Recently autogenous nerve graft was usually used for segmental defect of peripheal nerve injury. In case of inappropriate size or amount of donor nerve graft, there were many studies included nerve regeneration with special nerve conduit material. To compare the result of autogenous nerve graft with that of silicone tubing method in segmental defect of sciatic nerve, the experiments were carried out on adult rats with autogenous nerve graft on the left side and silicone tubing on the right side. The results were as follows; 1. Myelinated nerve fibers were larger in silicone tubing method than autogenous nerve graft at postop. 4 weeks. 2. There was no difference in nerve regeneration in both groups at postop. 12 weeks. 3. Some atrophic changes were showed in denervated muscles in both groups at postop. 4 weeks. Skeletal muscle changes between the two groups were meagre. 4. Perineural adhension was rare in silicone tubing group in contrast to autogenous nerve graft group. 5. Nerve Conduction Velocity was similar between autogenous nerve graft and silicone tubing method after 4 weeks postoperatively. In conclusion, this study suggests that silicone tubing can be useful method to repair the large nerve gaps and has a potential clinical utilization in large segmental nerve defect.
Adult ; Animals ; Autografts ; Humans ; Methods ; Muscle, Skeletal ; Muscles ; Nerve Fibers, Myelinated ; Nerve Regeneration ; Neural Conduction ; Rats ; Sciatic Nerve ; Silicon ; Silicones ; Tissue Donors ; Transplants

Background: s/Aims: The treatment landscape for hepatocellular carcinoma (HCC) has significantly evolved over the past decade. We aimed to analyze trends in treatment patterns for HCC using a nationwide claims database from the Korean Health Insurance Review and Assessment Service. Methods: This retrospective population-based cohort study analyzed 171,002 newly diagnosed HCC patients between 2008 and 2022. Etiologies and treatment modalities were categorized based on the ICD-10 codes and insurance data. Results: The annual incidence decreased from 11,814 in 2008 to 10,443 in 2022. However, patients aged ≥70 increased noticeably, with those aged ≥80 rising from 3.8% in 2008 to 13.1% in 2022. From 2008 to 2022, the predominant cause of hepatitis B virus decreased from 68.9% to 59.7%, whereas nonalcoholic fatty liver disease increased from 8.9% to 15.8%. The initial treatment trends shifted: surgical resection and systemic therapy increased from 12.2% to 21.3% and from 0.2% to 9.6%, whereas transarterial therapy decreased from 49.9% to 36.6%. Best supportive care decreased from 31.7% to 21.3%. In the subgroup analysis, laparoscopic resection rate increased from 10.6% to 60.6% among the surgical resections. Sorafenib initially accounted for 100%, lenvatinib peaked at 36.5% in 2021, and atezolizumab-bevacizumab became the most widely used (63.1%) by 2022 among the systemic therapies. Conclusions This study demonstrates the temporal changes in the treatment patterns of Korean HCC patients. Surgical resection, particularly laparoscopic liver resection, and systemic therapy has increased significantly. These changes may have been influenced by reimbursement policies and advances in clinical research.

No abstract available.
Compartment Syndromes*

Bone defect of the long bone continues to challenge orthopedic surgeons. It is usually very difficult to obtain union. Ilizarov ext. fixation has recently gained popularity as a multifactorial approach to the management of tibial bone defect because nonunion, bone defects, limb shortening, and deformity can all be addressed simultaneously with the Ilizarov apparatus. From February 1992 to May 1993 at the department of orthopedic surgery, Inje University Pusan Paik Hospital, 9 patients aged from 8 to 37 years were treated for tibial bone defect. The causes were open comminuted fractures with initial bone loss and bone defect after removal of infected necrotic bone. Bony defect size was ranged from 2cm to 14cm, averaging 7.2cm. Bony defects were gradually closed by the Ilizarov's internal bone transport technique, and final equalization of leg length discrepancy was achieved by means of external lengthening technique. Soft tissue defects were treated with secondary closure, split thickness skin graft, and muscle flap. The average healing index was 42.8 days/cm. According to Paley's classification the complications were developed as follows; The problem included pin tract infection(9), knee flexion contracture(4), and intractable pain(1), the obstacles included delayed union(3) and premature consolidation(1), the complication included nonunion(9) and equinus ankle(1). At an average 1 years follow up, according to Paley and Catagnl's classification, body and functional results were either excellent or good in 7 cases. So, we recommend that Ilizarov technique is very useful treatment for open fracture with bone loss, bone defect after removal of infected necrotic bone and limb shortening.
Busan ; Classification ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Fractures, Comminuted ; Fractures, Open ; Humans ; Ilizarov Technique ; Knee ; Leg ; Orthopedics ; Skin ; Surgeons ; Tibia ; Transplants

