• Title/Summary/Keyword: Bone Union

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Mineralized Polysaccharide Transplantation Modules Supporting Human MSC Conversion into Osteogenic Cells and Osteoid Tissue in a Non-Union Defect

  • Ge, Qing;Green, David William;Lee, Dong-Joon;Kim, Hyun-Yi;Piao, Zhengguo;Lee, Jong-Min;Jung, Han-Sung
    • Molecules and Cells
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    • v.41 no.12
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    • pp.1016-1023
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    • 2018
  • Regenerative orthopedics needs significant devices to transplant human stem cells into damaged tissue and encourage automatic growth into replacements suitable for the human skeleton. Soft biomaterials have similarities in mechanical, structural and architectural properties to natural extracellular matrix (ECM), but often lack essential ECM molecules and signals. Here we engineer mineralized polysaccharide beads to transform MSCs into osteogenic cells and osteoid tissue for transplantation. Bone morphogenic proteins (BMP-2) and indispensable ECM proteins both directed differentiation inside alginate beads. Laminin and collagen IV basement membrane matrix proteins fixed and organized MSCs onto the alginate matrix, and BMP-2 drove differentiation, osteoid tissue self-assembly, and small-scale mineralization. Augmentation of alginate is necessary, and we showed that a few rationally selected small proteins from the basement membrane (BM) compartment of the ECM were sufficient to up-regulate cell expression of Runx-2 and osteocalcin for osteoid formation, resulting in Alizarin red-positive mineral nodules. More significantly, nested BMP-2 and BM beads added to a non-union skull defect, self-generated osteoid expressing osteopontin (OPN) and osteocalcin (OCN) in a chain along the defect, at only four weeks, establishing a framework for complete regeneration expected in 6 and 12 weeks. Alginate beads are beneficial surgical devices for transplanting therapeutic cells in programmed (by the ECM components and alginate-chitosan properties) reaction environments ideal for promoting bone tissue.

HISTOLOGICAL CHANGES IN THE ELONGATED BONE AFFECTED BY OSTEODISTRACTION OF THE MANDIBLE IN THE DOG (성견 하악골 절단 후 기계적 골 견인에 의해 형성된 골 신장부에 대한 시기별 조직학적 변화)

