Background: Accurate measurement of the lower limb alignment is one of the most crucial factors in advanced knee osteoarthritis patients scheduled for surgery. Recently, EOS biplanar stereoradiography with three-dimensional reconstruction was developed. The purpose of this study was to compare radiographic parameters between conventional scanography and EOS in patients with advanced knee osteoarthritis who need surgical treatment. Methods: A total of 52 consecutive patients (104 knees) with bilateral knee osteoarthritis of advanced stage (Kellgren-Lawrence [KL] grade 3 or 4) were retrospectively reviewed. We measured the hip-knee-ankle angle (HKA) on conventional scanograms. In EOS, we measured HKA, hip-knee-shaft angle, mechanical lateral distal femoral angle, and mechanical medial proximal tibial angle. To evaluate sagittal and axial plane alignment, knee flexion angle (KFA), and knee joint rotation (KJR) were also measured. Results: Ninety knees were KL grade 4, and 14 knees were grade 3. The average HKA was 10.14° ± 6.16° on conventional scanograms and 11.26° ± 6.21° in EOS. HKA was greater in EOS than on conventional scanograms, and the difference (1.12°; range, −1.07° to 3.22°) was statistically significant (p < 0.001). Significant correlations were observed on the difference in HKA and mechanical medial proximal tibial angle (r = –0.198, p = 0.044), KFA (r = 0.193, p = 0.049), and KJR (r = 0.290, p = 0.003). In multivariable linear regression analysis, the difference in HKA had significant relationship with KFA (β = 0.286, p = 0.003) and KJR (β = 0.363, p < 0.001). Conclusions HKA measured on conventional scanograms and in EOS differed significantly and the difference had a significant correlations with KFA, KJR, and medial proximal tibial angle. Surgeons can consider these results before orthopedic surgery in patients who have advanced knee osteoarthritis.

PURPOSE: This study was conducted to describe the postopertive MRI findings with contrast enhancement following anterior cervical fusion(ACF). MATERIALS AND METHODS: Thirteen patients after anterior cervical fusionsfor disc herniation or traumatic injury were studied with MRI 1 month to 10 months after operation. MRI findings were analysed with attention to the remained vertebral body, disc material, retropharyngeal soft tissue, grafted bone fragment, and biological orthopedic prosthesis(BOP). RESULTS: In 8/13 cases(62%), enhancement of the retropharyngeal soft tissue was seen with good demarcation between soft tissue and surrounding vertebra or disc.In 9/13 cases(69%), grafted bone or BOP was well defined by intersurface with low signal intensity. In 4 cases ofACF with bone graft, 2 cases(50%) showed heterogeneous or homogeneous enhancement of grafted bone fragments. Remained vertebral bodies and discs showed enhancements in 8/13 cases(62%). CONCLUSION: Postoperative MR findings after ACF included good margination of enhanced retropharyngeal soft tissue, grafted bone, and remained vertebral bodies/discs. The MRI could be a useful study to differentiate findings after ACF from posoperative inflammations such as spondylitis or discitis, and be a good imaging modality for follow up of grafted bony fragment or BOP.
Discitis ; Humans ; Magnetic Resonance Imaging ; Orthopedics ; Spine ; Spondylitis ; Transplants

PURPOSE: To evaluate the air contamination of the gelfoam in the angio-intervention room. MATERIALS AND METHODS: After exposing four groups of gelfoam(group A1 : gelfoam fragment, group A2 : gelfoam fragment+ saline +contrast media, group B1 : gelfoam powder, group B2 : gelfoam powder + saline + contrast media) to air in the angio-intervention room, we inoculated gelfoam in each group to 30 agar plates each at every fifteen minutes for one hour with aseptic cotton buds. Cultivating them in the incubator for one day, we evaluated the growth of bacteria or fungus. RESULTS: Out of 480 inoculated agar plates, the growth of coagulase(-) staphylococci was visible in 14 ; in group A1, two at 30 minutes, three at 45 minutes, and four at 60 minutes ; in group A2, one at 45 minutes and two at 60 minutes ; in group B1 and B2, one each at 45 minutes. The stastical analysis on bacterial contamination according to time sequence and group revealed no significance(p<0.05). CONCLUSIONS: If gelfoam is exposed to room air for less than 30 minutes, it is possible to reduce contamination by air-borne bacteria. Since coagulase-negative Staphylococci resistant to commonly used antibiotics, it is ideal to reduce exposure of gelfoamto room air for less than 30 minutes.
Agar ; Anti-Bacterial Agents ; Bacteria ; Fungi ; Gelatin Sponge, Absorbable* ; Incubators

