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Lu HY, Lin CC, Shih KS, Lu TW, Kuo MY, Li SY, Hsu HC. Integration of statistical shape modeling and alternating interpolation-based model tracking technique for measuring knee kinematics in vivo using clinical interleaved bi-plane fluoroscopy. PeerJ 2023; 11:e15371. [PMID: 37334125 PMCID: PMC10276557 DOI: 10.7717/peerj.15371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/18/2023] [Indexed: 06/20/2023] Open
Abstract
Background A 2D fluoroscopy/3D model-based registration with statistical shape modeling (SSM)-reconstructed subject-specific bone models will help reduce radiation exposure for 3D kinematic measurements of the knee using clinical alternating bi-plane fluoroscopy systems. The current study aimed to develop such an approach and evaluate in vivo its accuracy and identify the effects of the accuracy of SSM models on the kinematic measurements. Methods An alternating interpolation-based model tracking (AIMT) approach with SSM-reconstructed subject-specific bone models was used for measuring 3D knee kinematics from dynamic alternating bi-plane fluoroscopy images. A two-phase optimization scheme was used to reconstruct subject-specific knee models from a CT-based SSM database of 60 knees using one, two, or three pairs of fluoroscopy images. Using the CT-reconstructed model as a benchmark, the performance of the AIMT with SSM-reconstructed models in measuring bone and joint kinematics during dynamic activity was evaluated in terms of mean target registration errors (mmTRE) for registered bone poses and the mean absolute differences (MAD) for each motion component of the joint poses. Results The mmTRE of the femur and tibia for one image pair were significantly greater than those for two and three image pairs without significant differences between two and three image pairs. The MAD was 1.16 to 1.22° for rotations and 1.18 to 1.22 mm for translations using one image pair. The corresponding values for two and three image pairs were 0.75 to 0.89° and 0.75 to 0.79 mm; and 0.57 to 0.79° and 0.6 to 0.69 mm, respectively. The MAD values for one image pair were significantly greater than those for two and three image pairs without significant differences between two and three image pairs. Conclusions An AIMT approach with SSM-reconstructed models was developed, enabling the registration of interleaved fluoroscopy images and SSM-reconstructed models from more than one asynchronous fluoroscopy image pair. This new approach had sub-millimeter and sub-degree measurement accuracy when using more than one image pair, comparable to the accuracy of CT-based methods. This approach will be helpful for future kinematic measurements of the knee with reduced radiation exposure using 3D fluoroscopy with clinically alternating bi-plane fluoroscopy systems.
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Affiliation(s)
- Hsuan-Yu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, R.O.C.
| | - Cheng-Chung Lin
- Department of Electrical Engineering, Fu-Jen Catholic University, New Taipei, Taiwan, R.O.C.
| | - Kao-Shang Shih
- Department of Orthopedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C.
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, R.O.C.
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan, R.O.C.
| | - Mei-Ying Kuo
- Department of Physical Therapy, China Medical University, Taichung, Taiwan, R.O.C.
| | - Song-Ying Li
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, R.O.C.
| | - Horng-Chaung Hsu
- Department of Orthopaedic Surgery, China Medical University, Taichung, Taiwan, R.O.C.
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Lin CY, Wang YL, Chen YJ, Ho CT, Chi YH, Chan LY, Chen GW, Hsu HC, Hwang DW, Wu HC, Hung SC. Collagen-binding peptides for the enhanced imaging, lubrication and regeneration of osteoarthritic articular cartilage. Nat Biomed Eng 2022; 6:1105-1117. [PMID: 36229661 DOI: 10.1038/s41551-022-00948-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 09/02/2022] [Indexed: 01/15/2023]
Abstract
Treatments for osteoarthritis would benefit from the enhanced visualization of injured articular cartilage and from the targeted delivery of disease-modifying drugs to it. Here, by using ex vivo human osteoarthritic cartilage and live rats and minipigs with induced osteoarthritis, we report the application of collagen-binding peptides, identified via phage display, that are home to osteoarthritic cartilage and that can be detected via magnetic resonance imaging when conjugated with a superparamagnetic iron oxide. Compared with the use of peptides with a scrambled sequence, hyaluronic acid conjugated with the collagen-binding peptides displayed enhanced retention in osteoarthritic cartilage and better lubricated human osteoarthritic tissue ex vivo. Mesenchymal stromal cells encapsulated in the modified hyaluronic acid and injected intra-articularly in rats showed enhanced homing to osteoarthritic tissue and improved its regeneration. Molecular docking revealed WXPXW as the consensus motif that binds to the α1 chain of collagen type XII. Peptides that specifically bind to osteoarthritic tissue may aid the diagnosis and treatment of osteoarthritic joints.
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Affiliation(s)
- Chin-Yu Lin
- Drug Development Center, Institute of Translational Medicine and New Drug Development, School of Medicine, China Medical University, Taichung, Taiwan
| | - Yung-Li Wang
- Drug Development Center, Institute of Translational Medicine and New Drug Development, School of Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Jen Chen
- Integrative Stem Cell Center, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Te Ho
- Integrative Stem Cell Center, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Hsuan Chi
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan
| | - Long Yi Chan
- Drug Development Center, Institute of Translational Medicine and New Drug Development, School of Medicine, China Medical University, Taichung, Taiwan
| | - Guan-Wen Chen
- Molecular Science Center, GGA Corporation, Taipei, Taiwan
| | - Horng-Chaung Hsu
- Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan.,Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Dennis W Hwang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Han-Chung Wu
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan.
| | - Shih-Chieh Hung
- Drug Development Center, Institute of Translational Medicine and New Drug Development, School of Medicine, China Medical University, Taichung, Taiwan. .,Integrative Stem Cell Center, China Medical University Hospital, Taichung, Taiwan. .,Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan.
