PURPOSE: The aim of this study was to analyze the osteogenic effect of cultured rabbit mesenchymal stem cells(MSCs). MATERIALS AND METHODS: MSCs were obtained from rabbit femur and were cultured in a Dulbecco's Modified Eagle's Medium(DMEM) with beta-glycerophosphatate, L-ascorbic acid, and dexamethasone to proliferate and differentiate into osteoprogenitor cells until 12 weeks. The expression of osteogenic markers was detected by reverse transcription-polymerase chain reaction(RT-PCR) and the release of osteocalcin was measured by Enzyme-linked Immunosorbent Assay(ELISA). MSCs that were cultured on the porous poly-L-lactic-co-glycolic acid(PLGA) scaffold were implanted into athymic nude mouse to observe the osteogenic activity. RESULTS: As the time, we observed osteoblastic-like cells on the culture flask. Mineralized nodules were observed at 3-4 weeks. Osteogenic markers such as osteopontin, osteonectin, type I collagen, and alkaline phophatase were all identified at 2 weeks. But, expression of osteocalcin was only detected after cells differentiation. The amount of osteocalcin which is a specific protein in osteoblast, increased gradually from 2 weeks until 7 weeks. Scanning electron microscopy revealed that the MSCs were well adhered and proliferated within the PLGA scaffold. Immature bone was identified after 10 weeks in the histological examination of transplanted cell-scaffold composit. CONCLUSION: Our results demonstrate gradual differentiation of MSCs into osteoblastic cells. The adhesion and proliferation of the cells within the biodegradable scaffold represents the possibility of bone formation using cell-scaffold composites.
Animals ; Ascorbic Acid ; Bone Marrow* ; Collagen Type I ; Dexamethasone ; Femur ; Mesenchymal Stromal Cells* ; Mice ; Mice, Nude ; Microscopy, Electron, Scanning ; Osteoblasts ; Osteocalcin ; Osteogenesis ; Osteonectin ; Osteopontin

Osteoporotic fractures of the pelvic ring are not uncommon and among them sacral insufficiency fractures (SIFs) are often overlooked in patients with buttock or low back pain following no or minimal trauma, which results in diagnostic delays. SIFs are often bilateral and are commonly associated with other fractures - most frequently with a pubic ramus fracture. However, it remains unclear which fracture (sacral or pubic ramus) occurs first, and the only report on the subject found that the fracture sequence is initiated by a sacral fracture. The authors describe a case of sequential bilateral SIFs in a 74-year old woman following superior and inferior pubic rami fractures on one side. In conclusion we suggested that SIFs can occur after pelvic ring injury in any side because biomechanical disruption of the pelvic ring can induce the sacral fracture in patients with severe osteoporosis.
Buttocks ; Female ; Fractures, Stress ; Humans ; Low Back Pain ; Osteoporosis ; Osteoporotic Fractures

Osteoporotic fractures of the pelvic ring are not uncommon and among them sacral insufficiency fractures (SIFs) are often overlooked in patients with buttock or low back pain following no or minimal trauma, which results in diagnostic delays. SIFs are often bilateral and are commonly associated with other fractures - most frequently with a pubic ramus fracture. However, it remains unclear which fracture (sacral or pubic ramus) occurs first, and the only report on the subject found that the fracture sequence is initiated by a sacral fracture. The authors describe a case of sequential bilateral SIFs in a 74-year old woman following superior and inferior pubic rami fractures on one side. In conclusion we suggested that SIFs can occur after pelvic ring injury in any side because biomechanical disruption of the pelvic ring can induce the sacral fracture in patients with severe osteoporosis.
Buttocks ; Female ; Fractures, Stress ; Humans ; Low Back Pain ; Osteoporosis ; Osteoporotic Fractures

PURPOSE: To identify socio-demographic factors in cataract surgery in Korea and expect future effect of the bundle of service system. METHODS: We analyzed the number of people undergoing cataract surgery and associated factors such as surgery ratio, region, age, income, and insurance status of 28,980 patients older than 40 years using data from the fifth Korea National Health and Nutrition Examination Survey 2008-2012 (KNHANES). RESULTS: Among total population in 2012, 47.5% of elderly aged 80 years and older have received cataract surgery. According to region in patients older than 40, Jeollanam-do showed the highest proportion of patients undergoing cataract surgery, at 12%, Daejeon showed the lowest proportion of 3.6%, and Seoul showed 6.8%. Regional analysis was also performed by analyzing the number of cataract patients per ophthalmologist. Jeollanam-do showed the highest with 40,115 patients per ophthalmologist, and Seoul showed the least with 1,094 patients per ophthalmologist. The sociodemographic factors such as education or income, were not associated with cataract surgery after adjusting for age and regional difference. On the other hand, subjects with medicaid were associated with 1.6-fold (95% confidence interval, 1.3-2.0) higher rate of cataract surgery than subjects with national health insurance. CONCLUSIONS: Regional disparity was found in the cataract surgery rate and surgery rate per an ophthalmologists, whereas sociodemographic factors were not significant in receiving benefits of cataract surgery. Before the amount of bundled payment is changing, down-leveling of quality of care and deepening of disparities among health care provider should be considered.
Aged ; Cataract* ; Education ; Hand ; Health Personnel ; Humans ; Insurance Coverage ; Jeollanam-do ; Korea ; Medicaid ; National Health Programs ; Nutrition Surveys ; Seoul

