Improvement of osteogenic potential of biphasic calcium phosphate bone substitute coated with synthetic cell binding peptide sequences

Purpose : The aim of this study was to evaluate the improvement of osteogenic potential of biphasic calcium phosphate (BCP) bone substitute coated with synthetic cell-binding peptide sequences in a standardized rabbit sinus model. Methods : Standardized 6-mm diameter defects were created bilaterally on the maxillary sinus of ten male New Zealand white rabbits, receiving BCP bone substitute coated with synthetic cell binding peptide sequences on one side (experimental group) and BCP bone substitute without coating (control group) on the other side. Histologic and histomorphometric analysis of bone formation was carried out after a healing period of 4 or 8 weeks. Results : Histological analysis revealed signs of new bone formation in both experimental groups (4- and 8-week healing groups) with a statistically significant increase in bone formation in the 4-week healing group compared to the control group. However, no statistically significant difference in bone formation was found between the 8-week healing group and the control group. Conclusions : This study found that BCP bone substitute coated with synthetic cell-binding peptide sequences enhanced osteoinductive potential in a standardized rabbit sinus model and its effectiveness was greater in the 4-week healing group than in the 8-week healing group.ope

Improvement of osteogenic potential of biphasic calcium phosphate bone substitute coated with two concentrations of expressed recombinant human bone morphogenetic protein 2

Purpose : The aim of this study was to determine whether biphasic calcium phosphate (BCP) bone substitute with two different concentrations of Escherichia coli-expressed recombinant human bone morphogenetic protein 2 (ErhBMP-2) enhances new bone formation in a standardized rabbit sinus model and to evaluate the concentration-dependent effect of ErhBMP-2. Methods : Standardized, 6-mm diameter defects were made bilaterally on the maxillary sinus of 20 male New Zealand white rabbits. Following removal of the circular bony windows and reflection of the sinus membrane, BCP bone substitute without coating (control group) was applied into one defect and BCP bone substitute coated with ErhBMP-2 (experimental group) was applied into the other defect for each rabbit. The experimental group was divided into 2 subgroups according to the concentration of ErhBMP-2 (0.05 and 0.5 mg/mL). The animals were allowed to heal for either 4 or 8 weeks and sections of the augmented sinus and surrounding bone were analyzed by microcomputed tomography and histologically. Results : Histologic analysis revealed signs of new bone formation in both the control and experimental groups with a statistically significant increase in bone formation in experimental group 1 (0.05 mg/mL ErhBMP-2 coating) after a 4-week healing period. However, no statistically significant difference was found between experimental group 1 and experimental group 2 (0.5 mg/mL ErhBMP-2 coating) in osteoinductive potential (P<0.05). Conclusions : ErhBMP-2 administered using a BCP matrix significantly enhanced osteoinductive potential in a standardized rabbit sinus model. A concentration-dependent response was not found in the present study.ope

Effect of alendronate on bone remodeling around implant in the rat

PURPOSE: The purpose of this study was to evaluate the effect of alendronates on bone remodeling around titanium implant in the maxilla of rats. MATERIALS AND METHODS: The maxillary first molars were extracted and customized-titanium implants were placed immediately in thirty male Sprague-Dawley rats. The rats were divided into experimental (bisphosphonate) group and control group. At 4 weeks after implantation, the rats in the bisphosphonate group were subcutaneously injected with alendronate three times a week for 6 weeks where as the rats in control group were injected with saline. The rats were sacrificed at 1, 2, 3, 4, or 6 weeks after starting of injection and maxillary bones were collected subsequently. Alveolar bone remodeling around the implants were evaluated by radiographic and histologic analysis. Microarray analysis and immunohistomorphologic analysis were also performed on one rat, sacrificed at 6 weeks after starting of injection, from each group. Statistical analysis was performed using repeated measures analysis of variance and independent t test at a significance level of 5%. RESULTS: There was no statistically significant difference in the bone area (%) around implant between the bisphosphonate group and the control group. However, the amount of empty lacuna was significantly increased in the bisphosphonate group, especially in the rats sacrificed at 4 weeks after starting of injection compared to that of the corresponding control group. The bisphosphonate group showed the same level of TRAP positive cell count, osteocalcin and angiopoietin 1 as the control group. CONCLUSION: Alendronate may not decrease the amount of osteoclast. However, the significantly increased amount of empty lacuna in the bisphosphonate group may explain the suppression of bone remodeling in the bisphosphonate group.ope

