Establishment of a chronic obstructive pulmonary disease mouse model based on the elapsed time after LPS intranasal instillation / 한국실험동물학회지

Chronic obstructive pulmonary disease (COPD) was the 3rd leading cause of death in 2012 worldwide. It is particularly severe in the elderly, who are at risk of death by coughing, mucous hypersecretion, and finally breathlessness. Recently, anti-COPD drug development has increased, and many animal screening systems have been studied. Tobacco smoke animal models are the best known animal screening system, but have several preparation requirements, such as a tobacco smoke generator and a separate facility to prevent smoke release. Accordingly, we evaluated the properties of a lipopolysaccharide (LPS) murine model for COPD screening and the effect of the time elapsed from 0 to 72 hr after LPS intranasal instillation on various biomarkers of COPD severity, such as WBC and neutrophils in bronchoalveolar fluid (BALF), IgE in serum, histopathology in the lung, and cytokines (IL-8, TNF-α, IFN-γ, and TGF-β) and chemokines (CCL-2, CXCL1, CXCL9, CXCL10, and CXCL11) in the respiratory system. Although from 48 hr after LPS treatment several factors which could be evaluated as biomarkers for COPD establishment such as WBC and neutrophil in BALF, IgE in serum, cytokines (IL-8, TNF-α, and IFN-γ), and chemokines (CCL-2, CXCL1, CXCL9, CXCL10, and CXCL11) increased at 72 hr the increment of important factors for COPD establishment such as IgE, fibrosis in the lung, and cytokines (IL-8, TNF-α, and IFN-γ) was more clear. Based on our results, we concluded that the optimal time after LPS intranasal instillation is 72 hr.

The Efficacy of Meniscal Treatment Associated with Lateral Tibial Plateau Fractures

PURPOSE: The purpose of this study was to examine the incidence of lateral meniscal tears associated with lateral tibial plateau fractures and report the clinical outcomes of meniscal treatment with internal fixation of fractures. MATERIALS AND METHODS: All lateral tibial plateau fractures (Schatzker types II and III) in skeletally mature patients treated operatively at our institution between January 2010 and February 2016 were included. All patients underwent open reduction and internal fixation using a buttress plate or cancellous screws. All meniscal tears were initially considered for repair using an all-inside technique. RESULTS: The incidence of lateral meniscal tears with lateral tibial plateau fractures was 64%. Ten patients underwent meniscal repair. In second-look arthroscopy, normal healing was observed in all of the repaired lateral menisci. At the last follow-up, none of the 10 patients had clinical symptoms related to meniscal injuries. One of the 4 patients who had not undergone meniscal treatment although a lateral tear was suspected based on magnetic resonance imaging achieved stable bony union; however, due to the complaint of persisting knee pain, lateral meniscectomy was performed. CONCLUSIONS: Treatment of meniscal lesions associated with lateral tibial plateau fractures showed good clinical and second-look arthroscopic results. Therefore, we believe that recognition and treatment of a meniscal injury at the time of surgical fixation can improve clinical outcome.

Botulinum Toxin Type A Attenuates Activation of Glial Cells in Rat Medullary Dorsal Horn with CFA-induced Inflammatory Pain

The activation of glial cells in the spinal cord has been contribute to the initiation and maintenance of pain facilitation induced by peripheral inflammation and nerve injury. The present study investigated effects of botulinum toxin type A (BoNT-A), injected subcutaneously or intracisternally, on the expression of microglia and astrocytes in rats. Complete Freund's Adjuvant (CFA)-induced inflammation was employed as an orofacial chronic inflammatory pain model. A subcutaneous injection of 40 microL CFA into the vibrissa pad was performed under 3% isoflurane anesthesia in SD rats. Immunohistochemical analysis for changes in Iba1 (a microglia marker) and GFAP (an astrocyte marker), were performed 5 days after CFA injection. Subcutaneous injection of CFA produced increases in Iba1 and GFAP expression, in the ipsilateral superficial lamia I and II in the medullary dorsal horn of rats. Subcutaneous treatment with BoNT-A attenuated the up-regulation of Iba1 and GFAP expressions induced by CFA injection. Moreover intracisternal injection of BoNT-A also attenuated the up-regulated Iba1 and GFAP expressions. These results suggest that the anti-nociceptive action of BoNT-A is mediated by modulation activation of glial cells, including microglia and astrocyte.

