New Bone Formation Following Transplantation of Stem Cells and Nanoscale Hydroxyapatite Scaffold Materials into Rabbit Long Bone Defects / 대한정형외과학회잡지

PURPOSE: We observed new bone formation following the transplantation of allogenic periosteum-derived stem cells and different sizes of hydroxyapatite (HA) scaffold materials into rabbit long-bone defects. MATERIALS AND METHODS: Thirty-two white rabbits were grouped according to the material transplanted into their tibial bone defects: group 1 (microscale HA only); group 2 (nanoscale HA only); group 3 (microscale HA plus stem cells); and group 4 (nanoscale HA plus stem cells). Viscosity was controlled by the relative amounts of HA and agar. After surgery, radiologic, microscopic, and biochemical observations were performed weekly for 8 weeks. RESULTS: Nanoscale HA (groups 2 and 4) provided better bone formation than microscale HA (groups 1 and 3). The rabbits that had been transplanted with nanoscale HA plus stem cells (group 4) had more homogeneous bone formation during the natural repair process than the other groups. CONCLUSION: Further study is required using nanoscale HA plus organic substance and stem cells, which are more similar to human bone structure, for better bone formation.

Comparison of Bone Formation between Allogenic Periosteum-Derived Mesenchymal Stem Cells and Cultured Osteoblasts Transplanted into Long-Bone Defects of Rabbits / 대한정형외과연구학회지

PURPOSE: To analyze the bone formation between allogenic periosteum-derived mesenchymal stem cells and cultured osteoblasts transplanted into rabbit long-bone defects. MATERIALS AND METHODS: Forty white rabbits were grouped according to the material transplanted into their tibial bone defects: stem cells plus agar (group 1); osteoblasts plus agar (group 2); osteoblasts plus gelfoam (group 3). Bone formation was evaluated radiologically, histologically, and using serum osteoblastic markers during 8 weeks following transplantation. RESULTS: Group 1 and 2 both showed satisfactory bone formation, with group 2 showing thicker and more abundant bone trabeculae than group 1. Rabbits in group 3 showed worse bone formation than group 1 and 2. CONCLUSION: These results demonstrate that rabbits implanted with osteoblasts (with agar) showed more satisfactory bone formation than those inserted with stem cells; thus osteoblasts may be useful in the treatment of bone defects.

Factors Related to the Compliance of Hormone Replacement Therapy for Menopausal Women

BACKGROUND: Hormone replacement therapy (HRT) is the most effective treatment for climacteric symptoms. It also has definitive role in reducing or preventing the risk of osteoporosis. However, compliance with HRT is very poor. This study was conducted to know the compliance of hormone replacement therapy and investigate the determining factors for compliance. METHODS: Review of charts and telephone questionnaires were completed among 107 women who had received HRT in a family medicine clinic at a university hospital. Compliance was determined by the medication availability ratio (MAR): (HRT treated days)/(total number of observed days). An individual with MAR less than 0.75 was considered as partial compliance, and more than 0.75 was considered as complete compliance group. RESULTS: The average age of 107 subjects was 57.4 years. Among the 107 study subjects, 59 persons (55.1%) were compliant with HRT. Mean observation period was 17.6 months. The compliance with HRT was 60.9%, 55.1%, 49.6% at 12, 24, 36 months, respectively. The compliance was higher in high-perception group compared to low- perception group (P=0.01). Education level, presence of osteoporosis, hysterectomised state, difference in doctor and past fracture history were not associated with compliance. The reasons for starting HRT were physician's recommendation, osteoporosis prevention, treatment of menopausal symptoms, and influence of mass media, in descending order. CONCLUSION: The compliance with HRT was 61% at one- year treatment and 50% at three-year teatment period. Positive attitude for HRT was related to higher compliance with HRT. Patient education on HRT is essential for successful compliance of HRT.

