Background: Renal insufficiency reduces the excretion of uric acid and inflammatory factors and exacerbates the structural deformities caused by gouty arthritis. Musculoskeletal ultrasonography (MSKUS) is often used to evaluate the severity and inflammatory progression of gout. Aim: We aimed to determine whether ultrasound help to identify structural damage in patients with chronic kidney disease (CKD) and gout. Methods: This was a retrospective review of the clinical manifestations and abnormalities observed with MSKUS in 280 patients with gouty arthritis between August 2004 and April 2017. MSKUS identified intra-articular features, including joint effusion, synovial proliferation, Baker's cysts, double contour sign, tophi, and extra-articular tenosynovitis. Serum and synovial fluid were collected and analyzed. Significant differences were identified using the Pearson correlation coefficient and independent t-test. Results: This retrospective cohort included 257 men (91.8%) and 23 women (8.2%) with a mean age of 54.6 years. CKD stage correlated positively with the presence of joint Baker's cyst (P = 0.004). Notably, serum estimated glomerular filtration rate correlated negatively with serum C-reactive protein level in patients with CKD (P < 0.001), and more severe CKD correlated with a higher prevalence of Baker's cyst in CKD patients (P = 0.0037). Conclusion: Insufficient control of hyperuricemia can lead to chronic gouty arthritis and subsequent structural deformities. Reciprocally, acute inflammation of joints is downregulated as chronic gouty arthritis develops. Patients with hyperuricemia and CKD should receive regular MSKUS examination to avoid the progression of structural damage in the joints.

Background: Chitosan is a kind of chitin derivative, which has unique biological properties, including biocompatibility, biodegradability, and extremely low toxicity, considered as a suitable material for promoting wound healing. Aim: We aimed to investigate the effectiveness of chitosan dressing for burn wound healing in swine model. Methods: In this study, we evaluated the wound healing in a swine model of full thickness cutaneous burn to assess the benefits of chitosan dressing treatment compared to commercial gauze. We also investigated the effect of chitosan dressing in inhibiting the growth of bacteria as well as the survival ability of 3T3-L1 cells in contact with the dressings. Results: After wounding swine treated with chitosan dressing, it showed an increased wound closer compared to commercial gauze, suggesting that the chitosan dressing treatment results in better accelerated healing. In the antibacterial test, the results showed that antibacterial effect of chitosan dressing was better than commercial gauze. Conclusion: The presence of chitosan dressing was characterized by their high antibacterial activity, and it was confirmed against Staphylococcus aureus in the burn wound of swine. The superior wound healing effect on deep dermal burns of presented wound dressing was demonstrated in a swine model. Our finding suggests that the chitosan wound dressing has a great potential application in severe wound care.

Background: Liver fibrogenesis is a process of hepatic cell repairment. Hepatic fibrosis is the pathological status of liver health under different stress, including infection or inflammation. Iron is an essential micronutrition with the specific function of human cells, while excess iron may induce oxidative stress in cells and tissues. Aim: The liver is the main organ of iron storage. The study aimed to evaluate the relationship of serum iron with the hepatic stiffness measurement (liver stiffness measurement [LSM]). Methods: A total of 5521 adult participants aged 20 and over with recorded LSM and serum iron concentration from the U. S. National Health and Nutrition Examination Survey datasets (2017–2018) were enrolled in this study. The association between serum iron concentration and LSM is analyzed by multivariate linear regression models. Results: An increased serum iron concentration was significantly correlated with decreasing LSM in the adjusted model (β coefficient: –0.0005; 95% confidence interval: –0.001, –0.00008; P = 0.020). Moreover, the subgroup analysis also disclosed a negative association in nongeriatric adults. The serum ferritin concentration was positively associated with LSM. The quartile-based analysis found a significant inverse correlation between quartile serum iron concentration and the lowest serum iron concentration. Conclusion: Serum iron concentration and LSM was inversely associated. The assessment of iron biomarkers might be a part of evaluating liver health and chronic liver diseases. Decrease serum iron or increase ferritin implies a possible pro-inflammatory process in the liver, and within the normal range, higher serum iron levels and lower serum ferritin are considered to be a balance status of body iron homeostasis and reduced the risks of liver fibrosis.

Background: Lyme disease or Lyme borreliosis is the most commonly transmitted tick-borne infection in the United States and among the most frequently diagnosed tick-borne infections worldwide. Lyme disease is caused by Borrelia burgdorferi. Aim: In this study, we explored the epidemiological characteristics, differences, and trends in domestic and imported cases of Lyme disease in Taiwan between 2007 and 2020 according to patient sex, age, month of confirmation, and area of residence. Methods: We analyzed publicly available annual summary data on domestic cases of Lyme disease from 2007 to 2020 obtained from a Taiwanese Centers for Disease Control (TCDC) database. In total, 17 confirmed imported cases of Lyme disease were reported. Results: Cases in individuals aged 20–59 years gradually increased, and a distinct pattern of seasonal variation (summer) was observed as a potential risk factor. Furthermore, more men had domestically acquired Lyme disease, and cases were identified in individuals living in the Taipei metropolitan area (11 cases [64.7%]) and rural areas (Gao-Ping region, three cases [17.6%]). Imported cases originated in North America (11 cases [64.7%]) and Europe (6 cases [35.3%]). The incidence of Lyme disease per million population was 0–0.13. The incidence of Lyme disease increased from 2007–2013 to 2014–2020, indicating that the recentness of imported cases may be a risk factor. Conclusion: This is the first study to compare imported cases of Lyme disease from 2007 to 2020 from the surveillance data of the TCDC database. This study highlights the essentiality of longitudinal and geographically extended studies in understanding zoonotic disease transmission in Taiwan. Our findings may inform future surveillance and research efforts.

