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Osteoporosis and osteoporotic fractures cause socioeconomic concerns, and medical system and policies appear insufficient to prepare for these issues in Korea, where the older adult population is rapidly increasing. Many countries around the world are already responding to osteoporosis and osteoporotic fractures by adopting fracture liaison service (FLS), and such an attempt has only begun in Korea. In this article, we introduce the operation methods for institutions implementing FLS and characteristics of services, and activities of the FLS Committee for FLS implementation in the Korean Society for Bone and Mineral Research. In addition, we hope that the current position statement will contribute to the implementation of FLS in Korea and impel policy changes to enable a multidisciplinary and integrated FLS operated under the medical system.

Purpose: The intervertebral disc is a leading avascular organ in the body that may gather nutrition through diffusion. It maintains homeostasis by the use of autophagy and apoptosis to survive in unfavorable conditions such as stress and mechanical force. Therefore, excessive force and stress beyond normal conditions may cause intervertebral disc degeneration. The purpose of this study was to examine which is the better method, either external fixator (EF) or saline injection (SI), for inducing autophagy and apoptosis-mediated nucleus pulposus (NP) cell death in the discs of rat tail’s. Methods: Sixteen, nine-weeks-old male Sprague–Dawley rat tails were treated with 0.9% saline and EF (two-cross Kirschner wires) for a period ofsix and twelve weeks. Treated discs were dissected to identify the participation of autophagy and apoptosis in intervertebral disc degeneration. For identification purposes, H&E staining, Masson’s trichrome staining, and immunohistochemistry (IHC) for LC3, beclin-1, and P62 in addition to MMP-2, MMP-3, and TIMP-1 were performed. Furthermore, we performed real-time polymerase chain reaction (RT-PCR) to observe autophagy-related gene expression (beclin-1, LC3, and P62) and apoptosis-related gene expression (MMP-2, MMP-3, and TIMP-1). Results: TheEF group showed more insidious NP cell degeneration than the control (Ctrl) group. Degeneration was elevated with increasing compression duration of EF group, whereas the SI group could not distinguish the margin of annulus fibrosus (AF) and NP cells. LC3, beclin-1, and P62 showed the highest and lateral expression whilst MMP-2, MMP-3, and TIMP-1 showed up-regulated and central expression in both groups, although the SI group could not recognize the boundary between NP and AF cells. The EF group showed the highest autophagy-related gene expression whereas the SI group showed lower expression. In addition, the EF group showed more autophagy-accumulating materials than the SI group which elevated with increasing compression duration. Furthermore, the SI group induced the highest apoptotic gene expression, but the EF group showed the lowest expression. Conclusion: The EF method was better for studying autophagy and apoptosis because it enhanced intervertebral disc degeneration after compression, which is actively linked to autophagy and apoptosis. The degeneration process was elevated by increasing the compression duration, but SI could not distinguish AF and NP cell margins.

Purpose: Intervertebral disc is a leading avascular organ in the body. Hence, it may utilize autophagy and apoptosis to alive in unfavorable condition like stress and mechanical force. But excessive force and stress is a key cause to intervertebral disc degeneration (IVDD). Purpose of this study is to identify, external fixator (EF) and saline injection (SI) may induce autopahgy and apoptosis mediated nucleus pulposus (NP) cells death in rat tail’s disc and which method is better for studying autophagy and apoptosis. Methods: Sixteen 9-week-old male Sprague–Dawley rat tails were treated with 0.9% saline and EF (two-cross kirschner wires) for 6 weeks and 12 weeks as well. Treated discs were dissected for checking out participation of autopahgy and apoptosis to intervertebral disc degradation (IVDD). For identifying them, we performed H&E staining, Masson’s trichrome staining, and Immunohistochemistry (IHC) for LC3, Beclin-1and P62 as well as MMP-2, MMP-3 and TIMP-1.Furthermore, we performed quantitative polymerase chain reaction (qPCR)to check out autophagy related gene expression (beclin-1, LC3 and P62) and apoptosis related gene expression (MMP-2, MMP-3 and TIMP-1) respectively. Results: More insidious nucleus pulposus (NP) cell degeneration was indentified in (EF) group than in (Ctrl) control group. And rate of degradation was elevated with increasing duration of compression, but SI group cannot distinguish the margin of AF and NP cells. Highest along with lateral expression was found for LC3, Beclin-1, and P62 of both groups. Up-regulated and central expression was observed for MMP-2, MMP-3 and TIMP-1 of both groups, although SI group cannot recognize the margin between NP and AF cells. Utmost autophagy related gene expression was identified in EF group than in SI group. Besides, maximum autophagy accumulating materials was found in EF group than in SI group. And it was amplified along with increasing the duration of compression. Highest, apoptotic gene expression was observed in SI group, whereas, EF group showed lowest expression. Conclusion: External fixator (EF) method was better to study autophagy and apoptosis because it enhanced IVDD after compression which is actively linked with autophagy and apoptosis. Degeneration process was conversely proportional along with duration of compression. On contrary, saline injection (SI) could not distinguish AF and NP cell border.

In bone tissue engineering, the endogenous regeneration of bone defects still represents a clinical challenge despite the development of intervention therapy to achieve bone regeneration via autologous grafts, allogeneic grafts, bone morphogenetic protein (BMP)-2, etc. To overcome the limitation of endogenous bone regeneration, we assumed that the 3D-printed collagen pattern with BMP-2 and fibroblast growth factor (FGF)-2 in the 3D-printed polycaprolactone/nano-hydroxyapatite scaffold could guide the endogenous regeneration of bone defects. Therefore, to test our hypothesis, polycaprolactone/nano-hydroxyapatite/collagen scaffolds with dual growth factors (BMP-2 and FGF-2) and various hydrogel patterns (positive, edge, and radial patterns) were fabricated at the same ratio and concentration of dual growth factors. Consequently, we revealed that the in vitro released concentrations of BMP-2 and FGF-2 were not affected by collagen patterns in the PCL/nano-hydroxyapatite scaffold. Furthermore, endogenous bone regeneration and angiogenesis in the polycaprolactone/nano-hydroxyapatite/collagen scaffold with a radial pattern were promoted compared with those in the polycaprolactone/nano-hydroxyapatite/collagen scaffolds with positive and edge patterns. Therefore, we demonstrated that a collagen design loaded with dual growth factors in the 3D-printed scaffold could affect endogenous bone regeneration and angiogenesis.

