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Background The use of osteoanabolic agents to facilitate fracture healing has been of heightened interest to the field of orthopaedic trauma. This study aimed to evaluate the evidence of teriparatide for fracture healing and functional recovery in osteoporotic patients. Methods We performed a literature search in PubMed, EMBASE, Web of Science, and the Cochrane Library using terms including "Fracture" [tiab] AND "Teriparatide [tiab] OR "PTH" [tiab]. Results This systematic review included 6 randomized clinical trials, 4 well-controlled retrospective studies, and 1 retrospective post hoc subgroup analysis. Fracture location was 2 in pelvis, 3 in proximal femur, 1 in distal femur, 1 in shoulder, 2 in wrist and 2 in spine. The use of teriparatide yielded positive effects on radiographic bone healing in 6 studies, but was not associated with better radiographic outcome in 3. In terms of functional recovery, teriparatide injection was related with decrease in pain or shorter time to mobilization in 6 studies, but not related with pain numerical scale and mobility in 3. Conclusions Our findings suggest that teriparatide provide selective advantages to fracture healing or functional recovery in the management of osteoporotic fractures. A better understanding of the role of teriparatide on osteoporotic fractures requires greater evidences from large volume prospective trials.

Background and Objective Resistin was recently reported to play a role in inflammation-related diseases such as arthritis. However, the precise role of resistin in chronic inflammatory diseases, such as periodontal disease, remains unclear. The aim of this study was to investigate the combined effects of nicotine and lipopolysaccharide (LPS) on the expression of resistin and to assess whether resistin expression influences the levels of inflammatory cytokines, extracellular matrix (ECM) molecules and MMPs in human periodontal ligament cells (PDLCs) stimulated with both nicotine and LPS. Material and Methods PDLCs were pretreated with isoproterenol or resistin-specific small interfering RNA (siRNA), stimulated with LPS plus nicotine for 24 h, and then monitored for the production of inflammatory mediators. The concentrations of prostaglandin E2 (PGE2) and nitric oxide (NO) were measured by radioimmunoassay and the Griess method, respectively. RT-PCR and western blot analysis were used to measure the levels of mRNA and protein, respectively. Western blot analysis was also used to assess the activation of various signal-transduction pathways. Results Treatment with nicotine plus LPS up-regulated the expression of resistin mRNA and the production of resistin protein in PDLCs in a time- and concentration-dependent manner. Isoproterenol-mediated interference with the function of resistin, or siRNA-mediated knockdown of resistin expression, markedly attenuated the LPS plus nicotine-mediated stimulation of PGE2 and NO production, the production of cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase proteins and the expression of proinflammatory cytokines [tumor necrosis factor-α, interleukin (IL)-1β, IL-6 and IL-12] and MMPs (MMP-1, MMP-2 and MMP-9); however, these treatments restored the expression of ECM molecules. Furthermore, pretreatment with isoproterenol or resistin-specific siRNA blocked nicotine plus LPS-induced activation of phosphoinositide-3-kinase, glycogen synthase kinase-3 beta, β-catenin, p38, ERK, JNK and nuclear factor-κB. Conclusion This is the first study to show that the inhibition of resistin, by either a pharmacological or a genetic silencing approach, has anti-inflammatory effects. These effects include decreased levels of inflammatory cytokines and the prevention of ECM breakdown in a nicotine plus LPS-stimulated PDLC model.