Second-Look Arthroscopic Assessment and Clinical Results of Modified Pull-Out Suture for Posterior Root Tear of the Medial Meniscus

PURPOSE: To identify the structural integrity of the healing site after arthroscopic repair of a posterior root tear of the medial meniscus by second-look arthroscopy and to determine the clinical relevance of the findings. MATERIALS AND METHODS: From January 2005 to December 2010, 20 consecutive patients underwent arthroscopic modified pull-out suture repair for a posterior root tear of the medial meniscus. Thirteen patients were available for second-look arthroscopic evaluation. The healing status of the medial meniscus was classified as complete healing, lax healing, scar tissue healing, and failed healing. We evaluated the correlation between the clinical symptoms and second-look arthroscopic findings. Clinical evaluation was based on the Lysholm knee scores and Hospital for Special Surgery (HSS) scores. RESULTS: There were 4 cases of complete healing, 4 lax healing, 4 scar tissue healing, and 1 failed healing. The healing status of the repaired meniscus appeared to be related to the clinical symptoms. Patients who achieved complete tissue healing had no complaint. The healing status exhibited no relationship with age, mechanical axis, degree of subluxation, and symptom duration. The mean Lysholm score improved from 34.7 preoperatively to 75.6 at follow-up and the mean HSS score also significantly increased from 33.5 to 82.2. CONCLUSIONS: We achieved 4 complete and 8 partial healing (lax or scar) of the medial meniscus in this retrospective case series of posterior horn meniscus root repairs performed by 1 surgeon. Further research is needed to clarify why all patients showed clinical improvement despite findings of partial healing on second-look arthroscopy.

A Modified Outside-in Suture Technique for Repair of the Middle Segment of the Meniscus Using a Spinal Needle

INTRODUCTION: Several techniques have been used for arthroscopic repair of middle segment, posteromedial or posterolateral corner tears of the meniscus. One of the commonly used methods is the inside-out double arm needle technique. SURGICAL TECHNIQUE: We have developed a vertical mattress absorbable suture technique. It is easy to perform with a small sized skin incision for knot tying. This technique just necessitates 1 or 2 spinal needles for repair. MATERIALS AND METHODS: Between March 2010 and February 2012, 20 menisci were treated by this technique, a modified method of the outside-in vertical meniscal repair using a spinal needle and No. 2 PDS absorbable suture material. Evaluation of clinical results was done using the Lysholm score. RESULTS: The mean preoperative Lysholm score was 63.9 and the mean postoperative score was 97.3. A second look arthroscopy was performed in 13 knees (65%) and the repair sites were well healed. CONCLUSIONS: We recommend this method as an alternative technique for repair of the middle segment, posteromedial or posterolateral corner of the meniscus.

Comparison of Surgical Outcomes in Thoracolumbar Fractures Having 6 or Less Scored by Load-Sharing Classification Based on Posterior Fusion Level

PURPOSE: The aim of this study is to decide the optimal level of fusion with comparing the results between the short segment fusion and long segment fusion treated with pedicle screw instrumentation, including fractured vertebra in thoracolumbar junctional fractures. MATERIALS AND METHODS: From February 2000 to November 2009, fifty three patients with junctional fracture of thoracolumbar spine were treated with pedicle screws and posterior fusion at our hospital. They were divided into two groups, the short segment group and long segment group. Preoperatively, immediate postoperative and last follow-up lateral radiological evaluation was done by measuring the correction and loss of segmental kyphosis, wedge angle, body compression rate and instrumented vertebra angle. In addition, operation time and amount of intraoperative bleeding were measured. RESULTS: There were no significant differences of statistical analysis regarding the radiological variables between the two groups, especially the loss of corrected segmental kyphosis, wedge angle, body compression rate and instrumented vertebra angle (p>0.05). However, operative time in the short segment group (234 minutes) was shorter than the long segment group (284 minutes), and there was statistical significance (p=0.002). CONCLUSION: We recommend the short segment transpediculr instrumentation one level above and one level below, including the fractured vertebra for thoracolumbar junctional fracture with 6 points or less of the load-sharing score.

