Kuo-Ti Peng

Background: Anterior femoral notching (AFN) >3 mm during total knee arthroplasty (TKA) has traditionally been considered a risk factor for periprosthetic femoral fractures (PFF). However, clinical observations suggest fractures can occur with minimal notching, warranting investigation into additional risk factors. Objectives: This study aimed to evaluate the association between AFN ≤3 mm and the risk of PFF following total knee arthroplasty (TKA), and to identify additional independent risk factors. Materials and Methods: A retrospective cohort study analyzed 3342 consecutive TKA procedures (2018–2024). After excluding 10 cases with AFN >3 mm, 3332 patients were stratified into non-AFN ( n = 3,256) and AFN ≤3 mm ( n = 76) groups. Patient demographics, comorbidities, and surgical variables were analyzed to identify independent PFF risk factors. Results: The overall PFF rate was 0.87%. The fracture incidence was significantly higher in the AFN ≤3 mm group (7.90%; 6/76) compared to the non-AFN group (0.70%; 23/3,256). Notably, half of the fractures (3 of 6) in the AFN ≤3 mm group occurred in patients with rheumatoid arthritis (RA). Interestingly, no fractures occurred in the excluded deep AFN cohort. While factors like prosthesis brand or systemic comorbidities were not significant, both RA ( P < 0.0001) and decreased bone mineral density (BMD) ( P = 0.006) were identified as potentially important independent predictors of PFF. Conclusions: This study suggested that in addition to AFN depth, identifying RA and low BMD as the two primary independent predictors for PFF. We found a crucial synergistic effect: In patients with RA, even AFN ≤3 mm becomes a critical fracture trigger. These findings suggested that preoperative risk stratification could benefit from incorporating a comprehensive assessment of patient-specific factors beyond surgical geometry. This approach may be particularly relevant for all patients, especially females, who require careful assessment due to their higher prevalence of low BMD, despite a direct gender link not being found in our cohort.

Lung cancer remains the leading cause of cancer mortality worldwide, and outcomes for advanced non-small cell lung cancer (NSCLC) are limited by resistance and toxicity. Sirtuin 3 (SIRT3), a mitochondrial NAD⁺-dependent deacetylase, regulates mitochondrial homeostasis and redox balance, but its therapeutic potential in NSCLC is incompletely defined. Here, bioinformatic analyses, structure-based virtual screening, and in vitro and in vivo validation were used to evaluate SIRT3 modulation in NSCLC. Although SIRT3 mRNA expression varied across lung cancer cohorts, higher SIRT3 expression was associated with better overall survival in lung adenocarcinoma (LUAD), and protein-level analyses demonstrated reduced SIRT3 expression in lung cancer specimens. Immunohistochemical analysis of clinical specimens and western blotting of NSCLC cell lines further confirmed reduced SIRT3 expression in lung cancer. To identify a SIRT3-targeting compound, we performed structure-based virtual screening using the SIRT3 crystal structure and prioritized oroxylin A phosphate diethyl ester (OA-OEt), a derivative of oroxylin A. OA-OEt markedly enhanced SIRT3 activity and exhibited stronger antiproliferative effects than oroxylin A in H1299 and A549 cells. Mechanistically, OA-OEt suppressed cell growth, induced G2/M arrest, and increased apoptosis. OA-OEt disrupted mitochondrial homeostasis, including elevated mitochondrial superoxide, reduced SOD2, altered mitochondrial dynamics markers, and impaired mitochondrial respiration; mitochondrial ROS scavenging partially rescued apoptosis. In an H1299 xenograft model, OA-OEt reduced tumor growth without overt body-weight loss and increased tumor SIRT3 and cleaved caspase-3 with consistent mitochondrial marker changes. Collectively, these findings support SIRT3 as a functionally tumor-suppressive mitochondrial regulator in NSCLC and suggest that OA-OEt may represent a promising SIRT3-activating lead compound.

Prostate cancer (PCa), a highly prevalent cancer in men worldwide, is projected to rise in the coming years. As emerging data indicate the carcinogenic effects of fine particulate matter (PM2.5) in lung cancer and other site-specific cancers, there is an urgent need to evaluate the relationship between this environmental risk factor and PCa as a potential target for intervention. The present review provides up-to-date evidence about the impact of airborne PM2.5 pollution on the initiation and progression of PCa. Examining the composition and characteristics of PM2.5 reveals its ability to induce toxic effects, inflammatory injuries, and oxidative damages. Additionally, PM2.5 can attach to endocrine-disrupting chemicals implicated in prostatic carcinogenesis. Considering the potential significance of oxidative stress in the risk of the disease, our review underlines the protective strategies, such as antioxidant-based approaches, for individuals exposed to increased PM2.5 levels. Moreover, the findings call for further research to understand the associations and mechanisms linking PM2.5 exposure to PCa risk as well as to suggest appropriate measures by policymakers, scientific researchers, and healthcare professionals in order to address this global health issue.