During lower limb lengthening, poor bone regeneration is a devastating complication. Several local or systemic applications have been used to promote osteogenesis, and biologic stimulations are gaining attention, but their utility has not been proven in this setting.In patients undergoing bilateral tibial lengthening, we compared those receiving an osteotomy site injection of autologous bone marrow aspirate concentrate (BMAC) plus platelet-rich plasma (PRP) with those not receiving such an injection in terms of external fixator index (time in external fixation divided by amount of lengthening), full weightbearing index (time until a patient was permitted to do full weightbearing divided by amount of lengthening), four cortical healing indexes (time until each cortical union divided by amount of lengthening), and callus shape and type.Twenty-two patients (44 tibias) undergoing bilateral tibial lengthening enrolled in this randomized trial. Two patients were excluded, one due to insufficient radiographic evaluation and one who was lost to followup, leaving 20 patients (40 segments) for inclusion. Ten patients (20 segments) received BMAC combined with PRP injection (treatment group) and 10 patients (20 segments) received no injection (control group). All patients underwent stature lengthening for familial short stature with the lengthening over nail technique. Autologous BMAC combined with PRP was injected at the tibial osteotomy site at the end of the index surgery. Mean distraction rates were similar between groups (0.75 mm/day in the treatment group versus 0.72 mm/day in the control group; p = 0.24). Full weightbearing was permitted when we observed radiographic evidence of healing at two cortices; this assessment was made by the surgeon who was blinded to the treatment each patient received. Minimum followup was 24 months (mean, 28 months; range, 24-34 months).There was no difference in mean external fixator index between groups. However, mean cortical healing indexes (anterior/posterior/medial/lateral) were 1.14/0.81/0.96/0.88 months/cm in the treatment group and 1.47/1.26/1.42/1.22 months/cm in the control group (all p0.001), showing faster healing in the treatment group at each cortex. Full weightbearing was permitted earlier in the treatment group than in the control group (index: 0.99 months/cm and 1.38 months/cm, respectively, p0.001). Callus shape and type were not different between groups.Autologous BMAC combined with PRP injection at the osteotomy site helped improve bone healing in distraction osteogenesis of the tibia, although the effect size was small.Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Study Design Cross sectional study. Purpose To evaluate characteristics of back muscle strength in patients scheduled for lumbar fusion surgery. Overview of Literature Little is known regarding muscle strength in patients with symptomatic lumbar degenerative diseases who require fusion surgery. Methods Consecutive 354 patients scheduled for posterior lumbar interbody fusion due to symptomatic degenerative diseases were approached for participation. 316 patients were enrolled. Before surgery, muscle strength was assessed by measuring maximal isometric extension strength at seven angular positions (0°, 12°, 24°, 36°, 48°, 60°, and 72°) and mean isometric strength was calculated. The Oswestry Disability Index (0-100) and visual analogue scale (0-100) for back pain were recorded. Muscle strength was compared according to gender, age (0.05). Isometric strengths showed significant, but weak, inverse correlations with age and Oswestry Disability Index (r

척추의 변형이 있는 환자들에서 전체적인 외모적인 면뿐만이 아 니라 심각한 요통이나 하지 방사통, 파행 등의 기능적 이상도 흔 하게 호소하게 되며, 많은 수의 환자에서 정상적인 보행이 어려 워 일상 생활에 심각한 장애를 초래하기도 한다. 척추의 변형은 주로 관상면의 변형과 시상면의 변형으로 나눌 수가 있는데, 이 중 관상면의 변형보다는 시상면의 변형이 있는 경우에 미용적인 부분이나 일상생활의 기능적인 측면에서 제한이 심하게 나타난 다. 시상면의 불균형이 악화될수록 인체의 기능장해가 더욱 심해 지는 것은 문헌상으로도 잘 알려져 있는데, Glassman 등은 비교 적 많은 수의 성인 척추 변형 환자를 대상으로 시상면의 불균형 이 실제로 신체의 기능을 심각하게 저하시킴을 보고하였다. 관상면의 변형은 청소년기 측만증이 방치된 상태에서 성인이 된 후에 악화 혹은 발견된 경우나 퇴행성 변화가 진행이 되면서 새로 발생된 퇴행성 측만증이 대부분이다. 이러한 측만증은 인대 와 관절의 심한 비후(hypertrophy of ligament and facet joint), 골 극 형성(formation of bony spur) 및 추체의 비대칭(asymmetry of body)으로 인하여 대부분 만곡이 심하게 강직되어 있는 경우가 많다. 대부분의 관상면 변형은 측만증이 있는 것이 특징적이며, 위쪽이나 아래쪽 척추에서 보상을 이루는 경우가 많으나 심한 경 우엔 보상 실조(decompensation)가 발생되어 체간이 좌우로 쏠림 현상이 일어나게 된다. 또한 시상면 변형까지 동반하는 경우가 종종 있어 수술적 치료 시에는 이러한 요인까지 함께 고려해야 한다. 반면, 시상면 변형은 여러 원인에 의해서 나타날 수 있다. 대표 적인 원인은 퇴행성 질환의 일종인 요부 변성 후만증(lumbar degenerative kyphosis)이고, 그 외에 외상 후 변형, 수술 후 의인성 변 형, 신경 근육성 원인이거나 선천성에 의해서 발생할 수 있으며, 강직성 척추염이나 Scheuermann씨 병과 같은 질환으로 시상면의 pISSN : 1226-2102, eISSN : 2005-8918 30