  • Baek, Sun-Ho;Ahn, Byoung-Keun;Park, Young-Ju;Park, Hee-Geon;Park, Jun-Woo;Rhee, Gun-Joo;Lee, Yong-Chan;Cho, Byoung-Ouck
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.27 no.5
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    • pp.404-416
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    • 2001
  • Purpose : Traditionally, the treatement of choice has been a bone grafting procedure to increase the length of bone in case of actual length discrepancy. But, bone grafting procedure has many disadvantages, for example, graft resorption, donor site morbidity, and so on. So, many trials have been performed to avert the use of autogenous bone graft via introducing new materials or methods. And, one of those trials has been realized by the development of a technique inducing bone lengthening by osteotomy (or corticotomy) and slow gradual distraction of the osteotomized segments. This new technique of bone lengthening dates back to the early 20th century. But, the majority of information concerning the biology of new bone formation during bone lengthening and technical details of the procedure were produced by extensive clinical and experimental studies performed by Ilizarov, a Russian surgeon. According to Ilizarov, with adequate blood supply, preservation of periosteum, rigid fixation of the osteotomized segments, and proper rate and rhythm of distraction, intramembranous bone rapidly develops within the distraction gap in the limb lengthening procedure. In the limb lengthening, many orthopedic surgeons try to observe the biologic and clinical principles recommended by Ilizarov. In the oral and maxillofacial region, however, not a few studies must be performed to apply this surgical technique in the clinical cases. Besides, the mechanism of bone formation in the distraction gap is not clear, yet. The purpose of this experiment was to scrutinize serially the histological changes in the elongated bone affected by osteodistraction of the mandibular body in an adult canine model. In addition, it was performed to confirm the presence of specific region(s) which was important in the bone formation in the gap through the observation of the expression pattern of osteocalcin and osteonectin with the immunohistochemical examination. Materials and Methods : The experimental and control specimens were obtained from seven adult male mongrel dogs weighing over 20kg. The distractors were custom-made linear extraoral devices and bicortical fixation screws were 2.3mm in diameter, 50mm in total length, 15mm in screw length. The distractors were devised to produce a linear gap of 0.75mm between two bony segments every $360^{\circ}$ turn of the rotation rod of the device. The mandibular body of the right side of each animal was corticotomized perpendicular to the occlusal plane and then two bony segments were separated completely by careful manipulation of the segments with bone forceps. The left side of each animal was left intact. This side was served as control. At sixth day after osteotomy and fixation of the segments were performed, distraction of the segments was commenced with a rate of 1.1mm/day and a rhythm of two/day for ensuing 7 days. The animals were euthanized at the 16th. 29th, and 44th day after the osteotomy. The bony specimens were decalcified, embedded in paraffin, sectioned $5{\mu}m$ thick and stained with H&E. The prepared specimens were examined under the light microscope. And, immunohistochemical examinations using anti-osteocalcin antibody (OC1, Biodesign, USA) and anti-osteonectin antibody (Haematologic Technologies Inc., Essex, VT) to locate the expressions of osteocalcin and osteonectin, respectively, were performed. Results : 1. New bone was observed already at the 16th. day after osteotomy. This suggests that new bone formation in osteodistraction was commenced at an early stage of the regenerative process. But, radiologically and microscopically, bony union was not completed in the distraction gap at the 44th. day after osteotomy. Therefore, rigid fixation must be maintained between the bony fragments till the complete bony union is confirmed clinically rather than one month or so after the completion of distraction.

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Effect of Hormone Therapy on Long-term Outcomes of Patients with Human Epidermal Growth Factor Receptor 2-and Hormone Receptor-Positive Metastatic Breast Cancer: Real World Experience in China

  • Du, Feng;Yuan, Peng;Wang, Jia-Yu;Ma, Fei;Fan, Ying;Luo, Yang;Xu, Bing-He
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.3
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    • pp.903-907
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    • 2015
  • Background: Among human epidermal growth factor receptor 2 (HER2)-positive breast cancer, more than half are also hormone receptor (HR)-positive. Although HR is a predictive factor for the efficacy of hormone therapy, there are still some uncertainties in regard to the effects on patients with HR-positive and HER2-positive metastatic breast cancers due to the potential resistance to hormone therapy caused by co-expression of HR and HER2. There are no clinical trials directly comparing the efficacy of hormonal therapy with chemotherapy. Materials and Methods: To examine the real-world effect of hormone therapy on patients with HR-positive and HER2-positive metastatic breast cancers, a cross-sectional study of a representative sample of the Chinese population was conducted. The study included 113 patients who received first-line and second-line palliative treatment between 2005 and 2010 in the Cancer Institute and Hospital, Chinese Academy of Medical Science. The effect of hormone therapy on overall survival (OS) was studied. Results: The patients who received hormone therapy (n=51) had better overall survival in contrast to those who received chemotherapy with anti-HER2 therapy (n=62) in first- or second-line treatment. The difference was of borderline statistical significance (51.8m vs 31.9m, p=0.065). In addition, the effect of hormone therapy did not differ significantly with other prognostic factors, including age (${\leq}50$ years or >50 years), disease free survival (${\geq}2$ years or < 2 years) and site of metastasis (visceral or bone/soft tissue). On multivariate analysis, administration of hormone therapy was associated with a trend toward a favorable prognosis (p=0.148, HR=0.693, 95%CI 0.422-1.139). Age more than 50 years was the sole independent harmful prognostic factor (p<0.001, HR=2.797, 95%CI 1.676-4.668). Conclusions: Our data suggest that hormonel therapy may improve outcomes of the patients with ER-positive and HER2-positive metastatic breast cancer.