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Chan LY, Chang CC, Lai PL, Maeda T, Hsu HC, Lin CY, Kuo SJ. Cre/LoxP Genetic Recombination Sustains Cartilage Anabolic Factor Expression in Hyaluronan Encapsulated MSCs Alleviates Intervertebral Disc Degeneration. Biomedicines 2022; 10:biomedicines10030555. [PMID: 35327357 PMCID: PMC8945655 DOI: 10.3390/biomedicines10030555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Inexplicable low back and neck pain frequently results from spinal disc degeneration with an imbalanced intervertebral disc (IVD) cell homeostasis. We hypothesize that introducing MSC expressing a sustained cartilage-anabolic factor in the IVD may stimulate the mucoid materials secreted from the IVD cells, promote the MSC’s chondrogenesis and maintain the hydration content providing mechanical strength to decelerate the disc degeneration progression; (2) Methods: This study expressed a cartilage-anabolic factor runx1 by a baculoviral vector (BV) transduced MSCs through a Cre/LoxP gene editing and recombination system for sustained recombinant runx1 transcription factor production. The Cre/LoxP BV modified MSCs were encapsulated by hyaluronan hydrogel, due to its’ vital composition in ECM of a healthy disc and transplanted to a punctured coccygeal disc in rats through micro-injection, followed by X-ray radiography and histological analysis at the 4- and 12-weeks post-transplantation; (3) Results: Data reveals the Cre/LoxP BV system-mediated long-termed runx1 gene expression, possessing good biosafety characteristics in the in vitro cell transduction and in vivo MSCs transplantation, and maintained superior hydration content in the disc than that of mock transduced MSCs; (4) Conclusions: This proof-of-concept study fulfills the need of implanting therapeutic cells accompanied with microinjection in the disc, such as a discography and paves a road to manufacture composite hyaluronan, such as peptide modified hyaluronan as an MSC carrier for IVD regeneration in the future study.
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Affiliation(s)
- Long-Yi Chan
- Institute of New Drug Development, College of Medicine, China Medical University, Taichung 40402, Taiwan; (L.-Y.C.); (C.-C.C.)
| | - Cheng-Chung Chang
- Institute of New Drug Development, College of Medicine, China Medical University, Taichung 40402, Taiwan; (L.-Y.C.); (C.-C.C.)
| | - Po-Liang Lai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Tau-Yuan 333, Taiwan;
| | - Tomoji Maeda
- Tsuzuki Institute for Traditional Medicine, College of Pharmacy, China Medical University, Taichung 40402, Taiwan;
- Department of Pharmaceutical Sciences, Nihon Pharmaceutical University, Kitaadachi-gun, Saitama 362-0806, Japan
| | - Horng-Chaung Hsu
- School of Medicine, China Medical University, Taichung 40402, Taiwan;
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Chin-Yu Lin
- Institute of New Drug Development, College of Medicine, China Medical University, Taichung 40402, Taiwan; (L.-Y.C.); (C.-C.C.)
- Tsuzuki Institute for Traditional Medicine, College of Pharmacy, China Medical University, Taichung 40402, Taiwan;
- Master Program for Biomedical Engineering, Collage of Biomedical Engineering, China Medical University, Taichung 40402, Taiwan
- Correspondence: (C.-Y.L.); (S.-J.K.); Tel.: +886-4-2205-3366 (ext. 8108) (C.-Y.L.); +886-4-2205-2121 (ext. 5052) (S.-J.K.)
| | - Shu-Jui Kuo
- School of Medicine, China Medical University, Taichung 40402, Taiwan;
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 40447, Taiwan
- Correspondence: (C.-Y.L.); (S.-J.K.); Tel.: +886-4-2205-3366 (ext. 8108) (C.-Y.L.); +886-4-2205-2121 (ext. 5052) (S.-J.K.)
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Kumar A, Hung CH, Hsieh SL, Kuo CC, Mao JT, Lin ET, Hsu HC. Makoplasty medial unicondylar knee replacement: Correction or postoperative angle matters? Int J Med Robot 2021; 18:e2356. [PMID: 34921488 DOI: 10.1002/rcs.2356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Various considerations prevail around optimal postoperative varus deformity, correction angle and physiological constitutional varus deformity. The goal of our present study was to understand correlation between these parameters and their influence over Western Ontario McMaster University Osteoarthritis Index scale (WOMAC). MATERIALS AND METHODS Consecutive robotic-arm-assisted medial onlay fixed bearing unicompartmental knee arthroplasty (UKA) in 143 knees studied. WOMAC score was recorded preoperatively and at specific intervals after surgery for consecutive 2 years. RESULTS Mean preoperative and postoperative varus deformities were 10.2° and 4.8°, respectively, and mean correction angle was 5.4°. The preoperative varus and correction angles were found well correlated (r = 0.815). The amount of improvement in the WOMAC total score was not influenced by the postoperative varus angle. CONCLUSION The correction angle has a stronger correlation with preoperative varus deformity, and postoperative varus deformity does not imply favourable clinical outcomes.