A retrospective comparative study.To present the results of thoracoscopic surgery in the treatment of adolescent idiopathic scoliosis (AIS) and to compare the results of thoracoscopic surgery with those of posterior surgery.Although racoscopic scoliosis correction has attracted attention since the early 2000s, its use has declined gradually, whereas posterior surgery using pedicle screws has become popular. Few studies have compared thoracoscopic surgery with posterior pedicle screw fixation for single thoracic AIS correction.Sixty-five patients with Lenke type-1 AIS were included and followed up for a minimum of 24 months. Forty-two patients underwent thoracoscopic surgery (thoracoscopic group) and 23 patients underwent posterior surgery (posterior group). Radiographic outcomes, including the correction rate and loss of correction, perioperative morbidities, and complications, were compared.Both groups were similar in terms of the preoperative baseline data. Although the correction rate of major thoracic curve was similar, the posterior group had a tendency to have a greater correction rate (72% vs. 66%). A loss of correction was significantly greater in the thoracoscopic group. The thoracoscopic group had a longer operation time and less intraoperative blood loss, with a lower transfusion rate than the posterior group. There was no difference at the last follow-up in terms of pain score and satisfaction. Five implant failures (12%) occurred in the thoracoscopic group and none in the posterior group. There were 3 patients with significant pulmonary complications necessitating active treatments in the thoracoscopic group.Despite its advantages, thoracoscopic surgery is losing its place in the surgical correction of AIS because of the frequent perioperative pulmonary complications and fixation problems compared with posterior pedicle screw fixation. Nevertheless, it can be utilized in selected cases particularly in cases of patient's strong demand for minimally invasive surgery.

Thoracic ossification of the ligamentum flavum (OLF), a main cause of thoracic myelopathy, is an uncommon disease entity. It is seen mostly in East Asia, although the majority of reports have issued from Japan. In the present study, the clinical features and prognostic factors of thoracic OLF were examined in a large number of Korean patients.Data from 51 consecutive patients who underwent decompressive laminectomy with or without fusion for thoracic OLF between 1998 and 2008 were retrospectively analyzed. Patients were evaluated pre- and postoperatively using the modified Japanese Orthopedic Association (JOA) scale (maximum total score of 11). Patient age, sex, preoperative symptoms, duration of initial symptoms, number of involved segments, duration of follow-up, presence of dural adhesion (dural tearing), intramedullary high signal intensity, morphological classification of OLF (axial or sagittal), coexisting disease, and fusion or no fusion were also evaluated. Surgical outcomes were assessed using JOA recovery rate/outcome scores, and patient satisfaction grades and prognostic factors were analyzed.There were 18 men and 33 women with a mean age of 60.9 years (range 38-80 years). A mean preoperative JOA score of 5.5 improved to a mean score of 7.4 at the last follow-up (mean 52 months after surgery). The mean duration of the initial symptoms was 34.5 months (range 0.1-240 months) prior to surgery. The most common symptoms were motor dysfunction (80%); sensory deficit (67%); and pain, numbness, and claudication (59%) in the lower extremities. Knee hyperreflexia appeared in 69% of the patients. There were a total of 130 ossified segments, and the mean number of segments per patient was 2.6. Ninety-two (71%) of 130 segments were located below T-8. Recovery outcomes were good (18 patients), fair (16 patients), unchanged (11 patients), or worse (6 patients). Thirty-one patients (61%) were satisfied with their operations. Patients with a beak type of OLF on sagittal MR images experienced a higher recovery rate and a better satisfaction grade than did those with a round OLF. The patients with higher preoperative JOA scores demonstrated significantly higher JOA scores postoperatively (p0.001), and the preoperative JOA score had a significant correlation with the recovery rate in patients exhibiting mainly motor dysfunction (p = 0.040, r = 0.330).Of the thoracic OLF studies published to date, the present analysis involves the largest Korean population. The most common symptoms of thoracic OLF were motor dysfunction and sensory deficit in the lower extremities, although pain, numbness, and claudication were observed in some patients and were notably accompanied by knee hyperreflexia. At a minimum of 2 years after surgery for thoracic OLF, operative outcomes were generally good, and the prognostic factors affecting good surgical outcomes included a beak type of OLF and a preoperative JOA score6.