BackgroundEpidural fibrosis is one of the aetiologies of pain following a spinal revision surgery. It is reported that the specific members of the mitogen – activated protein kinases (MAPK) family might mediate neuropathic pain. However, roles of epidural fibrosis caused by repeated spinal surgeries and pain-related proteins in causing the post spinal surgery syndrome remain unknown. Using a rat spinal surgery epidural fibrosis and adhesion model, in this study, we evaluated and investigated the relationship between pain markers and epidural fibrosis.MethodsSprague–Dawley rats that underwent the spinal surgery were divided into three groups: group A (single laminectomy), group B (two repeated surgeries) and group C (three repeated surgeries). Dural thickness was measured in each experimental group, and immunohistochemical analysis and western blotting of mitogen-activated protein kinases were performed (ERK, p38 and JNK) using the spine cord.ResultsDural thickness was 6.363 ± 1.911 μm in group A, 13.238 ± 2.123 μm in group B and 19.4 ± 2.115 μm in group C, respectively. In the western blotting, phosphorylated ERK expression gradually increased with the number of repeated surgeries, and expression in groups B (1.77-fold) and C (2.42-fold) increased as compared to expression in group A. Phosphorylated p38 showed an increasing trend with the number of repeated surgeries, and groups B (1.17-fold) and C (1.33-fold) expression increased compared with group A. However, phosphorylated JNK expression did not gradually increase with the number of repeated surgeries, and groups B (1.62-fold) and C (1.43-fold) expression increased compared with group A. Excluding phosphorylated JNK, immunohistochemical analysis revealed that phosphorylated ERK and p38 expression gradually increased with the number of repeated surgeries in the spine dorsal horn, as evidenced by western blotting.ConclusionsRepeated spinal surgeries may increase dural thickness and expression of phosphorylated ERK and p38 in the spinal dorsal horn, and it suggests that the neuropathic pain is likely induced by epidural fibrosis and that the pain increases with the number of repeated surgeries.

STUDY DESIGN Retrospective multicenter case series. OBJECTIVE We sought to evaluate the safety and efficacy of anterior cervical plating in anterior cervical debridement and fusion (ACDF) for patients with cervical pyogenic spondylodiscitis (CPS). SUMMARY OF BACKGROUND DATA Due to concerns about bacterial seeding on the foreign material after instrumentations in pyogenic infections, the safety and efficacy of anterior cervical plating for CPS are still undetermined and controversial. Little information is available about the safety and efficacy of anterior cervical plating to manage CPS. METHODS Twenty-three patients who underwent ACDF with (n = 12) or without (n = 11) plating for CPS were included. The mean age was 62.6 years. Medical records were reviewed and radiological parameters including segmental height, segmental angle, C2-C7 angle, and fusion status were analyzed. The mean follow-up period after surgery was 21.3 months. RESULTS After ACDF with plating, segmental height, segmental angle, and C2-C7 angle were significantly improved compared with preoperative conditions and remained well-maintained at the last follow-up. After ACDF without plating, three radiological parameters were also initially improved compared with preoperative condition, but significantly deteriorated to preoperative levels at the time of the last follow-up. The fusion rate was higher in the ACDF with plating group compared with the ACDF without plating group (90.9% vs. 63.6%; P

Objectives To elaborate on the relationship between degeneration grade and autophagy expression in human nucleus pulposus obtained from surgical procedures. Methods For the 16 patients included in the present study, we determined the Pfirrmann classifications of degenerative lesions by MRI. Western blot analysis, LC3, LAMP2, and p62 protein expressions were quantified in different degeneration grades of disc nucleus pulposus. Double immunofluorescence staining was used to show co‐localization of LC3 and LAMP2, and immunohistochemistry to show LC3 and p62 in the nucleus pulposus. Results In the western blot analysis, LC3‐II was highly expressed in grade III and decreased progressively from grade IV to V. In addition, LC3‐II expression in grade III was significantly higher than in grade II, IV, and V (P

Study design Retrospective case analyses. Purpose To investigate the causes, diagnosis, and management of esophageal perforation, depending on the time of diagnosis. Overview of literature To date, few studies have addressed these issues. Methods A total of seven patients were included in this study. The patients were classified into three groups based on esophageal perforation diagnosis time: intraoperative (diagnosed during surgery), perioperative (diagnosed within 30 days postoperatively), and delayed (diagnosed >30 days postoperatively) groups. Results In the intraoperative group (N=2), infectious spondylitis was the main cause of esophageal perforation. Anterior plate and screw removal, followed by posterior instrumentation, was performed. The injured esophagus was managed by omentum flap repair in one patient and primary repair in one patient. In the perioperative group (N=2), revision surgery for infection and metal failure were the main causes of esophageal perforation. In both cases, food residue was drained on the third postoperative day. The injured esophagus was managed conservatively. In the delayed group (N=3), chronic irritation caused by metal failure was the main cause of esophageal perforation. In all patients, there was no associated infection. The anterior instrumentation was removed, and the two patients were treated by primary repair, and one patient was treated using sternocleidomastoid muscle flap. One patient in intraoperative group died of sepsis. Conclusions The main cause of intraoperative esophageal perforation was esophageal adhesions because of infectious spondylitis. However, perioperative and delayed esophageal perforations were caused by chronic irritation because of metal failure. Anterior plate and screw removal was necessary, and posterior instrumentation and fusion may be considered, depending on the fusion status.

In this study, we developed a powder extruder system that can extrude and deposit powder mixtures to overcome the reported limitations of conventional dual-pore scaffold manufacturing methods. To evaluate the extrusion and deposition capability of the powder extruder system, 3D tissue-engineering scaffolds with dual-pore characteristics were fabricated with a PCL/PEO/NaCl (polycaprolactone/polyethylene oxide/sodium chloride) powder mixture. In addition, to evaluate the fabricated scaffolds, their compressive modulus, morphology, and in-vitro cell activity were assessed. Consequently, it was confirmed that the proposed powder extruder system can fabricate dual-pore scaffolds with well-interconnected pores as well as arbitrary 3D shapes shown by the fabrication of a 3D femur-shape scaffold similar to the femur model. The results of the cell proliferation and Cell Counting Kit-8 (CCK-8) assays, DNA content analysis and viability assays confirm that the dual-pore scaffold fabricated by the powder extruder system improves cell attachment, proliferation, and viability.

