Chihlee University of Technology

This study aimed to structure and evaluate the effectiveness of the Arthroscopic Cartilage Regeneration Facilitating Procedure (ACRFP) in treating medial osteoarthritis of the knee, focusing on its impact on patient outcomes, specifically changes in numerical rating scale pain scores and patient satisfaction. This article addresses the lack of detailed procedural steps in the current literature on ACRFP surgery. A retrospective review was conducted of 108 patients (143 knees) who underwent ACRFP. The inclusion criteria were patients over 40 years of age who experienced anterior knee pain or crepitus, a palpable band at the medial femoral condyle, a diagnosis of medial osteoarthritis of the knee via radiography (Kellgren and Lawrence grades 2-4), and had undergone conservative treatment for >6 months. Patients who had undergone prior knee surgery or were under 40 years of age were excluded. Surgical techniques including diagnostic arthroscopy, medial synovectomy, medial release, lateral release, and any additional necessary orthopedic procedures have been meticulously documented to improve procedural clarity and reproducibility. The outcomes were assessed based on subjective satisfaction (categorized as excellent, good, fair, or poor) and numerical rating scale pain scores. Following exclusions and losses to follow-up, 88 patients (58 female and 30 male), involving a total of 120 knees, completed at least 3 years of follow-up. The median age was 69.8 years. The procedure demonstrated a significant reduction in pain scores (from a mean of 6.5 preoperatively to 1.2 postoperatively; P < .001). Satisfactory outcomes were reported in 87.5% of the cases, with patients with X-ray grade 2 showing higher rates of excellent satisfaction. Our outcomes are consistent with those reported by developers of this surgical technique. The detailed surgical technique, divided into 5 main parts and further delineated into ten key steps, facilitated the achievement of these outcomes. This study provides a standard operating procedure for ACRFP that enhances the reproducibility of the technique and offers a reliable alternative to total knee arthroplasty in patients with medial osteoarthritis of the knee. We hypothesize that a structured ACRFP could open new treatment avenues for degenerative knee osteoarthritis, inviting further validation from the orthopedic community.

Autonomous cortisol secretion (ACS) is not uncommon in patients with primary aldosteronism (PA). However, the cardiovascular burden of ACS due to its dysregulated cortisol secretion remains poorly understood. Thus, we examined the effects of ACS on vascular calcification in a hyperaldosteronism environment in vitro and in vivo. A total of 339 patients with PA with adrenal incidentaloma and low-dose dexamethasone suppression test data (cutoff level: cortisol > 1.8 μg/dL) from a prospectively maintained database were enrolled; abdominal aortic calcification (AAC) scores were quantitatively estimated. Human aortic smooth muscle cells (HAOSMCs) were used as in vitro model of vascular calcification. In this study, 65 of the 339 patients with PA had ACS; 274 did not. Patients with PA/ACS had a higher AAC score (1171.0 ± 2434.0 vs. 489.5 ± 1085.3, P = 0.012) than patients without ACS. ACS was independently associated with AAC score (β = 0.139, P = 0.004) in multivariate analysis, and post-suppression cortisol level was significantly correlated with the AAC score (P = 0.004). In the HAOSMC model, co-treatment with cortisol synergistically stimulated alkaline phosphatase activity and calcium deposition in a hyperaldosteronism environment. The stimulatory effect of cortisol was abolished by the mineralocorticoid receptor (MR) antagonist eplerenone, but not glucocorticoid receptor antagonist mifepristone, indicating a MR-dependent mechanism. In conclusion, the presence of ACS is associated with heavier vascular calcification in patients with PA. Aldosterone and cortisol synergistically activate HAOSMC calcification via MR signaling, via a process that can be attenuated by eplerenone.

The COVID-19 pandemic has revealed clear deficiencies in global public health policies and healthcare systems when confronted with the emergence of a novel and deadly infectious disease.

With 4 years elapsed since the onset of the pandemic, ample data now exist to analyse the associations between the implementation of diverse public health policies, sociodemographic factors and COVID-19 mortality rates.

This study utilised the dataset compiled by 'Our World in Data' spanning the period of the COVID-19 pandemic from 2020 to 2022. Stochastic frontier analysis was employed to assess the influencing factors and their relationship with mortality rates resulting from COVID-19 infections across 156 countries or regions.

This study yielded several key findings: (1) There remains a 33% margin for improvement in the global mortality rate concerning the COVID-19 pandemic; (2) During the initial stage of the pandemic, when an effective vaccine was not yet available, implementing public health control policies could reduce both the infection and mortality rates; (3) Areas characterised by higher population densities, a greater proportion of individuals aged 65 and over, and elevated prevalence rates of diabetes demonstrated higher mortality rates; and (4) Increasing vaccination coverage emerged as an effective strategy for reducing mortality rates.

As our understanding of the COVID-19 virus improves, global economies and social interactions have gradually returned to normality. It is anticipated that the findings of this study can serve as a valuable reference in combating potential future pandemics caused by unknown viruses.