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Affiliation(s)
- Abhishek Kumar
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hung Hung
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Shang-Lin Hsieh
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Chien-Chung Kuo
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Jui-Ting Mao
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Erh-Ti Lin
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
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Lu HY, Shih KS, Lin CC, Lu TW, Li SY, Kuo HW, Hsu HC. Three-Dimensional Subject-Specific Knee Shape Reconstruction with Asynchronous Fluoroscopy Images Using Statistical Shape Modeling. Front Bioeng Biotechnol 2021; 9:736420. [PMID: 34746102 PMCID: PMC8564181 DOI: 10.3389/fbioe.2021.736420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background and objectives: Statistical shape modeling (SSM) based on computerized tomography (CT) datasets has enabled reasonably accurate reconstructions of subject-specific 3D bone morphology from one or two synchronous radiographs for clinical applications. Increasing the number of radiographic images may increase the reconstruction accuracy, but errors related to the temporal and spatial asynchronization of clinical alternating bi-plane fluoroscopy may also increase. The current study aimed to develop a new approach for subject-specific 3D knee shape reconstruction from multiple asynchronous fluoroscopy images from 2, 4, and 6 X-ray detector views using a CT-based SSM model; and to determine the optimum number of planar images for best accuracy via computer simulations and in vivo experiments. Methods: A CT-based SSM model of the knee was established from 60 training models in a healthy young Chinese male population. A new two-phase optimization approach for 3D subject-specific model reconstruction from multiple asynchronous clinical fluoroscopy images using the SSM was developed, and its performance was evaluated via computer simulation and in vivo experiments using one, two and three image pairs from an alternating bi-plane fluoroscope. Results: The computer simulation showed that subject-specific 3D shape reconstruction using three image pairs had the best accuracy with RMSE of 0.52 ± 0.09 and 0.63 ± 0.085 mm for the femur and tibia, respectively. The corresponding values for the in vivo study were 0.64 ± 0.084 and 0.69 ± 0.069 mm, respectively, which was significantly better than those using one image pair (0.81 ± 0.126 and 0.83 ± 0.108 mm). No significant differences existed between using two and three image pairs. Conclusion: A new two-phase optimization approach was developed for SSM-based 3D subject-specific knee model reconstructions using more than one asynchronous fluoroscopy image pair from widely available alternating bi-plane fluoroscopy systems in clinical settings. A CT-based SSM model of the knee was also developed for a healthy young Chinese male population. The new approach was found to have high mode reconstruction accuracy, and those for both two and three image pairs were much better than for a single image pair. Thus, two image pairs may be used when considering computational costs and radiation dosage. The new approach will be useful for generating patient-specific knee models for clinical applications using multiple asynchronous images from alternating bi-plane fluoroscopy widely available in clinical settings. The current SSM model will serve as a basis for further inclusion of training models with a wider range of sizes and morphological features for broader applications.
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Affiliation(s)
- Hsuan-Yu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Kao-Shang Shih
- Department of Orthopedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Cheng-Chung Lin
- Department of Electrical Engineering, Fu Jen Catholic University, Taipei, Taiwan
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Song-Ying Li
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Hsin-Wen Kuo
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopaedic Surgery, China Medical University, Taipei, Taiwan
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Missiuna P, Shen J, Nahle I, Shen J, Alanazi M, Rutges J, Rocos B, Miyanji F, Lohkamp L, Grootjen L, Hachem L, Aldebeyan S, Machida M, Padhye K, Rushton P, Jentzsch T, Jentzsch T, Lewis S, Passias P, Pierce K, Lewis S, Passias P, Nielsen C, Glennie A, Crawford E, Schneider N, Ayling O, Christie S, Greene R, Singh S, Beauchamp-Chalifour P, Balasuberamaniam P, Singh S, Mercure-Cyr R, Wilson J, Evaniew N, Martin A, Rienmueller A, Martin A, Karim M, Martin A, Cheung A, Badhiwala J, Diotalevi L, Jaja B, Fallah N, Badhiwala J, Wasim A, Manson N, Lasry O, Crawford E, Brown A, MacLean MA, Khan O, Badhiwala J, Odai KG, Bailly N, Khan O, Evaniew N, Yamamoto S, Singh M, Kashigar A, Persad A, Fernandes RJR, Malakoutian M, Ahuja C, Morris S, Stukas S, Chen T, Babadagli E, Xu M, Nater A, Oitment C, Karim M, Aziz M, Pahuta M, Versteeg A, Sundararajan K, Tanguay R, Stratton A, Cushnie D, Correale M, Sadiq I, Badhiwala J, Passias P, Badhiwala J, McGregor