Vascular Calcification in Patients Undergoing Total Knee Arthroplasty: Frequency and Effects on the Surgery

Backgroud: This study aims to investigate the frequency of distal femoral and popliteal arterial calcification and to evaluate the intraoperative and postoperative effects of arterial calcification in patients undergoing total knee arthroplasty using a tourniquet. Methods: The records of 5,438 patients who had undergone primary total knee arthroplasty between January 2003 and January 2017 were retrospectively reviewed. We examined the preoperative radiographs of the knee from all patients for calcifications of the femoral and popliteal arteries. Vascular calcification was identified on preoperative radiographs in 223 cases. Intraoperative and postoperative complications were investigated among these patients. Postoperative complications were analyzed from the time of surgery to the last follow-up (minimum 1-year follow-up). Results: Vascular calcification of the arteries around the knee was found in 223 cases (4.1%). The mean patient age was 70.6 years in the non-calcification group and 73.8 years in the calcification group (p > 0.05). The calcification group was classified into medial, intimal, or mixed subgroups according to the morphology of calcification on preoperative radiographs. The medial type included 46 cases (20.6%); intimal type, 161 cases (72.2%); and mixed type, 16 cases (2.7%). There was no statistically significant difference in demographic and surgical data among the three groups. There were intraoperative complications in two cases in the medial type group, both of which involved tourniquet failure. There was also a postoperative complication in one case in the medial type group, which involved wound dehiscence at 2 weeks postoperatively. No other postoperative complications were identified during 1-year follow-up. Conclusions: Despite the presence of calcifications in the arteries around the knee, total knee arthroplasty (using a tourniquet) can be performed without serious complications.ope

A Study on the Strategic Plans of Korean Non-Life Insures due to the Introduction of Bancassurance in Korea

It is expected that the paradigm of the Korean financial industry will be restructured from the current financial specialty system to the universal banking system due to the introduction of Bancassurance in September, 2003. In particular, the activation of Bancassurance is expected to influence greatly on the Korean insurance industry such as changes in insurance marketing channels, restructuring of insurance industry, expansion of universal banking and globalization of insurance business. In this respect, this study is designed to analyze the effects of the introduction of Bancassurance on the Korean non-life insurance industry and hence, establish strategic plans that non-life insurers can utilize. The introduction of Bancassurance will result in the following situationsfirstly, emerging of the bank-based financial group, getting worse of small and medium non-life insurers' financial soundness and weakening of competitiveness of currently existing non-life insurers due to the increase of risks resulting from the interest change of saving-oriented insurance products, secondly, encroaching of existing bank-based financial institutes on insurance markets, thirdly, reorganizing of traditional insurance marketing channels. Accordingly, it is expected that the introduction of Bancassurance will be a threatening factor rather than favorable factor to the Korean non-life insurance industry. Therefore, Korean non-life insurers should try to find out the ways of continuing growth and making profits in order to survive by utilizing accumulated knowledge and skills as professional insurance institutes, harmonizing the product mix with non-life insurers' common products and special products, and constructing various insurance marketing channels.제 1 장 서 론 1 제 1 절 연구의 배경 및 목적 1 제 2 절 연구의 방법 및 구성 4 제 2 장 방카슈랑스의 이론적 고찰 및 현황 6 제 1 절 방카슈랑스의 개념 및 도입배경 6 제 2 절 국내 방카슈랑스 환경 및 현황 15 제 3 절 주요국의 방카슈랑스 분석 26 제 3 장 방카슈랑스 도입이 손해보험사에 미치는 영향 32 제 1 절 금융산업의 환경변화 32 제 2 절 보험시장의 잠식 36 제 3 절 판매채널의 변화 40 제 4 장 방카슈랑스 도입에 따른 손해보험사의 대응전략 43 제 1 절 종합 금융화 전략 44 제 2 절 대형화 및 다각화 전략 47 제 3 절 상품개발 전략 55 제 4 절 판매채널 다변화 전략 59 제 5 장 요약 및 결론 65 참고문헌 6

What can the radiological parameters of superior migration of the humeral head tell us about the reparability of massive rotator cuff tears?

