An-Nan Hospital

The main objective of the study is to evaluate the outcomes and safety of using vertebral augmentation (VA) with expandable intravertebral implants (EIIs) for osteoporotic vertebral fractures, with subgroup analysis on type OF4 osteoporotic vertebral fractures. A retrospective cohort study was conducted at a tertiary medical center from January 2017 to December 2021. Seventy-five patients (mean age 72.3 ± 7.4 years; 22.7% male) with single-level osteoporotic vertebral fractures (OVFs) who had undergone vertebral augmentation with expandable intravertebral implants were included, and the mean follow-up was 36.7 ± 19.1 months. For clinical outcomes, we evaluated the visual analog scale (VAS) for pain scale, Oswestry Disability Index (ODI) for functional outcomes, and occurrences of complications. Key radiological parameters including anterior vertebral height compression ratio (AVH CR), middle vertebral height compression ratio (MVH CR), local kyphotic angle (LKA), regional kyphotic angle (RKA), local coronal angle (LCA) and Cobb’s angle (CBA), were collected and compared. Multivariate logistic regression was used to identify risk factors for complications. Patients classified as type OF4 fracture (n = 45) were selected for further subgroup analysis. All population as well as OF4 group demonstrated significant clinical improvements in the VAS pain score (P < 0.0001) and ODI functional score (P < 0.0001) postoperatively. Most radiological parameters also improved significantly in all patients and OF4 group, including anterior vertebral height compression ratio (P < 0.0001), middle vertebral height compression ratio (P < 0.0001), local kyphotic angle (P < 0.0001), and regional kyphotic angle (P < 0.0001). For complications, adjacent level fractures happened in 26.7% of patients; cement leakage happened in 40% of patients, and bone cement dislodgement happened in 22.7% of patients. Re-operation rate was low (4%). Body mass index (BMI) (P = 0.032) and age (P = 0.003) were identified as potential risk factors for adjacent level fractures. Preoperative anterior vertebral height compression ratio (P = 0.011) was risk factor for cement leakage. BMI (P = 0.008), osteoporosis (P = 0.023), and preoperative middle vertebral height compression ratio (P = 0.028) were risk factors for bone cement dislodgement. Vertebral augmentation with expandable intravertebral implant appears to be a viable alternative for elderly patients with type OF4 osteoporotic vertebral fractures. It offers comparable efficacy in pain relief and functional improvement, with few severe complications making it suitable for those who may not tolerate invasive surgeries. This study is retrospectively registered.

<h3>Background and Importance</h3> Pharmacists are essential in providing care, counselling, and adverse drug reaction (ADR) monitoring for chemotherapy patients. Beyond dispensing, pharmacists help patients understand treatment regimens, manage toxicities, and adhere to therapy. As key members of the multidisciplinary team, pharmacists ensure timely identification and management of ADRs. However, increasing patient volumes and the lack of structured documentation can compromise follow-up and care quality. A practical, user-friendly digital system is needed to strengthen the pharmacist’s role in delivering safe and consistent oncology services. <h3>Aim and Objectives</h3> This study aimed to design, implement, and evaluate a no-code digital system supporting pharmacists in patient counselling and side effect monitoring among adults receiving chemotherapy. <h3>Material and Methods</h3> The system was developed using AppSheet (no-code platform) and implemented in a hospital chemotherapy unit from July to December 2024. Pharmacists contributed throughout the development process, defining clinical workflows, structuring the knowledge assessment, and determining ADR documentation standards. The system included modules for patient education, a 15-item quiz to assess knowledge, and ADR reporting with severity grading (1–4). Pharmacists provided three structured counselling sessions per patient, reinforcing knowledge and capturing ADRs across treatment cycles. Patients with grade 2 ADRs were monitored closely by ward pharmacists, while grade 3 cases prompted collaborative management with physicians. The digital platform reduced repetitive paperwork, enabled systematic follow-up, and allowed pharmacists to devote more time to direct patient care. <h3>Results</h3> A total of 196 patients were enrolled. Knowledge scores improved significantly from 45.6% before counselling to 72.0% after the second session and 91.8% after the third (p &lt; 0.01). Over 80% of patients receiving three sessions achieved scores above 80%. Fatigue (92.9%), anorexia (76.0%), and nausea (60.2%) were the most common ADRs, while hand-foot syndrome (22.2%) was the most frequent severe ADR. Pharmacists’ structured interventions ensured that all patients with grade ≥2 ADRs received timely follow-up. Pharmacists reported enhanced efficiency, better communication with physicians, and improved continuity of care. <h3>Conclusion and Relevance</h3> The digital system reinforced the central role of pharmacists in oncology care. It improved patient knowledge, standardised ADR monitoring, and optimised pharmacy workflows. Wider adoption could advance safe, coordinated, and pharmacist-led supportive care for chemotherapy patients. <h3>Conflict of Interest</h3> No conflict of interest