Percutaneous Cannulated Screws with Tension Band Wiring Technique in Patella Fractures

INTRODUCTION: Most patellar fractures are transverse involving the central third. Open reduction and stabilization of transverse patellar fractures is indicated if there is more than 2-3 mm of fragment separation and/or articular incongruity. SURGICAL TECHNIQUE: This study describes a percutaneous 2 cannulated screws and modified tension band wiring technique to treat transverse patellar fractures. MATERIALS AND METHODS: We performed 30 cases of displaced transverse patellar fractures with this technique. The clinical outcomes of these patients were evaluated with simple radiographs, range of motion and Lyshom score. RESULTS: This technique has shown to provide satisfactory clinical results and excellent knee functions. CONCLUSIONS: This technique provide stable fixation, allows early motion exercise by minimizing injury to extensor mechanism and reduce cosmetic problem in scar.

Muscle Infarction and Calcification of the Semitendinosus Tendon: A Case Report / 대한골관절종양학회지

The most common anatomic location of calcific tendinitis is the suprasupinatus muscle of the shoulder joint. However, it is known to develop in any joint including the hip, knee. Infarction of skeletal muscle in the distal areas of the limbs due to vascular occlusion is a well recognized systemic condition in patients who have diabetes. The author experienced mass-like lesion combined muscle infarction and calcification within pure semitendinosus tendon without diabetes in posterosuperior area of distal thigh in old age.

Clinical Results of Direct Arthroscopic Excision of Popliteal Cyst Using a Posteromedial Portal

PURPOSE: To evaluate the efficacy of the direct arthroscopic excision of a popliteal cyst without additional skin incision using a posteromedial portal based on minimum 2 year follow-up clinical results. MATERIALS AND METHODS: From January 2003 to January 2010, 105 patients (111 cases) with popliteal cyst have been treated by a direct arthroscopic excision. Direct arthroscopic excision using a 70 degree arthroscopy and posteromedial portal can correct the valvular mechanism of capsular fold and reduce the complications with no additional skin incision at the popliteal area. In all cases, preoperative magnetic resonance imaging (MRI) was performed to detect combined intraarticular pathology. At 2 years postoperatively, a follow-up ultrasonography or MRI was performed to detect the recurrence of cysts. We used Rauschning and Lindgren criteria for clinical evaluation. RESULTS: All cases had neither recurrence nor complaints of pain, swelling, or functional impairment more than 2 years after the surgery. At ultrasonography or MRI, no recurrence was found, and 5 complications were 1 skin lesion and 4 hematoma. Postoperatively, Rauschning and Lindgren criteria were more than grade 1. CONCLUSIONS: Direct arthroscopic excision using 70 degree arthroscope and posteromedial portal is an effective method for the treatment of popliteal cyst.

Modified Pull-out Suture in Posterior Root Tear of the Medial Meniscus: Using a Posteromedial Portal

In cases with root tear of the medial meniscus posterior horn, the meniscus usually can be repaired by a pull out suture technique. However, there is difficulty in manipulating a suture hook via the anteromedial portal and looking through the arthroscopic camera via anterolateral portal in the narrow medial joint space at the same time. This article describes a modified simple pull out suture technique for root tear of the medial meniscus posterior horn using a posteromedial portal that provides a safe and easy handling of the suture hook. Our indications of this technique used in patients with Outerbridge 1-2 arthritic change and minimal varus axis change. Benefits of this technique are simple, less invasive, and reduced operation time by simultaneous suture with a hook via posteromedial portal and pulling of a string with grasper. It may reduce the possibility of an additional chondral or meniscal injury.

