BACKGROUND: Several different surgical techniques have been described to address the coracoclavicular (CC) ligaments in acromioclavicular (AC) joint injuries. However, very few techniques focus on reconstructing the AC ligaments, despite its importance in providing stability. The purpose of our study was to compare the biomechanical properties of two free-tissue graft techniques that reconstruct both the AC and CC ligaments in cadaveric shoulders, one with an extramedullary AC reconstruction and the other with an intramedullary AC reconstruction. We hypothesized intramedullary AC reconstruction will provide greater anteroposterior translational stability and improved load to failure characteristics than an extramedullary technique. METHODS: Six matched cadaveric shoulders underwent translational testing at 10 N and 15 N in the anteroposterior and superoinferior directions, under AC joint compression loads of 10 N, 20 N, and 30 N. After the AC and CC ligaments were transected, one of the specimens was randomly assigned the intramedullary free-tissue graft reconstruction while its matched pair received the extramedullary graft reconstruction. Both reconstructed specimens then underwent repeat translational testing, followed by load to failure testing, via superior clavicle distraction, at a rate of 50 mm/min. RESULTS: Intramedullary reconstruction provided significantly greater translational stability in the anteroposterior direction than the extramedullary technique for four of six loading conditions (p < 0.05). There were no significant differences in translational stability in the superoinferior direction for any loading condition. The intramedullary reconstructed specimens demonstrated improved load to failure characteristics with the intramedullary reconstruction having a lower deformation at yield and a higher ultimate load than the extramedullary reconstruction (p < 0.05). CONCLUSIONS: Intramedullary reconstruction of the AC joint provides greater stability in the anteroposterior direction and improved load to failure characteristics than an extramedullary technique. Reconstruction of the injured AC joint with an intramedullary free tissue graft may provide greater strength and stability than other currently used techniques, allowing patients to have improved clinical outcomes.
Acromioclavicular Joint/physiology/*surgery ; Aged ; Biomechanical Phenomena ; Humans ; Male ; Middle Aged ; Orthopedic Procedures/*methods ; Reconstructive Surgical Procedures/*methods ; Transplants/*physiology

BACKGROUND: Tendon and ligament injuries accounted for 30% of all musculoskeletal consultations with 4 million new incidences worldwide each year and thus imposed a significant burden to the society and the economy. Damaged tendon and ligament can severely affect the normal body movement and might lead to many complications if not treated promptly and adequately. Current conventional treatment through surgical repair and tissue graft are ineffective with a high rate of recurrence.METHODS: In this review, we first discussed the anatomy, physiology and pathophysiology of tendon and ligament injuries and its current treatment. Secondly, we explored the current role of tendon and ligament tissue engineering, describing its recent advances. After that, we also described stem cell and cell secreted product approaches in tendon and ligament injuries. Lastly, we examined the role of the bioreactor and mechanical loading in in vitro maturation of engineered tendon and ligament.RESULTS: Tissue engineering offers various alternative ways of treatment from biological tissue constructs to stem cell therapy and cell secreted products. Bioreactor with mechanical stimulation is instrumental in preparing mature engineered tendon and ligament substitutes in vitro.CONCLUSIONS: Tissue engineering showed great promise in replacing the damaged tendon and ligament. However, more study is needed to develop ideal engineered tendon and ligament.
Bioreactors ; Exosomes ; In Vitro Techniques ; Incidence ; Ligaments ; Physiology ; Recurrence ; Referral and Consultation ; Stem Cells ; Tendons ; Tissue Engineering ; Transplants

Human embryonic stem (hES) cells are considered to be a valuable resource for research in regenerative medicine, drug screening, and developmental studies. However, hES cells are usually established and maintained on mouse embryonic fibroblast feeder layers, and the risk of animal origin contamination from feeder layer generally excludes the clinical use of these hES cells. The main emphasis over the last several years has been in finding defined serum-and feeder layer-free system for derivation and culture of hES cells to enable the clinical use of hES cell for cell transplantation.
Cell Culture Techniques ; Cell Differentiation ; physiology ; Cell Division ; physiology ; Cell Line ; Coculture Techniques ; Culture Media, Serum-Free ; Embryo Culture Techniques ; Embryo, Mammalian ; cytology ; Embryonic Stem Cells ; physiology ; Humans ; Pluripotent Stem Cells ; cytology ; Stem Cells ; physiology ; Transcription Factors ; physiology ; Transplants

