Peroxisome Proliferator-Activated Receptor γ Activation Promotes Adipogenesis in Human Mesenchymal Stem Cells

Purpose: In this study, we determined that the troglitazones could induce uniform adipogenesis of human mesenchymal stem cells (MSCs) within a short time in a dose- and a time-dependent manners. Materials and Methods: Human MSCs were isolated from bone marrow and cultured in basal or adipogenic medium in the presence of 0 50 μM troglitazone for 5 days. Then we performed flow cytometry, RT-PCR and western blot analysis. Results: In FACS assay, troglitazone induced adipocyte differentiation in a dose-dependent manner. At concentration of 25 μM troglitazone in adipogenic medium, over 50% of the cells differentiated into adipocytes at day 5. This was accompanied by increased mRNA levels for the adipocyte gene markers (LPL, aP2 and PPARγ) in RT-PCR. In western blot analysis, we found that ERK phosphorylation was inhibited in the early stage of adipogenesis. Conclusion: Through the addition of troglitazone as a PPAR γ agonist, we could get the uniform adipogenic differentiation within a short time. Thus, troglitazone directly regulates differentiation of human MSCs into adipocytes; induced PPAR γ expression may play a key regulatory role in this process. And we suggest a role for ERK as a regulatory switch for these differentiation pathwaysope

Diagnostic Value of Distal Radio-ulnar Joint Arthrography in TFCC Tear

Purpose: When it seems that TFCC is injured, it is known that MR arthrography is the most excellent method to confirm among examinations. However, MR arthrography has demerit by its cost for the case that is not covered by medical insurance. In this study, it is discussed about the diagnostic value of Arthrography. Materials and Methods: Between March 2003 and July 2008, fifty-nine patients are selected who have possibility of TFCC injury by clinical examination. Arthrography was examined by injection of contrast media into distal radio-ulnar joint, Pain of arthrographic procedure is compared with intravenous injection by visual analogue scale (VAS). Results: In case of the arthrography, Conservative treatment for 43 normal cases by arthrographic finding. Among them, 35 cases (81%) showed favorable improvement of the symptom and finished follow-up only by 8.7weeks. In 16 cases who showed TFCC injury in arthrography, 7 cases were done arthroscopic surgery without further-evaluation. Other 9 cases were examined with MR arthrography, these cases showed same result as in the result by arthrography Conclusion: In case of possibility of TFCC injury by clinical examination, arthrography is regarded as available diagnosis method with its economical merit and there is no problem with the pain of patients during the arthrographic procedure.ope

The Treatment of Nonunion of the Scaphoid with a Horse-Shoe Bone Graft and Fixation with Two Screws

Purpose: Three dimensional anatomical reconstruction of an old scaphoid nonunion injury with a humpback deformity is not an easy procedure. The single interpositional bone graft technique has its limitation for accurate anatomic reconstruction. We report here on the effect of a cortical interpositional horse-shoe graft using two screws and a volar cancellous chip bone graft for the treatment of scaphoid nonunion with a humpback deformity or a miss-match fracture surface in scaphoid nonunion. Materials and Methods: We retrospectively reviewed nineteen patients who were treated for scaphoid nonunion using a cancellous chip bone graft and a cortical interpositional horse-shoe graft with 2 screws (a Herbert's screw and a mini screw). The mean follow up period was 24 months (range: 14-36 months). The mean age was 30.5 years (range: 17-52 years) and 18 patients were male and 1 patient was female. The mean period between injury and operation was 6.7 years (range: 1 to 30 years). The nonunion sites were located in the waist in 15 wrists and in the distal third in 4 wrists. The volar approach was used in 18 cases and the dorsal approach was used in 1 case. In 2 cases, one additional kirschner's wire was used due to the instability of fixation. The clinical results were assessed by the criteria of Maudesley and Chen at the last follow-up. Results: Bony union was obtained in 18 (95%) cases. The average time for union was 13 weeks. There were improvements in the scapholunate angle (from 65.2 degrees to 49.5 degrees) and the intrascaphoid angle (from 43.5 degrees to 29.6 degrees). There are 3 cases with excellent results, 10 cases with good results and 6 cases with fair results. There was one complication. In 1 case, a nonunion gap was seen at 7 months after operation, but there were no clinical symptoms. Conclusion: A cortical interpositional horse-shoe graft using two screws and a cancellous chip bone graft for treating scaphoid nonunion with a humpback deformity or a large defect seems to be an encouraging procedure for regaining the normal anatomy of the scaphoid.ope