BackgroundThe utilization of all-suture anchors in coracoclavicular (CC) suture fixations offers satisfactory clinical advantages. This study aimed to compare the biomechanical properties of suture looping, conventional metallic anchors, and all-suture anchors in CC suture fixation in a synthetic bone model.HypothesisSuture looping for CC fixation would result in smaller cyclic elongation and greater ultimate pull-out strength than suture anchor techniques.MethodsA total of 27 composite scapula were divided into three groups: suture looping group (group L), metallic anchor group (group M), and all-suture anchor group (group A). In group L, two No. 2 braided sutures were looped into the coracoid base for CC fixation. In groups M and A, 5.0mm metallic suture anchors and 2.8mm all-suture anchors were used, respectively. Prepared specimens were secured using a material testing machine. Each specimen was tested with a preload between 0 and 20N for 10 cycles, cyclic loading between 20 and 70N for 1000 cycles, and final loading to failure. Cyclic elongation, linear stiffness, ultimate load, and failure modes were recorded.ResultsAll the specimens were subjected to cyclic loading tests. Elongation after cyclic loading in group L (1.0 ± 0.2mm) was significantly smaller than that in groups M (1.4 ± 0.2mm) (p = .002) and A (2.5 ± 1.1mm) (p < .001). Cyclic elongation in group M was also significantly lower than that in group A (p = .004). Ultimate failure load in group L (472 ± 53N) was significantly greater than that in group M (380 ± 35N) (p = .002) and A (354 ± 94N) (p = .010). Suture rupture was the most common failure pattern in group L, whereas two specimens failed because of a coracoid fracture. Both suture rupture and anchor pull-out were common in groups M and A.ConclusionsThe suture looping technique in CC fixation provides a significantly smaller cyclic displacement and greater ultimate failure load than metallic and all-suture anchors. The clinical relevance is that smaller cyclic elongation and greater ultimate failure load imply a reduced risk of fixation construct failure.

A 52-year-old male, a property broker known for his fast-paced lifestyle, presented with a history of severe chest discomfort immediately after consuming a large slice of bread (Figure 1) in his rush to get to work. He exhibited a type A personality, had no comorbidities, and did not take any regular medications. Since then, he has experienced ongoing chest pain accompanied by a sensation of the bread being lodged in his chest. Six hours later, his incarcerated sensation started to decrease after massive water and milk consumption. However, the chest pain still persisted. His gastroduodenoscopy showed a 3.5-cm ulcer in the middle esophagus (Figure 2). His chest symptoms gradually improved after a week treatment with sucralfate 1 g four times daily. The decision to use sucralfate instead of proton pump inhibitors was based on its direct action on the ulcer, forming a protective film that could prevent further deterioration of the esophageal ulcer. A compression ulcer produced by incarcerated bread might occur, possibly due to compression-related ischemia of the mucosa. A bread-related esophageal ulcer tends to occur at middle esophagus, the anatomical narrowing site behind left atrium. Esophageal ulcers can arise from various factors, including reflux esophagitis, viral infections, or medication use.1-3 In this case, the mechanical obstruction caused by the bread likely contributed to the development of the ulcer given the sequence of events. In the literature, there have been reports of fatality and laceration caused by bread crust and bagel, respectively.4, 5 The autopsy of the former case revealed perforation at the upper end of the esophagus with a mediastinal abscess.4 In the latter case, a barium-swallow exam indicated a 4-cm mucosal tear extending from the upper esophagus to the cricopharyngeal muscle.5 However, the patient survived with conservative medical treatment involving narcotic analgesics, antacids, and intravenous hydration. All authors contributed equally to the review of data, drafting of manuscript, and approval of final version. The study was funded by research foundation of An Nan Hospital (grant numbers: ANHRF112-09 and ANHRF112-45), China Medical University, Taiwan and Ping Tung Christian Hospital Research Fund (grant number: PS 113005). The authors declare no conflicts of interest. Informed consent was taken from patient for clinical image submission.

Minor physical abnormalities (MPAs) are neurodevelopmental markers that can be traced to prenatal events and may be significant features of early-onset schizophrenia (EOS). Therefore, our study aimed to (1) find the primary and interaction effects of MPAs for EOS and (2) develop and validate the model for EOS based on explainable machine learning algorithms. The study included 549 patients with schizophrenia (193 EOS and 356 AOS) and 420 healthy controls (HC) in southern Taiwan. For the feature selection, variable selection using random forests (varSelRF) and recursive feature elimination (RFE) were applied to identify the important variables of MPAs. We used different machine learning algorithms to build the prediction models based on the selected MPAs variables. The results showed that the mouth anomalies are significant MPAs variables and have interaction effects with craniofacial MPAs variables for EOS. The prediction models using the selected MPAs variables performed better in discriminating EOS vs HC compared to AOS vs HC. The AUC values for distinguishing EOS vs HC were 0.85-0.93, AOS vs HC were 0.80-0.87, and EOS vs AOS were 0.67-0.77 in validation sets. This risk prediction model provides a clinical decision support system for detecting patients at high risk of developing EOS and enables early intervention in clinical practice.

Study DesignMeta-analysis study.ObjectivesWe aimed to compare clinical outcomes, radiologic parameters, and complications between the stand-alone anchored spacer and the plate-cage construct as treatment options for patients with multilevel cervical degenerative spondylopathy involving 3 or 4 levels.MethodsIn this meta-analysis, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search for relevant studies covered the Embase, PubMed, and Cochrane Central Register of Controlled Trials databases, encompassing data from the inception of each database up to July 1, 2024.ResultsThe analysis included 12 studies, involving a total of 817 patients. Patients in the stand-alone anchored spacer group exhibited decreased intraoperative blood loss and shorter surgical durations. Clinical outcomes, including visual analog scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, Neck Disability Index (NDI) scores, and Odom’s criteria for clinical outcomes, demonstrated no significant differences between the two groups. Radiographic outcomes revealed no statistically significant difference in fusion rates between stand-alone cages and plate-cage constructs. However, the plate-cage group exhibited more favorable maintenance of segmental angle and cervical alignment (C2-C7 angle).ConclusionsBoth stand-alone anchored spacer and plate-cage constructs are viable treatment options for patients with cervical degenerative spondylopathy involving more than two levels. Stand-alone cages have the benefit of reducing intraoperative blood loss and shortening surgical durations, but they are associated with a higher risk of cage subsidence. Plate-cage constructs offer better maintenance of segmental angle and cervical alignment; however, they carry a higher risk of dysphagia.