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The use of mobile health technologies has been necessary to deliver patient education to patients with diabetes during the COVID-19 pandemic. This open-label randomized controlled trial evaluated the effects of a diabetes educational platform-Taipei Medical University-LINE Oriented Video Education-delivered through a social media app. Patients with type 2 diabetes were recruited from a clinic through physician referral. The social media-based program included 51 videos: 10 about understanding diabetes, 10 about daily care, 6 about nutrition care, 21 about diabetes drugs, and 4 containing quizzes. The intervention group received two or three videos every week and care messages every 2 weeks through the social media platform for 3 months, in addition to usual care. The control group only received usual care. Outcomes were measured at clinical visits through self-reported face-to-face questionnaires at baseline and at 3 months after the intervention, including the Simplified Diabetes Knowledge Scale (true/false version), the Diabetes Care Profile-Attitudes Toward Diabetes Scales, the Summary of Diabetes Self-Care Activities, and glycated hemoglobin (HbA ) levels. Health literacy was measured at baseline using the Newest Vital Sign tool. Differences in HbA levels and questionnaire scores before and after the intervention were compared between groups. The associations of knowledge, attitudes, and self-care activities with health literacy were assessed. Patients with type 2 diabetes completed the 3-month study, with 91 out of 181 (50.3%) patients in the intervention group and 90 (49.7%) in the control group. The change in HbA did not significantly differ between groups (intervention group: mean 6.9%, SD 0.8% to mean 7.0%, SD 0.9%, P=.34; control group: mean 6.7%, SD 0.6% to mean 6.7%, SD 0.7%, P=.91). Both groups showed increased mean knowledge scores at 12 weeks, increasing from 68.3% (SD 16.4%) to 76.7% (SD 11.7%; P<.001) in the intervention group and from 64.8% (SD 18.2%) to 73.2% (SD 12.6%; P<.001) in the control group. Positive improvements in attitudes and self-care activities were only observed in the intervention group (attitudes: mean difference 0.2, SD 0.5, P=.001; self-care activities: mean difference 0.3, SD 1.2, P=.03). A 100% utility rate was achieved for 8 out of 21 (38%) medication-related videos. Low health literacy was a significant risk factor for baseline knowledge scores in the intervention group, with an odds ratio of 2.80 (95% CI 1.28-6.12; P=.01); this became insignificant after 3 months. The social media-based program was effective at enhancing the knowledge, attitudes, and self-care activities of patients with diabetes. This intervention was also helpful for patients with low health literacy in diabetes knowledge. The program represents a potentially useful tool for delivering diabetes education to patients through social media, especially during the COVID-19 pandemic. ClinicalTrials.gov NCT04876274; https://clinicaltrials.gov/ct2/show/results/NCT04876274.

Background Percutaneous coronary interventions (PCI) in very small vessel lesions represent an intriguing aspect of coronary artery disease (CAD). Uncertainty still exists in stent implantation in very small caliber vessels. This study aimed to evaluate the long‐term outcomes of patients treated with 2.0‐mm drug‐eluting stent (DES). Method This retrospective observational study included 134 patients undergoing PCI with 2.0‐mm zotarolimus DES from December 2016 to May 2020. The primary endpoint was major adverse cardiovascular events (MACE) at 2‐year follow‐up, which was composed of all‐cause mortality, target vessel myocardial infarction, and ischemia‐driven target lesion revascularization. Multiple logistic regression analysis was used to identify the independent predictors of MACE, and odds ratios (OR) and 95% confidence intervals (CI) were calculated. Result The lesions were diffuse (mean length 20.9 ± 5.51 mm) and belong to type B2/C lesions (90.3%). On follow‐up, the MACE rate was 20.1% and mostly driven by late lumen loss demanding revascularization (11.9%). In multivariable analysis, chronic kidney disease (CKD) (OR: 4.291, 95% CI: 1.574−11.704, p = 0.004) and calcified lesions (OR: 3.688, 95% CI: 1.311−10.371, p = 0.013) were the independent predictors of subsequent cardiovascular events, whereas statin was associated with better outcomes (OR: 0.335, 95% CI: 0.119−0.949, p = 0.040). Conclusion 2.0‐mm DES is a feasible option for treating very small vessel CAD in complex lesions. Patients with CKD and calcified lesions carry the hazard of worse outcomes, and careful consideration should be taken before stenting in this high‐risk population. Long‐term outcomes and associated factors of 2.0 mm drug‐eluting stent implantation in very small vessel coronary artery disease.