S, Passias P, Badhiwala J, Chen T, Singh S, Ayling O, Bond M, Rienmueller A, Chen T, Lasry O, Lyons F, Ahmed U, Inglis T, Waheed Z, Wilson J, Nater A, Pahuta M, Klein G, McKibben N, Kassam F, Clement A, Kanawati A, Shaikh N, Kanawati A, Alshammari A, Kanawati A, Yamamoto S, Hamilton K, Huschi Z, Peng YN, Huschi Z, Filgueira É, Goulet J, Kashigar A, Chen T, Hadgaonkar S, MacLean M, Chen T, Kerr HL, Meagher J, Wilson J, Stevens M, Rocos B, Pai A, Kingwell S, Thibault J, Touchette C, Moskven E, Greene R, DeVries Z, Sarraj M, Bosakhar B, Thornley P, Donnellan J, Kishta W, Darby P, Nahle I, Alzakri A, Roy-Beaudry M, Joncas J, Turgeon I, Parent S, Shen J, Alzakri A, Roy-Beaudry M, Joncas J, Turgeon I, Parent S, Samson N, Lamontagne-Proulx J, Soulet D, Tremblay Y, Praud JP, Parent S, Parent S, Gross D, Renkens J, Schlösser T, Stadhouder A, Kruyt M, Mostert A, Tee J, de Klerk L, De Kleuver M, Castelein R, Zeller R, Lewis S, Tan T, Lebel D, Rushton P, Petcharaporn M, Samdani A, Newton P, Marks M, Drake J, Dirks P, Rutka J, Kulkarni A, Ibrahim G, Taylor M, Dewan M, Zeller R, Donze S, Damen L, Rutges J, Hokken-Koelega A, Mathieu F, Lamberti-Pasculi M, Hanak B, Zeller R, Kulkarni A, Drake J, Ibrahim G, Rushton P, Ghag R, Miyanji F, Zeller R, Lewis S, Lebel D, Peiro-Garcia A, Benavides B, Parsons D, Ferri-de-Barros F, Aldebeyan S, Ghag R, Miyanji F, Kutschke L, Laux C, Kabelitz M, Schüpbach R, Böni T, Farshad M, Nielsen C, Lewis S, Lenke L, Shaffrey C, Cheung K, Berven S, Qiu Y, Matsuyama Y, Pellisé-Urquiza F, Polly D, Sembrano J, Dahl B, Kelly M, de Kleuver M, Spruit M, Alanay A, Alas H, Kim HJ, Lafage R, Soroceanu A, Hockley A, Ames C, Klineberg E, Burton D, Diebo B, Bess S, Line B, Shaffrey C, Smith J, Schwab F, Lafage V, Passias P, Lafage R, Soroceanu A, Hockley A, Line B, Klineberg E, Bess S, Protopsaltis T, Shaffrey C, Schwab F, Scheer J, Smith J, Lafage V, Ames C, Lenke L, Shaffrey C, Cheung K, Berven S, Qiu Y, Matsuyama Y, Pellisé-Urquiza F, Polly D, Sembrano J, Dahl B, Kelly M, de Kleuver M, Spruit M, Alanay A, Bortz C, Pierce K, Alas H, Brown A, Soroceanu A, Hockley A, Vira S, Ahmad W, Naessig S, Diebo B, Raman T, Protopsaltis T, Buckland A, Gerling M, Lafage R, Lafage V, Lewis S, Lenke L, Shaffrey C, Cheung K, Berven S, Qiu Y, Matsuyama Y, Pellisé-Urquiza F, Polly D, Sembrano J, Dahl B, Kelly M, de Kleuver M, Spruit M, Alanay A, Bailey C, Rampersaud R, Fisher C, Chen T, McIntosh G, Rampersaud R, Karim M, Urquhart J, Fisher C, Street J, Dvorak M, Paquette S, Charest-Morin R, Ailon T, Glennie A, Manson N, Rampersaud R, Thomas K, Rasoulinejad P, Bailey C, Ailon T, Fisher C, Greene R, Glennie A, Duquette D, LeBlanc D, Martell B, Schmidt M, Christie S, Wong DBT, Di Paola C, Ailon T, Charest-Morin R, Dea N, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Street J, Flexman A, Charest-Morin R, Wasim A, Schwartz C, Stark R, Shrikumar M, Finkelstein J, Gara A, Banaszek D, Wong T, Ailon T, Bryce E, Charest-Morin R, Dea N, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Persad A, Spiess M, Wu A, Woo A, Hnenny L, Fourney D, Joshi H, Khan O, Badhiwala J, Rampersaud R, Lewis S, Massicotte E, Fehlings M, Cadotte D, Bailey C, Christie S, Dea N, Fisher C, Paquet J, Soroceanu A, Thomas KC, Rampersaud YR, Wilson J, Manson N, Johnson M, Hall H, McIntosh G, Jacobs B, Kalsi-Ryan S, Akbar MA, Badhiwala J, Wilson J, Tetreault L, Nouri A, Rienmuller A, Massicotte E, Fehlings M, Kalsi-Ryan S, Riehm L, Martin A, Badhiwala J, Akbar M, Massicotte E, Fehlings M, Kalsi-Ryan S, Akbar MA, Badhiwala J, Wilson J, Tetreault L, Nouri A, Rienmuller A, Massicotte E, Fehlings M, Jacobs B, Johnson M, Bailey C, Christie S, Paquet J, Nataraj A, Cadotte D, Wilson J, Manson N, Hall H, Thomas K, Rampersaud R, McIntosh G, Fisher C, Dea N, Wilson J, Jentzsch T, Jiang F, Badhiwala J, Moghaddamjou A, Akbar MA, Nater A, Rienmuller A, Ganau M, Massicotte E, Fehlings M, Tu L, Manouchehri N, Kim KT, So K, Webster M, Fisk S, Tigchelaar S, Dalkilic S, Sayre E, Streijger F, Macnab A, Kwon B, Shadgan B, Wilson J, Fehlings M, Bailly N, Wagnac E, Mac-Thiong JM, Goulet J, Petit Y, Badhiwala J, Grossman R, Geisler F, Fehlings M, Wilson J, Rivers C, Kwon B, Waheed Z, Buenaventura J, Humphreys S, Noonan V, Evaniew N, Dvorak M, Wilson J, Fehlings M, Shrikumar M, Balasuberamaniam P, Rapkin B, Schwartz C, Stark R, Finkelstein J, Bigney E, Darling M, Richardson E, El-Mughayyar D, Abraham E, Street J, Radomski L, Rampersaud R, Pierce K, Bortz C, Alas H, Naessig S, Ahmad W, Vira S, Diebo B, Sciubba D, Hassanzadeh H, Hockley A, Soroceanu A, Protopsaltis T, Buckland A, Passias P, Greene R, Christie SD, Badhiwala J, Fehlings M, Witiw C, Wilson J, Fehlings M, Nessek H, Wai E, Phan P, Diotalevi L, Beauséjour MH, Wagnac E, Mac-Thiong JM, Petit Y, Badhiwala J, Fehlings M, Mazlouman S, Belley-Côté E, Jacobs B, Kwon B, Malakoutian M, Theret M, Street J, Brown S, Rossi F, Oxland T, Singh P, Chandra S, Laratta J, Carreon L, Bisson E, Ghogawala Z, Yew A, Mkorombindo T, Mummaneni P, Glassman S, Kindrachuk M, Hnenny L, Wu A, Norton J, Fourney D, Gee A, Kerr HL, Kanawati A, Zdero R, Gurr K, Bailey C, Rasoulinejad P, Yamamoto S, Sadaram S, Speidel J, Liu J, Street