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Wang C.-J.,Chang Gung University | Huang C.-C.,Chang Gung University | Wong T.,Kaohsiung Municipal United Hospital | Yang Y.-J.,Chang Gung University
Biomedical Journal | Year: 2012

Background: This study analyzed the long-term outcomes of extracorporeal shockwave therapy (ESWT) and core decompression for early osteonecrosis of the femoral head (ONFH) with 8- to 9-year follow-up. Methods: The study cohort consisted of 48 patients with 57 hips including 23 patients with 29 hips in the ESWT group and 25 patients with 28 hips in the surgical group. Patients in ESWT group received shockwave therapy to the affected hip. Patients in surgical group underwent core decompression and autogenous cancellous bone and allogenous fibular graft. The average length of follow-up was 103.5 ± 3.4 (ranged 93-106) months and 104.5 ± 4.3 (ranged 95-108) months for the ESWT and the surgical group, respectively. The evaluations included clinical assessment for pain and function, X-ray and MRI of the affected hips. Results: The overall clinical results were 76% good or fair and 24% poor for the ESWT group; and 21% good or fair and 79% poor for the surgical group. THA was performed in 3% and 21% at one year, 10% and 32% at 2 years and 24% and 64% at 8-9 years for ESWT and the surgical group respectively. Significant differences in pain and Harris hip scores were observed at different time intervals favoring the ESWT group. There was a trend of decrease in the size of the lesion in the ESWT group when compared with the surgical group. Conclusion: ESWT appears to be more effective than core decompression and bone grafting for early ONFH with 8- to 9-year long-term follow-up. Source


Wong T.,Kaohsiung Municipal United Hospital | Wang C.-J.,Chang Gung University | Wang J.-W.,Chang Gung University | Ko J.-Y.,Chang Gung University
Biomedical Journal | Year: 2014

Background: Uni-knee arthroplasty (UKA) has shown better knee kinematics and motion that may better suit the activities of daily living in Eastern countries. The purpose of this study was to evaluate the functional outcomes of UKA for medial compartment knee arthropathy in Asian patients.Methods: The study cohort consisted of 48 patients with 51 UK A knees. Only one type of prosthesis was used and all components were cemented. Postoperative management included ambulation with weight bearing, range of motion, and muscle strengthening exercises as tolerated until full recovery. The average follow-up was 52.0 ± 24.0 (range 12-92) months. The evaluation included functional assessment, the Knee Society knee and functional scores, the International Knee Document Committee (IKDC) subjective and objective scores, and radiographs of the knee.Results: The overall clinical outcomes of the knee showed the functional outcome of the knee to be normal in 51%, nearly normal in 37%, abnormal in 8%, and severely abnormal in 4%. The functional activities included stair climbing in 96%, squatting in 76%, jogging in 71% and kneeling in 47%. Three-quarters of the patients were able to kneel for daily activities. Approximately 98% of the patients were satisfied with the operation. The survivorship of the prosthesis was 98% with one revision pending. Radiographic evaluations revealed the components were centered in 82% and off-centered in 18%. Osteoarthritis was 22% preoperative and 27% postoperative for the patellofemoral compartment, and 0% before and 4% after surgery for the lateral compartment. The functional outcomes showed no difference between patients with and without patellofemoral arthritis. The complications included one component malposition and one knee pain of undetermined origin.Conclusions: UKA provides excellent pain relief and restoration of knee function including kneeling, squatting, and sit-to-stand activities that perfectly fit the oriental lifestyle and high patient satisfaction in Asian patients at medium-term follow-up. The complications were rare and the survival rate was 98% at medium-term follow-up. © 2014, Biomedical Journal. All Rights Reserved. Source


Tseng H.-C.,Kaohsiung Medical University | Wang H.-H.,Kaohsiung Medical University | Weng W.-C.,Kaohsiung Municipal United Hospital
Kaohsiung Journal of Medical Sciences | Year: 2013