Internal Fixation of Mallet Fractures Using a Hook Plate

Purpose: The purpose of this study is to introduce the result of treatment for bony mallet finger using hook plate Materials and Methods: From September 2007 to Feburary 2008, 7 patients were treated with hook plate for bony mallet finger. Indications of operative treatment are fractures involving more than 30% of articular surface or those with palmar subluxation or fracture fragment displaced more than 3 mm. We used hook plate which prebend the 1.2 mm miniplate (Leibinger?). The mean follow-up period was 7 months. The clinical results were evaluated using Crawford classification. Results: According to Crawford classification, 6 cases were excellent and 1 case was good. There were marginal necrosis in one case and nail deformities in 3 cases. These complications were healed spontaneously. Conclusion: Internal fixation of mallet finger using Hook plate is a relatively easy method which can achieve anatomical reduction and firm fixation for earlier interphalangeal joint exercise.ope

The Results of Treatment for Motor Vehicle-related Crushing Injuries of Foot in Children

Purpose: The purpose of this work was to describe the results of treatment for motor vehiclerelated crushing injuries among children and adolescents under sixteen years in Korea. Materials and Methods: A retrospective analysis was conducted of data from children who were under sixteen year and injured foot by motor vehicles. Cases were documented 1) age at the time of injury, 2) injured site, 3) the area of accident, 4) the kind of vehicle, 5) associated injuries, 6) methods of treatment for soft tissue reconstruction and 7) complications. The relationships between the area of accident and associated injuries, and the kind of vehicle and associated injuries were analyzed using Chi-square test and Fisher exact test. Results: There were 97 children who were 15 year and younger. The mean age was 7.4 years, and 65% were boys. The left foot was more dominant side of injury (57%). Seasonal variation was seen with the number of injuries peaking during the summer (43%, p<0.05). Among the vehicles, 78.3% were the large vehicles (bus, truck or van). The where of accident was more frequent at an alley or less than two lanes of traffic. But, the relationships between the place of accident and associated injury or the kind of vehicles and associated injury were not statistically significant. The associated injury were fracture or dislocation (23 cases, 35.9%), injury of tendon (21 cases, 32.8%). There were amputation or disarticulation of foot in 8 cases (8.2%) and post-traumatic deformities such as flatfoot, hindfoot varus or valus deformities by tendon injury in 7 cases (7.2%). Conclusion: More than 50% of crushing or degloving injuries of child's foot by traffic accidents happened in boys between 5 to 9 years old. The associated injury was unrelated with size of vehicles or accident place at the time of accident. But, even though foot injury happened in an alley or one lane by small vehicles, child who hurt feet by car need thorough investigation about associated injury. If a surgeon keep in mind and treat child to associated injury necessarily, can minimize complication. Microsurgical reconstruction for soft tissue defect was prior to other methods.ope

Idiopathic Avascular Necrosis of the Capitate

Idiopathic avascular necrosis of the capitate is a very rare condition. Only 7 cases have been reported until 2002 in the literature since the lesion was originally described by Jonsson in 1942. The incidence of the injury has not been documented and no report has been issued in Korea. The author experienced one case of idiopathic capitate avascular necrosis which was treated by curettage and autoiliac bone graft.ope

Osteogenic Potential of Human Mesenchymal Stem Cells During Serial Subculture

Purpose: The purpose of this study was to evaluate the osteogenic differentiation potential of human mesenchymal stem cells during serial subculture. Materials and Methods: Human bone marrow-derived MSCs were serially subcultured and then maintained in basal or osteogenic medium for 14 days. Then we performed FAC analysis, RT-PCR, alkaline phosphatase activity and stains. Results: Human MSCs had different morphologies, immunophenotypes, and growth rates that were correlated with the length of serial subculture. The phenotype changed from small spindle-shaped cells at passage 1 into large cuboidal or flattened cells at passage 7. The osteogenic capacity of human MSCs decreased during serial subculture. Using RT-PCR, the mRNA levels of bone-specific genes, such as cbfa1/runx2 and osteocalcin, decreased with increasing passage number. Strong positive staining was observed for ALP and Alizarin reds in osteogenic medium on day 14, but declined significantly with increasing passage number. Conclusion: We have shown that osteogenic potential of human MSCs decreased during serial subculture. This result can provide the helpful information to decide the timing of human MSC transplantation during in vitro culture expansion for treatment of bone defects and so on.ope