A Study on the Recent Labor-Management Dispute Cases at Medical Institutions (의료기관 노사분규 사례분석연구)

  • Shin, Gang-Wook;Yu, Seung-Hum;Kim, Young-Hoon;Kim, Tae-Woong
    • Korea Journal of Hospital Management
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    • v.14 no.1
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    • pp.123-144
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    • 2009
  • Recently, a long strike by hospital labor union emerged as a serious social issue. During the Worldcup Games in June, 2002, labor strikes broke up at 'C', 'K' and other hospitals, and in 2007, 'Y' hospital suffered much from a strike. Such series of extreme labor disputes have awakened people of importance of a more stable labor-management relationship for the medical institutions responsible for people's health than any other business organization. The purpose of this study was to examine the labor-management disputes at 'Y' hospital in 2007 and 'C' and 'K' hospitals in 2002. The results of this study can be summarized as follows; First, requests of the labor union such as pay raise, reemployment of the irregular workers as regular employees and participation of the labor union in personnel affairs are the long-held or core issues suffered by the medical institutions. Such issues are not independent from each other but complicated with each other surrounding the pay raise. Accordingly, it is not easy to determine the genuine bone of issue for labor-management disputes. Second, the model type of disputes between labor and management at medical institutions may be strike. However, it is conceived that the type of disputes would be subject to change as the essential medical service area system began to be operated since 2008. Third, the common characteristic of the labor strike among the 3 sample hospitals was occupation of the hospital lobby for a sit-in strike to maximize the negative effects of strike. Article 42 (Prohibition of Violence) of Labor Union and Labor Relation Coordination Act prohibits occupation of production or other important business facilities. In addition, since Ministry of Labor interprets that the hospital lobby belongs to the important business facilities enumerated by Article 42 of the above act, occupation of the hospital lobby for a sit-in strike may be too controversial to be admitted as a fair act of labor dispute when its legitimacy should be judged. Fourth, the counter-measures taken by the hospitals against the strike were observance of the principle 'no labor no pay,' closure, legal action, accusation, claim for recovery of damage, provisional seizure, disciplinary punishment, etc., but the principle of 'no labor, no pay' was not applied in a fair manner by 'C' and 'K' hospitals. However, 'Y' hospital applied this principle thoroughly to the strike; the hospital conduced to correction of the wrong labor-management relationship by refusing inclusion in the labor collective agreement of a provision about payment of wage during the period of strike or labor union's request to that effect during a strike. In addition, 'Y' hospital took an effective measure to end the strike earlier by notifying the labor union of cancellation of the collective agreement and banning the unionists from entering the hospital.

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Compression Plate Fixation with Autogenous Bone Graft for Humerus Shaft Nonunion (상완골 간부 불유합에 대한 금속판 고정 및 자가골 이식술)

  • Cho, Chul-Hyun;Song, Kwang-Soon;Bae, Ki-Cheor;Kim, In-Kyoo;Kwon, Doo-Hyun
    • Clinics in Shoulder and Elbow
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    • v.12 no.1
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    • pp.33-37
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    • 2009
  • Purpose: To evaluate the results of the compression plate fixation and autogenous bone graft in the management of humerus shaft nonunion. Materials and Methods: Eighteen cases were treated for humerus shaft nonunion using compression plate fixation and an autogenous iliac bone graft. The mean follow-up period was 28 months. Bony union was confirmed from the serial radiographs and the clinical outcomes were assessed according to ASES scoring system. Results: In 12 cases of initial plate fixation, the causes of nonunion were 6 cases of inadequate plate length, 2 with a broken plate, 2 with screw loosening, 1 infection and 1 noncompliance of a psychiatric patient. In 3 cases of initial intramedullary fixation, the cause of nonunion was a distraction of the fracture site. In 3 cases of external fixation, the cause of nonunion was inadequate fixation. All cases showed bony union after an average of 24 weeks. The clinical outcomes were 11 excellent, 6 good and 1 fair. Conclusion: In the treatment for nonunion, compression plate fixation with autogeneous bone graft after complete removal of the fibrous and necrotic tissue is believed to give satisfactory results.