Efforts to minimize the sacrifice of laboratory animals have become a recent worldwide trend. This trend has triggered a number of studies toward developing effective methods to replace the animal experiments. In this study, we developed a biomimetic bioreactor system that simulates the movements of the human knee joint. The system consists of a knee-joint drive and a unit capable of culturing cells at the joint surface. The knee-joint drive is designed to apply dynamic stimulation similar to the real bending motion of the knee joint. We employed a commercial incubator for comparative evaluation and validation of our laboratory-made cell-culture unit mounted in a bioreactor. The results revealed that the ability of the proposed system in culturing cells was similar to that of the commercial incubator. The cell culture was evaluated by dividing the knee joint into zones according to the size of the stimulus. The results confirmed that the cell assessment stimulated by the knee-joint movement was two times higher than that having no stimulation. Overall, the study helped establish that the cell characteristics is more effective when an appropriate external stimulus is applied according to the target tissue. The study is also expected to form the basis for implementing an ex-vivo environment that can potentially replace animal and cadaver experiments in the future. In the future, follow-up studies will be conducted on the in-vivo environment and the characteristics of each organ and tissue for effective tissue regeneration.

In this study, to compare the relative abilities of dual-pore structure and hydroxyapatite to enhance the proliferation of osteoblastlike cell in well-interconnected scaffolds, several types of scaffolds were fabricated using combined SLUP (Salt-Leaching Using Powder) and WNM (Wire-Network Molding) techniques: well-interconnected dual-pore scaffolds with hydroxyapatite particles, wellinterconnected dual-pore scaffolds without hydroxyapatite particles, and single-pore scaffolds with hydroxyapatite particles. To assess the characteristics of the fabricated scaffolds, their morphology, compressive modulus, water absorption, and in-vitro cell activity were measured. Consequently, it was found that while the hydroxyapatite (which is hydrophilic) provides some advantage for cell attachment, the cell attachment in the dual-pore scaffold with hydroxyapatite particles was similar to that of the dual-pore scaffold without hydroxyapatite particles. Moreover, regarding cell proliferation, we verified that the effect of the dual-pore structure was dominant compared with the existence of hydroxyapatite particles and co-existence of dual-pore structure/hydroxyapatite particles. However, the cell vitality of the dual-pore scaffold with hydroxyapatite particles was higher than that of the dual-pore scaffold without hydroxyapatite particles because of ions released by the hydroxyapatite particles.

Salt-leaching using powder (SLUP) scaffolds are novel salt-leaching scaffolds with well-interconnected pores that do not require an organic solvent or high pressure. In this study, in vitro and in vivo cell behaviors were assessed using a PCL (polycaprolactone) SLUP scaffold. Moreover, using PCL, conventional salt-leaching and 3D-plotted scaffolds were fabricated as control scaffolds. Morphology, mechanical property, water absorption, and in vitro/in vivo cell response assessments were performed to clarify the characteristics of the SLUP scaffold compared with control scaffolds. Consequently, we verified that the interconnectivity between the pores of the SLUP scaffold was enhanced compared with conventional salt-leaching scaffolds. Moreover, in vitro cell attachment and proliferation of the SLUP scaffold were higher than those of the 3D-plotted scaffold because of their morphological characteristic. Furthermore, we revealed that new bone formation and bone ingrowth of the SLUP scaffold was superior to those of the calvarial defect model and 3D-plotted scaffold because of the high porosity and improved interconnectivity of pores by the SLUP technique without high pressure using powders. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 3432-3444, 2017.

BACKGROUND Opioids are recently recommended for those who do not gain adequate pain relief from the use of acetaminophen or nonsteroidal anti-inflammatory drugs. Medical opioids are administered in various routes, and transdermal opioid products that can make up for the weaknesses of the oral or intravenous products have been developed. This study is to evaluate the clinical usefulness of fentanyl matrix in terms of the long-term improvement in pain and physical and mental functions. METHODS This was a multicenter, open, prospective, observational study that was conducted in 54 institutions in Korea. Patients with non-cancerous chronic pain completed questionnaires, and investigators also completed questionnaires. A total of 1,355 subjects participated in this study, and 639 subjects completed the study. Subjects received transdermal fentanyl matrix (12 µg/hr, 25 µg/hr, or 50 µg/hr depending on the patient's response and demand). Subjects visited at 29 ± 7 days, 85 ± 14 days, and 169 ± 14 days after administration, respectively, to receive drug titration and fill out the questionnaires. The results were analyzed using the intention-to-treat (ITT) analysis, full analysis set (FAS), and per-protocol (PP) analysis. The FAS analysis included only 451 participants; the PP analysis, 160 participants; and the ITT analysis, 1,355 participants. RESULTS The intensity of pain measured by the Numeric Rating Scale decreased from 7.07 ± 1.78 to 4.93 ± 2.42. The physical assessment score and mental assessment score of the Short-Form Health Survey 12 improved from 28.94 ± 7.23 to 35.90 ± 10.25 and from 35.80 ± 11.76 to 42.52 ± 10.58, respectively. These differences were significant, and all the other indicators also showed improvement. Adverse events with an incidence of ≥ 1% were nausea, dizziness, vomiting, and pruritus. CONCLUSIONS The long-term administration of fentanyl matrix in patients with non-cancerous pain can reduce the intensity of pain and significantly improves activities of daily living and physical and mental capabilities.

In this study, the fabrication method was proposed for the well-interconnected polycaprolactone/hydroxyapatite composite scaffold with exposed hydroxyapatite using modified WNM technique. To characterize well-interconnected scaffolds in terms of hydroxyapatite exposure, several assessments were performed as follows: morphology, mechanical property, wettability, calcium ion release, and cell response assessments. The results of these assessments were compared with those of control scaffolds which were fabricated by precision extruding deposition (PED) apparatus. The control PED scaffolds have interconnected pores with nonexposed hydroxyapatite. Consequently, cell attachment of proposed WNM scaffold was improved by increased hydrophilicity and surface roughness of scaffold surface resulting from the exposure of hydroxyapatite particles and fabrication process using powders. Moreover, cell proliferation and differentiation of WNM scaffold were increased, because the exposure of hydroxyapatite particles may enhance cell adhesion and calcium ion release. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2315-2325, 2017.

