Changes in the Body Mass Index after Total Knee Arthroplasty in Asians / 대한정형외과학회잡지

Purpose@#This study examined the changes in the body mass index (BMI) and the effects of BMI on the knee function and risk factors for an increase in BMI after total knee arthroplasty (TKA) in Asians. @*Materials and Methods@#A prospective observational study was conducted on 100 cases of TKA performed by one surgeon. Obesity was defined as BMI ≥25 kg/m 2 . The BMI and Knee Society Score, consisting of the Knee Score and Function Score, were measured on the day before surgery and one year after surgery. @*Results@#The BMI decreased or was maintained in 34 cases (34%) and increased in 66 cases (66%) one year after surgery. An increase in BMI of 5% or more was considered a clinically significant increase in BMI and occurred in 28 cases (28%). The patients with an increased BMI by more than 5% showed a significantly lower knee function score. The age and preoperative function score were significantly associated with an increased BMI by more than 5%. As the age increased by one year, the odds ratio at which the BMI would increase by more than 5% one year after surgery was 0.905. Moreover, as the preoperative function score increased by one point, the odds ratio that the BMI would increase by 5% one year after surgery was 0.902. In other words, a younger preoperative age and a lower preoperative function score mean a higher risk of a more than 5% postoperative increase in BMI. @*Conclusion@#The BMI increased by more than 5% one year after surgery in 28% of the TKA patients examined. They had a lower functional score. The risk factors for a more than 5% increase in BMI after TKA were young age and a low preoperative function score. Therefore, surgeons should educate patients, particularly those who are young or have a low preoperative function score, so that the patient’s BMI would not increase after surgery.

Synergistic Effect of Intraarticular Tranexamic Acid Injection and the Use of Navigation in Total Knee Arthroplasty for Reducing Blood Loss / 대한정형외과학회잡지

Purpose@#This study investigated the synergistic effects of an injection of tranexamic acid and using navigation to reduce the need for blood transfusion and postoperative bleeding after total knee arthroplasty (TKA). @*Materials and Methods@#Patients were divided into three groups and compared. Group 1 (58 cases) included those who had manual TKA with the injection of tranexamic acid in the joint. Group 2 (30 cases) was comprised of those who had navigated TKA without tranexamic acid. Group 3 (32 cases) consisted of patients who had navigated TKA with tranexamic acid. The frequency of transfusion after the operation was measured. To compare bleeding after surgery, drainage volume during 24 hours after surgery was compared and analyzed. @*Results@#Group 1 had five cases of transfusion (8.6%), while there were 9 cases in group 2 (30%) and three cases in group 3 (9.4%). The Chi-squared test revealed a significant difference (p=0.016). An average of 343.67±165.20 ml, 452.10±197.91 ml, and 311.00±129.32 ml was drained in the 24 hours after surgery in groups 1, 2, and group 3, respectively. This difference was analyzed using ANOVA test, which showed a significant difference (p=0.003). The need for transfusion in group 2 was 3.71 times higher than that in group 1. The need for transfusion in group 2 was 4.14 times higher than that of group 3. @*Conclusion@#The combination of navigation use and injection of tranexamic acid has no synergistic effect in reducing the need for blood transfusion and post TKA bleeding. In addition, an injection of tranexamic acid in the joint is more effective in reducing blood transfusions and blood loss after TKA than navigation.

Enhanced Cardiomyogenic Differentiation of P19 Embryonal Carcinoma Stem Cells

BACKGROUND AND OBJECTIVES: We investigated the effects of different concentrations of serum, 5-azacytidine, and culture time on the cardiomyogenic differentiation of P19 embryonal carcinoma stem cells in the course of developing an efficient protocol for generating the cardiomyogenic lineage. MATERIALS AND METHODS: P19 cells were plated at a density of 1x10(6) cells on 10-cm bacterial dishes for 96 hours in the presence of 1% dimethyl sulfoxide to form embryoid bodies. The embryoid bodies were cultured in medium with 2% or 10% fetal bovine serum for an additional 10 or 15 consecutive days in the presence of 0, 1, or 3 microM 5-azacytidine. RESULTS: Quantitative real-time polymerase chain reaction (PCR) analysis showed that the messenger ribonucleic acid (mRNA) expression of cardiac muscle-specific genes, such as GATA4, alpha-actin, alpha-myosin heavy chain, and cardiac troponin T, were significantly higher in the 15-day culture groups than in the 10-day culture groups. Furthermore, the cardiac muscle-specific genes were expressed more in the high-serum groups compared to the low-serum groups regardless of the culture time. Cardiomyogenic differentiation of the P19 cells was most effective in 1 microM 5-azacytidine regardless of the serum concentrations. In addition, the stimulation effects of 5-azacytidine on cardiomyogenic differentiation were more significant under low-serum culture conditions compared to high-serum culture conditions. Cardiomyogenic differentiation of P19 cells was further confirmed by immunostaining with cardiac muscle-specific antibodies. CONCLUSION:Taken together, these results demonstrated that cardiomyogenic differentiation of P19 cells was enhanced by a combination of different experimental factors.

