Gene Therapy for Bone Tissue Engineering

Gene therapy holds a great promise and has been extensively investigated to improve bone formation and regeneration therapies in bone tissue engineering. A variety of osteogenic genes can be delivered by combining different vectors (viral or non-viral), scaffolds and delivery methodologies. Ex vivo & in vivo gene enhanced tissue engineering approaches have led to successful osteogenic differentiation and bone formation. In this article, we review recent advances of gene therapy-based bone tissue engineering discussing strengths and weaknesses of various strategies as well as general overview of gene therapy.

Phenolic Compounds and Triterpenes from the Barks of Diospyros burmanica

Diospyros burmanica Kurz. is an evergreen deciduous tree distributed in Mandalay of Myanmar, which belongs to the family of Ebenaceae. In Myanmar, it has been used to treat diarrhea, diabetes, diabetes and also as lumbers. In this study, seven flavonoids (1 - 7), a phenolic compound (8), and five triterpenes (9 - 13) were isolated from the barks of D. burmanica and their chemical structures were elucidated. Isolates were identified to be (+)-catechin (1), (+)-catechin 3-O-alpha-L-rhamnopyranoside (2), (+)-catechin 3-O-gallate (3), (-)-epicatechin (4), (-)-epicatechin 3-O-gallate (5), (+)-afzelechin 3-O-alpha-L-rhamnopyranoside (6), (+)-2,3-trans-dihydrokaempferol 3-O-alpha-L-rhamnopyranoside (7), methyl gallate (8), lupeol (9), methyl lup-20(29)-en-3-on-28-oate (10), beta-amyrin (11), alpha-amyrin (12), 3beta-hydroxy-D:B-friedo-olean-5-ene (13) through MS, 1H NMR and 13C NMR spectroscopic evidences.

Relationship between the Incidence of Vocal Cord Palsy and Aspiration Risk in Acute Ischemic Stroke Patients

OBJECTIVE: To investigate the incidence of vocal cord palsy (VCP) in acute ischemic stroke patients and its influence on aspiration risk. METHOD: Fifty patients with first-ever acute stroke were enrolled. The mean age was 68.3 years and there were 21 men and 29 women. Based on clinical and neuroimaging findings, their stroke subtype was categorized into cortical/ subcortical (Group A), lateral medulla (Group B) and other brainstem (Group C). We examined them by using flexible fiberoptic rhinolaryngoscope and videofluroscopic swallowing study (VFSS) within 2 weeks after stroke onset. The Penetration - Aspiration Scale (PAS) was used to score each VFSS. RESULTS: Among the 50 patients, VCP was found in 15 (30%): 15.8% of group A, 100% of group B and 40% of group C. VCP was contralateral to the brain lesion in group A and ipsilateral in 85.7% of group B. Aspiration risk was found in 38% of the all patients and 53% of VCP had aspiration risk. No differences in the incidence of aspiration risk were noted according to VCP (chi-square=2.138, p=0.144). CONCLUSION: There was no relationship between VCP and aspiration risk in acute ischemic stroke patients. Although VCP is a known risk factor for aspiration, other factors are important in determining an effective swallowing.

The Effect of Extracorporeal Shock Wave Therapy in Plantar Fasciitis

OBJECTIVE: To evaluate the effect of extracorporeal shock wave therapy (ESWT) in plantar fasciitis with visual analog scale score and thickness of fascia by ultrasonography. METHOD: The subjects consisted of 32 feet (24 patients) with established diagnosis of chronic plantar fasciitis, including 17 feet in the ESWT group and 15 feet in the control group. In the ESWT group, three session of ESWT (0.24 mJ/mm2 FED, 1,200 impulse, weekly) were performed. The visual analog scale (VAS) score and thickness of the plantar fascia were measured by ultrasound before therapy and at the 6-week and 6-month follow-up. Patients in the control group were treated with medication, orthotics, physical therapy and exercise program. VAS and thickness of plantar fascia was evaluated at the same time as ESWT group. RESULTS: In the ESWT group, thickness of plantar fascia decreased significantly at 6-week follow-up (p 0.05). Visual analog scale score showed no significantly difference at 6-week follow-up (>0.05), but decreased at 6-month follow-up. On the other hand, in the control group, thickness of plantar fascia did not change significantly at 6-week follow-up (>0.05) and 6-month follow-up (>0.05). VAS score was not significant different at the 6-week follow-up (>0.05), but decreased at the 6-month follow-up (p <0.05). CONCLUSION: ESWT in plantar fasciitis is effective in relieving subjective pain and reducing thickness of plantar fascia at 6-month follow-up.