The patient is a 95-year-old male with underlying disease of hypertensive cardiovascular disease, Type 2 diabetes mellitus, and old cerebrovascular accident. Persistent abdominal cramping pain with fullness sensation and poor appetite had been noted. The flexible colonoscopy could not pass through sigmoid colon. Abdomen computed tomography demonstrated tumor obstruction over sigmoid colon, measurable size in 5.2 cm, with highly suspicion of duodenum invasion. During operation, tumor which located in the sigmoid colon invaded to fourth portion of the duodenum. En bloc resection of the tumor, duodenorrhaphy, and feeding jejunostomy were performed. An end-to-end anastomosis and protective loop ileostomy formation at the right lower quadrant were performed as totally bypass of anastomoses consequently. Direct invasion of colorectal adenocarcinoma into adjacent structures occurs frequently, but only rarely in the duodenum involved. In the case presented above, we could aim that active surgical management is useful for improving patient prognosis without increasing the risk associated with surgery.

Acute colonic pseudoobstruction (ACPO) is a medical emergency defined as acute colonic distention without mechanical obstruction or inflammatory status. The initial treatment for ACPO includes conservative therapy and gastrointestinal tube decompression. Colonic endoscopic decompression is indicated in patients who fail to respond to conservative treatment. If none of the above treatments are effective, surgeries such as cecostomy must be considered. We report the case of a 77-year-old man with a history of Parkinson's disease who was receiving anti-Parkinson agent therapy. The patient presented with abdominal distention for 1 week, and ACPO was diagnosed. The patient received conservative treatment after admission; however, the symptoms and imaging findings did not improve. Endoscopic decompression was unsuccessful. Subsequently, we successfully treated the patient with a novel technique by placing a decompression tube into the proximal colon under the guidance of a colonoscope.

Huge or enlarged solid ovarian tumor, elevated serum CA-125 levels, massive ascites, and even pleural effusions are common features of ovarian cancer which have the worst outcome of gynecological malignancy. Here, we report a 53-year-old woman with fibrothecoma-associated Meigs syndrome mimicking ovarian malignancy, whose symptoms resolved gradually, and subsequently, serum CA-125 level declined to normal range after surgical intervention. The pathological diagnosis revealed fibrothecoma of the ovary compatible with Meigs syndrome containing the triad of benign ovarian tumor, ascites, and pleural effusion. Therefore, Meigs syndrome should be considered one of the clinical differential diagnoses for a large ovarian tumor with ascites, pleural effusion, and elevated CA-125.

Restriction of gamma-hydroxybutyrate (GHB) in 1990 resulted in a shift toward the use of gamma-butyrolactone (GBL) or 1,4-butanediol (1,4-BD), which remain unregulated in most countries, including Taiwan. Self-reported GBL and 1,4-BD use are less common than GHB use, and the prevalence of GBL or 1,4-BD abuse may be underestimated. The first patient, a 45-year-old male, used GBL to enhance his sexual activity. He developed respiratory system and central nervous system (CNS) suppression; he was intubated and admitted to the intensive care unit. His urine GHB concentration was 289.5 mg/L. The second patient was a 24-year-old male who used 1,4-BD in conjunction with mixed new psychoactive substances to enhance his sexual activity. He also developed CNS suppression, and his urine GHB concentration was 1192.4 mg/L. By reporting these cases, we highlight the recreational use of GHB precursors, such as GBL and 1,4-BD, which is relatively unfamiliar to clinicians. Patients may present with CNS and respiratory depression after the voluntary recreational use of these drugs.

Strongyloidiasis is caused by infection with the helminth, Strongyloides stercoralis. The life cycle of S. stercoralis in the host could last decades owing to autoinfection. Most symptoms of strongyloidiasis are nonspecific and may involve the skin, respiratory tract, or gastrointestinal tract. Severe anemia is a less frequently reported symptom of strongyloidiasis. The prevalence of strongyloidiasis is low in Taiwan, and sporadic cases have been previously reported. We present a case of strongyloidiasis in an 82-year-old woman diagnosed by microscopic examination of stool, presenting with severe normocytic anemia. After treatment with the antiparasitic medication, ivermectin, and blood transfusion, her anemia improved. Therefore, parasite infection should be considered in immunosuppressed patients despite atypical laboratory results. Physicians should be aware of the rare incidence of strongyloidiasis in Taiwan and consider it as a possible differential diagnosis for anemia.