Following enucleation or evisceration surgery, the anatomy and physiology of the orbit are changed. During the course of fitting prosthesis, several complications including an ophthalmic enophthalmos, anophthalmic ptosis, extrusion or migration of implant and socket contracture could develop. These changes affect not only the cosmetic appearance of anophthalmic patient but also the physiological problems. The author used the hydroxyapatite as a orbital implant in 27 eyes(27 patients) and dermis-fat graft was performed in 3 eyes(3 patients) with moderate contracted sockets in which four rectus muscles couldn't be found during operation. They underwent primary implantation; enucleation(9 cases), evisceration(3 cases), secondary implantation(15 cases) and dermis-fat graft(3 cases) between June 1993 and January 1996. Average follow-up period was 18 months ranged from 6 to 27 months. There were no complications after the first hydroxyapatite insertion surgery. But preoperative condition of patients for the secondary hydroxyapatite insertion and dermis-fat graft have been anophthalmic enophthalmos(13 eyes), loss of lower cul-de-sac(4 eyes) and ptosis(3 eyes). They wanted to fit prosthesis after surgery of lower cul-de-sac and secondary hydroxyapatite insertion. As complications, 3 cases of wound disruption, 2 cases of loss of lower cul-de-sac were encountered after the secondary hydroxyapatite insertion surgery. There were developed anophthalmic enophthalmos and recurrent socket contracture(1 case) after dermis-fat graft surgery.
Anophthalmos ; Contracture ; Durapatite ; Enophthalmos ; Follow-Up Studies ; Humans ; Muscles ; Orbit ; Orbital Implants ; Physiology ; Prostheses and Implants ; Transplants ; Wounds and Injuries

In cirrhotic patients undergoing liver transplantation, reperfusion of a liver graft typically increases portal venous blood flow (PVF) because of a decrease in resistance in the liver graft to the PVF and underlying hyperdynamic splanchnic circulation, which develops due to liver cirrhosis complicated by portal hypertension and persists even after successful liver transplantation. If the liver graft has enough capacity to accommodate the increased PVF, the shear stress inflicted on the sinusoidal endothelial cells of the graft promotes hepatic regeneration; otherwise, small-for-size syndrome (SFSS) develops, leading to poor graft function and graft failure. In particular, a partial graft transplanted to patients undergoing living donor liver transplantation has less capacity to accommodate the enhanced PVF than a whole liver graft. Thus, the clinical conditions that the partial graft encounters determine either hepatic regeneration or development of SFSS. Consistent with this, this review will discuss the two conflicting effects of portal hyperperfusion (hepatic regeneration vs. portal hyperperfusion injury) on the partial grafts in cirrhotic patients suffering from hyperdynamic splanchnic circulation, in addition to normal physiology and pathophysiology of hepatic hemodynamics.
Endothelial Cells ; Hemodynamics ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Liver Regeneration ; Liver Transplantation ; Liver* ; Living Donors ; Physiology ; Regeneration* ; Reperfusion ; Splanchnic Circulation* ; Transplants*

The nose is the most prominent area of the face, therefore susceptible to trauma and skin cancer. When small sized defect is in nasal tip, it results in disturbance of the facial harmony even if replantation, composite graft, skin graft or median forehead flap has been used for the reconstruction. So it is needed that the best method reconstruction is performed according to the degree of defect or deformity. And at the same time the physiology and anatomy of nose were clarified and its aesthetic subunits were employed. How can we cover the about 3 cm sized nasal defect in nasal tip with cartilage exposure? At first, we can think forehead island flap is most appropriate. We performed 7 cases of the forehead island flap for reconstruction of the defect in nasal tip(4 cases: cancer, 3 cases: trauma) from March, 2001 to August, 2004. This result was satisfactory in the point of texture, color, donor scar, and there were no complication such as wound disruption, infection, flap atrophy, and hematoma. The advantages of forehead island flap are: 1) No injury of deep vessel and nerve, 2) control of shape and volume, 3) Short operation time, 4) primary closure of donor site, 5) one stage operation. Also, forehead island flap can cover the defect in nose where skin graft and local flap can not cover. But, operator always must take care for flap congestion and donor site scar. We thought forehead island flap is one of the best option of reconstruction of nasal tip defect.
Atrophy ; Cartilage ; Cicatrix ; Congenital Abnormalities ; Estrogens, Conjugated (USP) ; Forehead* ; Hematoma ; Humans ; Nose ; Physiology ; Replantation ; Skin ; Skin Neoplasms ; Tissue Donors ; Transplants ; Wounds and Injuries