To the editor, In our investigation, we injected a combination of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) at the osteotomy site. Because of this approach, we could not determine which had a greater impact on bone healing, or whether they had any individual synergistic or antagonistic effects on the bone. As you noted, we do mention these limitations in our paper. We also agree with the need for additional studies, perhaps using research designs along the lines you suggest. The local application of the BMAC is gaining attention. In addition to its abundant mononuclear cells [6], it enables surgeons to perform both harvesting and transplanting at the same time during the surgery, preventing culture-related (in vitro) complications, such as decreased viability or contamination of the cells [6, 10]. The differentiation of osteoblasts from the BMC is well described and standardized [6]. The granules of platelet contain different kinds of growth factors, including platelet-derived growth factors, vascular endothelial growth factors, and transforming growth factor-beta [5]. These proteins set the stage for the tissue healing process, which includes cellular chemotaxis, proliferation, differentiation, and angiogenesis [3, 8]. The role of PRP in bone regeneration remains controversial, and while its mechanism is not yet fully understood, several experimental studies have identified a positive effect of PRP on bone healing [4, 5, 7]. Gandhi et al. [4] suggested that the PRP mediated early phase of bone repair process, up-regulated cellular proliferation, and improved mechanical strength of the healing bone. Kanno et al. [7] showed the PRP had a favorable effect on human osteoblast-like cells, and acted on enhancing bone regeneration. Gruber et al. [5] proved that the platelets stimulated the formation of osteoclast-like cells which can help bone growth and remodeling. Zhong et al. [11] reported that the PRP had similar ability with the BMAC on enhancing bone regeneration. However, there have been several other reports showing no effect of PRP on bone healing [1, 2, 9]. In light of these reports, I believe that BMAC may play a larger role than PRP. However, given the remaining gaps in our knowledge, I acknowledge that this matter will only be resolved by well-designed studies that have yet to be performed.

Purpose The purpose of this study was to compare the clinical outcomes and the retear rates of arthroscopic single-row (SR) and double-row (DR) suture anchor repair in 2- to 4-cm rotator cuff tears. Methods From 2005 to 2007, 71 patients with a 2- to 4-cm rotator cuff tear (proven by arthroscopy) were prospectively randomized to SR and DR repair groups. Of these patients, 62 (31 in each group) were available for evaluation at final follow-up. Demographic data, clinical scores, mean surgical times, and patient satisfaction were compared. Retear rates and clinical scores were also analyzed for 47 patients who underwent follow-up magnetic resonance imaging. Results Comparisons of demographic data, tear size on preoperative magnetic resonance imaging, global fatty degeneration index, and concomitant procedures showed no differences between the SR and DR groups. Preoperative clinical scores were significantly improved postoperatively in both groups. No intergroup differences in pain visual analog scale, American Shoulder and Elbow Surgeons, Constant, or University of California, Los Angeles scores were found at final follow-up. Only mean surgical time was significantly different between the 2 groups. In the SR group, there were 4 full-thickness retears and 11 partial-thickness retears, whereas in the DR group, there were 6 full-thickness retears and 1 partial-thickness retear. However, despite numerical differences, these differences were not statistically different. Statistically, there were no significant differences both in full-thickness retear ( P = .999) and retear including partial-thickness tear between the 2 groups ( P = .124). Conclusions This study indicates that the clinical results and retear rates of DR repair with 1 additional medial suture anchor were not significantly different from those of SR repairs with 2 lateral suture anchors in patients with medium to large rotator cuff tear. Level of Evidence Level I, randomized controlled trial.

Owing to the increasing number of intelligent homes (or called smart home), the corresponding cost is much higher. Low voltage circuit breakers are widely used in the intelligent homes to interrupt fault current rapidly and to assure the reliability of the power supply. This paper was focused on understanding the interrupting capability in the current molded case circuit breaker (hereafter MCCB). In order to improve the capability of MCCB, the analytic method of the capability, based on the 3-D magnetic flux analysis, were developed. After all, this paper presented a good agreement between the computational analysis and the test for the newly developed MCCB 460 V/225 A/ 50 kA contact system

This is a case report of a 38-year-old man with severe radiating pain on upper extremity after cervical total disc replacement (TDR). We faced an unusual complication that has not been reported yet. He underwent cervical TDR for left central disc protrusion on C5-6. After the surgery, preoperative symptom disappeared. However, at postoperative 1 year, he complained severe right-sided radiating pain that had a sudden onset. On postoperative X-ray, a metal fragment which seemed like a broken drill bit was shown within the spinal canal. To remove that, right-sided anterior microforaminotomy on C5-6 was performed and the metal fragment was removed successfully. After that, anterior fusion was done because the motion of the artificial disc was minimal and the removed structure seemed to attenuate stability during cervical motion. The operation resulted in prompt symptomatic relief. During cervical TDR, particular attention should be paid to the procedures that require using drill-bits.