Although attempts to improve tissue-engineering scaffolds have been made using composite materials (synthetic polymers, bioceramics, etc.), research on bone tissue engineering has been limited to improving mechanical properties because of the intrinsic drawbacks of the grid-type structures conventionally used as scaffolds. To overcome this limitation, this study proposes a polycaprolactone/nano-hydroxyapatite scaffold with a kagome structure formed via material-extrusion process. The kagome structure is reported to be a mechanically superior open-pore structure. The mechanical properties and in vitro cell activities of 3D scaffolds have been studied with respect to the nano-hydroxyapatite (nHA) content in the scaffold. The compressive modulus of the PCL/nHA scaffold with kagome structure was found to be significantly improved. In addition, nHA particles on the surface of the scaffold were exposed through alkaline erosion, improving bone-regenerating ability. The alkaline erosion did not affect the structural characteristics of the scaffold, including pore size, porosity, hydroxyapatite content, and compressive modulus. Additionally, we observed that the exposure of PCL/nHA particles promoted bone-regeneration activity through enhanced osteoconduction of the scaffold.

Corticosteroids are commonly used for pain control in rotator cuff tear. Deregulated NF-κB activation is a hallmark of chronic inflammatory diseases and has been responsible for the pathogenesis of rotator cuff tear. The Dexamethasone(DEXA) is a synthetic corticosteroid. The purpose of this study was to examine the exact effect of dexamethasone on NF-κB signaling in rotator cuff tear. We measured NF-κB expression in four groups: control, TNF-α-treated, DEXA-treated, and combined treatment with TNF-α and DEXA. Tenocytes were isolated from patients with rotator cuff tears and pre-incubated with TNF-α (10 ng/ml), DEXA (1 µM), or both of them for 10 min, 1 h, and 2 h. Expression of p65, p50, and p52 in the nuclei and cytosol was analyzed by western blotting and immunofluorescence imaging using confocal microscopy. We also evaluated nucleus/cytosol (N/C) ratios of p65, p50, and p52. In our study, the combined treatment with DEXA and TNF-α showed increased N/C ratios of p65, p50, and p52 compared with those in the TNF-α group at all time points. Additionally, in the DEXA group, N/C ratios of p65, p50, and p52 gradually increased from 10 min to 2 h. In conclusion, DEXA promoted the nuclear localization of p65, p50, and p52, but was not effective in inhibiting the inflammatory response of TNF-α-stimulated rotator cuff tear.

BACKGROUND CONTEXT If lateral mass displacement (LMD) exceeds 6.9 mm, burst fracture of the C1 atlas is considered an unstable fracture due to transverse atlantal ligament (TAL) injury. Recently, unilateral sagittal split fracture (USSF) of C1 lateral mass (LM) was recognized as a rare variant of C1 atlas fracture. Conservatively-treated USSF of C1 LM is reported to cause late deformity of occipitocervical junction requiring major reconstructive surgery. Therefore, it is necessary to verify whether such LMD criteria can be applied to determine TAL injury in USSF of C1 LM. PURPOSE We performed the current study to investigate radiologic criteria to predict the presence of injury of TAL in USSF of C1 LM. STUDY DESIGN/SETTING Retrospective case analyses. PATIENT SAMPLE Twenty-six consecutive cases of USSF of C1 LM were included in this study. The fractures associated with other cervical spines, such as C2 and occiput, were excluded from the study. The mean age was 52 years-old; 16 were male and 10 were female. OUTCOME MEASURES Two radiologists determined presence of TAL injury in MRI using Dickman's classification and divided the cases into two groups: TAL injury and TAL intact. If the results of two judgements were not identical, the third radiologist re-evaluated. The radiologic results were measured and compared between TAL intact and TAL injury. METHODS Three spine surgeons measured radiologic parameters and the averages were used as final results: total LMD of both sides, unilateral LMD of the fracture side, atlanto-dental interval (ADI), and fracture gap. Radiologic parameters were measured and compared between TAL injury and TAL intact. RESULTS Sixteen were TAL injury group (9 type I and 7 type II) and 10 were TAL intact group. Total LMD (5.9 mm vs 1.2 mm, p CONCLUSIONS Compared to the rule of Spence (LMD > 6.9 mm) in C1 burst fracture, total LMD > 5.9 mm (or unilateral LMD > 4.3 mm) are the radiological criteria to predict the presence of TAL injury in USSF of C1 LM, which is considered as an unstable fracture. In addition, if fracture gap more than 7 mm is considered together, the possibility of diagnostic error for TAL injury can be further reduced in USSF of C1 LM. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Purpose The purpose of this study was to report clinical results of open excision of extra-articular ganglion cysts around the knee joint combined with arthroscopic management of intra-articular pathologies if present. Materials and Methods Of the total 107 cases of cystic lesions around the knee, 23 cases of extra-articular ganglion cysts were reviewed between January 2006 and July 2011. There were 13 males and 10 females with a mean age of 48 years (range, 30 to 73 years). The mean follow-up duration was 40 months (range, 30 to 60 months). Preoperative magnetic resonance imaging (MRI) scan was done in all cases. Open surgical excision of the cyst was performed after arthroscopic management of intra-articular pathologies in all but 1 case. At the last follow-up, Lysholm and International Knee Documentation Committee (IKDC) scores were evaluated and MRI was conducted to detect recurrence. Results The mean Lysholm and IKDC scores showed significant improvement (p=0.005 and 0.013, respectively).The location of the cysts was anterior in 9, lateral in 7, medial in 6, and posterosuperior in 1. Intra-articular pathologies were found in 16/23 cases (69.6%). In 10/23 cases (43%), the cyst was connected to the knee joint. Three months postoperative MRI did not show any recurrence of ganglion cysts except for 1 case. Conclusions In the treatment of extra-articular ganglion cysts, MRI can be useful for detecting intra-articular lesions and connecting orifices, and arthroscopic management of intra-articular pathologies with open excision of the cyst should be considered as a viable treatment option.