Background Acute coronary syndrome (ACS) is a major cause of morbidity and mortality worldwide. Identifying biomarkers that predict outcomes is essential for guiding management. This study evaluated whether elevated serum uric acid (SUA) is associated with increased risks of major adverse cardiovascular events (MACE), recurrent myocardial infarction (re-MI), and all-cause mortality (ACM) in patients with ACS. Methods This retrospective cohort study enrolled 829 inpatients with ACS admitted to a tertiary referral hospital in Taiwan from 2015 to 2019. Patients were divided into normal (< 7.25 mg/dL, n  = 566) and high (≥ 7.25 mg/dL, n  = 263) SUA groups based on a receiver operating characteristic–derived cutoff for whole cohort. All patients received standard ACS care, and SUA levels were retrospectively analyzed. The primary outcome was MACE, defined as ACM, re-MI, and target lesion/vessel revascularization (TLR/TVR), assessed up to 60 months. Kaplan–Meier survival analysis, logistic regression, and Cox proportional hazards regression were applied. Results The overall incidences of MACE (19.54%), re-MI (2.90%), and ACM (4.46%) were higher in the high SUA group compared with the normal SUA group (MACE: 26.62% vs. 16.25%, p  = 0.0005; re-MI: 6.08% vs. 1.41%, p  = 0.0002; ACM: 7.22% vs. 3.18%, p  = 0.0087). No significant difference was observed in TLR/TVR (overall 11.94%; 11.48% vs. 12.93%, p  = 0.5508). Kaplan–Meier analysis at 60 months demonstrated higher event-free rates for MACE, re-MI, and ACM in the normal SUA group (log-rank p  = 0.0117, 0.0006, and 0.0261, respectively). Multivariable logistic regression showed that SUA ≥ 7.25 mg/dL was associated with increased odds of MACE (odds ratio = 1.639, 95% confidence interval [CI] = 1.084–2.477, p  = 0.0191). Cox regression revealed higher hazards of MACE (hazard ratio [HR] = 1.399, 95% CI = 1.024–1.191, p  = 0.0350), re-MI (HR = 3.758, 95% CI = 1.605–8.799, p  = 0.0023), and ACM (HR = 1.956, 95% CI = 1.019–3.753, p  = 0.0438) in the high SUA group after adjustment for age, uremia, use of drug-eluting stent, and number of diseased vessels. Conclusions Elevated SUA is an independent prognostic marker for increased risks of MACE, re-MI, and ACM in patients with ACS. SUA assessment can enhance risk stratification, helping to identify higher-risk patients who may benefit from more intensive secondary prevention strategies and closer follow-up.

Background: There are several possible links that have been used to claim that osteoporosis and peripheral artery disease (PAD) are associated; however, the solid evidence is not sufficient. This study aimed to use the Taiwan National Health Insurance Research Database (NHIRD) to determine if osteoporosis is associated with peripheral artery disease (PAD). Method: NHIRD records from 23 million patients were collected to recruit two matched cohort groups: 64,562 patients with and 64,562 patients without osteoporosis. To compare the crude hazard ratio (HR) and the incidence rate ratio between the two cohort groups for PAD, the Cox model was used. Result: With an adjusted HR of 1.18 (95% CI, 1.08–1.29), the osteoporosis cohort group had a significantly greater risk for PAD than the group without osteoporosis. The cumulative incidence of PAD in the cohort group was also statistically higher than it was in the group without osteoporosis (1.71% and 1.39%; p ≤ 0.0001, log-rank) over the 10-year follow-up period. In addition, the osteoporotic patients with ischemic stroke, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF) had a significantly increased risk of PAD based on subgroup analysis. Conclusions: There was a positive association between osteoporosis and the development of PAD, as patients with osteoporosis had an increased incidence of PAD over time.

Objective Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors are a standard therapy for patients who respond poorly to or cannot tolerate statins. However, identifying responders to PCSK9 inhibitors remains unclear. This study investigates the characteristics of patients who achieve target LDL-C reduction (< 70 mg/dl) after PCSK9 inhibitor therapy. Methods A multicenter, retrospective cohort study included patients initiating PCSK9 inhibitors at 11 teaching hospitals in Taiwan (2017–2021). Baseline characteristics, lipid-lowering therapies, and lipid profile changes were analyzed. Results Among 211 patients (mean age 57.2 ± 13.1 years, 72.0% male), 73.5% used alirocumab and 26.5% used evolocumab. More than half had coronary artery disease and/or hypertension. Of these, 120 patients achieved the LDL-C target. Target achievers had a lower baseline BMI (25.8 ± 3.7 vs. 27.4 ± 4.5 kg/m 2 , P = 0.028) and a higher incidence of myocardial infarction and anti-platelet use compared to non-achievers. Baseline cholesterol and LDL-C levels were similar, but target achievers experienced greater LDL-C reductions (− 71.5; IQR − 81.8, − 62.2 vs. − 29.4; IQR − 38, − 10.5 mg/dl, P < 0.001), as well as decreases in triglycerides and increases in HDL-C. Glucose levels and liver enzymes did not differ significantly. Logistic regression revealed BMI as the only independent predictor of LDL-C target achievement (odds ratio: 0.899, 95% CI 0.821–0.984, P = 0.021). Conclusions Lower BMI at baseline was associated with a higher likelihood of achieving LDL-C < 70 mg/dl after 12 weeks of PCSK9 inhibitor therapy. These findings support personalized strategies for optimizing cholesterol management in statin-intolerant patients while further investigations are required. Graphical abstract

