Treatment of Periprosthetic Fracture after Total Elbow Replacement Arthroplasty

The indications for total elbow replacement arthroplasty (TERA) include rheumatoid arthritis, degenerative arthritis, acute fracture, nonunion, malunion, posttraumatic arthritis, tumor, and chronic instability. With the development of designs and the increasing use of TERA, more periprosthetic fractures are occurring. On the other hand, there is less data on periprosthetic fractures after TERA because TERA is a relatively rare procedure. Thus, a careful review of the previous literature and appropriate selection of surgical indications are essential for achieving a satisfactory outcome, which should be accompanied by precise surgery as planned. This article presents the causes, risk factors, classification, and principles of treatment of periprosthetic fractures after TERA.

PEGylated Erythropoietin Protects against Brain Injury in the MCAO-Induced Stroke Model by Blocking NF-κB Activation

Cerebral ischemia exhibits a multiplicity of pathophysiological mechanisms. During ischemic stroke, the reactive oxygen species (ROS) concentration rises to a peak during reperfusion, possibly underlying neuronal death. Recombinant human erythropoietin (EPO) supplementation is one method of treating neurodegenerative disease by reducing the generation of ROS. We investigated the therapeutic effect of PEGylated EPO (P-EPO) on ischemic stroke. Mice were administered P-EPO (5,000 U/kg) via intravenous injection, and middle cerebral artery occlusion (MCAO) followed by reperfusion was performed to induce in vivo ischemic stroke. P-EPO ameliorated MCAO-induced neurological deficit and reduced behavioral disorder and the infarct area. Moreover, lipid peroxidation, expression of inflammatory proteins (cyclooxygenase-2 and inducible nitric oxide synthase), and cytokine levels in blood were reduced by the P-EPO treatment. In addition, higher activation of nuclear factor kappa B (NF-κB) was found in the brain after MCAO, but NF-κB activation was reduced in the P-EPO-injected group. Treatment with the NF-κB inhibitor PS-1145 (5 mg/kg) abolished the P-EPO-induced reduction of infarct volume, neuronal death, neuroinflammation, and oxidative stress. Moreover, P-EPO was more effective than EPO (5,000 U/kg) and similar to a tissue plasminogen activator (10 mg/kg). An in vitro study revealed that P-EPO (25, 50, and 100 U/mL) treatment protected against rotenone (100 nM)-induced neuronal loss, neuroinflammation, oxidative stress, and NF-κB activity. These results indicate that the administration of P-EPO exerted neuroprotective effects on cerebral ischemia damage through anti-oxidant and anti-inflammatory properties by inhibiting NF-κB activation.

Free Functioning Muscle Transfer in Brachial Plexus Injury

The free functional muscle transfer (FFMT) is the surgical procedure aimed at reconstructing defective or deteriorated muscle function by grafting free muscles including blood vessels and nerves. Since the free gracilis transfer in the facial paralysis was introduced in 1976, there have been many studies and clinical applications of the FFMT in various donor and recipient sites in brachial plexus injury, muscle ischemic contracture, muscle defect after tumor resection, congenital muscular deficit, multiple trauma. When the reconstruction of the nerve is delayed for 9 months to 1 year after the brachial plexus injury, voluntary muscle contracture is impossible even after the nerve regeneration by the irreversible degeneration of the muscles. And it is difficult to obtain adequate function even if nerve transfer or nerve transplantation is performed because the distance to be regenerated is too long. In these cases, the FFMT has been improved the functions of the upper limb in flexion or extension of the elbow, fingers. Many good clinical results of the FFMT have been reported, so the FFMT gets much interests and attentions. The essential things for the successful outcome of the surgery are the anatomical knowledge, the skilled surgical technique and the choice of patients who can meet the indications and receive long-term rehabilitation. Recent advances in surgical techniques will result in improved results of the FFMT.