J, Brown S, Oxland T, Khazaei M, Walji I, Dadabhoy M, Gulati N, Aiyar N, Ostmeier S, Hasan A, Senthilnathan V, Punjani N, Yao Y, Yue S, Ozdemir G, Lou Z, Luong W, Post A, Tootsi A, Chan P, Fehlings M, Yung A, George S, Prevost V, Bauman A, Kozlowski P, Samadi F, Fournier C, Parker L, Dong K, Streijger F, Moore W, Laule C, Kwon B, Gill J, Cooper J, Dong K, Streijger F, Street J, Paquette S, Ailon T, Charest-Morin R, Fisher C, Dvorak M, Dhall S, Mac-Thiong JM, Parent S, Bailey C, Christie S, Wellington C, Kwon B, Crawford E, Zhang Y, Hardisty M, Finkelstein J, Kureshi N, Julien L, Abidi R, Christie S, Parashin S, Gascoyne T, Goytan M, Chuang J, Liu K, Quraishi N, Pasku D, Wilson J, Fehlings M, Bozzo A, Reinmuller A, Martin A, Hananel SY, Thornley P, Gazendam A, Aoude A, Nielsen C, Rampersaud R, Dea N, Versteeg A, Sahgal A, Verlaan JJ, Morin RC, Rhines L, Sciubba D, Schuster J, Weber M, Lazary A, Fehlings M, Clarke M, Arnold P, Boriani S, Laufer I, Gokaslan Z, Fisher C, Rosenzweig D, Weber M, Fisk F, Versteeg A, Fisher C, Sahgal A, Gokaslan Z, Rhines L, Boriani S, Bettegowda C, Dea N, Gal R, Charest-Morin R, Verlaan JJ, Verkooijen L, Fisher C, Perruccio A, Rampersaud R, Eckenswiller D, Yu A, Klassen K, Lewkonia P, Thomas K, Jacobs B, Miller N, Swamy G, Yang M, Soroceanu A, Phan P, Wai E, Kingwell S, Moravek D, Tierney S, Street J, Sundararajan K, Bosma R, Faclier G, Di Renna T, Rampersaud R, Frederick A, Kassam F, Nicholls F, Swamy G, Lewkonia P, Thomas K, Jacobs B, Miller N, Tanguay R, Soroceanu A, Platt A, Traynelis V, Witiw C, Horn S, Weiser-Horwitz S, Bortz C, Segreto F, Pierce K, Lafage R, Hockley A, Vira S, Lafage V, Witiw C, Wilson J, Nassiri F, da Costa L, Nathens A, Fehlings M, Jacobs B, Alas H, Pierce K, Brown A, Bortz C, Hockley A, Soroceanu A, Vira S, Naessig S, Ahmad W, Lafage R, Lafage V, Witiw C, Wilson J, da Costa L, Nathens A, Fehlings M, Crawford E, McIntosh G, Rampersaud R, Fisher C, Manson N, Thomas K, Hall H, Rampersaud R, Dea N, McIntosh G, Charest-Morin R, Investigators CSORN, Ailon T, Fisher C, Evaniew N, Aldebeyan S, Thomas K, Sundararajan K, Oitment C, Lewis S, Perruccio A, Rampersaud R, Christie S, Yee A, Fisher C, Jarzem P, Roy JF, Bouchard J, Evans D, Kwon B, Splawinski J, Warren D, Street J, Morris S, Costello J, Farrell M, Humphreys S, Kurban D, Rivers C, Jeffrey M, Juutilainen S, Casha S, Christie S, Clarke T, Drew B, Ethans K, Fehlings M, Fox R, Linassi G, Marion T, O’Connell C, Paquet J, Reid J, Scott L, Fourney D, Schouten R, Rivers C, Chen M, Nunnerley J, Croot T, Young L, Patel A, Dvorak M, Kwon B, Rivers C, Buenaventura J, Humphreys S, Noonan V, Fallah N, Evaniew N, Dvorak M, Cronin S, Badhiwala J, Ginsberg H, Fehlings M, Kwon B, Jaglal S, Wilson J, Fehlings M, Fisk F, Versteeg A, Fisher C, Sahgal A, Gokaslan Z, Rhines L, Boriani S, Bettegowda C, Dea N, Martel A, Sahgal A, Finkelstein J, Whyne C, Hardisty M, Baksh N, Nguyen T, Brown S, Jaboin J, Lin C, Yach J, Hardisty M, Whyne C, Fernandez R, Gee A, Urquhart J, Bailey C, Rasoulinejad P, Zhang H, Shewchuk J, Street J, Wilson D, Oxland T, Fernandez R, Gee A, Urquhart J, Bailey C, Rasoulinejad P, Algarni N, Aljarboa N, Jarzem P, Fernandez R, Gee A, Urquhart J, Bailey C, Rasoulinejad P, Whyte T, Van Toen C, Melnyk A, Shewchuk J, Street J, Cripton P, Oxland T, Avila M, Hurlbert RJ, Neuburger L, Ahmed SU, Cheng Y, Fourney D, Hsu HC, Kao CH, Neuburger L, Ahmed SU, Cheng Y, Fourney D, Meves R, de Oliveira AI, da Silva HC, Richard-Denis A, Petit Y, Diotalevi L, Mac-Thiong JM, Laratta J, Bisson E, Carreon L, Yew A, Mkorombindo T, Glassman S, Christie S, Bouchard J, Fisher C, Roy JF, Yee A, Jarzem P, Khurjekar K, Kothari A, Zawar A, Sanchetui P, Shyam A, Touchette C, Han JH, Christie S, Pickett G, Yee A, Bouchard J, Christie S, Fisher C, Jarzem P, Roy JF, Hashem L, Urquhart J, Rasoulinejad P, Gurr K, Siddiqi F, Bailey C, Attabib N, Bigney E, Richardson E, El-Mughayyar D, Darling M, Manson N, Abraham E, Badhiwala J, Jiang F, Wilson J, Fehlings M, Dunning C, Oxner W, Stewart S, Glennie A, Hutchinson J, Oxland T, Zhang H, Shewchuk J, Wilson D, Street J, Wilk S, Wai E, Phan P, Stratton A, Mohammed S, Tsai E, Alkerayf F, Michalowski W, Phan P, Wai E, Hoda M, MacLean M, Brunette-Clément T, Abduljabba F, Weber M, Fourney D, Charest-Morin R, Flexman A, Street J, Frey M, Mackey S, De Carvalho D, Barrowman N, Smit K, Tice A, Mervitz D, Jarvis J, Kingwell S. Canadian Spine SocietyPresentation CPSS1: Spinal insufficiency fracture in the geriatric pediatric spinePresentation CPSS2: The clinical significance of tether breakages in anterior vertebral body growth modulation: a 2-year postoperative analysisPresentation CPSS3: Anterior vertebral body growth modulation for idiopathic scoliosis: early, mid-term and late complicationsPresentation CPSS4: Ovine model of congenital chest wall and spine deformity with alterations of respiratory mechanics: follow-up from birth to 3 monthsPresentation CPSS5: Test–retest reliability and minimum detectable change of the English translation of the Italian Spine Youth Quality of Life questionnaire in adolescents with idiopathic scoliosisPresentation B1. Abstract 31: Incidence of delayed spinal cord