The effect of alendronates administration duration on the healing of extraction socket in rats: pilot study

PURPOSE. The purpose of this study was to investigate the effect of different administration duration of alendronate on initial wound healing and new bone formation of extraction socket in rats. MATERIALS AND METHODS. Fifteen male Sprague-Dawley rats (body weight 130-140 g, 4 weeks old, male) were divided into control group (no alendronate administration) and experimental group (alendronate administration). Experimental group was subdivided into 1 week administrated group, 2 week administrated group, 4 week administrated group and 6 week administrated group according to duration of administration. For the experimental groups, during the designated time period (at the time of extraction, 1 week before extraction, 3 week before extraction and 5 week before extraction) till 1 week after extraction, rats were subcutaneously injected with Alendronate at the dose of 1.0 mg/Kg three times a week. Each specimen from 6 week experimental group and control group were used for microarray analysis, and other specimens were used for histological analysis. The rate of new bone formation within the extraction site and bone loss activity was analyzed using TRAP staining. Statistical analysis was performed using Kruskal Wallis test. (α=.05) RESULTS. After one week from the time of extraction, the rate of new bone formation within extraction site for the control group (16.77% ± 1.36%) compared to the 4 week experimental group (14.99% ± 6.26%) was lower. However, no statistically significant difference was found. Increase in the number of inactive lacuna (empty lacuna) and decrease in the number of TRAP positive cell were identified with increased duration of administration. There was no significant difference. CONCLUSION. The results of this study showed as the duration of Alendronate administration increased the rate of new bone formation decreased with loss of bone activity and reduced number of osteoclast.ope

Morphometric analysis of maxillary alveolar regions for immediate implantation

PURPOSE: The purpose of this study was to provide an actual guideline in determining the shape, diameter, and position of the implant in immediate implantation by the measurement of the thickness of facial and palatal plate, the thickness of cortical bone on the facial and palatal plate, the diameter of the root, and the distance between the roots in the cadavers. MATERIALS AND METHODS: The horizontal sections of 20 maxillae were measured and analyzed to obtain the average values. Resin blocks were produced and cut serially at 1 mm intervals from the cervical line to the root apex. Images of each section were obtained and the following measurements were performed: The thickness of the facial and palatal residual bone at each root surface, the thickness of the facial and palatal cortical bone at the interdental region, the diameter of all roots of each section on the faciopalatal and mesiodistal diameter, and the interroot distance. Three specimens with measurements close to the average values were chosen and 3-dimensional images were reconstructed. RESULTS: The thickness of the facial and palatal cortical bone at the interdental region in the maxilla, the buccal cortical bone was thicker in the posterior region compared to the anterior region. The interroot distance of the alveolar bone thickness between the roots increased from anterior to posterior region and from coronal to apical in the maxilla. CONCLUSION: In this study, the limited results of the morphometric analysis of the alveolar ridge using the sections of maxilla in the cadavers may offer the useful information when planning and selecting optimal implant for immediate implantation in the maxilla.ope