In this study, to fabricate dual-pore scaffolds with interconnected pores, Non-solvent Induced Phase Separation (NIPS) and Wire-Network Molding (WNM) techniques were combined. First, a mold with uniform slits was prepared, and needles were inserted into the mold. Subsequently, polycaprolactone (PCL) pellets were dissolved in tetrahydrofuran (THF) at a specified ratio. The slurry was mixed using hot plate stirrer at 1200 rpm for 24 hours at 40 °C. The PCL slurry was subsequently injected into the mold. Thereafter, to exchange the THF (solvent) with the ethanol (non-solvent), the mold was soaked in an ethanol bath. After removing the mold from the ethanol bath, the needles were removed from the mold. Consequently, dual-pore scaffold with interconnected pores was obtained. The surface morphology of the fabricated scaffolds were observed using Scanning Electron Microscope (SEM). Moreover, cell culture experiments were performed using the CCK-8 assay, and the characteristics of cells grown on the dual-pore scaffolds were assessed and were compared with the NIPS-based 3D plotting scaffold.

Unique biodegradable property of magnesium has spawned countless studies to develop ideal biodegradable orthopedic implant materials in the last decade. However, due to the rapid pH change and extensive amount of hydrogen gas generated during biocorrosion, it is extremely difficult to determine the accurate cytotoxicity of newly developed magnesium alloys using the existing methods. Herein, we report a new method to accurately determine the cytotoxicity of magnesium alloys with varying corrosion rate while taking in-vivo condition into the consideration. For conventional method, extract quantities of each metal ion were determined using ICP-MS and the result showed that the cytotoxicity due to pH change caused by corrosion affected the cell viability rather than the intrinsic cytotoxicity of magnesium alloy. In physiological environment, pH is regulated and adjusted within normal pH (∼7.4) range by homeostasis. Two new methods using pH buffered extracts were proposed and performed to show that environmental buffering effect of pH, dilution of the extract, and the regulation of eluate surface area must be taken into consideration for accurate cytotoxicity measurement of biodegradable magnesium alloys.

To enhance the mechanical properties of three-dimensional (3D) scaffolds used for bone regeneration in tissue engineering, many researchers have studied their structure and chemistry. In the structural engineering field, the kagome structure has been known to have an excellent relative strength. In this study, to enhance the mechanical properties of a synthetic polymer scaffold used for tissue engineering, we applied the 3D kagome structure to a porous scaffold for bone regeneration. Prior to fabricating the biocompatible-polymer scaffold, the ideal kagome structure, which was manufactured by a 3D printer of the digital light processing type, was compared with a grid-structure, which was used as the control group, using a compressive experiment. A polycaprolactone (PCL) kagome-structure scaffold was successfully fabricated by additive manufacturing using a 3D printer with a precision extruding deposition head. To assess the physical characteristics of the fabricated PCL-kagome-structure scaffold, we analyzed its porosity, pore size, morphological structure, surface roughness, compressive stiffness, and mechanical bending properties. The results showed that, the mechanical properties of proposed kagome-structure scaffold were superior to those of a grid-structure scaffold. Moreover, Sarcoma osteogenic (Saos-2) cells were used to evaluate the characteristics of in vitro cell proliferation. We carried out cell counting kit-8 (CCK-8) and DNA contents assays. Consequently, the cell proliferation of the kagome-structure scaffold was increased; this could be because the surface roughness of the kagome-structure scaffold enhances initial cell attachment.

In this study, a novel technique was proposed to fabricate dual-pore scaffolds combining both SLUP (salt leaching using powder) and WNM (wire-network molding) techniques. This technique has several advantages: solvent-free, no limit on the use of thermoplastic polymers as a raw material, and easiness of fabricating scaffolds with dual-scale pores that are interconnected randomized small pores. To fabricate dual-pore scaffolds, PCL and NaCl powders were mixed at a certain ratio. Subsequently, needles were inserted into a designed mold, and the mixture was filled into the mold thereafter. Subsequently, after the mold was pressurized, the mold was heated to melt the PCL powders. The PCL/NaCl structure and needles were separated from the mold. The structure was sonicated to leach-out the NaCl particles and was dried. Consequently, the remaining PCL structure became the dual-pore scaffold. To compare the characteristics of dual-pore scaffolds, control scaffolds, which are 3D plotter and SLUP scaffolds were fabricated.

Background:Intratendinous tears of the rotator cuff are rare, and little has been written about them.Purpose:To investigate the prevalence and clinical and radiological outcomes of arthroscopically confirmed intratendinous tears treated with transtendon suture bridge repair.Study Design:Case series; Level of evidence, 4.Methods:Included in the study were 33 patients (16 male, 17 female; mean age, 53.4 years) with arthroscopically confirmed intratendinous tears treated with transtendon suture bridge repair from March 2006 to July 2012. A history of trauma was found in 10 cases (30.3%). The dominant arm was involved in 26 cases (78.8%). The mean follow-up duration was 56 months. Preoperatively, a thorough physical examination was performed; at final follow-up, shoulder range of motion (ROM) in forward flexion, abduction, external rotation (ER) at the side, and internal rotation (IR) at the back was noted, and clinical outcomes (American Shoulder and Elbow Surgeons [ASES] score; University of California, Los Angeles [UCLA] score; visual analog scale [VAS] for pain; and Simple Shoulder Test [SST]) were recorded and compared with the preoperative data. Postoperative magnetic resonance imaging (MRI) was performed at 6 months to investigate rotator cuff healing status and repair integrity.Results:The prevalence of arthroscopically confirmed intratendinous tears was 4.7% among all arthroscopically treated partial-thickness rotator cuff tears. Impingement signs were positive in most of the patients (positive Hawkins-Kennedy test result in 78.8%, positive Neer sign in 66.7%, and either positive Hawkins-Kennedy test result or Neer sign in 84.8%). At final follow-up, mean ASES, UCLA, VAS, and SST scores improved significantly from a preoperative mean of 51.4, 18.9, 6.0, and 5.4, respectively, to a postoperative mean of 90.6, 32.9, 1.4, and 10.8, respectively ( P < .001). According to the UCLA rating scale, outcomes were excellent in 17, good in 13, and fair in 3 cases. Shoulder ROM in forward flexion, abduction, ER at the side, and IR at the back improved from a preoperative mean of 135°, 129°, 25°, and L2, respectively, to a postoperative mean of 161°, 160°, 29°, and T10, respectively ( P < .001 for all except ER). As per the Sugaya classification, on postoperative MRI, type I healing status was found in 10 (30.3%), type II in 18 (54.5%), and type III in 2 (6.1%) cases. None of the patients showed any evidence of retears.Conclusion:Transtendon suture bridge repair yielded satisfactory clinical and radiological outcomes in patients with intratendinous rotator cuff tears.