The purpose of this study was to explore senior nursing students' perceptions toward the nursing profession and their experiences in clinical practicum in Taiwan. This study used semistructured interview guides and unstructured face-to-face dialogue with the participants based on a qualitative method. A purposive sample with a snowball method from a baccalaureate nursing program in Southern Taiwan was used to recruit participants. A total of 30 senior nursing students participated in this study. Data were collected from February to May 2011. The interviews were transcribed verbatim, and data were analyzed based on the phenomenological approach of qualitative methodology. Data were categorized into three major themes: in-depth recognition of nursing, recognition of the meaning and value of life, and decision conflicts for being a nurse. The findings of the study not only help nursing educators further understand the educational effects of clinical practicum, but also provide information for managers of medical organizations to recruit and train newly graduated nurses. © 2013, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. All rights reserved. Source


Wang C.-J.,Chang Gung University | Sun Y.-C.,Chang Gung University | Wong T.,Kaohsiung Municipal United Hospital | Hsu S.-L.,Chang Gung University | And 2 more authors.
Journal of Surgical Research | Year: 2012

Background: Recent studies reported that extracorporeal shockwave therapy (ESWT) has a chondroprotective effect on the initiation and regression of osteoarthritis of the knee in rats. However, the time course effects of ESWT in the osteoarthritic knee are not fully understood. The purpose of this study was to evaluate the effects of ESWT over time on osteoarthritis of the knee in rats. Methods: We used 72 8-week-old male Sprague-Dawley rats with body weights ranging from 245 to 265 g. We randomly divided the rats into three groups, with 24 rats in each group. The control group received neither surgery nor ESWT. The anterior cruciate ligament transected (ACLT) group underwent anterior cruciate ligament transection but received no ESWT. The ACLT plus ESWT group underwent ACL transection and received ESWT at 1 wk after surgery. The animals were killed at 2, 4, 8, and 12 wk, 6 rats from each group at each time course. Evaluation parameters included Mankin score, Safranin O stain, and collagen II for the articular cartilage; and vascular endothelial growth factor (VEGF), bone morphogenetic-2 (BMP-2), and osteocalcin for the subchondral bone using histopathological examination and immunohistochemical analysis. Results: The ACLT group showed significant increases in Mankin score and Safranin O stain, and a decrease in collagen II in the articular cartilage, and significant decreases in VEGF, BMP-2, and osteocalcin in the subchondral bone compared with the control (P <.05). The ACLT + ESWT group showed significant decreases in Mankin score and Safranin O stain and an increase in collagen II in the articular cartilage, and significant increases in VEGF, BMP-2, and osteocalcin in the subchondral bone compared with the control group. The changes in the ACLT + ESWT group appeared to correlate with the time courses of treatment; the most beneficial effects were noticed 4 weeks after ESWT. Conclusion: Extracorporeal shockwave therapy is effective in preventing osteoarthritis of the knee in rats. The beneficial effects of ESWT appear to be time-dependent beginning at 4 weeks after treatment. © 2012 Elsevier Inc. All rights reserved. Source


Wang C.-H.,Kaohsiung Medical University | Leung M.,Kaohsiung Municipal United Hospital | Liang W.-C.,Kaohsiung Medical University | Hsieh T.-J.,Kaohsiung Medical University | And 2 more authors.
Neuromuscular Disorders | Year: 2012

This study aimed to evaluate muscle involvement pattern and correlate the lesions on muscle imaging with clinical features and D4Z4 fragment size in 24 patients with facioscapulohumeral muscular dystrophy (FSHD). The grading of the muscle image detected by computed tomography (CT) was based on a four-point semi-quantitative visual scale. On muscle CT, the most affected muscle was trapezium, followed by hamstrings. CT image identified hamstrings involvement rather than shoulder-girdle in clinically asymptomatic subjects. CT image also showed that axial muscle was affected in one-third of patients which appeared even earlier than clinical manifestation. Strong correlations between CT findings, serum creatine kinase level and clinical severity scores were also found. Asymmetric involvement was more evident on CT image than it identified in manual muscle strength testing. Inverse correlation between CT grade and D4Z4 fragment size was clearly demonstrated. These findings suggest muscle CT will be helpful for the process of early intervention in FSHD, even in subjects in a preclinical status. © 2011 Elsevier B.V. Source

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