injury in pediatric spine deformity surgery seems to be higher than previously assumedPresentation B2. Abstract 155: What is the optimal surgical method for achieving successful symptom relief in pediatric high-grade spondylolisthesis?Presentation B3. Abstract 47: Vertebral body tethering: Truly motion preserving or rather limiting?Presentation B4. Abstract 180: Fusion rates in pediatric patients after posterior cervical spine instrumentationPresentation B5. Abstract 102: Effects of 8 years of growth hormone treatment on the onset and progression of scoliosis in children with Prader–Willi syndromePresentation B6. Abstract 144: Klippel–Feil syndrome: clinical phenotypes associated with surgical treatmentPresentation B7. Abstract 123: Anterior release for idiopathic scoliosis: Is it necessary for curve correction?Presentation B8. Abstract 62: Severe scoliosis: Do we know a better way? A retrospective comparative studyPresentation B9. Abstract 21: Intraoperative skull femoral traction in adolescent idiopathic scoliosis: the correlation of traction with side-bending radiographsPresentation B10. Abstract 147: What is the effect of intraoperative halo-femoral traction on correction of adolescent idiopathic scoliosis?Presentation B11. Abstract 174: Extreme long-term outcome of surgically versus non-surgically treated patients with adolescent idiopathic scoliosisPresentation B12. Abstract 172: The influence of multilevel spinal deformity surgery on the clinical outcome in the elderly: a prospective, observational, multicentre studyPresentation B13. Abstract 49: Demographics of a prospective evaluation of elderly deformity surgery: a prospective international observational multicentre studyPresentation B14. Abstract 119: Timing of conversion to cervical malalignment and proximal junctional kyphosis following surgical correction of adult spinal deformityPresentation B15. Abstract 44: Prioritization of realignment associated with superior clinical outcomes for surgical cervical deformity patientsPresentation B16. Abstract 50: Outcome of multilevel spinal deformity surgery in patients over 60 years of age: a multicentre international prospective studyPresentation B17. Abstract 122: A simpler, modified frailty index weighted by complication occurrence correlates to pain and disability for adult spinal deformity patientsPresentation B18. Abstract 75: Change in Oswestry Disability Index at 24 months following multilevel spinal deformity surgery in patients over 60 years of age: a multicentre international prospective studyPresentation C19. Abstract 19: A prospective cohort study evaluating trends in the surgical treatment of degenerative spondylolisthesis in Canada and the utility of a novel surgical decision aidPresentation C20. Abstract 154: Decompression compared with decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian Spine Outcomes and Research Network (CSORN) studyPresentation C21. Abstract ID 77: Lumbar degenerative spondylolisthesis: factors impacting decision to fusePresentation C22. Abstract 27: Patient-reported outcomes following surgery for lumbar disc herniation: comparison of a universal and multitier health care systemPresentation C23. Abstract 151: Do patients with recurrent lumbar disc herniations fair worse with discectomy than primary operations? A retrospective analysis from the Canadian Spine Outcomes and Research NetworkPresentation C24. Abstract 136: A province-wide assessment of the appropriateness of lumbar spine MRIPresentation D25. Abstract 32: Surgical site infection reduction — a 10-year quality improvement journeyPresentation D26. Abstract 34: The impact of frailty on patient-reported outcome measures following elective thoraco-lumbar spine surgeryPresentation D27. Abstract 8: Moving toward better health: exercise practice is associated with improved outcomes after spine surgeryPresentation D28. Abstract 33: Preoperative decolonization does not adversely affect the microbiologic spectrum of spine surgical site infectionPresentation D29. Abstract 61: Feedback: reducing after-hours spine cases using an encrypted messaging systemPresentation D30. Abstract 177: Complex spine surgery is safe and effective in the extremely elderly age group: results from an ambispective study of 722 patients over 75 years old from a single institutionPresentation E31. Abstract 38: Clinical predictors of achieving minimal clinically important difference after surgery for cervical spondylotic myelopathy: an external validation study from the Canadian Spine Outcomes and Research NetworkPresentation E32. Abstract 66: The natural history of degenerative cervical myelopathy: an ambispective longitudinal cohort studyPresentation E33. Abstract 159: Quantitative assessment of gait characteristics in degenerative cervical myelopathy (DCM): a prospective studyPresentation E34. Abstract 130: Prognostic factors in degenerative cervical myelopathy (DCM) for patients managed operatively and nonoperativelyPresentation E35. Abstract 175: Efficacy of surgical decompression in patients with cervical spondylotic myelopathy: results of a Canadian prospective multicentre studyPresentation E36. Abstract 67: Interobserver reliability of the modified Japanese Orthopedic Association (mJOA) score in degenerative cervical myelopathyPresentation F37. Abstract 128: Continuous optical monitoring of spinal cord hemodynamics during the first 7 days after injury in a porcine model of acute spinal cord injuryPresentation F38. Abstract 106: Development of a prediction model for central cord syndrome: an evaluation of motor recovery and the effectiveness of early surgery in a prospective, multicentre cohortPresentation F39. Abstract 135: Spinal cord dynamics under different clinical configurations of thoracolumbar burst fractures through numerical simulationsPresentation F40. Abstract 60: Predicting the heterogeneity of outcome following sensorimotor complete cervical spinal cord injury: trajectory-based analysis of 655 prospectively enrolled patientsPresentation F41. Abstract 167: Mortality in the year following discharge to the community from inpatient care for acute traumatic spinal cord injury: When and why?Presentation F42. Abstract 104: A novel method to classify patients with cervical incomplete spinal cord injury based on potential for recovery: a group-based trajectory analysis using prospective, multicentre data from over 800 patientsPresentation G43. Abstract 7: Responsiveness of standard spine outcome tools: Do they measure up?Presentation G44. Abstract 142: Patient outcomes: important psychological measuresPresentation G45. Abstract 84: Accuracy of surveillance for surgical site infections after spine surgery: a Bayesian latent class analysis using 4 independent data sourcesPresentation G46. Abstract 169: Econometric modelling: development of a surgical cost calculator for degenerative conditions of the lumbar spinePresentation G47. Abstract 124: The economic impact of nonreimbursable events in open, minimally invasive and robot-assisted lumbar fusion surgeryPresentation G48. Abstract 164: Are there sex differences in preoperative health status and health care delivery for patients undergoing scheduled lumbar surgery? An analysis from the Canadian Spine Outcomes and Research NetworkPresentation H49. Abstract 41: Patient phenotypes associated with functional outcomes after spinal cord injury: a principal component analysis in 1119 patientsPresentation H50. Abstract 103: Early versus late surgical decompression for acute traumatic spinal cord injury: a pooled analysis of prospective, multicentre data in 1548 patientsPresentation H51. Abstract 79: Clinical outcome correlation of diffusion tensor imaging and magnetic resonance imaging values: a systematic reviewPresentation H52. Abstract 137: A numerical study on the pathogenesis of central cord syndromePresentation H53. Abstract 42: Feasibility and utility of machine learning in prediction of bladder outcomes after spinal cord injury: analysis of 1250 patients from the European Multicenter Study about Spinal Cord Injury (EMSCI) registryPresentation H54. Abstract 18: Interventions to optimize spinal cord perfusion in patients with acute traumatic spinal cord injuries: a systematic reviewPresentation i55. Abstract 55: The effect of posterior lumbar spinal surgery on passive stiffness of rat paraspinal muscles 13 weeks post-surgeryPresentation i56. Abstract 43: A computed tomographic based morphometric analysis of the axis in adult populationPresentation i57. Abstract 92: Is there value to flexion–extension x-rays for degenerative spondylolisthesis? A multicentre retrospective studyPresentation i58. Abstract 98: The novel “7/20 EMG protocol” in combination with O-arm image-guided navigation for accurate lumbar pedicle placement while minimizing diagnostic radiation exposurePresentation i59. Abstract 148: Comparative biomechanical study of 2 types of transdiscal fixation implants for high-grade L5/S1 spine spondylolisthesis in a porcine modelPresentation i60. Abstract 85: The effects of fibre bundle size and vertebral level on passive stiffness of the lumbar paraspinal muscles in a rat modelPresentation J61. Abstract 157: A self-assembling peptide biomaterial to enhance human neural stem cell-based regeneration of the injured spinal cordPresentation J62. Abstract 162: Measuring demyelination, axonal loss and inflammation after human spinal cord injury with quantitative magnetic resonance imaging and histopathologyPresentation J63. Abstract 179: Characterization of ubiquitin C-terminal hydrolase L1 (UCH-L1) as a fluid biomarker of human traumatic spinal cord injuryPresentation J64. Abstract 13: Utility and role of virtual reality based simulation models in spinal decompression trainingPresentation J65. Abstract 160: Investigating the determinants for predicting surgical patient outcomes through the application of machine learning methodsPresentation J66. Abstract 143: Comparison of screw design and technique on cervical lateral mass screw fixationPresentation K67. Abstract 57: Development of clinical prognostic models for postoperative survival and quality of life in patients with surgically treated metastatic epidural spinal cord compressionPresentation K68. Abstract 170: Sarcomas of the spine: a 20-year survey of disease and treatment strategy in