Cyclosporin A(CsA) is an immunosuppressive agent widely used for preventing graft rejecting response in organ transplantation. The basic properties of CsA to osteoblast has not been well known yet. A better understanding of the mechanisms of CsA function on bone could provide valuable information regarding basic properties of bone remodeling, pharmacotherapeutic intervention in metabolic bone disease, and the consequences of immunosuppression in bone physiology. The purpose of this study was to investigate the effect of CsA on osteoblast by evaluating parameters of proliferation, collagen synthetic activity, alkaline phosphatase activity, and ALP mRNA expression in mouse calvarial cell. 1. CsA(3microgram/ml) treated mouse calvarial cell showed statistically significant increase in cell proliferation.(P<0.05) 2. CsA(1, 3microgram/ml) treated MC3T3 cell line showed statistically significant increase in cell proliferation. 3. The amount of collagen of CsA(3microgram/ml) treated mouse calvarial cell was decreased statistically significantly. 4. Alkaline phosphatase activity was increased statistically significantly in CsA treated group(1microgram/ml). 5. mRNA expression of ALP was increased in CsA treated group These results suggest that CsA could affect bone remodeling by modulating proliferation & differentiation of osteoblast.
Alkaline Phosphatase ; Animals ; Bone Diseases, Metabolic ; Bone Remodeling ; Cell Line ; Cell Proliferation ; Collagen ; Cyclosporine* ; Immunosuppression ; Mice ; Organ Transplantation ; Osteoblasts* ; Physiology ; RNA, Messenger ; Transplants

Hepatitis E, caused by hepatitis E virus (HEV) infection, usually leads to an acute clinical course, and is the most common diagnosis among cases of acute viral hepatitis. From 2008, there have been increasing reports of chronic HEV infection in immunocompromised patients such as organ transplant recipients. Without intervention with antiviral treatment, approximately 60% of HEV infections in organ transplant recipients evolve into chronic HEV infections. Of these chronic hepatitis E patients, 10% may develop liver fibrosis and progress to liver cirrhosis. This article reviews chronic HEV infection and treatment in organ transplant recipients.
Animals ; Antiviral Agents ; therapeutic use ; Hepatitis E ; drug therapy ; virology ; Hepatitis E virus ; genetics ; isolation & purification ; physiology ; Hepatitis, Chronic ; drug therapy ; virology ; Humans ; Transplant Recipients ; Transplants ; virology

High blood pressure (hypertension) is implicated in the development of atherosclerosis. Blood vessels are constantly subjected to stretch due to blood pressure and changes in stretch usually instigate adaptive vascular remodeling, including abnormal growth and proliferation of vascular smooth muscle cells (VSMCs) as well as extracellular matrix (ECM). In this experiment, we used bovine aortic endothelial cells and smooth muscle cells (EC-SMC) co-cultured ePTFE vascular grafts subjected to normal atmospheric pressure (as a control), and 100 mmHg hydrostatic pressure for 7 d. The increase of cell layer thickness was observed. When measured, the cell layer thickness increased by 116.2%. The increase of collagen (Type IV) synthesis was also observed in the immunohistochemistry assay. When stained with toluidine blue, the cells showed metachromatic phenomenon.
Animals ; Blood Vessel Prosthesis ; Cattle ; Cell Culture Techniques ; methods ; Cell Proliferation ; Cells, Cultured ; Collagen Type IV ; metabolism ; Hydrostatic Pressure ; Mechanotransduction, Cellular ; physiology ; Muscle, Smooth, Vascular ; cytology ; physiology ; Polytetrafluoroethylene ; chemistry ; Tissue Engineering ; methods ; Transplants