Background Triangular fibrocartilage complex (TFCC) has become an interest over the last few decades, discovering its understanding in anatomy, pathomechanism, biomechanics, and management in treatments. Currently, TFCC does not have a golden standard procedure, and not one surgical procedure is superior to the other. This study is to evaluate the comparative outcomes in TFCC patients that underwent either in all-inside arthroscopic suture anchors or the arthroscopic transosseous suture technique. Method From 2017 to 2019, 30 patients were analyzed. Eight patients were in an arthroscopic transosseous group and 22 patients were in an all-inside arthroscopic group. Comparison between patients’ flexion and extension range of motion (ROM), grip strength, and visual analog pain scale (VAS) preoperative and six-month follow-up were analyzed. Result There were significant increases in flexion ROM, extension ROM, and VAS between preoperative and postoperative in all-inside arthroscopic and arthroscopic transosseous. Only the all-inside arthroscopic group had a significant increase in grip strength. Postoperative flexion ROM had a significant difference between all-inside arthroscopic and arthroscopic transosseous. Conclusion Both the all-inside arthroscopic suture anchor technique and the arthroscopic transosseous suture technique are appropriate treatments to treat patients with TFCC. Both procedures have achieved the ultimate goal of improved longevity and optimal function. Level of evidence Level III; retrospective comparative cohort study.

Necrotizing fasciitis is a relatively rare and serious fatal soft-tissue infection that is characterized by a rapidly spreading bacterial infection located in the subcutaneous tissues. We report a 59-year-old man who was diagnosed with acute necrotizing fasciitis, following a primary total knee replacement. He received primary total knee replacement that was uneventful and smooth intraoperatively. An immediate high fever was reported in the next few days, with several complications, confirming a diagnosis of necrotizing fasciitis. The most effective treatment for this disease is a rapid primary diagnosis and surgical debridement. Gold standard treatment includes intravenous therapy, such as antibiotics, surgical debridement, and intensive care. As a result of possible GI complications that triggered necrotizing fasciitis, the patient underwent flap reconstruction. This report’s aim is to review the comprehensive treatment, management, and experience of necrotizing fasciitis, highlighting the roles with a multidisciplinary care team for improving the condition of this patient.

Few reports discussed the issue of the relationship between the stent fracture and the formation of coronary artery aneurysms. We reported a case about the stent fracture associated with dissected flaps and one giant coronary artery aneurysms.

Background. Current treatment options for both unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) are still controversial with no consistent results in which one is superior to others. This is the first study to examine and analyze the following related data available in patients receiving either UKA or TKA from the National Health Research Database (NHIRD) in Taiwan. Methods. The database was searched from NHIRD, pooling one million random patients. Patients’ age, gender, and comorbidities were analyzed in either UKA or TKA between January 2005 and December 2013, or up until death. For the patients that had received bilateral surgeries, further subgrouping was divided into TKA to TKA, UKA to UKA, TKA to UKA, and UKA to TKA to analyze the completion rate curve. Additional analysis of the order codes 64202B, 64053B, and 64198B was defined as failures, and the related failure rate curves were analyzed separately within ten years. Finally, infection-related codes were analyzed. Results. 6,179 patients (n=276 UKA; n=5903 TKA) were selected. Age (p<0.0001) and gender (p=0.037) had significant differences, with more young population and males having UKA than TKA. Most comorbidities had no significant difference. For the bilateral surgery analysis, the UKA to UKA group had the fastest completion rate (p<0.001) and UKA to TKA was the slowest. There were no significant differences in the failure rates of 64202B, 64053B, and 64198B. Conclusion. Most UKA and TKA are appropriate solutions to treat patients with osteoarthritis or osteonecrosis. UKA to UKA is the quickest bilateral completion surgery, and UKA has a higher chance of undergoing revision surgery than TKA.

BackgroundThe existing literature lacks studies examining the epidemiological link between scrub typhus and deep vein thrombosis (DVT) or pulmonary embolism (PE), and the long-term outcomes. The objective of this study is to explore the potential association between scrub typhus and the subsequent risk of venous thromboembolism, and long-term mortality.MethodThis nationwide cohort study identified 10,121 patients who were newly diagnosed with scrub typhus. Patients with a prior DVT or PE diagnosis before the scrub typhus infection were excluded. A comparison cohort of 101,210 patients was established from the general population using a propensity score matching technique. The cumulative survival HRs for the two cohorts were calculated by the Cox proportional hazards model.ResultAfter adjusting for sex, age, and comorbidities, the scrub typhus group had an adjusted HR (95% CI) of 1.02 (0.80–1.30) for DVT, 1.11 (0.63–1.93) for PE, and 1.16 (1.08–1.25) for mortality compared to the control group. The post hoc subgroup analysis revealed that individuals younger than 55 years with a prior scrub typhus infection had a significantly higher risk of DVT (HR: 1.59; 95% CI: 1.12–2.25) and long-term mortality (HR: 1.75; 95% CI, 1.54–1.99).ConclusionThe scrub typhus patients showed a 16% higher risk of long-term mortality. For those in scrub typhus cohort below 55 years of age, the risk of developing DVT was 1.59 times higher, and the risk of mortality was 1.75 times higher. Age acted as an effect modifier influencing the relationship between scrub typhus and risk of new-onset DVT and death.