Comparative Study of Peripheral Rim Fixation Using Jumbo Cup in Revisional Hip Arthroplasty / 대한고관절학회지

PURPOSE: It is challenging procedure to revise acetabular component in acetabulum with severe bone defect or deformity. The jumbo cup is good option for revisional arthroplasty in large bone defect. The purpose of this study is to compare the prognosis of revisional total hip arthroplasty using jumbo cup with peripheral rim fixation and no rim fixation. MATERIALS AND METHODS: We included the patients who had performed acetabular revisional total hip arthroplasty from January 2002 to March 2015 in our institute. Total of 51 hips (51 patients) were included. The mean follow up period was 51 months (range, 12 to 154 months) and mean age was 60.7 years (range, 30 to 81 years). We divided into two groups (peripheral rim fixation group and no rim fixation group) by anteroposterior and lateral plain radiograph. We compared survival rate, hip center change and clinical outcomes between two groups. RESULTS: There were 37 patients in peripheral rim fixation group and 14 patients in no rim fixation group. There was one patient who had aseptic loosening necessary to re-revision in rim fixation group and 3 patients in no rim fixation group. And one patient had superficial infection in rim fixation group and one patient had periprosthetic fracture in no rim fixation group. Survival rate was higher in the peripheral rim fixation group (97.3%) than no rim fixation group (78.6%, P=0.028) CONCLUSION: Based on our findings, peripheral rim fixation might be recommended to improve short-term outcome after revision total hip arthroplasty using jumbo cup.

Clinical Results of Supracondylar Dome Osteotomy for Cubitus Varus and Valgus Deformities in Adults

BACKGROUND: Cubitus varus and cubitus valgus deformities are common complications of distal humeral fractures in children. We evaluated the usefulness of supracondylar dome osteotomy as a treatment option for adults with cubitus varus or valgus deformity developed during childhood. METHODS: Ten patients who had received supracondylar dome osteotomy and stabilization with plates to treat cubitus varus or valgus deformity between July 2006 and August 2013 were included in this study. Their mean age at the time of surgery was 36.50 ± 10.22 years. The mean follow-up duration was 54.80 ± 32.50 months. We evaluated humerus-elbow-wrist angles (HEWA), improvements in the lateral prominence index (LPI) or medial prominence index (MPI), Mayo elbow performance scores (MEPS), and overall results in accordance with the Banerjee criteria. RESULTS: For the six patients with cubitus varus, the mean postoperative HEWA, mean correction angle, and mean improvement in LPI were 9.72°± 3.95°, 27.67°± 10.75°, and 6.92% ± 3.40%, respectively. For the four patients with cubitus valgus, the mean postoperative HEWA, mean correction angle, and mean improvement in MPI were 14.73°± 2.97°, 11.55°± 3.26°, and 11.33% ± 6.39%, respectively. There was no significant difference between postoperative and preoperative mean MEPS. The subjective ulnar nerve symptoms were alleviated in all patients. The overall results were excellent in six and good in four patients. CONCLUSIONS: This study suggests that supracondylar dome osteotomy with secure fixation using double plates may be useful in correcting cubitus varus or cubitus valgus deformity, yielding good functional outcomes in adults.

Evaluation of the Foveal Involvement of the Ulnar Styloid Fracture: A Comparison of the Plain Radiography and Three-Dimensional Computed Tomography

PURPOSE: There remains uncertain whether to fix or not an ulnar styloid fracture acommpanied by distal radius fracture. Fixation might be required in cases of the fracture involving a fovea of ulnar head, an attachment site of deep triangular fibrocartilage, which is thought to be important to distal radioulnar joint stability. We analyzed a fovea involvement of an accompanied ulnar styloid fracture in patients with distal radius fracture by simple radiograph and three-dimensional computed tomography (3D CT). METHODS: We retrospectively reviewed 168 patients who underwent surgery with volar locking plate for distal radius fracture in our hospital from January 2005 to March 2015 and evaluated a fovea involvement of ulnar head by simple radiographs and 3D CT respectively, and compared. RESULTS: On simple X-ray, 64 cases (38%) were ulnar styloid fovea fractures; however, 21 cases of these revealed non-fovea fractures by 3D CT. And 7 out of 104 cases determined as non-fovea fracture by simple radiographs were diagnosed as fovea fractures by 3D CT. Sensitivity, specificity and accuracy of evaluation by simple radiograph were 86%, 82% and 83% respectively, when compared with those of 3D CT based evaluation. CONCLUSION: Accuracy of evaluating an accompanied ulnar styloid fovea fracture in patients with distal radius fracture by simple radiograph, when compared with 3D CT, was 83%; therefore, we recommend using the 3D CT based evaluation instead of simple radiograph based one for determination of fovea involvement of ulnar head.