Development of a portable iontophoretic drug delivery device with in-vitro experiments for androgeneticalopecia treatment

This study presents the development of a portable drug delivery device using an iontophoresis method to treat the androgenetic alopecia with in-vitro experiment. To treat this condition, the drugs for alopecia treatment need to be delivered into the scalp. Therefore, iontophoretic stimulation was used in a portable drug delivery device to enhance the penetration of the drug delivery. The designed device consisted of a drug container, an iontophoretic stimulation part and a rechargeable part. The iontophoretic part included a voltage boosted circuit, a protection circuit to achieve the iontophoresis effect and to protect the device. The device was tested with an oscilloscope and an in-vitro experiment was also performed to test the operation of the device. According to the experiment's results, the iontophoresis circuit board performed well as did the designed drug delivery device. And the results of the in-vitro experiment also performed well with the penetration enhanced drug delivery via stimulation with the iontophoresis method. The presented portable iontophoretic device enhances the penetration of the drug delivery as proven by the experiment. Also, a positive feature of the device is that it allows patients to use it everywhere by themselves. Improving the device's functionality and usage safety will be researched in the future

A Case of Delayed Recurrent Hemarthrosis after Percutaneous Pin Fixation of the Patellar Fracture

A 24-year-old man underwent percutaneous fixation with pins for an undisplaced patellar fracture. At 7 months follow-up postoperatively, he presented with recurrent, painful swelling of the operated knee following trivial activities of daily life. Aspiration had been performed two times before he presented to us with symptoms. An x-ray showed that one of the pins was suspected to be protruding at the inferior pole of the patella. Magnetic resonance imaging confirmed effusion in the joint. Arthroscopy revealed that the pin was prominent intraarticularly, and the adjacent infrapatellar fat pad with surrounding synovial tissue seemed to be abraded. The pins were removed under arthroscopic guidance and any pain or hemarthrosis disappeared thereafter.

Arthroscopic Direct Repair for a Complete Radial Tear of the Posterior Root of the Medial Meniscus

We report here on a new arthroscopic direct repair technique for a radial tear of the posterior root of the medial meniscus (PRMM) using a posterior trans-septal portal. Radial tears of the PRMM are commonly observed in the elderly population of Korea and Japan, and the life style of these people requires squatting and kneeling down in daily life. A radial tear of the PRMM results in the loss of hoop tension and this accelerates degenerative changes in the knee joint and causes early osteoarthritis. Several reports in the medical literature have focused on various repair techniques for these tears by using pull out sutures. These techniques result in nonanatomic fixation of the meniscus, which may lead to disturbed meniscal excursion and failure to restore hoop tension. Arthroscopic direct repair may contribute to restoring hoop tension and preventing accelerated degenerative changes in the knee joint of these patients.

Dream time estimation by wireless ECG telemetry system

This paper illustrates the design and implementation of ECG telemetry system used to automatically estimate the dream time of a health subject. The dream time estimation has been done by acquiring variance of heart rate variability in sleep cycle. The implemented system has low power consumption and of small size [2.5cm x 3cm]. Using ECG telemetry system, the estimation of dream time is easier and faster than conventional method such as polysomnography by EEC, EMG or EOG. The experimental results enlighten that the subject experienced the dream 4 times in the whole night and by adding the time of each stage we will achieve the total dream time. The total dream time is 500 second. Compare it with commercial product shows the 2.91% error in result

Seven-year Results of a Tapered, Titanium, Hydroxyapatite-Coated Cementless Femoral Stem in Primary Total Hip Arthroplasty