PURPOSE: To identify socio-demographic factors in cataract surgery in Korea and expect future effect of the bundle of service system. METHODS: We analyzed the number of people undergoing cataract surgery and associated factors such as surgery ratio, region, age, income, and insurance status of 28,980 patients older than 40 years using data from the fifth Korea National Health and Nutrition Examination Survey 2008-2012 (KNHANES). RESULTS: Among total population in 2012, 47.5% of elderly aged 80 years and older have received cataract surgery. According to region in patients older than 40, Jeollanam-do showed the highest proportion of patients undergoing cataract surgery, at 12%, Daejeon showed the lowest proportion of 3.6%, and Seoul showed 6.8%. Regional analysis was also performed by analyzing the number of cataract patients per ophthalmologist. Jeollanam-do showed the highest with 40,115 patients per ophthalmologist, and Seoul showed the least with 1,094 patients per ophthalmologist. The sociodemographic factors such as education or income, were not associated with cataract surgery after adjusting for age and regional difference. On the other hand, subjects with medicaid were associated with 1.6-fold (95% confidence interval, 1.3-2.0) higher rate of cataract surgery than subjects with national health insurance. CONCLUSIONS: Regional disparity was found in the cataract surgery rate and surgery rate per an ophthalmologists, whereas sociodemographic factors were not significant in receiving benefits of cataract surgery. Before the amount of bundled payment is changing, down-leveling of quality of care and deepening of disparities among health care provider should be considered.
Aged ; Cataract* ; Education ; Hand ; Health Personnel ; Humans ; Insurance Coverage ; Jeollanam-do ; Korea ; Medicaid ; National Health Programs ; Nutrition Surveys ; Seoul

BACKGROUND: In primary total hip replacements (THRs), the dissected femoral heads (FHs) are commonly used to make the bone-chips for the reconstruction in the orthopaedic surgery. The donated FHs are routinely microbiologically cultured to identify and contaminated FHs are discarded. This study examines whether a positive FH culture predicts an infection and prosthetic failure after primary THR. METHODS: The study sampled 274 donated FHs from patients with osteonecrosis (ON), hip joint osteoarthritis (OA), and femoral neck fracture (FNF) in THR to culture the microbes. The FH contamination rates were analyzed for ON, OA, and FNF groups. Proportion of the postoperative infection or prosthetic failure in the group of donors with a positive FH culture were compared to the proportion in the group of donors with a negative FH culture. RESULTS: The rates of the positive culture in the ON, OA, and FNF groups were 7.1%, 3.8%, and 4.0%, respectively. The infection rate was found to be non-significantly greater in the ON group than in the OA and FNF groups. In the negative culture group, one patient (0.63%) had a postoperative superficial infection, and five patients (3.2%) experienced additional surgeries including a fixation for a periprosthetic fracture, within a minimum follow-up of two years. However, no postoperative infection was encountered, and no revision surgery was required in the positive culture group. CONCLUSIONS: A positive FH culture is not always associated with elevated risks of infection or prosthetic failure after THR. Therefore, such finding cannot be used as a prognostic factor of THR. The FHs that return a positive culture may not lead to the orthopaedic assessment of an infection or other postoperative complication risks in primary THR.
Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/adverse effects/*methods ; Female ; Femoral Neck Fractures/surgery ; Femur Head/*microbiology ; Humans ; Male ; Middle Aged ; Osteoarthritis, Hip/surgery ; Osteonecrosis/surgery ; Prognosis ; Prosthesis-Related Infections/*microbiology ; Staphylococcus/isolation & purification

Productivity analysis of physician is one of essential factors for the optimal health manpower planning. Among 690 physicians operating clinic and registered on the Kyeongsangnamdo Medical Association, 623 physicians were studied with a structural questionnaire from April 1 to May 31, 1990. This study covers the general characteristics and productivity of physicians and attempts to find relevant determinants of their productivity through stepwise multiple regression analysis based on collected data. The major results were as follows. First, physicians were more prevalent 35~44 group (38.2%) in age, male (95.8%) in sex, specialist (76.5%) in specialization, city (78.0%) in geographical location. Age group of 35-54 and specialist were more prevalent in cities than in counties, while age group of 25-44 and 55 over and general practitioner in counties (p<0.001). Second, daily outpatient load of all physician were 77.1 persons on average. Age group of 35~44 had the most outpatient load (90.3 persons) among all age group, 6~10 years group (94.2 persons) in years of duration of practice, 11 hours per day group (83.4 persons) in working hours per day. Specialists had more outpatient load (82.6 persons) than general practitioners (61.1 persons) and physicians in cities had more (80.2 persons) than physicians in counties (66.3 persons). Daily average outpatient load of physicians were significantly different by their age, speciality, number of assistants and years of practice (p<0.001) and working location (p<0.05), but not significantly different by working hours per day of physician (p>0.1). Third, the productivity of physicians operating clinic were significantly affected by the three factorsnumber of assistants of physician, age of physician and duration of practice at the current clinic. Age of physician had negative regression coefficient.
Efficiency* ; General Practitioners ; Health Manpower ; Humans ; Male ; Outpatients ; Surveys and Questionnaires ; Specialization