Clinical Results of Supracondylar Dome Osteotomy for Cubitus Varus and Valgus Deformities in Adults

BACKGROUND: Cubitus varus and cubitus valgus deformities are common complications of distal humeral fractures in children. We evaluated the usefulness of supracondylar dome osteotomy as a treatment option for adults with cubitus varus or valgus deformity developed during childhood. METHODS: Ten patients who had received supracondylar dome osteotomy and stabilization with plates to treat cubitus varus or valgus deformity between July 2006 and August 2013 were included in this study. Their mean age at the time of surgery was 36.50 ± 10.22 years. The mean follow-up duration was 54.80 ± 32.50 months. We evaluated humerus-elbow-wrist angles (HEWA), improvements in the lateral prominence index (LPI) or medial prominence index (MPI), Mayo elbow performance scores (MEPS), and overall results in accordance with the Banerjee criteria. RESULTS: For the six patients with cubitus varus, the mean postoperative HEWA, mean correction angle, and mean improvement in LPI were 9.72° ± 3.95°, 27.67° ± 10.75°, and 6.92% ± 3.40%, respectively. For the four patients with cubitus valgus, the mean postoperative HEWA, mean correction angle, and mean improvement in MPI were 14.73° ± 2.97°, 11.55° ± 3.26°, and 11.33% ± 6.39%, respectively. There was no significant difference between postoperative and preoperative mean MEPS. The subjective ulnar nerve symptoms were alleviated in all patients. The overall results were excellent in six and good in four patients. CONCLUSIONS: This study suggests that supracondylar dome osteotomy with secure fixation using double plates may be useful in correcting cubitus varus or cubitus valgus deformity, yielding good functional outcomes in adults.

Volar Locking Plate Fixation for Distal Radius Fractures in Hemodialysis Patients

PURPOSE: Although the possibility of distal radius fractures is strong in hemodialysis patients, there are many difficult problems such as the bleeding tendency, hypervascularity and injury to arteriovenous fistula. We studied the outcomes of open reduction and volar locking plate fixation of the distal radius fractures in hemodyalisis patients with ipsilateral arteriovenous fistula. METHODS: From 2007 to 2009, a retrospective chart review was performed of eleven hemodialysis patients who underwent volar locking plate fixation for treatment of distal radius fractures. Eight of them were female and three were male and mean age was 68 years (range, 57-81 years). Mean follow-up period was 19 months (range, 12-28 months). All patients had osteoporosis with mean T-score of -2.7. All operations were performed on the next day of hemodialysis. Scheduled hemodialysis was possible on the next day of surgery without splint. We analyzed radiographic results, the wrist range of motion, Mayo wrist score and disabilities of the arm, shoulder and hand (DASH) score at the last follow-up. RESULTS: All fractures achieved anatomical reduction and united at final follow-up. Complications such as hematoma or occlusion of arteriovenous fistula were not observed. Mean Mayo wrist score was 78 and mean DASH score was 22. CONCLUSION: Volar locking plate fixation for distal radius fractures provides immediate support for continuing hemodialysis and exercise. Open reduction of the fractures and the use of tourniquet don't seem to increase the vascular complications like hematoma and fistula occlusion.