LATE RECONSTRUCTION OF PARTIALLY-RESECTED MANDIBLE AFTER REMOVAL OF AMELOBLASTOMA OF THE MANDIBLE (하악골 부분절제술후 이물성형재료에 의한 즉시재건술이 실패된 예에서 양측 장골뼈와 Miniplate Osteosynthesis 를 이용하여 재건시킨 법랑아세포종 치험 1예)

  • Park, Hyung-Sik;Kim, Sun-Yong;Kwon, Joon-Ho;Lee, Sang-Hye
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.12 no.1
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    • pp.171-179
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    • 1990
  • This is a report on a case of delayed reconstruction after partial mandibularectomy for Ameloblastoma involving symphysis and bodies of the mandible by using of two large pieces of corticocancellous bone blocks obtained from both iliac crests. The authors failed immediate reconstruction with two kinds of Alloplasts(metal, methylmethacrylate) at two times of trial due to known infection and suggestive poor histocompatibility of materials aginst the host who has been suffered from long-term and active pulmonary tuberculosis. However we could get success late reconstruction of this problem-occured and curved area with two pieces of large corticocancellous blocks by using of miniplate osteosynthesis and biphasic external pin fixation. From our experience we are obtained some results as follows : 1. Alloplastic graft materials seemed to be dangerous to maintain successfuly in patient who has a long-term debilitating disease as a active pulmonary tuberculosis. 2. Biphasic external skeletal pin fixation appliance gave many advantages such as maintain functional position of the remained bodies and condyles of the mandible after removal of failed alloplasts and during control of inflammation of this area, assist supportive roles to fix and maintain bone grafts during healing, allow mandibular movement during healing and so offer to conduct normal functional stimuli to bone grafts during osteogenesis etc. 3. Bony union was successful between not only normal bones and grafted bones but also grafted bone pieces even though we used two pieces of large blocks of corticocancellous bone for graft. 4. Miniplate osteosynthesis was not affect any adverse effects to bone grafts but offered good role of fixation and maintenance for bone grafts.

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Reconstruction of the Glenoid Using Iliac Bone Graft for Recurrent Anterior Shoulder Instability with Severe Glenoid Bone Defect - A Report of Two Cases - (관절와의 심한 골결손을 동반한 견관절 전방 불안정성에서 장골 이식술을 이용한 관절와 재건술 - 2예 보고 -)

  • Lee, Seong-Man;Jung, Won-Ju;Lee, Hyun-Joo;Jeon, In-Ho
    • Clinics in Shoulder and Elbow
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    • v.13 no.1
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    • pp.117-122
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    • 2010
  • Purpose: The purpose of this report was to assess a surgical technique-using an autogenous tricortical iliac crest bone graft in patients with epilepsy-for anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with severe glenoid deficiency. Materials and Methods: We studied two cases of recurrent anterior dislocation of the shoulder due to epilepsy. These cases were treated with anatomical glenoid reconstruction using an autogenous tricortical iliac crest bone graft. Results: Both cases achieved bone union in 5 months. There was no recurrence of instability and pain. Both cases had normal range of motion. Conclusion: Anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with severe glenoid deficiency using an autogenous tricortical iliac crest bone graft is a successful surgical technique for achieving shoulder stability.