Objective: The interrelation and clinical utility of the parameters for superior migration of the humeral head, such as the acromiohumeral interval (AHI), inferior glenohumeral distance (IGHD), and upward migration index (UMI), in the management of massive rotator cuff tears are not clear. The objectives of this study were to identify the relation between AHI, IGHD, and UMI when measured with radiography and MRI and to determine whether superior migration can predict the irreparability of massive rotator cuff tears. Methods: We retrospectively reviewed the files of 64 consecutive patients who underwent arthroscopic partial or complete repair for massive rotator cuff tears at our institution between August 2015 and August 2018. We recorded both radiography and MRI measurements of AHI, IGHD, and UMI, and further the tangent sign, fatty infiltration of the rotator cuff muscles, and the Patte grade. We performed correlation assessments and multiple logistic regression analysis to identify potential predictors of the reparability of massive rotator cuff tears. Results: Thirty-five patients had partially reparable and 29 had completely reparable tears. Parameters measured with either radiography or MRI were highly correlated with each other. The radiographic measurements showed a moderate or low correlation with the MRI measurements. All parameters of superior migration of the humeral head on radiography and MRI, the tangent sign, fatty infiltration of the infraspinatus muscle, and the Patte grade showed significant differences between patients with partially and completely repaired tears. Among these, the independent predictors for irreparability was Patte grade = 3. Conclusion: The AHI, IGHD, and UMI were highly correlated when measured with either radiography or MRI, but not when comparing their radiographic with their MRI values. Furthermore, they were not independent indicators of reparability in massive rotator cuff tears.ope

Particulated Costal Allocartilage With Microfracture Versus Microfracture Alone for Knee Cartilage Defects: A Multicenter, Prospective, Randomized, Participant- and Rater-Blinded Study

Background: Microfracture is the first-line treatment for cartilage defects; however, the suboptimal quality of the repaired cartilage remains an issue. Purpose/hypothesis: The aim of this first in-human study was to compare the clinical efficacy and safety of a combination of particulated costal allocartilage and microfracture versus microfracture alone in treating knee cartilage defects. We hypothesized that the particulated costal allocartilage with microfracture would result in superior cartilage repair quality and better clinical outcomes at 48 weeks postoperatively. Study design: Randomized controlled trial; Level of evidence, 1. Methods: Patients with cartilage defects were allocated randomly to the treatment group (particulated costal allocartilage with microfracture) and control group (microfracture alone). Magnetic resonance imaging (MRI) outcomes of cartilage repair (the primary outcome measure) were evaluated at the 48-week follow-up using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Patient-reported clinical outcomes (visual analog scale [VAS] pain score, Knee injury and Osteoarthritis Outcome Score [KOOS], and International Knee Documentation Committee score) and adverse events were evaluated at 12, 24, and 48 weeks postoperatively. Results: Overall, 88 patients were included (44 patients each in the treatment and control groups). The total MOCART score at 48 weeks postoperatively was significantly higher in the treatment group than in the control group (P < .001). Among the 9 MOCART variables, 6 were significantly superior in the treatment versus the control group: degree of repair and defect filling (P < .001), integration to the border zone (P < .001), surface (P = .006), structure (P = .011), signal intensity of the repair tissue (P < .001), and subchondral lamina (P = .005). There were significant between-group differences in KOOS-Pain (P = .014), KOOS-Activities of Daily Living (P = .010), KOOS-Sports (P = .029), and KOOS-Symptoms (P = .039) at 12 weeks postoperatively and in VAS pain (P = .012) and KOOS-Pain (P = .005) at 24 weeks postoperatively. At 48 weeks postoperatively, clinical outcomes were comparable between the groups. Conclusion: Microfracture augmented with particulated costal allocartilage resulted in superior cartilage repair quality compared with microfracture alone in terms of MRI evaluation of the knee joint cartilage defect at the 48-week follow-up. Functional outcomes were favorable for both treatments at final follow-up. Registration: KCT0004936 (Clinical Research Information Service [CRiS] of the Republic of Korea).ope

The Relationship Between Lateral Femoral Anatomic Structures and the Femoral Tunnel Outlet in Anterior Cruciate Ligament Reconstruction Using the Transportal Technique: A 3-Dimensional Simulation Analysis