A Nation-Wide, Outpatient-Based Survey on the Pain, Disability, and Satisfaction of Patients with Osteoporotic Vertebral Compression Fractures

STUDY DESIGN: A nation-wide, outpatient-based, cross-sectional survey with the use of questionnaires. PURPOSE: To evaluate the pain, disability and satisfaction of patients with osteoporotic vertebral compression fractures (OVCFs). OVERVIEW OF LITERATURE: There are no nation-wide data in Korea on the degree of pain, disability and satisfaction with treatment in patients with OVCFs. METHODS: We performed a cross-sectional survey of 573 patients with OVCFs. After excluding incomplete questionnaires (missing more than 30% of the variables), 430 patient-physician-matched data sets were collected for this survey. RESULTS: Patients with OVCFs were managed with conservative treatment in 63% and with a vertebroplasty in 37%. The means of the latest visual analogue scale (VAS, 5.2) and Oswestry Disability Index (ODI, 47.7) scores checked at the time of survey were significantly higher than those VAS and ODI scores prior to OVCFs (the prefracture VAS and ODI scores, 3.6 and 26.3, respectively; p<0.001 for both comparisons). However, the means of the latest VAS and ODI scores were insignificantly different between the conservative and vertebroplasty groups, irrespective of the duration from the fractures. Overall, 75% of patients were satisfied with their clinical outcomes. However, the percentages of patient's satisfaction were not significantly different between the conservative and vertebroplasty groups. Eighty-eight percent of patients felt some or marked deterioration of their general health condition following OVCFs. CONCLUSIONS: These results indicate that although most patients with OVCFs were satisfied with their clinical outcomes, their subjective general health conditions, as well as their pain and disability, did not recover to the prefracture state.

Overexpression of bone morphogenetic protein 4 in STO fibroblast feeder cells represses the proliferation of mouse embryonic stem cells in vitro

Embryonic stem cells (ESCs) can be propagated in vitro on feeder layers of mouse STO fibroblast cells. The STO cells secrete several cytokines that are essential for ESCs to maintain their undifferentiated state. In this study, we found significant growth inhibition of mouse ESCs (mESCs) cultured on STO cells infected with adenovirus containing a dominant-negative mutant form of IkappaB (rAd-dnIkappaB). This blockage of the NF-kappaB signal pathway in STO cells led to a significant decrease in [3H]thymidine incorporation and colony formation of mESCs. Expression profile of cytokines secreted from the STO cells revealed an increase in the bone morphogenetic protein4 (BMP4) transcript level in the STO cells infected with adenoviral vector encoding dominant negative IkappaB (rAd-dnIkappaB). These results suggested that the NF-kappaB signaling pathway represses expression of BMP4 in STO feeder cells. Conditioned medium from the rAd-dnIkappaB-infected STO cells also significantly reduced the colony size of mESCs. Addition of BMP4 prevented colony formation of mESCs cultured in the conditioned medium. Our finding suggested that an excess of BMP4 in the conditioned medium also inhibits proliferation of mESCs.

The Correction of the Mandibular Defect Using Porous Polyethylene: Case Report

HIV Screening Using the OraQuick(R) ADVANCE(TM) Rapid HIV-1/2 Antibody Test (OraQuick Test) in Dentistry: A Literature Review

The epidemiologic study of the patients with temporomandibular joint disorders, using Research Diagnostic Criteria for TMD (RDC/TMD): Preliminary Report