Despite aggressive antibiotic therapy and surgical debridement, Aeromonas necrotizing fasciitis (NF) can lead to high amputation and mortality rates. Our study compares the different antibiotic minimum inhibitory concentrations (MICs) via Epsilometer tests (E-tests) between non-survivors and survivors of Aeromonas NF of limbs. A prospective review of 16 patients with Aeromonas NF was conducted for 3.5 years in a tertiary coastal hospital. E-tests were conducted for 15 antimicrobial agents to determine the MIC value for Aeromonas species. These patients were divided into non-survival and survival groups. The clinical outcomes, demographics, comorbidities, presenting signs and symptoms, laboratory findings, and microbiological results between the two periods were compared. A total of four patients died, whereas 12 survived, resulting in a 25% mortality rate. A higher proportion of bloodstream infections (100% vs. 41.7%; p = 0.042), monomicrobial infections (100% vs. 33.3%; p = 0.021), shock (100% vs. 33.3%; p = 0.021), serous bullae (50% vs. 0%; p = 0.009), liver cirrhosis (100% vs. 25%; p = 0.009), chronic kidney disease (100% vs. 33.3%; p = 0.021), lower susceptibility to cefuroxime (25% vs. 83.3%; p = 0.028), and ineffective antibiotic prescriptions (75% vs. 16.7%; p = 0.029) was observed in non-survivors. Aeromonas NF is an extremely rare skin and soft-tissue infection that is associated with high mortality, bacteremia, antibiotic resistance, and polymicrobial infection. Therefore, antibiotic regimen selection is rendered very challenging. To improve clinical outcomes and irrational antimicrobial usage, experienced microbiologists can help physicians identify specific pathogens and test MIC.

This study aimed to compare the outcomes of arthroscopic rotator cuff repair (ARCR) surgery between younger and older patients. We performed this systematic review and meta-analysis of cohort studies comparing outcomes between patients older than 65 to 70 years and a younger group following arthroscopic rotator cuff repair surgery. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and other sources for relevant studies up to 13 September 2022, and then assessed the quality of included studies using the Newcastle–Ottawa Scale (NOS). We used random-effects meta-analysis for data synthesis. The primary outcomes were pain and shoulder functions, while secondary outcomes included re-tear rate, shoulder range of motion (ROM), abduction muscle power, quality of life, and complications. Five non-randomized controlled trials, with 671 participants (197 older and 474 younger patients), were included. The quality of the studies was all fairly good, with NOS scores ≥ 7. The results showed no significant differences between the older and younger groups in terms of Constant score improvement, re-tear rate, or other outcomes such as pain level improvement, muscle power, and shoulder ROM. These findings suggest that ARCR surgery in older patients can achieve a non-inferior healing rate and shoulder function compared to younger patients.

Background. Aeromonas necrotizing fasciitis (NF) causes high rates of amputation and mortality, even after aggressive surgical debridement and antibacterial therapy. This study investigated the effects of rational use of antibiotics and education by infectious disease (ID) physicians on Aeromonas NF treatment outcomes. Methods. Retrospective review for conducted for four years (period I, without an ID physician, December 2001 to December 2005) and 15 years (period II, with an ID physician, January 2006 to March 2021). In period II, the hospital-wide computerized antimicrobial approval system (HCAAS) was also implemented. A pretest-posttest time series analysis compared the two periods. Differences in clinical outcomes, demographics, comorbidities, signs and symptoms, laboratory findings, Aeromonas antibiotic susceptibility, and antibiotic regimens were compared between the two periods. Results. There were 19 patients in period I and 53 patients in period II. Patients had a lower rate of amputation or mortality in period II (35.8%) compared with period I (63.2%). Forty-four patients (61.1%) had polymicrobial infections. In the emergency room, the rate of misdiagnosis decreased from 47.4% in period I to 28.3% in period II, while effective empiric antibiotic usage increased from 21.1% in period I to 66.0% in period II. After the ID physician’s adjustment, 69.4% received monotherapy in period II compared to 33.3% in period I. Conclusions. Because Aeromonas NF had a high mortality rate and was often polymicrobial, choosing an antibiotic regimen was difficult. Using the HCAAS by an experienced ID physician can improve rational antibiotic usage and clinical outcomes in Aeromonas NF.