Background: The purpose of this study was to evaluate the association of body mass index (BMI) and waist circumference (WC) with the risk of Achilles tendinopathy (AT) or Achilles tendon rupture (ATR), using data from a nationwide population-based cohort.We hypothesized that higher BMI and WC would be independently associated with the increased risk of AT or ATR. In addition, a higher WC may potentiate the association between BMI and the risk of Achilles tendon problems. Methods: We used the National Health Insurance database that covers the entire South Korean population to follow up subjects who participated in the National Health Screening Program (NHSP) from January 2009 to December 2010. The NHSP data include subjects’ BMI, WC, blood test results, blood pressure, and information about lifestyle. Among the subjects, those who were newly diagnosed as having AT or ATR before December 31, 2017, were selected. To examine the association of the variables with the risk of AT or ATR and determine whether the effect of higher BMI varied according to WC, multivariate Cox proportional hazards regression was used. Results: Among a total of 16,830,532 subjects, 125,814 and 31,424 developed AT and ATR, respectively. A higher BMI showed a greater association with the increased risk of ATR than AT (adjusted hazard ratio [HR], 3.49 vs. 1.96). A higher WC was associated with the increased risk of AT (adjusted HR, 1.22), but not ATR. In a separate analysis, the association between BMI and the risk of AT was higher when subjects had higher WC as compared to those with lower WC, being most significant in individuals with both higher BMI and higher WC. Conclusions Higher BMI was more associated with the increased risk of ATR than AT. Moreover, a high central fat distribution played an independent and potentiating role in the development of AT. This implies the greater importance of a high central fat distribution contributing to the development of AT in obese people.

PURPOSE: Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). On the other hand, a standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. The clinical progress of staged reimplantation in patients who had fungus-related PJI after TKA was reviewed retrospectively. MATERIALS AND METHODS: Ten patients who had a fungal related PJI after TKA between 2006 and 2017 using staged reimplantation surgery were reviewed. These patients were compared with 119 patients who had a PJI in the same period. The failure rate of infection control, intravenous antimicrobial using the period, and the clinical results were evaluated by comparing the range of motion and Korean knee score (KKS) between pre-staged reimplantation and the last follow-up. RESULTS: In the fungal infection group, 7 out of 10 cases (70.0%) had failed in infection control using staged reimplantation and in the non-fungal group, 7 out of 119 cases (5.9%) had failed (p=0.04). In the non-fungal group, the mean duration of antibiotics was 6.2 weeks. In the fungus group, the mean duration of antibiotics was 15.3 weeks, which was 9.1 weeks longer (p < 0.001). The range of motion of the knee was increased in the two groups (p=0.265). At the last follow-up, the KKS was 71.01 points in the non-fungal group and 61.3 points in the fungal group (p=0.012). Erythrocyte sedimentation rate and C-reactive protein (CRP) decreased in the two groups, but the CRP was significantly different in the two groups (p=0.007). CONCLUSION: The treatment of fungus-related PJIs using staged reimplantation showed uneven clinical progress and unsatisfactory clinical improvements compared to non-fungal PJI. Therefore, it is necessary to consider the use of an antifungal mixed cement spacer at resection arthroplasty and oral antifungal agent after reimplantation.
Anti-Bacterial Agents ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Blood Sedimentation ; C-Reactive Protein ; Follow-Up Studies ; Fungi ; Hand ; Humans ; Infection Control ; Joints ; Knee ; Range of Motion, Articular ; Replantation ; Retrospective Studies

BACKGROUND: After the resection at the mandibular site involving oral cancer, free vascularized fibular graft, a type of vascularized autograft, is often used for the mandibular reconstruction. Titanium mesh (T-mesh) and particulate cancellous bone and marrow (PCBM), however, a type of non-vascularized autograft, can also be used for the reconstruction. With the T-mesh applied even in the chin and angle areas, an aesthetic contour with adequate strength and stable fixation can be achieved, and the pores of the mesh will allow the rapid revascularization of the bone graft site. Especially, this technique does not require microvascular training; as such, the surgery time can be shortened. This advantage allows older patients to undergo the reconstructive surgery. CASE PRESENTATION: Reported in this article are two cases of mandibular reconstruction using the ready-made type and custom-made type T-mesh, respectively, after mandibular resection. We had operated double blind peer-review process. A 79-year-old female patient visited the authors’ clinic with gingival swelling and pain on the left mandibular region. After wide excision and segmental mandibulectomy, a pectoralis major myocutaneous flap was used to cover the intraoral defect. Fourteen months postoperatively, reconstruction using a ready-made type T-mesh (Striker-Leibinger, Freibrug, Germany) and iliac PCBM was done to repair the mandible left body defect. Another 62-year-old female patient visited the authors’ clinic with pain on the right mandibular region. After wide excision and segmental mandibulectomy on the mandibular squamous cell carcinoma (SCC), reconstruction was done with a reconstruction plate and a right fibula free flap. Sixteen months postoperatively, reconstruction using a custom-made type T-mesh and iliac PCBM was done to repair the mandibular defect after the failure of the fibula free flap. The CAD-CAM T-mesh was made prior to the operation. CONCLUSIONS: In both cases, sufficient new-bone formation was observed in terms of volume and strength. In the CAD-CAM custom-made type T-mesh case, especially, it was much easier to fix screws onto the adjacent mandible, and after the removal of the mesh, the appearance of both patients improved, and the neo-mandibular body showed adequate bony volume for implant or prosthetic restoration.
Aged ; Autografts ; Bone Marrow ; Carcinoma, Squamous Cell ; Chin ; Computer-Aided Design ; Female ; Fibula ; Free Tissue Flaps ; Humans ; Mandible ; Mandibular Osteotomy ; Mandibular Reconstruction ; Middle Aged ; Mouth Neoplasms ; Myocutaneous Flap ; Titanium ; Transplants