PURPOSE: This epidemiologic research was carried out to investigate the degree and aspects of symptoms of patients suffered from TMD using RDC/TMD. SUBJECTS AND METHODS: Subjects were the patients who had visited to SNUBH dental clinic from Jan. 2005 to Dec. 2005, and total 117 patients were included (M: 22, F:95). The signs and symptoms of physical, psychological and behavioral factors were retrospectively evaluated by questionnaires in the RDC/TMD. The patients were examined through clinical and radiological method, and diagnosed by same investigator. They were divided into 3 groups such as osteoarthritis group (group 1), internal deragnement (group 2), myofascial pain dysfunction syndrome group (MPDS, group 3). In addition, in patient with complex diagnosis they were divided into subgroups in detail (ex. group 1+group 2). In the questionnaire, several items were selected to calculate the graded pain score (grade 0~IV), depression and vegetative symptoms, nonspecific physical symptoms(pain items included) and nonspecific physical symptoms(pain items excluded) in each group. RESULTS: As a result of classification by diagnostic criteria of this study, the patients were distributed to 45 % of group 1, 47 % of group 2, 8 % of group 3 in this study. In younger patients (under 25-year old, n=40), group 2 was occupied 57 % (n=23) and group 1 was 35 % , group 3 was 8 %, while group 1 was occupied 75 % in elderly-patients (over 40-year old, n=28) in present study (group 2: 21 % , group 3: 4 %). In the analysis of depression and vegetative symptoms, majority of patients in Group 2 were included in 'normal? and in Group 3 it appeared to have larger proportion of 'moderate' & 'severe' than others. According to nonspecific physical symptoms, there have been tendencies of higher ratio of 'severe' in patients with MPDS. In graded pain score, more than half (58 %) of subjects were included in grade 0 and low disability (Grade I and II), and 27 % were revealed high disability (grade III, IV).

The epidemiologic study of the patients with temporomandibular joint disorders, using Research Diagnostic Criteria for TMD (RDC/TMD): Preliminary Report

PURPOSE: This epidemiologic research was carried out to investigate the degree and aspects of symptoms of patients suffered from TMD using RDC/TMD. SUBJECTS AND METHODS: Subjects were the patients who had visited to SNUBH dental clinic from Jan. 2005 to Dec. 2005, and total 117 patients were included (M: 22, F:95). The signs and symptoms of physical, psychological and behavioral factors were retrospectively evaluated by questionnaires in the RDC/TMD. The patients were examined through clinical and radiological method, and diagnosed by same investigator. They were divided into 3 groups such as osteoarthritis group (group 1), internal deragnement (group 2), myofascial pain dysfunction syndrome group (MPDS, group 3). In addition, in patient with complex diagnosis they were divided into subgroups in detail (ex. group 1+group 2). In the questionnaire, several items were selected to calculate the graded pain score (grade 0~IV), depression and vegetative symptoms, nonspecific physical symptoms(pain items included) and nonspecific physical symptoms(pain items excluded) in each group. RESULTS: As a result of classification by diagnostic criteria of this study, the patients were distributed to 45 % of group 1, 47 % of group 2, 8 % of group 3 in this study. In younger patients (under 25-year old, n=40), group 2 was occupied 57 % (n=23) and group 1 was 35 % , group 3 was 8 %, while group 1 was occupied 75 % in elderly-patients (over 40-year old, n=28) in present study (group 2: 21 % , group 3: 4 %). In the analysis of depression and vegetative symptoms, majority of patients in Group 2 were included in 'normal? and in Group 3 it appeared to have larger proportion of 'moderate' & 'severe' than others. According to nonspecific physical symptoms, there have been tendencies of higher ratio of 'severe' in patients with MPDS. In graded pain score, more than half (58 %) of subjects were included in grade 0 and low disability (Grade I and II), and 27 % were revealed high disability (grade III, IV).

Clinical retrospective study of sinus bone graft and implant placement

Item Analysis of Clinical Performance Examination Using Item Response Theory and Classical Test Theory / 한국의학교육