PURPOSE: To evaluate the usefulness of total hip arthroplasty with the mini-incision technique (mini-incision THA) by comparing it with conventional THA. MATERIALS AND METHODS: Two groups were compared; one group received conventional THA, the other group mini-incision THA. All these patients were treated using same prosthesis. We compared the postoperative clinical and radiological results. RESULTS: Skin incisions ranging from 13 cm to 28 cm were needed for conventional THA and 5.5-9 cm for mini-incision THA. The mean operative time was 53 minutes for the conventional method and 52 minutes for the mini-incision method. Mean blood loss in mini-incisionTHA was less than in conventional THA by about 240 cc, mean length of hospital stay was shortened by 5 days. Using a 5-point scale, pain was reduced in mini-incision THA. No differences were found between the two groups in terms of the opening angle of the acetabularcomponent and the intramedullary status of the femoral stem insertion. CONCLUSION: Mini-incision THA produced better clinical results and no differences were observed in the radiological findings versus conventional THA. Mini-incision THA is believed to be a useful method of reducing the skin incision and soft tissue dissection, and permits earlyrehabilitation and increases patient satisfaction.
Arthroplasty, Replacement, Hip* ; Humans ; Length of Stay ; Operative Time ; Patient Satisfaction ; Prostheses and Implants ; Skin

PURPOSE: To compare the radiographic results of unicompartmental knee arthroplasty using a navigation system with those using a manual alignment system. MATERIALS AND METHODS: The results of 50 cases (46 patients) of unicompartmental knee arthroplasty using a navigation system (24 patients, 25 cases) and using a manual alignment system (22 patients, 25 cases) were evaluated. Knee anteroposterior, lateral, and weight-bearing full-length lower extremity radiographs before and after the arthroplasty were used for the measurements. RESULTS: The mean postoperative femorotibial alignment was 3.6 degrees of valgus in the manual alignment group and 5.4 degrees of valgus in the navigation group. The postoperative mechanical axis measured using Kennedy and White's method was located at zone 1 in 4 cases (16%), at zone 2 or C in 21 cases (84%) in the manual group, and at zone C for all cases in the navigation group (p=0.001). In the coronal axis of the femoral component, 11 cases (44%) were excellent, 7 cases (28%) were good and, 7 cases (28%) were poor in the manual alignment group. In the navigation group, 15 cases (60%) were excellent and 10 cases (40%) were good and there were no poor results (p<0.05). In the coronal axis of the tibial component, 22 cases (88%) showed excellent results and 3 cases (12%) showed poor results in the manual alignment group. In the navigation group, all cases were showed excellent results (p>0.05). In the sagittal axis of the tibial component, 9 cases (36%) showed poor results in manual group and there were no poor results in the navigation group (p<0.05). CONCLUSION: Unicompartmental knee arthroplasty using navigation produced better results in restoring the alignment of the prosthesis and the mechanical axis of the lower extremity than that using manual alignment.
Arthroplasty* ; Axis, Cervical Vertebra ; Humans ; Knee* ; Lower Extremity ; Prostheses and Implants ; Weight-Bearing

Although the rare earth elements (REEs) recycling industry is expected to increase worldwide in high-tech industry, regulations for worker safety have yet to be established. This study was conducted to understand the potential hazard/risk of REE recycling and to support the establishment of regulations or standards. We review the extensive literature on the toxicology, occupational safety, and health issues, and epidemiological surveys related to the REEs, and propose suitable management measures. REE recycling has four key steps such as collection, dismantling, separation, and processing. In these processes, hazardous substances, such as REEs-containing dust, metals, and chemicals, were used or occurred, including the risk of ignition and explosion, and the workers can be easily exposed to them. In addition, skin irritation and toxicities for respiratory, nervous, and cardiovascular systems with the liver toxicity were reported; however, more supplementary data are needed, owing to incompleteness. Therefore, monitoring systems concerning health, environmental impacts, and safety need to be established, based on additional research studies. It is also necessary to develop innovative and environment-friendly recycling technologies, analytical methods, and biomarkers with government support. Through these efforts, the occupational safety and health status will be improved, along with the establishment of advanced REE recycling industry.
Biomarkers ; Cardiovascular System ; Dust ; Environmental Health ; Explosions ; Hazardous Substances ; Liver ; Metals ; Occupational Health ; Recycling ; Skin ; Social Control, Formal ; Toxicology