BACKGROUND: Aseptic loosening of cemented hip prostheses is recognized as a long-term problem, and especially in males and younger patients. Much energy has been focused on developing new prostheses that are designed for cementless fixation. We evaluated the performance of and periprosthetic bone response to a tapered, titanium, hydroxyapatite (HA)-coated femoral hip prosthesis at a minimum of 7 years of follow-up after treatment with primary total hip arthroplasty. METHODS: Seventy-eight patients and 86 hips were included in the study. There were 35 men and 43 women; the mean age at the time of the operation was 59 years (range, 41 to 81 years). We used a tapered, titanium (Ti6Al4V), HA-coated femoral implant. We evaluated the patients at a minimum of 7 years of follow-up after treatment with primary total hip arthroplasty. Clinical evaluation was performed using the scoring system and the hip scores were assigned according to the level of pain, the functional status and the range of motion. The patients who refused to return, but who did forward X-rays for review after being contacted were questioned by phone about the functional status of their hip. Radiographic follow-up was performed at six weeks, at three, six and twelve months and yearly thereafter. All the available radiographs were collected and assessed for implant stability, subsidence, osseointegration, osteolysis, stress shielding and evidence of periprosthetic lucency. RESULTS: Eighty-six hips (78 patients) were available for review at follow-up of greater than 7 years. In 11 of the 86 cases, acetabular failure required revision of the acetabular component, but the femoral stem survived and it was available for long-term evaluation. The radiographs were obtained at 7-year follow-up for another 20 hips, but the patients would not come in for the 7-year clinical evaluation. Therefore, a phone interview was conducted to assess any change in the functional status at a minimum of 7 years. CONCLUSIONS: The mechanical fixation of a tapered, titanium, HA-coated femoral implant was excellent in this study. This femoral design provided reliable osseointegration that was durable at a mean of 7 years follow-up.

A comparative study of two transobturator tape procedures: 'Outside-in' (TOT) and 'inside-out' (TVT-O) for surgical treatment of female stress urinary incontinence / 대한산부인과학회지

OBJECTIVE: To compare the outcomes of the 'outside-in' (TOT) and 'inside-out' (TVT-O) transobturator tape procedures for surgical treatment of female urinary incontinence. METHODS: We enrolled 320 stress urinary incontinence women who could be followed-up and they underwent the TOT procedure (N=184) and TVT-O procedure (N=136) from January 1, 2003 to June 30, 2006. The preoperative evaluation included a history taking, physical examination, residual urine check, pad test, Q-tip test and urodynamic test. And we investigated the patients' characteristics, success rates, operation times, concomitant surgeries, hospital days, hemoglobin changes and complications. RESULTS: There were no statistically significant differences in patients' characteristics and urodynamic tests except the intrinsic sphincter deficiency rate (ISD: 5.6% vs. 30.6%, p=0.000). The success rates were similar in both groups (98.4% vs. 97.8%). Most common complication of TOT group is operation site erosion (2.1%), and TVT-O group is thigh or vaginal pain (3.6%). There were noted other complications, such as postoperative urinary retention, de novo urgency and urinary tract infection. Total complication rates of both groups were not statistically different (7.6% vs. 9.5%, p=0.415). There were no statistic differences in the postoperative complication rates of between only TOT group and TOT with colporrhaphy group (p=0.371), also between only TVT-O group and TVT-O with colporrhaphy group (p=0.692). There were no correlation with ISD and postoperative complications in TOT (p=0.373) and TVT-O group (p=0.082). CONCLUSIONS: The two procedures of transobturator tape procedure for female stress urinary incontinence appear to be equally effective and safe. However, long-term follow-up, surgeons' learning course, skill and experience for transobturator tape procedures should be evaluated at further studies.

Emerging Therapies in Vegetative and Minimally Conscious State after Brain Injury

The practice of coma arousal and brain stimulation in vegetative state or minimally conscious state is becoming the focus of heated debate. There is no definite theory on which patients may benefit, at what time in their recovery, or how the 'arousal' or 'stimulation' procedures should be applied. In this review, old and new therapeutic methods for recovery of vegetative state or minimally conscious state will discussed. And we consider some of the information processing mechanisms that are important mediators of arousal and awareness in current practices.