Comparison of Blind and Ultasonography Guided Approach of Suprascapular Nerve Block

OBJECTIVE: To compare ultrasonography guided versus blind approach in a randomized trial examining the efficacy of suprascapular nerve block in patients with non-specific shoulder pain. METHOD: A total of 20 patients with shoulder pain lasting for more than 1 month were included in this study. After 1:1 randomization, patients were included either in the blind group (n=10) or in the ultrasonography guided group (n=10) of suprascapular nerve block. All patients were evaluated before and after treatment, in terms of shoulder pain and disability index (SPADI) and nerve conduction study. RESULTS: Significant improvements were seen in all pain scores and disability after both types of nerve block, with no significant difference in the improvement of pain and disability between the two approaches. However, amplitude changes of nerve conduction study were larger in ultrasonography guided approach than blind approach. CONCLUSION: This study suggests ultrasonography guided approach of suprascapular nerve block could place the needle closer to the nerve compared to blind approach.

Comparison of the Effects between Growth Hormone and Hyaluronic Acid on Degenerative Cartilage of Knee in Rabbit

OBJECTIVE: To explore whether the growth hormone is effective in the treatment of degenerative cartilage of knee in rabbits. METHOD: Thirty New Zealand white rabbits were administered intra-articular injection with monosodium iodoacetate (Sigma, St. Louis, USA) 2.5 mg and divided into 3 groups. Each group was administered with hyaluronic acid (Hyruan plus(R), LG life science, Seoul, Korea)(group A) 0.6 ml, growth hormone (Declage(R), LG life science, Seoul, Korea) (group B) or saline (group C) 0.6 ml intra-articulary once a week for 4 weeks, beginning 4 weeks after the degeneration induction. All rabbits were killed 9 weeks after degeneration induction. The histologic morphology was observed by optical microscope with knee cartilage. RESULTS: Mankin score was 2.4+/-1.3 in group A, 3.9+/-1.7 in group B, 7.4+/-0.8 in group C. Yoshimi score was 1.5+/-0.7 in group A, 2.2+/-0.9 in group B, 4.4+/-0.6 in group C. Gross and microscopic morphologic findings showed that group C represented the more severe than group A & B (p<0.01), also group A was better than group B (p<0.05). CONCLUSION: Growth hormone is effective on degenerative knee cartilage in rabbit model, but less than the hyaluronic acid.

The relationship between the Alzheimer's Disease Assessment Scale and other measures of dementia

BACKGROUND: The cognitive subscale of the Alzheimer's Disease Assessment Scale(ADAS-Cog) has been extensively valiated in assessing cognitive function in patients with Alzheimer's Disease(AD) and used as an efficacy measure in clinical trials of AD. There is a need for additional data on the relationship between cognitive performance and other measures of dementia to fully assess the value of the ADAS-Cog as a measure of treatment efficacy. METHODS: We used data from 53 AD participants in 8 multicenter clinical drug trials to examine the distribution of baseline ADAS-Cog scores in relation to Mini-Mental State Examination(MMSE), Global Deterioration Scale(GDES), Katz Index of Activity of Daily Living(ADL), Lawton Instrumental Activity of Daily Living(IADL), Geriatric Depression Scale(GDS) and Mini-Nutritional Assessment(MNA). RESULTS: The ADAS-Cog score was statistically significantly correlated with MMSE (R=-0.755, P<0.001), GDES(R=0.403, P<0.003), ADL(R=-0.532, P<0.001), IADL(R=-0.626, P<0.001) and MNA(R=-0.427, P=0.004) scores. But GDS scores were not associated with ADAS-Cog scores.(R= -0.123, P=0.396) CONCLUSIONS: This study characterizes the relationship between ADAS-Cog scores and other commonly used measures of dementia in AD patients. As expected, baseline scores on ADAS-Cog and MMSE demonstrated significantly high correlation. The relatively weaker correlation between ADAS-Cog and GDES scores may be related to the fact that GDES does not evaluate cognitive function only. There are also significant correlations between ADAS-Cog and ADL, IADL, and MNA which indicate the severity and progression of dementia in AD patients. Further studies with larger samples including cognitive function of broader spectrum need to confirm the findings in this study.

Free Flap Reconstruction in the Head and Neck Regions: A Review of 40 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: With the advent of free flap reconstruction techniques, several free flaps were used for a variety of head and neck defects. The objective of this study was to review our experience during 3-year period in performing 40 microvascular free flaps for head and neck defects. Materials and Method: A review of 40 microvascular free flaps performed in 38 patients between April 1995 through August 1998 was undertaken. Patient's age, sex, stage of disease, types of free flaps, short-term postoperative outcome including the flap success rate, postoperative complications, effect of preoperative irradiation on the development of the wound complications such as fistula were evaluated. RESULTS: 36 (90%) of 40 free flaps were successful with 4 failures resulting from 3 venous thromboses and 1 infection. Emergent reexploration was done in 2 patients, none of whom were successfully salvaged. The postoperative surgical complications including donor site complications and medical complications were seen in 17 flaps (47%) and in 8 flaps (22%), with multiple complications seen in several patients. The preoperative radiotherapy did not affect the incidence of the postoperative surgical complications (p=0.273). CONCLUSION: In review of our experience, we believe that free flap reconstruction in head and neck regions has become a useful procedure with acceptable outcome and complication rates and has surpassed conventional techniques cosmetically and functionally.