Use of complementary therapies for rheumatologic conditions among patients of rheumatologists

BACKGROUND: Use of Complementary and Alternative Medicine(CAM) is common among patients with chronic conditions such as rheumatic disorder. This study was conducted to know rate and behavior of using CAM and to improve doctor patient relationship in rheumatic patients. METHODS: Among patients visiting a tertiary hospital rheumatology clinic, 867 persons (15.8% of total) were selected conveniently and interviewed by a trained nurse according to structured questionnaire from July 1st through July 31st 1999. Three hundreds and sixty two CAM users completed the interview. RESULTS: Among 867 persons interviewed, 372 persons had used CAM (use rate 44%). Use rate of Chinese medicine was 26%, CAM except Chinese medicine 21%. Herb medicine(49.4%) was the commonest single category of all CAM. Twenty four percents of users had used two or more types of CAM, 6.8% had experienced adverse effects. The average yearly cost for CAM was 704,000 won/person, 64% of the one for hospital use, 1,100,000 won/person. The subjectively rated degree of effectiveness was 6.3 points which was significantly higher when compared with 5.9 points for hospital services. The degree of satisfaction with CAM was 5.6 points which was higher than that of hospital services, 4.8 points. The most frequently reported reason for using CAM was the hope for synergic treatment effect(32%). The proportion of experiencing adverse effects from CAM was 7% of all users. Only one fourth of the users had discussed on the CAM use with the western doctors. The commonest reason for not discussing CAM was that the respondents had no need to discuss about it (40%). Among doctor's attitudes when discussing CAM with patient, limited approval was most common.(40%) CONCLUSION: Among patients with rheumatic conditions, 44% use CAM. Herb medicine was most commonly used CAM. Comparing with hospital services, cost for CAM is 2/3 but its subjective effectiveness and satisfaction are higher. Western doctors must consider appropriately the need from users of alternative medicine.

The interview skills observed in medical interview of third-year medical students

BACKGROUND: Establishing effective communication between doctor and patient help doctors treat their patients easily and influence patient's compliance with medical regimen and treatment outcome. The objective of this study was to evaluate common characteristic of third-year medical student's behavior in their patient interview and apply these results to medical education of communication. METHODS: Ninety-one third-year medical students in Hanyang University College of Medicine through their clerkship in family medicine had been instructed to perform medical interviews of patients who visited the Department of Family Medicine of Hanyang University Hospital. Video-taped records of the interviews using CCTV were done. The evaluation was done with a rating scale table consisting of 20 items. The rating scale was categorized in to 5 areas: beginning the interviews, collection of information, doctor-patient relationship, structure of interview and ending the interview. RESULTS: Among the 62 students who were enrolled in the study, 55 students were males(84%). In the process of collecting information 33 students(53%) applied open-ended question at least once. Eighteen students(29%) used leading question. In the doctor-patient relationship, 3 students gave empathic verbal response among 58 records which were applicable. In the structure of interview, 25 students(40%) appropriately avoided to shift abruptly the focus of discussion. When ending their interviews, 6 students(10%) clarified the interview in whole. CONCLUSIONS: We conclude that there are several deficiencies in medical students' communication skills during their process of interviews that might influence information gathering and doctor-patient relation ship.

Clinical Electrophysiological Study on Sick Sinus Syndrome

Nine patients of mean age 47.8 years, with suspected sinus node dysfunction, underwent extensive electrophysiological studies. Sinus bradycardia(6the electrophysiological study, AH and HV intervals were prolonged in 2/9 and 1/9 patients, respectively. Maximal sinus node recovery times were prolonged in 7/9 patients, ranging from 1,330 msec to 12,330msec. Sinoatrial conduction times measured by atrial premature stimulation technique were prolonged in 5/7 patients, ranging from 137msec to 310 msec. And sinoatrial conduction time measured by continuous pacing technique also revealed prolonged value in 4/6 patients ranging from 140 msec to 195 msec. The effective refractory periods, of atrium were prolonged in 6/8 patients (320 msec to 470 msec). The effective and functional refractory periods of AV node were prolonged in 3/8 patients (440 csec to 490 msec) and 4/8 patients (530 msec to 560 msec), respectively. Retrograde VA conduction could be observed in 3/7 patients and ventricular effective refractory periods were normal in 7/7 patients. Atrial flutter was induced in 1/9 patients by electric stimulation during electrophysiological study. Above data suggest that the electrophysiological study is very useful in assessing the sinus node function and other electrophysiological properties in sick sinus syndrome patients and also suggest that the data could be utilized in choosing the proper mode of artificial pacemaker for each patient.