Background: The relationship between the lateral femoral anatomic structures and femoral tunnel outlet according to changes in knee flexion and transverse drill angle during femoral tunnel creation in anterior cruciate ligament (ACL) reconstruction remains unclear. Purpose: To investigate the relationships between the lateral femoral anatomic structures and femoral tunnel outlet according to various knee flexion and transverse drill angles and to determine appropriate angles at which to minimize possible damage to the lateral femoral anatomic structures. Study design: Controlled laboratory study. Methods: Simulation of ACL reconstruction was conducted using a 3-dimensional reconstructed knee model from the knees of 30 patients. Femoral tunnels were created using combinations of 4 knee flexion and 3 transverse drill angles. Distances between the femoral tunnel outlet and lateral femoral anatomic structures (minimum safe distance, 12 mm), tunnel length, and tunnel wall breakage were assessed. Results: Knee flexion and transverse drill angles independently affected distances between the femoral tunnel outlet and lateral femoral anatomic structures. As knee flexion angle increased, the distance to the lateral collateral ligament, lateral epicondyle, and popliteal tendon decreased, whereas the distance to the lateral head of the gastrocnemius increased (P < .001). As the transverse drill angle decreased, distances to all lateral femoral anatomic structures increased (P < .001). Considering safe distance, 120°, 130°, or 140° of knee flexion and maximum transverse drill angle (MTA) could damage the lateral collateral ligament; 130° or 140° of knee flexion and MTA could damage the lateral epicondyle; and 110° or 120° of knee flexion and MTA could damage the lateral head of the gastrocnemius. Tunnel wall breakage occurred under the conditions of MTA - 10° or MTA - 20° with 110° of knee flexion and MTA - 20° with 120° of knee flexion. Conclusion: Approximately 120° of knee flexion with MTA - 10° and 130° or 140° of knee flexion with MTA - 20° or MTA - 10° could be recommended to prevent damage to the lateral femoral anatomic structures, secure adequate tunnel length, and avoid tunnel wall breakage. Clinical relevance: Knee flexion angle and transverse drill angle may affect femoral tunnel creation, but thorough studies are lacking. Our findings may help surgeons obtain a stable femoral tunnel while preventing damage to the lateral femoral anatomic structures.ope

Association Between Platelet Count and Osteoarthritis in Women Older Than 50 Years

Background: Osteoarthritis (OA) is a multifactorial disease involving inflammatory processes. Platelets play important roles in both hemostasis and the inflammatory response; however, the relationship between platelet count and OA is unclear. Our aim was to evaluate the association between platelet count and knee and hip OA in Korean women. Methods: In this cross-sectional designed study, we included a total of 6011 women aged ⩾50 years from the 2010-2013 Korea National Health and Nutrition Examination Survey. Knee and hip OA were defined as Kellgren-Lawrence grade ⩾2 and presence of knee or hip pain, respectively. Platelet counts were divided into quartiles as follows: Q1, 150-212 (103/µl); Q2, 213-246 (103/µl); Q3, 247-283 (103/µl); and Q4, 284-450 (103/µl). Multiple logistic-regression analysis was conducted to calculate odds ratios and 95% confidence intervals. Receiver operating characteristic analysis was performed to determine the optimal platelet count cut-off with which to discriminate participants with knee and/hip OA versus those without OA. Results: Of the 6011 participants, 1141 (18.1%) had knee or hip OA. The mean age of participants without OA was 60.6 years, and that of participants with OA was 68.0 years. Compared with the lowest quartile, odds ratios (95% confidence intervals) for OA were 1.08 (0.84-1.39) for Q2, 0.94 (0.73-1.23) for Q3, and 1.35 (1.08-1.69) for Q4 after adjusting for confounders. The prevalence of OA was significantly higher with platelet counts ⩾288 × 103/µl, compared with platelet counts <288 × 103/µl. Conclusion: High platelet counts within the normal range are significantly associated with knee and hip OA.ope

Medial Meniscus Posterior Root Tear: How Far Have We Come and What Remains?