Evaluation of fat sources (lecithin, mono-glyceride and mono-diglyceride) in weaned pigs: Apparent total tract and ileal nutrient digestibilities

This study was conducted to investigate the effects of lecithin, mono-glyceride and mono-diglyceride on apparent total tract and ileal nutrient digestibilities in nursery pigs. Twenty [(Landrace x Yorkshire) x Duroc] barrows were surgically fitted with simple T-cannulas. Dietary treatments included 1) CON (basal diet: soy oil), 2) LO (lecithin 0.5%), 3) MO (mono-glyceride 0.5%), 4) MG (mono-glyceride 1.0%) and 5) MDG (mono-diglyceride 1.0%). In apparent total tract nutrient digestibility, dry matter (DM) and gross energy (GE) digestibilities of MDG treatments were higher than LO and MG treatments (p<0.05). In nitrogen (N) digestibility, LO treatment showed the lowest compared to others (p<0.05). The digestibility of crude fat was higher in MDG treatment than CON and LO treatments (p<0.05). In apparent ileal nutrient digestibility, DM digestibility was higher in MDG treatment than LO and MG treatments (p<0.05). GE digestibility was higher in MDG treatment than LO, MO and MG treatments (p<0.05). N digestibility of MDG treatment was greater than LO treatment (p<0.05). Also, the digestibility of crude fat was higher in MDG treatment than CON and LO treatments (p<0.05). In conclusion, mono-diglyceride can increase apparent total tract nutrient and apparent ileal nutrient digestibilities of DM, GE, N and crude fat.

The Treatment of Patellar Fracture with Cannulated Screws and Modified Tension Band Wiring by Two Mini-incision Technique

PURPOSE: To evaluate that the radiological and clinical results of transverse patellar fractures treated with cannulated screws and modified tension band wiring by two mini-incision technique. MATERIALS AND METHODS: We reviewed 20 cases displaced transverse patellar fractures treated with cannulated screws and modified tension band wiring by two mini-incision technique. The radiological assessment was based on the time to union, maintenance of reduction. Mean duration of follow up was 27 months with mean age of 46 years. The functional outcome was assessed with the range of motion, complications and Lysholm score. RESULTS: All fractures was healed without displacement. The mean time to union was 7.3 weeks and degree of reduction were excellent in 11 cases and good in 9 cases and mean Lysholm score was 89 points(range, 81 to 95 points). We found no complication like limitation of range of motion of the knee, loss of reduction, irritation and migration of the hardware, and infection at last follow up. CONCLUSION: This surgical technique provide stable fixation, allows early motion exercise by minimizing injury to extensor mechanism and reduce cosmetic problem in scar.

Deep Infection following Instrumented Posterior Fusion / 대한정형외과학회잡지

PURPOSE: This study evaluated the diagnosis, treatment and related results for cases with a deep infection after instrumented posterior fusion. MATERIALS AND METHODS: Among the 306 cases of posterior instrumented spinal fusion, Seventeen cases who developed deep infection were reviewed retrospectively. RESULTS: The incidence of deep infections was 5.6% and the mean age of the cases with a deep infection was 55 years old. Nine out of 17 cases had the preoperative risk factors such as old age, diabetes, malnutrition, obesity, etc. The mean duration to diagnosis of a postoperative infection was 12.9 days (4-8 days). The clinical manifestations were fever, night pain and abscess drainage. In all cases, the value of the WBC, ESR and CRP were elevated. All cases were treated surgically as soon as possible with abscess drainage, debridement and the insertion of antibiotics-mixed cement beads without the removal of the instrument. The most common bacterial organisms were Coagulase negative Staphylococcus aureus in 11 cases. Vancomycin was used as the antibiotic. During the follow-up period, 2 cases were treated with the removal of the instruments due to metal failure and a delayed deep infection with loosening. The average follow-up was 32 months (12-56 months). 15 cases were controlled successfully without needing to remove the instruments and without complications. CONCLUSION: The meticulous care for a deep infection after posterior instrumented spinal fusion is essential. Favorable results can be achieved by surgery with drainage, debridement, and the insertion of antibiotics-mixed cement beads along with systemic antibiotics as soon as possible without removing the instruments.