Steroid applications are able to repress inflammatory activity in various conditions, including herniation of the nucleus pulposus (HNP), by inhibiting tumour necrosis factor (TNF)-α, but the effects of long-term use are unknown. Here, we investigated the effect of dexamethasone (DEXA) on TNF-α-stimulated intervertebral disc cells by monitoring the expression and localization of NF-κB in the cytoplasm and nucleus. Cultured human intervertebral disc cells were left untreated or treated with only TNF-α, only DEXA, or with TNF-α and DEXA simultaneously. Cytoplasmic and nuclear proteins were extracted and Western blotted after 10 min, 1 or 2 h, to evaluate the expression of p50, p65, p52, and p100 (components of NF-κB). Immunofluorescence analysis was used to determine the subcellular localization of the proteins at 1 h. DEXA had limited effects on NF-κB expression in TNF-α-stimulated disc cells within the first 10 min. At 1 h, DEXA prevented the TNF-α-stimulated translocation of p50, p52, and p65. After 2 h, DEXA reduced the nuclear expression of p50, p65, and p52. Thus, DEXA resulted in delayed expression of NF-κB components and inhibited the translocation of p50, p52, and p65 to the nucleus, which would prevent expression of the corresponding genes. Therefore, following stimulation with TNF-α, transcriptional regulation of NF-κB in disc cells is mainly mediated via the classical pathway, but also to some extent via the alternative pathway. Hence, blockade of sub-acute inflammatory changes in HNP can be achieved by early injection of steroids, whereas long-term injection of a steroid may initiate NF-κB autophosphorylation.

In this study, a three-dimensional (3D) cylindrical polycaprolactone (PCL) scaffold was fabricated from PCL monofilaments using a knitting machine. First, two types of multi-filaments were fabricated from PCL monofilaments with diameters of 120 μm using a knitting machine. The approximate diameters of the fabricated multi-filaments were 400 μm and 660 μm, respectively. These two types of multi-filaments were used to fabricate 2D PCL sheets. Next, the fabricated 2D PCL sheet was rolled up to form a cylindrical structure with a diameter of 5 mm. Subsequently, the end of the sheet was sewed onto the intimate surface of the rolled up sheet. Finally, the cylindrical knitted PCL structure was cut into several pieces, resulting in cylindrical scaffolds with lengths and diameters of 5 mm. The porosities of the 400 μm multi-filament and 660 μm multi-filament scaffolds were measured as 76.6% and 77.2%, respectively. Moreover, the compressive moduli of 400 μm multi-filament and 660 μm multi-filament scaffolds were measured as 13.3 MPa and 11.2 MPa, respectively. Additionally, to analyze cell proliferation, scaffolds were seeded with 1×106/20 μl in media osteosarcoma cells and cultured for 1, 3, 7, and 14 days and were analyzed using a CCK-8 assay. The results were compared with bio-plotter scaffolds, which have a porosity of 77% and size of 4.43 by 4.43 by 5 mm3, which is approximately the same as the scaffolds fabricated here. The scaffolds fabricated in this study showed better cell proliferation than the bio-plotter scaffold.

BACKGROUND: The purpose of this study was to determine whether in patients with rotator cuff tears a correlation exists between molecular changes and clinical parameters such as age, duration of symptom, range of motion, and tear size. Molecular changes of matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) were assessed by measuring messenger RNA (mRNA) levels of the two proteins.METHODS: The rotator cuff tissue from was obtained from the edge of a torn tendon revealed after debridement by a motorized shaver. Using the sample of rotator cuff tissue, the reverse transcription polymerase chain reaction was performed to quantify MMP-2 and TIMP-2 mRNA expression. To determine whether mRNA levels and the clinical variables, such as age, defect size, range of motion (ROM) of shoulder, and duration of symptoms, show any correlation, Spearman's correlation coefficients were used to test for significant differences.RESULTS: There was an inverse correlation between the mRNA levels of MMP-2 and TIMP-2 from the torn rotator cuff tendons regardless of the clinical variables. However, comparison of mRNA levels versus clinical parameters such as age, defect size, range of motion and duration of symptoms revealed a number of findings. We found a significant correlation between age and mRNA levels of MMP-2 from torn cuffs (r = 0.513, p = 0.021). Further, we found a significant correlation between defect size in the full thickness tears and mRNA levels of MMP-2 (r = 0.454, p = 0.045). Conversely, no significant association between mRNA levels of MMP-2 and ROM or duration of symptom was found.CONCLUSIONS: Our results suggest that both MMP-2 and TIMP-2 may be involved in the disease process of rotator cuff tears. Although the level of mRNA expression of MMP-2 and TMP-2 remain constant in torn rotator cuffs irrespective of the clinical variables, their levels may be influenced by age and defect size, which could account to change in tendon degradation and the healing process.

In the polycaprolactone/hydroxyapatite scaffold fabricated by the melting-extrusion-type 3D-printing system, hydroxyapatite (bioceramic) particles are usually covered by a thin-film polycaprolactone (thermoplastic polymer) layer because of the rheological characteristics of the melting-extrusion process. The original bioactive characteristics of the bioceramic particles can be disrupted by this thin-film thermoplastic polymer. Therefore, in this study, an alkaline erosion process was employed to eliminate the thin-film polycaprolactone layer to expose the hydroxyapatite particles. To investigate the influence of the enhanced exposure of hydroxyapatite on cell response and bone regeneration, the polycaprolactone scaffold, polycaprolactone scaffold with alkaline erosion, and polycaprolactone/hydroxyapatite scaffold were compared with the polycaprolactone/hydroxyapatite scaffold with alkaline erosion. Furthermore, to identify the characterization of the 3D-printed composite scaffold for hydroxyapatite's exposure, the morphology, pore size, porosity, mechanical compressive modulus, in-vitro cell response, and in-vivo bone regeneration were assessed. Consequently, the proposed alkaline erosion for the exposure of hydroxyapatite did not change the structural characteristics of the 3D-printed scaffolds, such as the pore size, porosity, and mechanical property. Additionally, we verified that the exposure of hydroxyapatite particles on the scaffold's surface promoted the bone-regeneration ability of the scaffold because of enhanced osteoconduction by hydroxyapatite's exposure.