In a conventional two-dimensional (2D) culture method, cells are attached to the bottom of the culture dish and grow into a monolayer. These 2D culture methods are easy to handle, cost-effective, reproducible, and adaptable to growing many different types of cells. However, monolayer 2D cell culture conditions are far from those of natural tissue, indicating the need for a threedimensional (3D) culture system. Various methods, such as hanging drop, scaffolds, hydrogels, microfluid systems, and bioreactor systems, have been utilized for 3D cell culture. Recently, external physical stimulation-based 3D cell culture platforms, such as acoustic and magnetic forces, were introduced. Acoustic waves can establish acoustic radiation force, which can induce suspended objects to gather in the pressure node region and aggregate to form clusters. Magnetic targeting consists of two components, a magnetically responsive carrier and a magnetic field gradient source. In a magnetic-based 3D cell culture platform, cells are aggregated by changing the magnetic force. Magnetic fields can manipulate cells through two different methods: positive magnetophoresis and negative magnetophoresis. Positive magnetophoresis is a way of imparting magnetic properties to cells by labeling them with magnetic nanoparticles. Negative magnetophoresis is a label-free principle-based method. 3D cell structures, such as spheroids, 3D network structures, and cell sheets, have been successfully fabricated using this acoustic and magnetic stimuli-based 3D cell culture platform. Additionally, fabricated 3D cell structures showed enhanced cell behavior, such as differentiation potential and tissue regeneration. Therefore, physical stimuli-based 3D cell culture platforms could be promising tools for tissue engineering.

BACKGROUND: Airway hyperresponsiveness (AHR) to direct stimuli, such as methacholine (MCh), is observed not only in asthma but other diseases. AHR to indirect stimuli is suggested to be more specific for asthma. The purpose of this study was to determine whether asthmatic airway inflammation is more closely related to AHR to hypertonic saline (HS), an indirect stimulus, than to MCh. METHODS: Sixty-four consecutive adult patients with suspected asthma (45 asthma and 19 non-asthma) performed a combined bronchial challenge and sputum induction with 4.5% saline, and MCh challenge on the next day. RESULTS: Both HS-PD15 and MCh-PC20 were significantly lower in asthma patients than in non-asthma patients. However, the sensitivity/ specificity for asthma was 48.9%/100%, respectively, in the HS test and 82.2%/ 84.2%, respectively, in the MCh test. There was a significant relationship between HS-PD15 and MCh-PC20 and only 52.9% of patients with MCh-PC20 < or= 4 mg/mL showed HS-AHR, but 4 patients with HS-AHR showed MCh-PC20 > 4 mg/mL. There were significant correlations between both HS-PD15 and MCh-PC20 and FEV1, or sputum eosinophils, but FEV1 was more closely related to MCh-PC20 (r=0.478, p < 0.01) than to HS-PD15 (r=0.278, p < 0.05), and sputum eosinophils were more closely related to HS-PD15 (r=-0.324, p < 0.01) than to MCh-PC20 (r=-0.317, p < 0.05). Moreover, the IL-5 level (r=-0.285, p < 0.05) and IFN-gamma/IL-5 ratio (r=0.293, p < 0.05) in sputum were significantly related to HS-PD15, but not to MCh-PC20. CONCLUSION: HS-AHR may reflect allergic asthmatic airway inflammation more closely than MCh-AHR.
Asthma/*physiopathology ; Bronchial Hyperreactivity/*physiopathology ; Bronchial Provocation Tests ; Bronchoconstrictor Agents/*diagnostic use ; Comparative Study ; Female ; Human ; Male ; Methacholine Chloride/*diagnostic use ; Saline Solution, Hypertonic/*diagnostic use ; Support, Non-U.S. Gov't

BACKGROUND: Exercise testing is a standard noninvasive method used in the evaluation and management of patients with suspected coronary artery disease. However, patients with lower limb impairment are unable to undergo a standard bicycle or treadmill test. Alternative methods of exercise testing are needed for patients with vascular, orthopedic or neurologic conditions who cannot perform leg exercise. This study was aimed to determine the diagnostic accuracy of arm exercise thallium-201 SPECT for evaluating chest pain in patients unable to perform leg exercise. METHOD: Twenty-five anginal patients performed arm ergometry testing in conjunction with thallium-201 SPECT. Thereafter all underwent coronary angiography. RESULT: Significant coronary artery disease (> or =50% stenosis) in at least one vessel was present in 22 (88%) of the 25 patients. The sensitivity of thallium-201 SPECT for detecting coronary artery disease was 91%, which was significantly higher than the 32% sensitivity found with the electrocardiographic response alone (p <0.001). Thallium-201 SPECT yielded a sensitivity of 88, 86 and 100% for one, two, and three vessel diseases, respectively, and an 84% sensitivity and 81% specificity for detecting individual vessel stenosis. CONCLUSION: Arm exercise thallium-201 SPECT is useful for detecting coronary artery disease in patients unable to perform leg exercise. In addition, it provides an information regarding exercise tolerance. Therefore, this test appears to be reliable and useful and should be considered in the detection of coronary artery disease in nonambulatory patients.
Angina Pectoris ; Arm* ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Electrocardiography ; Exercise Test ; Exercise Tolerance ; Humans ; Leg ; Lower Extremity ; Orthopedics ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