Ablation is a clinical cancer treatment, but some demands are still unsatisfied, such as electromagnetic interferences amongst multiple ablation needles during large tumour treatments. This work proposes a physical synthesis for composite particles of biocompatible iron oxide particles and liquid metal gallium (Ga) with different alternative-current (AC)-magnetic-field-induced heat mechanisms of magnetic particle hyperthermia and superior resistance heat. By some imaging, X-ray diffraction, and vibrating sample magnetometer, utilised composite particles were clearly identified as the cluster of few iron oxides using the small weight ratio of high-viscosity liquid metal Ga as conjugation materials without surfactants for physical targeting of limited fluidity. Hence, well penetration inside the tissue and the promotion rate of heat generation to fit the ablation requirement of at least 60 °C in a few seconds are achieved. For the injection and the post-injection magnetic ablations, the volume variation ratios of mice dorsal tumours on Day 12 were expressed at around one without tumour growth. Its future powerful potentiality is expected through a percutaneous injection.

Periprosthetic joint infection (PJI) is a troublesome clinical issue in total joint arthroplasty (TJA). Although methicillin-resistant Staphylococcus aureus (MRSA) is considered to be the most serious pathogen in PJIs, little is known about the genotypic and phenotypic characteristics of MRSA clones isolated from PJI patients. A total of 36 MRSA isolates from PJI patients were collected at the Chang-Gung Memorial Hospital in Taiwan from May 2016 to October 2019. All MRSA isolates were subjected to genome typing. The prevalence of Panton–Valentine leucocidin (PVL), the antibiotic susceptibility profile, and the biofilm formation ability were compared among different MRSA genogroups. Additionally, demographics and clinical manifestations of patients infected with different MRSA genogroups were investigated. Eight sequence types (STs) were identified among 36 isolated from PJIs. According to the incidence of MRSA genotypes in PJIs, in this study, we divided them into four groups, including ST8 (n = 10), ST59 (n = 8), ST239 (n = 11), and other STs (n = 7). For the antibiotic susceptibility testing, we found that all MRSA isolates in the ST239 group were highly resistant to ciprofloxacin, gentamicin trimethoprim-sulfamethoxazole, and levofloxacin. Additionally, ST239 MRSA also had a higher ability to form biofilm than other groups. Importantly, patients with ST239 infection typically had a fever and exhibited higher levels of inflammatory markers, including C-reactive protein (CRP) and white blood cell count (WBC). Epidemiological investigations revealed that knee PJIs were mainly attributed to infection with ST59 MRSA and increasing trends for infection with ST8 and other ST types of MRSAs in PJI patients were observed from 2016 to 2019. The identification of MRSA genotypes in PJIs may be helpful for the management of PJIs.

Osteosarcoma, a primary bone tumor, responds poorly to chemotherapy and radiation therapy in children and young adults; hence, as the basis for an alternative treatment, this study investigated the cytotoxic and antiproliferative effects of naringenin on osteosarcoma cell lines, HOS and U2OS, by using cell counting kit-8 and colony formation assays. DNA fragmentation and the increase in the G2/M phase in HOS and U2OS cells upon treatment with various naringenin concentrations were determined by using the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay and Annexin V/propidium iodide double staining, respectively. Flow cytometry was performed, and 2′,7′-dichlorodihydrofluorescein diacetate, JC-1, and Fluo-4 AM ester probes were examined for reactive oxygen species (ROS) generation, mitochondrial membrane potential, and intracellular calcium levels, respectively. Caspase activation, cell cycle, cytosolic and mitochondrial, and autophagy-related proteins were determined using western blotting. The results indicated that naringenin significantly inhibited viability and proliferation of osteosarcoma cells in a dose-dependent manner. In addition, naringenin induced cell cycle arrest in osteosarcoma cells by inhibiting cyclin B1 and cyclin-dependent kinase 1 expression and upregulating p21 expression. Furthermore, naringenin significantly inhibited the growth of osteosarcoma cells by increasing the intracellular ROS level. Naringenin induced endoplasmic reticulum (ER) stress-mediated apoptosis through the upregulation of ER stress markers, GRP78 and GRP94. Naringenin caused acidic vesicular organelle formation and increased autophagolysosomes, microtubule-associated protein-light chain 3-II protein levels, and autophagy. The findings suggest that the induction of cell apoptosis, cell cycle arrest, and autophagy by naringenin through mitochondrial dysfunction, ROS production, and ER stress signaling pathways contribute to the antiproliferative effect of naringenin on osteosarcoma cells.