BACKGROUND CONTEXT A unilateral sagittal split fracture (USSF) of the C1 lateral mass (LM) is a rare variant of C1 atlas fracture. To date, definite treatment guideline of USSF of C1 LM has not been established. The integrity of transverse atlantal ligament (TAL) is a key factor to determine the stability in C1 atlas fracture. However, the effect of TAL injury on treatment outcomes is controversial in USSF of C1 LM. Previous study of small case series reported that despite the TAL competency, conservatively-treated USSF of C1 LM causes late deformity of occipitocervical junction requiring major reconstructive surgery. PURPOSE Therefore, we performed the current study to investigate these two issues in USSF of C1 LM and suggest appropriate treatment guideline. STUDY DESIGN/SETTING Retrospective case analyses. PATIENT SAMPLE Twenty-six consecutive cases of USSF of C1 LM were included from 5 trauma centers of tertiary university hospitals. The fractures associated with other cervical spines, such as C2 and occiput, were excluded from the study. The mean age was 52 years old; 16 were male and 10 were female. OUTCOME MEASURES The radiologic outcomes were evaluated by comparing initial presentation and last follow-up in two groups. Clinical outcomes were evaluated by visual analog scale (VAS) and Odom's criteria. METHODS Of the total cases,16 were TAL injury group (9 type I and 7 type II according to Dickman's classification) and 10 were TAL intact group. All cases were treated by conservative measures including rigid brace or halovest for 12 weeks. The mean follow-up was 16 months (range, 12-47 months). Three spine surgeons measured radiologic parameters on lateral radiograph and open mouth view of cervical spine, 2-dimensional reconstructed CT scans and MRI of initial and last follow-up: total LM displacement (LMD), unilateral LMD of fracture side, atlanto-dental interval (ADI), clivus canal angle (CCA), atlanto-occipital joint axis angle (AOJAA), and basion-dens interval (BDI). The averages of three measurements were used as final results. RESULTS At the last follow-up, for TAL intact group, total LM displacement (LMD), unilateral LMD of fracture side, atlanto-dental interval, basion-dental interval, clivus canal angle, and atlanto-occipital joint axis angle were maintained compared to initial presentation. However, for TAL injury group, all radiological parameters were worsened. The worsening of radiological parameters was more severe in type I injury than type II injury except for total LMD and unilateral LMD. Neck VAS significantly decreased and patient's satisfaction was higher in TAL intact group compared to TAL injury group. CONCLUSIONS Conservative treatment for USSF of C1 LM with TAL injury failed to achieve healing of fracture site, which caused deterioration of lateral displacement of C1 LM. This caused coronal and sagittal malalignment of occipitocervical junction, resulting in unsatisfactory clinical outcomes. Our results suggest that early surgical treatment should be considered as the first choice treatment for USSF of the C1 LM, especially type I TAL injury. However, conservative treatment may be sufficient for USSF of the C1 LM with TAL intact. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

To report the clinical and radiological outcomes of arthroscopic suture bridge repair for the GT fractures of the shoulder joint.From March 2008 to July 2013, we performed arthroscopic suture bridge repair of the GT fractures displaced more than 5 mm superiorly or posteriorly, but less than 2 cm in 40 cases [20 men, 20 women; mean age, 56 (27-80) years] with the average 32 (24-48) months follow-up. At the final follow-up, clinical (ASES, UCLA, SST, KSS score and range of motions) and radiological outcomes using post-operative MRI or CT scan were evaluated. Associated injuries occurred in 21 cases (52.5%): 8 rotator cuff tears; 7 SLAP lesions; 3 glenoid rim fractures; 3 Bankart lesions; 5 biceps tendon tears; 1 partial subscapularis tear; 1 combined subscapularis and biceps tendon tear, and 1 brachial plexus injury.At the final follow-up, the mean VAS score improved from 7 to 1; ASES, to 92; UCLA, to 32; KSS, to 90; and SST, to 10. Mean forward flexion, abduction, external rotation at the side, and internal rotation at the back were improved to 157°, 157°, 37° and T11, respectively. Mean residual superior and posterior displacement of the fracture was 0 (range -5 to 3.3) mm and 0.1 (-5.5 to 3.2) mm, respectively, compared to pre-operative displacement of 4.9 (0-14) mm and 4.5 (0-20) mm, respectively (p 0.001). Complications included anchor protrusion in five cases.Arthroscopic suture bridge repair was useful for the treatment of displaced GT fractures with or without comminution and the management of the combined lesions. At the final follow-up, meaningful remodeling of the GT fracture and satisfactory clinical outcomes could be achieved.

Pseudoaneurysms in the foot are more often reported in the lateral plantar artery than the medial plantar artery, most likely because of its more superficial location. There are no reports of pseudoaneurysm of the medial plantar artery after trauma. We present two cases of pseudoaneurysm of the medial plantar artery after blunt foot trauma and foot laceration. This pseudoaneurysm compressed a posterior tibial nerve, resulting in tarsal tunnel syndrome. The patients were treated successfully using transcatheter embolization without the need for surgical intervention. The tarsal tunnel syndrome also subsided. Here, the authors report these cases and provide a review of literature.

Extensor tendon triggering is a rare disease entity. Even less common is a case of extensor digiti minimi (EDM) double triggering caused by impingement on the extensor retinaculum. Herein, we describe one patient with EDM double triggering developed at the extensor retinaculum and over the metacarpal head caused by its impingement on the extensor retinaculum.

The purposes of this preliminary study were to investigate the effect of increased Ca contents (5–10 wt% Ca) in Mg-Ca alloy on the mechanical properties and osseous healing rate in a standard rat defect model. Mechanical tests were performed using a compression system followed by qualitative histological analysis using the hemotoxylin and eosin (H&E) staining method and quantitative reverse transcriptase polymerase chain reaction (reverse transcriptase PCR). Mg-Ca alloy degraded fast in vivo while displaying a high level of the bone formation markersOC and ALP. Favorablemechanical strength properties were displayed as Ca content increased from 5 wt% to 10 wt% to show its potential to be considered as a load bearing implant material. The resultfrom this study suggests that the developed Mg-Ca alloy has the potential to serve as a biocompatible load bearing implant material that is degradable and possibly osteoconductive.