Rhabdomyolysis is defined as necrosis of the skeletal muscle fibers with release of the intracellular muscle constituents, including myoglobins,into the blood and urine. Severe myoglobinemia causes obstruction and necrosis of the renal tubule, resulting in acute renal failure (ARF). In this case, a patient with rhabdomyolysis-induced ARF was in recovery phase after treatment with fluid replacement and continuous renal replacement therapy (CRRT). However, a sudden relapse of severe myoglobinemia occurred during CRRT. To remove myoglobinas rapidly as possible, we applied two sessions of plasmapheresis (total plasma exchange, TPE) in addition to CRRT for two days. The myoglobin level of the patient successfully decreased by 91%, and clinical symptoms and laboratory-measuredabnormalities subsequently improved. If severe myoglobinemia is persistent, or if relapse in spite of CRRT occurs, it would be reasonable to consider TPEas an additional therapy.
Acute Kidney Injury ; Humans ; Muscle Fibers, Skeletal ; Myoglobin* ; Necrosis ; Plasma Exchange ; Plasmapheresis* ; Recurrence ; Renal Replacement Therapy ; Rhabdomyolysis*

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the effectiveness and selected adverse events of radiofrequency catheter ablation in patients treated for drug-refractory atrial fibrillation (AF) using claims data provided by the Health Insurance Review and Assessment Service, which covers all ablation procedures conducted in South Korea. SUBJECTS AND METHODS: The study population included patients who underwent catheter ablation for AF between January 2011 and December 2013. A total of 3,850 patients without a previous history of catheter ablation procedure were enrolled. We analyzed 2-year effectiveness of the index ablation. Any redo ablation, electrical cardioversion, or use of antiarrhythmic drug beyond the blanking period of 3 months was considered a failure of index ablation. RESULTS: Overall recurrence rate following AF ablation was 61.1%. The recurrence rate was lower in patients under 65 years old than in those over 65 years old (hazard ratio [HR] 0.89; 95% confidence interval [CI], 0.81 to 0.97, P=0.009). Repeat ablation was more frequent in men (HR 1.56; 95% CI, 1.20 to 2.04; P=0.001) and patients under 65 years old (HR 1.79; 95% CI, 1.34 to 2.38; P < 0.001). Electric cardioversion was more frequent in men (HR 1.35; 95% CI, 1.06 to 1.72; P=0.014) than in women. The overall rate of stroke, blood transfusion, significant pericardial complication, and cardiopulmonary resuscitation was 0.5%, 4.8%, 2.7%, and 0.2%, respectively. CONCLUSIONS: In the present study, old age was associated with treatment failure of catheter ablation for drug-refractory AF in the Korean population. Overall recurrence did not vary with respect to sex.
Atrial Fibrillation ; Blood Transfusion ; Cardiopulmonary Resuscitation ; Catheter Ablation ; Catheters ; Electric Countershock ; Female ; Hemorrhage ; Humans ; Insurance, Health ; Korea ; Male ; Pericardiocentesis ; Recurrence ; Stroke ; Treatment Failure

PURPOSE: Diffusion tensor imaging (DTI) data must be analyzed by an analyzer after data processing. Hence, the analyzed data of DTI might depend on the analyzer, making it a major limitation. This paper reviewed previous DTI studies reporting the repeatability and reproducibility of data from the corticospinal tract (CST), one of the most actively researched neural tracts on this topic. MATERIALS AND METHODS: Relevant studies published between January 1990 and December 2018 were identified by searching PubMed, Google Scholar, and MEDLINE electronic databases using the following keywords: DTI, diffusion tensor tractography, reliability, repeatability, reproducibility, and CST. As a result, 15 studies were selected. RESULTS: Measurements of the CSTs using region of interest methods on 2-dimensional DTI images generally showed excellent repeatability and reproducibility of more than 0.8 but high variability (0.29 to 1.00) between studies. In contrast, measurements of the CST using the 3-dimensional DTT method not only revealed excellent repeatability and reproducibility of more than 0.9 but also low variability (repeatability, 0.88 to 1.00; reproducibility, 0.82 to 0.99) between studies. CONCLUSION: Both 2-dimensional DTI and 3-dimensional DTT methods appeared to be reliable for measuring the CST but the 3-dimensional DTT method appeared to be more reliable.
Diffusion Tensor Imaging ; Diffusion ; Methods ; Pyramidal Tracts