Tumor necrosis factor-Related Apoptosis-Inducing Ligand (TRAIL) has been reported to specifically kill malignant cells but to be relatively nontoxic to normal cells. One of disadvantages to previous in vivo protocols was the need for large quantities of TRAIL recombinant protein to suppress tumor growth. To evaluate the antitumor activity and therapeutic value of the TRAIL gene, we constructed adenoviral vectors expressing the human TRAIL gene (Ad.hTRAIL) and transferred them into malignant glioma cells in vitro and tumors in vivo, as an alternative to recombinant soluble TRAIL protein. The results show that TRAIL-sensitive glioma cells infected Ad.hTRAIL undergo apoptosis through the production and expression of TRAIL protein. The in vitro transfer elicited apoptosis, as demonstrated by the quantification of viable or apoptotic cells and by the analysis of cleavage of poly (ADP-ribose) polymerase. Furthermore, in vivo administration of Ad.hTRAIL at the site of tumor implantation suppressed the outgrowth of human glioma xenografts in SCID mice. These results further define Ad.hTRAIL as an anti-tumor therapeutic and demonstrate its potential use as an alternative approach to treatment for malignant glioma.
Adenoviridae/*genetics ; Animals ; Apoptosis ; Apoptosis Regulatory Proteins/*genetics ; Cell Line, Tumor ; Gene Expression ; Gene Therapy/*methods ; Glioma/pathology/*therapy ; Humans ; Membrane Glycoproteins/*genetics ; Mice ; Mice, SCID ; Neoplasm Transplantation ; Research Support, Non-U.S. Gov't ; Transplantation, Heterologous ; Tumor Necrosis Factor-alpha/*genetics

A 39-yr-old female patient, diagnosed with tuberous sclerosis 10 years ago, presented for selective arterial embolization under general anesthesia. The symptoms of the patient were lower abdominal pain and gross hematuria. Renal arteriography showed multiple bilateral renal angiomyolipomas and ruptured aneurysms in right kidney. She had also pulmonary lymphangiomyomatosis, hepatic angiomyolipomas, and multiple subependymal nodules without mass effect in brain. We report the anesthetic management of this case with tuberous sclerosis for selective arterial embolization under general anesthesia.
Abdominal Pain ; Anesthesia ; Anesthesia, General ; Aneurysm, Ruptured ; Angiography ; Angiomyolipoma ; Brain ; Female ; Hematuria ; Humans ; Kidney ; Lymphangioleiomyomatosis ; Tuberous Sclerosis*

Purpose: Human breast milk (HBM) contains immune components that produced and delivered from the mother along with nutrients necessary for the baby. MicroRNA (miRNA) is a small noncoding RNA molecule, that is used as an ideal biomarker for diagnosis and prognosis of various diseases and are more abundant in HBM. We analyzed and compared the immune components and miRNAs of HBM. Methods: HBM were collected from 20 healthy breastfeeding mothers. We measured the amount of lactoferrin, lysozyme, and immunoglobulin A (IgA) and extracted the miRNAs from each breast milk samples. Next, the top 5 and bottom 5 expressed miRNAs were compared and analyzed based on the amounts of the 3 immune components. Results: The mean levels and ranges of lactoferrin, lysozyme, and IgA were 6.33 (2.24–14.77)×106 ng/mL, 9.90 (1.42–17.59)×107 pg/mL, and 6.64 (0.48–20.01)×105 ng/mL, respectively. The miRNAs concentration per 1 mL of skim milk was 40.54 (14.95–110.01) ng/μL. Comparing the bottom 5 and top 5 groups of each immune component, 19 miRNAs were significantly upregulated (6, 9, and 4 targeting lactoferrin, lysozyme, and IgA, respectively) and 21 were significantly downregulated (4, 9, and 8 targeting lactoferrin, lysozyme, and IgA, respectively). There were no miRNAs that were expressed significantly higher or lower in common to all 3 components.However, 2 and 3 miRNAs were commonly overexpressed and underexpressed, in the top 5 groups of lysozyme and IgA concentrations. Conclusion We identified the immune components and miRNAs in breast milk and found that each individual has different ingredients.