Analyses Using Micro-CT Scans and Tissue Staining on New Bone Formation and Bone Fusion According to the Timing of Cranioplasty via Frozen Autologous Bone Flaps in Rabbits : A Preliminary Report

  • Shin, Hee Sup;Lee, Deok-Won;Lee, Seung Hwan;Koh, Jun Seok
    • Journal of Korean Neurosurgical Society
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    • v.57 no.4
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    • pp.242-249
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    • 2015
  • Objective : The timing of cranioplasty and method of bone flap storage are known risk factors of non-union and resorption of bone flaps. In this animal experimental study, we evaluated the efficacy of cranioplasty using frozen autologous bone flap, and examined whether the timing of cranioplasty after craniectomy affects bone fusion and new bone formation. Methods : Total 8 rabbits (male, older than 16 weeks) were divided into two groups of early cranioplasty group (EG, 4 rabbits) and delayed cranioplasty group (DG, 4 rabbits). The rabbits of each group were performed cranioplasty via frozen autologous bone flaps 4 weeks (EG) and 8 weeks (DG) after craniectomy. In order to obtain control data, the cranioplasty immediate after craniectomy were made on the contralateral cranial bone of the rabbits (control group, CG). The bone fusion and new bone formation were evaluated by micro-CT scan and histological examination 8 weeks after cranioplasty on both groups. Results : In the micro-CT scans, the mean values of the volume and the surface of new bone were $50.13{\pm}7.18mm^3$ and $706.23{\pm}77.26mm^2$ in EG, $53.78{\pm}10.86mm^3$ and $726.60{\pm}170.99mm^2$ in DG, and $31.51{\pm}12.84mm^3$ and $436.65{\pm}132.24mm^2$ in CG. In the statistical results, significant differences were shown between EG and CG and between DG and CG (volume : p=0.028 and surface : p=0.008). The histological results confirmed new bone formation in all rabbits. Conclusion : We observed new bone formation on all the frozen autologous bone flaps that was stored within 8 weeks. The timing of cranioplasty may showed no difference of degree of new bone formation. Not only the healing period after cranioplasty but the time interval from craniectomy to cranioplasty could affect the new bone formation.

Treatment of Deformity in Polyostotic Fibrous Dysplasia Using Interlocking Intramedullary Nailing (다발성 섬유성 골이형성증 변형에 대한 나사못 맞물림 골수정을 이용한 치료)

  • Lee, Kwang-Suk;Oh, Jong-Keon;Koo, Ja-Seong
    • The Journal of the Korean bone and joint tumor society
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    • v.1 no.2
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    • pp.249-253
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    • 1995
  • The fibrous dysplasia is a progressive and disabling condition that lead to deformity, especially weight bearing bones. The morbidity that is associated with the polyostotic fibrous dysplasia is the recurrent fracture and deformity. Various methods of treatment had been failed to control this problem. We used osteotomy and reconstruction nailing for polyostotic fibrous dysplasia occured in the proximal part of right femur with varus deformity and reconstruction nailing in left femur without osteotomy, and interlocking intramedullary nailing in right tibia to prevent pathologic fracture. These methods brought a good result of bone union and full weight bearing ambulation after 1 year and 6 month follow up. We think these methods are useful methods to control refracture and deformity, so we reported this case with bibliographic reviews.

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Effects of Yuhyangjeongtong-san on Fracture Healing in Rats

  • Kim, Ki-Tae;Jo, Na-Young
    • The Journal of Korean Medicine
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    • v.40 no.4
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    • pp.61-71
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    • 2019
  • Objectives: The purpose of this study is to determine the effect of Yuhyangjeongtong-san on the recovery of tibial fractures in rats. Methods: In this study, osteocalcin and Calcitonin, CTX-2, TGF-β and BMP-2, which are used as indicators of bone formation, were analyzed after hematologic fractures using experimental rats. In addition, the fracture union process was confirmed using X-rays. Results: Osteocalcin, Calcitonin and BMP-2 showed a significant increase compared with the control at 4 weeks. CTX-2 and TGF-β showed a significant increase compared with the control at 3 weeks. On X-ray, YJS treated group, as the experiment progressed, the boundary line became blurred, the bone outline was clearly visible, and the fracture recover was progressing. Conclusion: The findings suggest that YJS can play a significant role in the repair of fractures. Therefore YJS is likely to be used to treat fractures.