and after transplant was 75%, regardless of major tumor component. However, patients with more than 50% CC component showed a decrease in 3-year survival rate to 50% when transplantation was performed. Conclusion The overall survival rate for combined tumor after either hepatectomy or transplantation seems to be satisfactory but carries a high risk of recurrent when compared to pure HCC. On the other hand, a major CC component tumor after transplantation is associated with poor survival outcome; thus, liver transplantation has no role and is not a good management option.
Background. Algorithms for the diagnosis of syphilis continue to be a source of great controversy, and numerous test interpretations have perplexed many clinicians. Methods. We conducted a ...cross-sectional study of 24 124 subjects to analyze 3 syphilis testing algorithms: traditional algorithm, reverse algorithm, and the European Centre for Disease Prevention and Control (ECDC) algorithm. Every serum sample was simultaneously evaluated using the rapid plasma reagin, Treponema pallidum particle agglutination, and chemiluminescence immunoassay tests. With the results of clinical diagnoses of syphilis as a gold standard, we evaluated the diagnostic accuracy of the 3 syphilis testing algorithms. The κ coefficient was used to compare the concordance between the reverse algorithm and the ECDC algorithm. Results. Overall, 2749 patients in our cohort were diagnosed with syphilis. The traditional algorithm had the highest negative likelihood ratio (0.24), a missed diagnosis rate of 24.2%, and only 75.81% sensitivity. However, both the reverse and ECDC algorithms had higher diagnostic efficacy than the traditional algorithm. Their sensitivity, specificity, and accuracy were 99.38%–99.85%, 99.98%–100.00%, and 99.93%–99.96%, respectively. Moreover, the overall percentage of agreement and κ value between the reverse and the ECDC algorithms were 99.9% and 0.996, respectively. Conclusions. Our research supported use of the ECDC algorithm, in which syphilis screening begins with a treponemal immunoassay that is followed by a second, different treponemal assay as a confirmatory test in high-prevalence populations. In addition, our results indicated that nontreponemal assay is unnecessary for syphilis diagnosis but can be recommended for determining serological activity and the effect of syphilis treatment.
Background
Acne vulgaris is a prevalent skin condition. We have found that some acromegaly patients have acne. However, no study has examined the relationship between acromegaly and acne.
Objective
...To explore prevalence and correlation of adult acne in patients with acromegaly.
Methods
For this cross-sectional study, we collected questionnaires, clinical information, and laboratory test results of acromegaly patients from January 2022 to December 2022 at Huashan Hospital. Of the 133 questionnaires returned, 123 had valid responses.
Results
Of the 123 patients with acromegaly enrolled in this study, 54.5% had adult acne. No statistically significant difference was found in prevalence between male and female patients. 61.2% of adult acne patients reported late-onset acne. Late-onset acne patients first developed acne years before acromegaly diagnosis (mean of 5.6 years for male and 4.5 years for female patients). Some acne patients have received traditional anti-acne treatment. Moreover, 31% of the patients reported no improvement, and only 3.5% of patients claimed complete resolution of acne after treatment. Before acromegaly treatment, the prevalence of adult acne was 51.2%, with mild acne accounting for 73.0%, moderate acne accounting for 23.8%, and severe acne accounting for 3.2%. After acromegaly treatment, the prevalence of adult acne was significantly decreased to 37.4% (
P
= 0.007). An overall decrease in acne severity was noted, with 93.5%, 6.5%, and 0% having mild, moderate, and severe acne, respectively. A total of 83.6% of the patients had self-assessed acne remission, and 33.3% of the patients reported complete acne resolution. However, 9.0% of patients reported that their condition had worsened after acromegaly treatment. After treatment, GH, IGF-1, IGF-1 index, insulin levels, and HOMA-IR decreased significantly in all patients with acromegaly (
P
< 0.05). Acne remission correlated positively with IGF-1 levels, but not with GH levels. The relationship between acromegaly and acne remains to be elucidated.
Conclusions
Our findings provide preliminary evidence of the high prevalence of adult acne in acromegaly patients, and a high rate of late-onset acne as well. Traditional anti-acne treatments are less effective. Acne could be considerably relieved by treating acromegaly. Acne remission positively correlated with IGF-1 decline as well, which revealed the correlation between acne and IGF-1.
Abstract
We report an unusual pressure-induced superconducting state that coexists with an antiferromagnetic ordering of Eu
2+
moments and shows a large upper critical field comparable to the Pauli ...paramagnetic limit in EuTe
2
. In concomitant with the emergence of superconductivity with
T
c
≈ 3–5 K above
P
c
≈ 6 GPa, the antiferromagnetic transition temperature
T
N
(
P
) experiences a quicker rise with the slope increased dramatically from d
T
N
/d
P
= 0.85(14) K/GPa for
P
≤
P
c
to 3.7(2) K/GPa for
P
≥
P
c
. Moreover, the superconducting state can survive in the spin-flop state with a net ferromagnetic component of the Eu
2+
sublattice under moderate magnetic fields
μ
0
H
≥ 2 T. Our findings establish the pressurized EuTe
2
as a rare magnetic superconductor possessing an intimated interplay between magnetism and superconductivity.
This article presents a hysteretic water retention curve (WRC) and unsaturated hydraulic conductivity model for deformable soils based on the change in pore-size distribution (PSD). The PSD plays a ...decisive role in the water retention behaviour of soils. Although its evolution during deformation is rather complicated, experimental data showed that, the overall shapes and distribution characteristics of the PSD function are not significantly altered. Based on these findings, the PSD function at a deformed state is obtained by horizontal shifting, and vertical scaling of the corresponding PSD function at a reference state. On this basis, a hysteretic WRC model is formulated to account for the influences of deformation and hysteresis on the variation of saturation, using seven model parameters with clear physical meanings. The proposed model is then incorporated in the Mualem model to predict the unsaturated hydraulic conductivity for deformable soils, using only one additional parameter. A large number of published laboratory tests are used to validate the proposed model, showing that, it can reasonably capture important features of retention and permeability properties for deformable soils in most cases under consideration.
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