Within the past decade it has been said that progress it pediatric anesthesia is especially the result of clinical application of developments in baic medicine, added to the anesthetist's technical improvements and experience in the use of apparatus and the knowledge of respiratory control. And so anesthetists sholud perform good pediatric anesthesia after understanding pediatric anatomy, physiology and the phamacology of all the drugs used in pediatric anesthesia. 803 cases (under 15years) of pediatric anesthesia were analyzed statistically according to sex, age, disease, department, physical status, premedication, anesthetic technic, anesthetic agents, length of anesthesia duration of Hospitalization, re-operation incidence, complications and mortality in the Department of Anesthesiology, Hanyang University, College of Medicine from August of 1979 to December 1980. The conclusions are as follows: 1) Sex and Age: 91 cases(11.33%) under 1year and 95 cases(11.83%) under 7years are of interest. The comparison of male (542 cases) to female (261 cases) is 2:1. 2) Departmente: 257 cases(32.00%) from ENT, and 217 cases(27.02% from general surgery were noted ont of the total. 3) Disease: It divided into two groups. 204 cases(25.40%) were congenital disease which comprised mainly of 70 cases of inguinal hernia and 45 cases of eleft lip and palate. 599 cases (74.60%) were acquired disease comprised mainly of 237 cases of tonsillitis and 43 cases of appendicitis. 4) Physical status: The time of operation divided into two groups. One group contained 657 cases of elective surgery and the other 146 cases of emergency surgery. According to the ASA classification of physical status, 741 cases(92.28%) were class 1 and 2, and 52 cases (64.8%) were class 3, and 10 cases(1.24%) were in class 4. 5) Premedication: 400 cases(49.81%) were premedicated with atropine sulfate and valium 161 cases(20.05%) were not premedicated because the patients had fever, dehydration, or tachycadia. 6) Anesthetic method and agents: they were divided into three groups. In the frist group using general inhalation, 206 cases(2565%) ont of 761, had non-rebreathing anesthesia and 555 cases(69.12%) had semiclosed circle technique anesthesia. In the second group 41 cases(5.10%) had intramuscular and intravenous anesthesia. Thirty 1 case(0.12%) was given spinal anesthesia. 711 cases(88.54%) received halothane + nitrone oxide _ oxygen. 7) Incidence of reoperation: 32 cases(3.98%) were reoperated and included colostomy repari, abdominal flap detachment, pin removal, skin graft, post operative bleeding control, remove of laryngeal papilloms, and urethral dilatation. 8) Complications: 20 cases which were made up of 8 cases of pneumonia, 5 cases of wound infection, 3 cases of post operative bleeding control, 2 cases of fistula formation, 1 case of gastroenteritis, 1 case of intestinal obstruction. The relationship between length of anesthesia and complications is statistically in significant(p<0.01). 9) Motality: 10 cases died 3 from respiratory insufficiency, 3 cases of sepsis, 1 case of intestinal obstruction and 3 cases of high intracranial pressure. There is statistical significance in the relationship between the anesthetic time, physical status, and mortality.(p<0.01).
Anesthesia* ; Anesthesia, Intravenous ; Anesthesia, Spinal ; Anesthesiology ; Anesthetics ; Appendicitis ; Atropine ; Classification ; Colostomy ; Dehydration ; Diazepam ; Dilatation ; Emergencies ; Female ; Fever ; Fistula ; Gastroenteritis ; Halothane ; Hemorrhage ; Hernia, Inguinal ; Hospitalization ; Humans ; Incidence ; Inhalation ; Intestinal Obstruction ; Intracranial Pressure ; Lip ; Male ; Mortality ; Oxygen ; Palate ; Palatine Tonsil ; Physiology ; Pneumonia ; Premedication ; Reoperation ; Respiratory Insufficiency ; Sepsis ; Skin ; Tonsillitis ; Transplants ; Wound Infection