Effects of Granulocyte-Colony Stimulating Factor and Bone Marrow Mononuclear Cells on Cardiac Function and Remodeling in the Porcine Reperfused Myocardial Infarction Model

BACKGROUND: Granulocyte stimulating factor (G-CSF) and bone marrow mononuclear cells (BM-MNC) were reported to improve cardiac function after myocardial infarction (MI). This study was to examine their combined beneficial effects and mechanisms of actions in reperfused MI, which have not been verified yet. METHODS:Fifteen pigs were divided into 3 groups after a 1-hour balloon occlusion and reperfusion of the left anterior descending coronary artery. G1 (n=5) was a control, G2 (n=5) was a G-CSF injected group (10 ug/kg/day, from day1 to day7 after MI), and G3 (n=5) was an autologous intracoronary BM-MNC infused group after G-CSF treatment RESULTS:Modified wall motion indices by echocardiography were similar among 3 groups at 24 hours after MI. However, they improved significantly in G2 and G3 at 35days after MI (p<0.05). The percentage of infarct area/left ventricular myocardial area measured from a triphenyltetrazolium chloride (TTC) stain was lower in G3 than in G1 or G2 (p=0.026). The number of vWF-positive vessels and the expressions of vWF and VE cardherin by RT-PCR were higher in G3 and G2 than in G1 (p<0.05). The number of TUNEL-positive cells and bcl2/bax ratio were not significantly different among 3 groups. CONCLUSION: This study suggests that intracoronary BM-MNC infusion with G-CSF treatment in reperfused MI reduced infarct size, improved left ventricular function and prevented ventricular remodeling.

Cardiac side population cells exhibit endothelial differentiation potential

Recent studies have shown that side population (SP) cells, isolated from adult myocardium, represent a distinct cardiac progenitor cell population that exhibits functional cardiomyogenic differentiation. However, information on the intrinsic characteristics and endothelial potential, of cardiac SP cells, is limited. The present study was designed to investigate whether cardiac SP cells exhibit endothelial differentiation potential. The cardiac SP cells more highly expressed the early cardiac transcription factors as well as endothelial cell markers compared to the bone marrow-SP cells. After treatment with VEGF, for 28 days, cardiac SP cells were able to differentiate into endothelial cells expressing von Willebrand factor as determined by immunocytochemistry. Furthermore, expression of endothelial cell markers increased several-fold in VEGF-treated cardiac SP cells compared to the control group when assessed by real-time PCR. We also confirmed that cardiac SP cells provided a significantly augmented ratio of ischemic/normal blood flow, in the cardiac SP cell-transplanted group compared with saline-treated controls on postoperative days 7, 14, 21 and 28, in a murine model. These results show that cardiac SP cells may contribute to regeneration of injured heart tissues partly by transdifferentiation into angiogenic lineages.

Stem Cell Research in Cardiovascular System / 대한해부학회지

Myocardial infarction leads to loss of tissue and impairment of cardiac performance. Because cardiomyocytes have a limited ability to self-renewal, and thus the transplantation of adult stem cells into infarcted region is a promising therapy to regenerate damaged cardiac tissue. Stem cells for myocardial regeneration are mesenchymal- and hematopoietic stem cells derived from bone marrow, or skeletal myoblasts in animals, and these stem cells generated cardiomyocytes and endothelial cells in the infarcted regions, and improved cardiac function. Clinical data showed that autologous mesenchymal stem cells and skeletal myoblasts increased ejection fraction and blood flow, and decreased infarct size in patients. Some researchers have used a different strategy that cytokine-mobilized bone marrow cells or angioblasts homed to the infarcted region, replicated, differentiated, and improved cardiac function. The current trend is the combined use of cytokine treatment and cell transplantation to increase the efficiency of myocardial regeneration. In addition, genetic manipulation of adult stem cells has been done to express cardioprotective recombinant proteins, or enhance angiogenesis in animal study. Thus cellular transplantation, cytokine induction and gene therapy should not be viewed as competitive but rather as complementary with the common and final goal of improving the outcome of heart failure patients. In this review, we will discuss about studies for myocardial repair in animal and in patients.