대사 증후군 환자에서 N-3 다중 불포화 지방산 투여가 염증 표지 인자와 인슐린 저항성에 미치는 영향에 대한 연구

Dept. of Medicine/석사[한글] [영문] N-3 polyunsaturated fatty acids (PUFA) supplement may be beneficial in patients with the metabolic syndrome (MS) through reduction of serum triglyceride (TG), systemic inflammation and insulin resistance. Recommendation dose of N-3 PUFA are 1 g/day for secondary prevention of myocardial infarction and 2-4 g/day for serum TG reduction. In the MS, there are few data regarding N-3 PUFA effect on the systemic inflammation and insulin resistance. Also, dose-dependent effects of N-3 PUFA on systemic inflammation and insulin resistance have never been evaluated. The goal of this study is to evaluate whether N-3 PUFA supplement may reduce systemic inflammation and insulin resistance in patients with the MS. We also investigate dose-dependent effects of N-3 PUFA on systemic inflammation and insulin resistance by comparing conventional (2 g/day) with high (4 g/day) dose of N-3 PUFA. Sixty patients with the MS were randomly enrolled in N-3 PUFA and placebo groups. Fifty-three (N-3 PUFA, N=26 and placebo, N=27) subjects completed this study. N-3 PUFA group received 2 g/day (conventional dose) for 6 weeks and 4 g/day (high dose) for another 6 weeks. We compared serum lipid and lipoprotein subclass profiles, inflammatory markers and insulin resistance between two groups. N-3 PUFA administration significantly reduced mean high sensitive C-reactive protein (hs-CRP; p = 0.01, repeated measures ANOVA) and homeostasis model assessment of insulin resistance (HOMA-IR; p = 0.03, repeated measures ANOVA) levels compared with placebo. N-3 PUFA mediated TG (p = 0.001, repeated measures ANOVA) and HOMA-IR (p = 0.000, repeated measures ANOVA) reduction were significantly related to dose-dependent effect of N-3 PUFA. However, there was no significant dose-dependent effect of N-3 PUFA on hs-CRP. In conclusion, N-3 PUFA administration in patients with the MS significantly reduced serum hs-CRP and insulin resistance compared with placebo. Especially, the improvement of insulin resistance was significantly related to dose-dependent effect of N-3 PUFA.ope

Comparison of voiding parameters according to the sub-classification of SS-penogram in patients combined with ED and LUTS

의학과/석사ope

골 재생능 향상을 위한 치성줄기세포의 기능조절 및 적용연구

Department of Dentistryopen박

Study on factors related to rise of nursing grade among Korean hospitals

보건정책관리학과/석사의료기관의 간호사 확보수준과 입원환자의 의료의 질은 매우 밀접한 관계가 있으며, 정부에서도 간호인력 확보수준에 따른 재정적 인센티브 사업인 간호관리료 차등제를 실시하였다. 그러나 간호등급은 병원종별, 규모에 따라서 점점 양극화 되고 있으며, 의료기관의 간호등급을 상승시키기 위한 관련요인 연구는 부족하다. 본 연구는 어떤 요인이 간호등급 상승이 상승하는데 영향을 미치는가를 파악함으로써, 의료기관의 간호등급 상승유인과 합리적인 정부정책을 수립하기 위한 기초자료를 제시하고자 하였다. 본 연구는 건강보험심사평가원 자원관리부 현황자료를 바탕으로 건강보험심사평가원 청구데이터를 연계하여 2008년 6월 30일부터 2013년 6월 30일까지 개설되어있는 1,104개 의료기관을 대상으로 분석하였다. 기본특성, 인적자원 특성, 물적자원 특성으로 나누어 변수를 설정한 후 기술분석, 카이제곱 검정, 로지스틱 회귀분석을 시행하였다. 통계분석에는 SAS 9.2를 사용하였다. 전체 요인을 고려하였을 때, 설립구분은 국공립에 비해서 기타 의료기관이 교차비가 0.264였으며, 설립년도는 1995년 6월이전 개설된 의료기관에 비해서, 2006년 11월 이후에 개설된 의료기관의 교차비가 2.383이었다. 소재지는 서울에 비해서, 강원도의 교차비가 0.084, 충청남도의 교차비가 0.036, 전라남도의 교차비가 0.194였다. 100병상당 전문의 수는 6.75명 이하 의료기관보다 6.75명 초과 의료기관이 7.514였고,. 100병상당 간호사 수는 17.48명 이하 의료기관을 기준으로 17.48초과 의료기관의 교차비가 3.300이었다. 병상가동률은 50%이하를 기준으로 50-75%의 교차비는 5.428, 75-90%의 교차비는 9.884, 90%초과 교차비는 10.699이었고, MRI보유대수는 0대를 기준으로 1대의 교차비가 2.018, 2대이상의 교차비가 2.942였다. 본 연구를 통해서, 설립연도가 오래된 병원의 간호등급 상승유인정책과, 지방의료기관에 대한 인센티브 제도가 필요하며, 병상가동률이 낮은 병원과 의료인력, 장비보유대수가 부족한 중소병원에 대한 정부의 정책개발이 필요하다.prohibitio