Free Flap Transfer for the Reconstruction of injured Hands

Purpose: The purpose is to analyze the clinical results of a free flap transfer for the reconstruction of variously injured hands. Materials and Methods: Between March 1983 and December 2002, we reviewed retrospectively 79 patients (68 mem, 11 women) treated for soft tissue defects or functional loss of hands or forearms. There were 49 mechanical injuries, 20 traffic accidents, 6 burn scars, 2 tumorous condition, 2 bite injuries. The results were evaluated with flap survival rate and functional score using 4 grading system of Jung’s criteria. Result: Sixty four out of total 79 flaps successfully survived (81%). There were 18 wrap around flaps (out of them 17 survived, 94%), 14 parascapular flaps (11, 78%), 16 groin flaps (14, 87%), 10 dorsalis pedis flaps (7, 70%), 5 lateral arm flaps (3, 60%), 3 deltoid flaps (2, 67%), 6 gracillis flaps (4, 67%), 3 first web space flaps (2, 67%), 2 latissimus dorsi flaps (2, 100%), 2 lateral thigh flaps (2, 100%). Out of survived 64 cases, excellent or good results were obtained in 62 cases. Conclusion: Free flap transfer for the reconstruction of injured hands is very useful method for the functional and cosmetic recovery. Especially combined transfer of several tissues enables the primary reconstruction and rapid recovery.ope

The role of DNA methylation to type II colagen expression in dedifferentiation of articular chondrocytes

Purpose: We explored the possibility of DNA methylation as a mechanism of loss of type II collagen expression in dedifferentiating chondrocytes by culturing in monolayer. Materials and Methods: Dedifferentiation was induced by low density subeulturing primary porcine chon￢drocytes in vitro. The mRNA expression of Type I collagen, Type II collagen and DNA methyltransferase (DNMT) was measured by RT-PCR. Induction of redifferentiation in dedifferentiated chondrocytes was performed in 3-dimensional alginate bead culture system As stimulating factors for reexpression of genes in dedifferentiated chondrocytes, 10 nglml TGF-f31 and 5,uM 5-azacytidine were used. Results: Type II collagen mRNAs was expressed strongly in freshly isolated cells but had decreased in monolayer cultured cells after 3 weeks up to 40%. In contrast, type I collagen expression was increased from 21 days and kept increasing during the 86 days of study. After treatment of 5 pM 5-azacytidine, fibroblast like morphology was changed to round shape such as traditional chondrocyte morphology at day 4. At day 10, type Ii collagen expression was increased by 5-azacytidine and TGF-(31 marginally and also integrin f31 expression was increased in all groups. RT-PCR analysis demonstrated that DNMT3A expression increased in dedifferentiating chondrocytes when compared with control cells for 40 days. Conclusion: Loss of type II collagen mRNA expression and increase of DNMT 3A expression were showed similar patterns during dedifferentiation. These results suggest that type II collagen gene expression may be influenced by DNA methylation. As stimulating factors, TGF-f31 and 5-azacytidine have potential activity to increase the type II collagen expression in alginate culture system.ope

Expression of Ubiquitin and Neural Cell Adhesion Molecule in the Muscles of Spastic Cerebral Palsy Patients

Purpose: This study was performed to examine the histopathologic changes of muscles and the expression patterns of ubiquitin and N-CAM (neural cell adhesion molecule) in accordance with cerebral palsy patient’s spasticity. Materials and Methods: We studied thirteen specimens from seven patients with spastic cerebral palsy, five patients suspected to have neuromuscular diseases, and one normal person. We performed the routine histologic procedures, the reverse transcriptional polymerase chain reaction (RT-PCR), and immunostaining. Results: There were no disease-specific abnormalities related with the degree of spasticity on histopathologic evaluation. However, in the cerebral palsy patients, the degree of spasticity seems to have positive correlations with the expression of ubiquitin gene and negative correlations with the expression of N-CAM gene. On the other hand, in the immunostaining procedures, the reactions to ubiquitin protein were all negative and reactions to N-CAM protein were strongly positive only in two hereditary motor sensory neuropathy patients. Conclusion: The results of our study seem to be caused by multiple mechanisms. If more studies about the changes after the transcription of ubiquitin and N-CAM genes are performed, these results can be applied to the research and treatment of cerebral palsy on molecular biologic aspects.ope