Medial meniscus posterior root tears (MMRTs), defined as tears or avulsions that occur within 1 cm of the tibial attachment of the medial meniscus posterior root, lead to biomechanically detrimental knee conditions by creating a functionally meniscal-deficient status. Given their biomechanical significance, MMRTs have recently been gaining increasing interest. Accordingly, numerous studies have been conducted on the anatomy, biomechanics, clinical features, diagnosis, and treatment of MMRTs, and extensive knowledge has been accumulated. Although a consensus has not yet been reached on several issues, such as surgical indications, surgical techniques, and rehabilitation protocols, this article aimed to comprehensively review the current knowledge on MMRTs and to introduce the author’s treatment strategiesope

Factors Influencing the Initial Constraint Level of the Knee Joint and Its Effect on Clinical Outcomes After ACL Reconstruction With Hamstring Graft

Background: A force-based tension protocol that uses a certain amount of tension at graft fixation could still give rise to variations in initial constraint levels of the knee joint in terms of side-to-side difference (SSD) in anterior translation. Purpose: To investigate the factors influencing the initial constraint level in anterior cruciate ligament (ACL)-reconstructed knees and compare outcomes according to the level of constraint in terms of anterior translation SSD. Study design: Cohort study; Level of evidence, 3. Methods: Included were 113 patients who underwent ipsilateral ACL reconstruction using an autologous hamstring graft and had minimum 2-year follow-up outcomes. All grafts were tensioned and fixed at 80 N using a tensioner at the time of graft fixation. The patients were classified into the following 2 groups according to the initial anterior translation SSD, measured using the KT-2000 arthrometer: a physiologic constraint group with restored anterior laxity ≤2 mm (group P; n = 66) and a high-constraint group with restored anterior laxity >2 mm (group H; n = 47). Clinical outcomes were compared between the groups, and preoperative and intraoperative variables were evaluated to identify factors affecting the initial constraint level. Results: Between group P and group H, generalized joint laxity (P = .005), posterior tibial slope (P = .022), and anterior translation measured in the contralateral knee (P < .001) were found to differ significantly. Measured anterior translation in the contralateral knee was the only significant predictor of high initial graft tension (P = .001). No significant differences were found between the groups regarding clinical outcomes and subsequent surgery. Conclusion: Greater anterior translation measured in the contralateral knee was an independent predictor of a more constrained knee after ACL reconstruction. The short-term clinical outcomes after ACL reconstruction were comparable, regardless of the initial constraint level in terms of anterior translation SSD.ope

제3차 항노화 지식연구회

항노화 초코렛 개발 및 상품화 전략 뷰티산업에서 바라본 화장품 산업의 동향 및 상품 개발전략 기능성 항노화 식품의 산업동향 및 개발전략 중소기업청 융합과제 발굴 RFP 참여 제안 항노화 지식연구회 회원사 소개 □ 목 적 ○ 항노화 지식연구회 우수기술을 가진 중소기업의 발굴 및 육성을 통해 자발적인 기술개발 능력재고 ○ R&amp;D 활성화를 통한 신규 사업 제안 및 항노화 지식연구회 지역 내 정착화 ○ ASTI 전문가 그룹 전문분야 산업체와 대학 등과 같은 교육연구기 관과의 Network 구축 ○ 개방혁신 (Open innovation) 촉진을 통한 기술개발의 전략적 제휴 도모 ○ 향후 정보공유 및 연구회 추진방안 협의 등 □ 일 정 ○ 일 시 : 2014. 8. 28(목) 15:00 ~ 18:00 ○ 장 소 : 차세대융합기술연구원 A동 세미나룸Ｖ(203호, 2층), 수원 광교밸리 내 □ 참석 인원 ○ 참석대상 : 한경대 최강덕 교수 등 연구회 위원 25명 내

An analysis of voucher programs in South Korea and the United States

최근 바우처가 시민의 선택권 확장, 공급자 사이의 경쟁 촉진, 형평성 제고차원에서 주목을 받고 있다. 하지만 국내의 경우 아직 바우처에 대한 체계적이 분석이 부족하다. 이에 본 연구는 바우처의 개념과 기능, 다른 정책수단과의 차이점, 그리고 한국과 미국을 중심으로 한 바우처 역할과 쟁점을 정리하고 있다. 마지막으로 바우처 정책설계 시 주요 고려사항과 향후 연구방향을 제시하고 있다. In recent years, vouchers have been used as a way to provide greater freedom of choice for beneficiaries of government programs, to improve efficiency through more competition among suppliers and to promote equity. There are, however, few systematic studies to provide an overview of vouchers as a tool of government action in South Korea. This study examines the definition and goals of voucher, differences between voucher and other policy tools, and key issues of voucher in South Korea and the United States. In conclusion, this study suggests key managerial issues for policy design and future research directions.이 논문은 2005년도 한국학술진흥재단 협동연구지원(B00254)으로 이루어졌습니다