PURPOSE: The objectives of this study were: 1) to analyze Clinical Performance Examination(CPX) items using item response theory(IRT) and classical test theory(CTT) and 2) to discuss how to apply and interpret these results in order to improve the quality of CPX items. In addition, we intended to explore statistical procedures in order to merge examination data from several different medical schools. METHODS: The subject of the study was the 2005 CPX examination data from 10 medical schools located in Seoul and the Kyunggi province. For merging data from ten different medical schools, Levene's test for homogeneity of variances was used. Homogeneous group selection was conducted based on ANOVA or Kruskal-Wallis' test and Tukey's multiple comparisons appropriately. The generalized partial credit model was applied to analyze polytomous items and the 2-parameter logistic model was used to analyze dichotomous items. RESULTS: Data from 8 medical schools were incorporated into the analysis. The result of the discrimination index by IRT was different from that of CTT in both polytomous and dichotomous items. Discrimination index from IRT tended to be lower than that of CTT. Difficulty index of dichotomous items of two models was correlated well with each other. However, for polytomous items, IRT model provided more information than CCT. CONCLUSION: We discovered that the CPX items were mostly easy in terms of difficulty index, and the result from IRT and CCT model did not correlated well in the discrimination index. IRT may provide more detailed information for polytomous items, but the checklist and criteria of scoring system should be cautiously reviewed.

Capsaicin promotes the development of burst-forming nits-erythroid (BFU-E) from mouse bone marrow cells

Capsaicin, the pungent component of chilli peppers, is known to induce mediators of hematopoiesis. We investigated the effect of capsaicin on hematopoiesis in mouse progenitor cells. Treatment of mouse bone marrow cells with capsaicin induced the formation of colony of burst-forming units-erythroid (BFU-E). We also found that the number of erythropoietin receptor (EpoR)-positive cells was increased by capsaicin. To clarify the effect of capsaicin on erythroid lineage, BFU-E colonies were separated from non-BFU-E colonies by colony-picking after in vitro culture of mouse bone marrow cells. Quantitative RT-PCR analysis revealed that capsaicin stimulated the expression of the erythroid-specific genes encoding EpoR, glycophorin A (GPA), beta-globin (Hbb-b1), GATA-1, PU.1, nuclear factor erythroid-derived 2 (NF-E2), and Kruppel-like factor 1 (KLF1) in the BFU-E colonies. Furthermore, capsaicin could effectively stimulate the transfected GATA-1 promoter in K562 cells. GATA-1 is known as an essential transcription factor for the development of erythroid cells. Our results show that development of the erythroid lineage from bone marrow cells can be induced by treatment with capsaicin, and that GATA-1 seems to play a role in this induced erythroid maturation.

Implant installation after guided bone regeneration: comparison between immediate and delayed group

Psychometric Analysis of Comprehensive Basic Medical Sciences Examination / 한국의학교육

PURPOSE: Since 2000, the Korea University Medical College has conducted Comprehensive Basic Medical Sciences Examination as a summative test. Summative assessment must be dependable in that it meets the highest standards of reliability and validity. The purpose of this study were to examine the validity and reliability of Comprehensive Basic Medical Sciences Examination and to improve the quality of the examination. METHODS: The subject of this study was the examination materials and scores of the test. We conducted exploratory factor analysis to testify validity. Cronbach alpha coefficient was used to examine the reliability. RESULTS: Only one factor was extracted from exploratory factor analysis. Its eigen value was 4.61 and it explained 65.93% of total variance. We could infer the extracted factor as an ability of basic medical sciences knowledge. The reliability coefficient of the test was ranged from 0.45 to 0.74. Of the total 335 item, overall acceptable items were 206(58.0%); the range of difficulty was 0.21~1.00 and discriminative indices were higher than 0.20. CONCLUSION: We confirmed the Comprehensive Basic Medical Sciences Examination in 2000 met the relative highest standards of reliability and validity. Item analysis could be of help to improve the quality of examination

Standard Setting in Student Assessment by Criterion Referenced Evaluation / 한국의학교육

Licensure, credentialling and academic institutions are seeking new innovative approaches to the assessment of professional competence. Central to these recent initiatives is the need to determine standards of performance, which separated the competent from the non-competent candidate. The goal of this study is to introduce the criterion referenced standard-setting methods to medical Schools. The authors used Angoff and Jaeger method, which are the simplest absolute standard setting methods. In this study, the cut-off score estimated by Jaeger method was higher than that of Angoff method.