미래의 전립선 수술을 위한 남성 치골뒤 공간과 비뇨생식 격막의 미세해부구조 및 3차원 영상의 효용성

I. 서론: 전립선 암이 조기 진단된 경우에는 근치적 전립선 적출술이 완 치를 위한 가장 확실한 치료방법으로 추천이 되나 술 후 발기부전과 요 실금의 합병증이 문제가 되어왔다. 이런 문제를 해결하기 위해 많은 술 기적 발전들이 있어 왔으며 최근엔 치골 뒤 공간 보존 및 회음부를 통한 수술적 접근법 등의 방법이 관심을 받고 있다. 하지만 이러한 구조들에 대한 해부학적 연구가 많이 부족하며 논란이 있어왔다. 따라서 이 분야 의 정확한 해부학적 구조를 연구하고 이해하는 것이 수술 술기 발전과 합병증 감소에 도움이 될 것으로 생각되어 본 연구를 진행하게 되었다. II. 재료 및 방법: 연세대학교 의과대학에 유언하고 기증된 시신 중 관련부위의 수술 처치를 하지 않은 한국 성인 남자 시신 30구를 사용하였다. 6 구의 시신은 CT 촬영을 위한 루골 염색을 하였다. 통상의 방법으로 골반을 정리하여 치골전립선인대를 관찰하였으며 회음부의 얕은 샅공강, 샅힘줄중심, 깊은 샅공간의 구조를 순서대로 해부하여 관찰하였다. 루골로 염색한 표본은 통상의 CT 촬영 후 3차원 재구성하여 관찰하였으며 이후 해부를 진행하여 비교하여 보았다. 통계적 분석은 T 검정과 카이 스퀘어 검증을 사용하였다. III. 결과: 치골전립선인대는 크게 4가지형태로 분류가 가능하였고 한쪽 에 2개가 있는 경우도 25% 정도에서 관찰되었다. 붙는 위치는 치골의 하방 1/3의 매우 깊은 곳에 붙는 것을 확인하였으며 인대 사이의 거리는 평균 8.5mm 로 관찰되었다. 피부항문괄약근과 망울해면체근을 연결하 는 피부 중심 띠가 있는 것을 관찰하였고, 보조 얕은샅 가로근의 존재도 처음으로 관찰하였다. 샅힘줄중심의 구조가 두 층으로 되어 있으며 서로 연결되어 있음을 관찰하였다. 깊은 샅공간에 요도를 말발굽 모양으로 감 싸는 근육이 관찰되었고 요도로부터 앞쪽 경계까지 거리가 짧은 경우와 긴 경우로 구분되었으며 긴 경우엔 앞쪽에 근 섬유가 관찰되었다. 루골 염색 후 CT를 촬영한 것을 3차원으로 재구성한 후 구조를 관찰한 결과 얕은층의 근육들은 그 층과 결이 자세히 보여지며 분석이 가능한 것을 확인 할 수 있었다. IV. 결론: 치골뒤 공간에서 치골전립선인대는 다양한 수와 형태로 관찰 되었으며, 전립선을 단단히 붙잡아서 안정시키는 매우 중요한 구조임을 확인하였다. 60% 이상에서 관찰된 보조 얕은샅 가로근은 처음으로 보고 하는 근육이며 발기 시 음경을 지지해 주며 발기시 음경을 위쪽으로 올 려주며 뒤쪽으로 당겨주는 수축에 관여하는 역할을 하는 것으로 생각되 므로 그 기능에 주목할 필요가 있다. 깊은샅 가로근의 형태는 연속적이 지 않았으며, U자나 둥근 형태인 부분을 관찰하였다. 특히 요도 앞쪽 부 분이 좁고 근육이 없는 경우가 50%였으며, 이 경우 치골뒤 공간에서 구 조들을 단단히 지지해 주는 치골 전립선인대의 해부학적 중요성을 재조 명할 필요가 있으므로, 이를 보존하는 수술법을 시행하는 것이 수술 후 요실금 등을 예방하는데 필요하다고 생각한다. Introduction: The anatomical and functional importance of the puboprostatic c ligament (PPL) is increasingly recognized as essential to prevent complications of urinary incontinence and erectile dysfunction following radical prostatectomy. The Retzius-sparing technique was recently introduced as a method to preserve the PPL and neurovascular bundles. Detailed understanding of the precise anatomy of the PPL and its variations, and the neurovascular bundle, proximal urethra, prostate, and surrounding structures is imperative for both surgical planning and subsequent reconstruction to preserve urinary continence and erectile function. However, despite greatly affecting surgical outcomes, due to the difficulty of microanatomic study in these small and variable perineal muscles, there are few papers detailing the basic anatomy of the retropubic space. We conducted this study to further understanding of the anatomic variations of the PPL and perineal muscles in the retropubic space. We also conducted a three-dimensional (3D) computed tomography (CT) scanning image study using Lugol’s solution and compared reconstructed images with real samples. Materials and Methods: Cadavers of 30 Korean men who had not undergone surgery in the relevant areas, donated to Yonsei University College of Medicine, were used in this study. In each case, the pelvis was dissected using a conventional technique to observe the PPL. The superficial perineal pouch, perineal body, and deep perineal pouch were dissected for observation of their anatomical structures. Six samples stained with Lugol’s solution were scanned using a conventional CT system. Images were reconstructed into 3D images for comparison with the actual dissection. For statistical analyses, Student’s t-test and chi-square test were used. Results: Depending on the site of attachment, PPLs mostly (54.7%) had a linear form (Type I). Type II PPL and Type III PPL, which are connected to the tendinous arch were also observed. In some samples it was quite challenging to classify the type. Two PPLs were observed in 25% of all samples. The location of the attachment of the PPLs to the pubis was very deep in the lower third of the pubic bone. The medial border of the PPL was attached to a point which was, on average, 3.5 mm from the inner margin of the pubic