5-azacytidine induces cardiac differentiation of P19 embryonic stem cells

The P19 embryonal carcinoma cell line is a useful model cells for studies on cardiac differentiation. However, its low efficacy of differentiation hampers its usefulness. We investigated the effect of 5-azacytidine (5-aza) on P19 cells to differentiate into a high-efficacy cardiomyocytes. Embryoid-body-like structures were formed after 6 days with 1 micrometer of 5-aza in a P19 cell monolayer culture, beating cell clusters first observed on day 12, and, the production of beating cell clusters increased by 80.1% (29 of 36-wells) after 18 days. In comparison, the spontaneous beating cells was 33.3% (12 of 36-wells) for the untreated control cells. In response to 1 micrometer of 5-aza, P19 cells expressed bone morphogenetic protein-2 (BMP-2), BMP-4, Bmpr1a and Smad1 at day 6 or 9, and also cardiac markers such as GATA-4, Nkx2.5, cardiac troponin I, and desmin were up-regulated in a time-dependent manner after induction of BMP signaling molecules. Immunocytochemistry revealed the expression of smooth muscle a-actin, sarcomeric a-actinin, cardiac myosin heavy chain, cardiac troponin T and desmin, respectively. The proportion of sarcomeric a-actinin positive cells accounted for 6.48% on day 15 after 5-aza exposure as measured by flow cytometry. This study has demonstrated that 5-aza induces differentiation of P19 cells into cardiomyocytes in a confluent monolayer culture in the absence of prior embryoid formation and dimethyl sulfoxide exposure, depending in part on alteration of BMP signaling molecules. These results suggest that 5-aza treatment could be used as a new method for cardiac differentiation in P19 cells.

A Case of Therapeutic Percutaneous Embolization of Spontaneous Arteriovenous Fistulas with Pulsatile Tinnitus Involving the Branches of the Left External Carotid Artery / 대한이비인후과학회지

Arteriovenous fistulas of head and neck, especially the external carotid artery are uncommon lesions usually of traumatic origin. They also may be spontaneous, inflammatory, or congenital origin. They maybe accompanied by symptoms and signs such as pulsatile tinnitus, pulsatile mass, palpable thrill, and machine like bruit. Recently, we experienced a case of spontaneous arteriovenous fistula of external carotid artery, treated by coil embolization. The patient noticed pulsatile tinnitus in the left posterior auricular area and left upper neck area. She had no history of head trauma. External carotid angiogram showed fistula between the branches of the external carotid artery (occipital artery, middle meningeal artery, posterior auricular artery) and the internal jugular vein. The fistulas were successfully controlled by coil embolization.

A Modified Whitehead Hemorrhoidectomy for Circumferential Hemorrhoid

This report is a clinico-statistical review of our experience with 64 patients with circumferential hemorrhoids who were admitted to and treated at the Surgical Department of Seoul Adventist Hospital during 10 years from Jan. 1986 to Dec. 1995. 1) The indication for a modified Whitehead hemorrhoidectomy was third and or fourth degree circumferential hemorrhoid. 2) The sex ratio of male to female was 1.8 to 1. 3) The peak incidence was in the 3rd and the 5th decades(89.3%). 4) The frequent pre-operative anorectal symptoms were anal prolapse (81.5%), anal pain (52.3%), and anal bleeding (55.6%). 5) The mean average post-operative hospital stay was 9.9 days. 6) The early post-operative problems were urinary retention(35.4%), severe anal pain(21.5%), mild anal bleeding(8.9%) and constipation(1.5%). 7) The late post-operative complications were mild anal stenosis(3.3%), flatus incontinence(1.6%), fissure(3.3%) and a nonhealing wound(1.6%). 8) Attention to the proctologic anatomy and experience are essential for a good result and for prevention of anal stenosis or prolapse.

A Modified Whitehead Hemorrhoidectomy for Circumferential Hemorrhoid

This report is a clinico-statistical review of our experience with 64 patients with circumferential hemorrhoids who were admitted to and treated at the Surgical Department of Seoul Adventist Hospital during 10 years from Jan. 1986 to Dec. 1995. 1) The indication for a modified Whitehead hemorrhoidectomy was third and or fourth degree circumferential hemorrhoid. 2) The sex ratio of male to female was 1.8 to 1. 3) The peak incidence was in the 3rd and the 5th decades(89.3%). 4) The frequent pre-operative anorectal symptoms were anal prolapse (81.5%), anal pain (52.3%), and anal bleeding (55.6%). 5) The mean average post-operative hospital stay was 9.9 days. 6) The early post-operative problems were urinary retention(35.4%), severe anal pain(21.5%), mild anal bleeding(8.9%) and constipation(1.5%). 7) The late post-operative complications were mild anal stenosis(3.3%), flatus incontinence(1.6%), fissure(3.3%) and a nonhealing wound(1.6%). 8) Attention to the proctologic anatomy and experience are essential for a good result and for prevention of anal stenosis or prolapse.