The pedicle screw fixation system has been used for various spinal disorders. Many studies have been conducted on the fixation ability of the pedicle screw, but variable results have been reported based on bone qualities, pedicle screw properties, insertion techniques, and experimental methods.An experimental and biomechanical study.To evaluate the geometric factors of screws affecting fixation ability after assessing pullout strength based on various pedicle screw designs and different bone densities.Nine types of pedicle screws were prepared according to the outer diameter shape (cylindrical or conical), the inner diameter shape (cylindrical or conical), and thread shape (V shape, buttress shape, and square shape). The pedicle screws were inserted into standardized polyurethane foams of Grades 5, 15, and 20. The pullout strength of each pedicle screw was determined using an MTS 858 machine (Material Testing System Corp., Minneapolis, MN, USA), and the results were analyzed statistically.Pullout strength based on the shape of thread was the highest in the V shape and lowest in the square shape for all foam grades (p.05). The outer cylindrical and inner conical shape of pedicle screw showed the highest pullout strength in Grades 5 and 15 foam (p.05). An outer cylindrical and inner conical shape with a V-shaped thread showed the highest pullout strength in all foam grades (p.05).Pedicle screw with an outer cylindrical and inner conical configuration with a V-shaped thread may have maximum pullout strength, regardless of bone density.

Almost all traumatic injuries can be classified using established criteria, but foot trauma can result in various combinations of injuries. Leibner et al. first described concomitant Lisfranc fracture-dislocation and complex dislocation of the metatarsophalangeal (MTP) joint, and coined the term ‘floating metatarsal.’ Since then several variants of floating metatarsal have been reported.2,4–7,9,10 Isolated floating metatarsal involving dislocation alone without fracture of the metatarsal is even more uncommon. We describe a case of an isolated locked floating metatarsal without fracture caused by minor trauma. In this case, the metatarsal head was button-holed and locked. The patient was treated by open reduction without fixation.

We present two patients with open pilon fractures with large bone defects treated successfully with fibular strut allografts. The patients were initially treated by massive irrigation, wound debridement, and temporary external fixation. After complete wound healing, the bone defects were managed. Because autologous iliac crest or fibular bone grafts were impossible to be harvested due to multiple fractures, the bone defects were reconstructed with fibular strut allografts. Fixation was performed with a periarticular distal tibia locking plate. At 2 months postoperatively, the patients ambulated with partial weight-bearing; at 6 months, they had full range of motion of the ankle joint and full weight-bearing.

절에서발생한화농성관절염과결핵성관절염에대한수술 술기와치료결과를보고하고자한다. 증례1 (결핵성관절염). 61세가정주부가약3개월전부터발생한우측흉쇄관절부위의압통과종창을주소로내원하였다. 흉쇄관절의종창으로개인병원에서2차례절제술을시행한후, 조직검사소견에서만성육아성염증인결핵성관절염으로확진되어전원되었다. 내원시흉쇄관절의절개창이개방되어있는소견과함께장액성의분비물이관찰되었다(Fig. 1). 발열등의전신증상은 없었다.이학적검사상발적, 압통과종창소견을보였고있었으며, 견관절운동범위는전방거상140도, 외전130도외회전및내전은각각30도및제2요추수준으로감소되어있었다. 검사소견상적혈구침강속도74mm/hr, C-반응성단백질0.29 mg/dl로관찰되었다. 내원시시행한단순방사선검사상우측흉쇄관절의내측연에피질골의파괴소견이보이고(Fig. 2A)MRI 소견상흉쇄관절의흉골쇄골관절양골단에피질골파괴소견과함께조직액이증가되어있었으며(Fig. 2B), 전후방및상하부위로관절밖으로파급되는양상으로관찰되었다. 조영증강영상에서이병변들은다수의조영되지않는부분을갖는테두리조영증강(rim enhanced lesion with multifocal non-enhanced foci) 병변을보이는농양 (abscess)의소견이여러군데에서관찰되었다 (Fig. 2C). 수술전폐사진소견에서폐결핵소견도같이발견되어호흡기내과에서항결핵제투여요법으로치료하기로하였다.수술소견전신마취하에해변의자자세로환자를위치시킨후우측쇄골과흉쇄관절에걸쳐비스듬하게약5 cm 의절개를가하였다. 피하지방층과근막을절개하여박리한후, 흉골쇄골관절의뼈부위까지깊게절개창을넣어골막과관절부위를노출시켰다. 피하지방층으로부터광범위하게감염된노란색의육아성염증조직이관찰되었다. 흉골의전연을큐렛으로소파술을시행하자흉쇄관절과제1늑골의후연을따라노란색의치즈같은조직파편(debris)이 관찰되어이를절제하였다. 심한골파괴양상이흉골근위부, 제1 늑골과근위부쇄골말단부에서관찰되었다(Fig. 3). 각각의골 조직에서색깔변화와함께괴사되어있는골을론저 (rongeur)를이용하여변연절제술및소파술을시행하였다(Fig. 4). 6개월이상추시상배액관 (sinus tract)이나장액성분비물없이잘봉합되어치유된상처의소견을보여주었다. 항결핵제로 INH (Isoniazid) 300mg. RMP (Rifampin) 600 mg, MBT (Ethambu-tol) 1200 mg, PZ (Pyrazinamide) 1500 mg 을2개월간투약하였으며이후에는INH 300 mg, RMP600 mg, MBT 800 mg 으로1년간 투약하였으며1년4개월이추시상재발소견은관찰되지않고있다. 증례2 (화농성관절염). 43세여자환자가3일전부터발생한좌측흉쇄관절부위의통증및부종그리고견관절운동시악화되는통증을주소로내원하였다. 외상병력은없었고과거력

We reviewed 19 patients over 50 years of age who had rotator cuff tears com-bined with shoulder dislocation between October 2004 and October 2008. There were 7 males and 12females with a mean age 64.7 years (range, 50 to 78 years). The average follow-up duration was 22months (range, 8 to 56 months). We investigated the number of dislocations, the size of the cuff tear, thepresence of Bankart lesions and the time interval from dislocation to surgery. We also investigated theASES score, UCLA score, SST score, and shoulder range of motion before and after surgery. We ana-lyzed clinical outcomes and contributing factors.