body; while the lateral border was attached to a point, on average, 8.5 mm from the pubic body. In cases with more than two ligaments on one side, the distance between the bilateral ligaments was shorter than average. The ‘cutaneous central band’ in the perineum was observed to connect the bulbospongiosus muscle (BSM) and cutaneous external anal sphincter. The cutaneous central band was a narrow and deeply formed band of fibrous tissue. The fibrous band of the BSM that connects to the median raphe was observed to connect to the cutaneous fibers of the anal sphincter. The accessory superficial perineal muscle, which is located closer to the surface than the perineal membrane, was found in 61.5% of all samples. The perineal body consists of superficial and deep layers. The muscles within the deep perineal pouch were not in the form of a fascia with the muscles aligned in a horizontal fashion, but were hoof shaped (similar to the anatomy of the female compressor urethra muscle). The anterior side of the urethra was either short or wide. In cases of urethra with a wide anterior side, muscle fibers were also observed around the anterior. Three-dimensional reconstruction of CT scans of the muscles of the urogenital diaphragm revealed individual layers and patterns of the shallow layers which were able to be visualized and analyzed in detail on the 3D images. However, because the muscles in the deep layers were thin and exhibited various patterns, clear observation of their structure on the 3D images was limited. Conclusions: PPLs exhibited various morphologies which were classified into four different types based on the attachment type: Type I, which connects linearly from the pubic bone to the prostate, accounted for 54.7% of cases. Type II, which starts from the pubic bone and attaches to the prostate and prostate, tendinous arch, accounted for 37% of cases. Type III, which occurs when the ligaments from the pubic bone and the tendinous arch combine and attach to the prostate, accounted for 6.7% of cases. Type IV is characterized by multiple ligaments arising from the pubic bone to form a complex structure. Two PPLs were observed in 25% of all samples. The PPL was attached to the pubis very deep in the lower third of the pubic bone. The medial border of the PPLs attached to a point, on average, 3.5 mm from the inner margin of the pubic body, while the lateral border attached to a point, on average, 8.5 mm from the pubic body. In cases with more than two ligaments, the distance was shorter than the average. The fibrous connecting band between the anus and bulbar was observed superficially. This cutaneous central band was narrow and deeply formed with fibrous tissue. The fibrous band of the BSM that connects to the median raphe was observed to connect to the cutaneous fibers of the anal sphincter. The accessory superficial perineal muscle, which is located closer to the surface than the perineal membrane, was observed in 61.5% of all samples. The perineal body consists of superficial and deep layers. The muscles within the deep perineal pouch were not observed in the form of a fascia with the muscles aligned in a horizontal fashion but were hoof shaped (similar to the female anatomical structure of the compressor urethra muscle). The anterior side of the urethra was either short or wide. In cases with a urethra with a wide anterior side, muscle fibers were also observed around the anterior. Three-dimensional reconstructions of CT scans of the muscles of the urogenital diaphragm were performed. During image analysis, individual layers and patterns of the shallow layers were visualized and analyzed in detail on the 3D images. However, because the muscles in the deep layers were thin and exhibited various patterns, clear observation of their structure on the 3D images was limited.open박