Ontario, CanadaPresentation K69. Abstract 15: Metastatic spine disease: Should patients with short life expectancy be denied surgical care? An international retrospective cohort studyPresentation K70. Abstract 29: Nanoparticle-functionalized polymethyl methacrylate bone cement for sustained chemotherapeutic drug deliveryPresentation K71. Abstract 90: Development of the Spine Oncology Study Group Outcomes Questionnaire – 8 Domain (SOSGOQ-8D)Presentation K72. Abstract 6: Treatment expectations of patients with spinal metastases: What do we tell our patients?Presentation L73. Abstract 48: Factors related to risk of opioid abuse in primary care patients with low back painPresentation L74. Abstract 65: QI/QA of a transitional outpatient pain program for spinePresentation L75. Abstract 168: The effect of preoperative opioid use on hospital length of stay in patients undergoing elective spine surgeryPresentation L76. Abstract 163: Disability or pain: Which best predicts patient satisfaction with surgical outcome? A Canadian Spine Outcomes and Research Network (CSORN) studyPresentation L77. Abstract 58: Rapid access to interventional pain management for lumbar nerve root pain through collaborative interprofessional provider networksPresentation L78. Abstract 63: Chronic preoperative opioid use associated with higher perioperative resource utilization and complications in adult spinal deformity patientsPresentation M79. Abstract 108: Cervical disc arthroplasty versus anterior cervical discectomy and fusion: a longitudinal analysis of reoperationsPresentation M80. Abstract 46: Preliminary results of randomized controlled trial investigating the role of psychological distress on cervical spine surgery outcomes: a baseline analysisPresentation M81. Abstract 110: Operative versus nonoperative treatment of geriatric odontoid fractures: a study of North American trauma centresPresentation M82. Abstract 74: Clinical outcome of posterior cervical foraminotomy versus anterior cervical discectomy and fusionPresentation M83. Abstract 45: “Reverse Roussouly”: ratios of cervical to thoracic shape curvature in an adult cervical deformity populationPresentation M84. Abstract 109: Treatment of acute traumatic central cord syndrome: a study of North American trauma centresPresentation N85. Abstract 118: Comparing minimally invasive versus traditional open lumbar decompression and fusion surgery: a Canadian Spine Outcomes and Research Network (CSORN) studyPresentation N86. Abstract 54: Time to return to work after lumbar spine surgeryPresentation N87. Abstract 28: Patient-reported outcomes following surgery for lumbar spinal stenosis: comparison of a universal and multitier health care systemPresentation N88. Abstract 93: Outcomes of surgery in older adults with lumbar spinal stenosisPresentation N89. Abstract 162: Functional objective assessment using the TUG test is a useful tool to evaluate outcome in lumbar spinal stenosisPresentation N90. Abstract 36: A Canadian Spine Outcomes and Research Network (CSORN) matched-cohort study comparing lumbar fusion and disk arthroplastyPresentation o91. Abstract 171: Development of clinical practice guidelines for the management of traumatic spinal column and cord injuries in British Columbia: an approach to standardizing care of spine trauma patientsPresentation o92. Abstract 22: Notes from a small island: stemming the tide of a spinal deluge. The use of encrypted software applications to ensure accountability, quality control and surgical consensus in a national acute adult spinal surgery centrePresentation o93. Abstract 129: Traumatic spinal cord injuries among Aboriginal and non-Aboriginal populations in Canada: an ambispective outcomes studyPresentation o94. Abstract 132: Traumatic spinal cord injury in New Zealand and Canada: a comparative analysisPresentation o95. Abstract 150: Exploring the reasons for readmission following traumatic spinal cord injuryPresentation o96. Abstract 59: Exploring the epidemiology and impact of spinal cord injury in the elderly: a 15-year Canadian population-based cohort studyPresentation P1. Abstract 139: Incidence and management of spinal metastasis in Ontario: a population-based studyPresentation P2. Abstract 91: A general population utility valuation study for the Spine Oncology Study Group Outcomes Questionnaire – 8DPresentation P3. Abstract 158: Metastatic vertebrae segmentation by augmented 3D convolutional neural networkPresentation P4. Abstract 73: Risk factors for failure of radiation therapy for spinal metastasesPresentation P5. Abstract 68: Significance of extracanalicular cement extravasation in thoracolumbar kyphoplastyPresentation P6. Abstract 120: Modelling fracture in osteoblastic vertebraePresentation P7. Abstract 97: The development of novel 2-in-1 patient-specific, 3D-printed laminar osteotomy guides with integrated pedicle screw guidesPresentation P8. Abstract 56: Effect of pelvic retroversion on pelvic geometry and muscle morphometry from upright magnetic resonance imagingPresentation P9. Abstract 161: Anatomic relationship between the accessory process of the lumbar spine and the pedicle screw entry pointPresentation P10. Abstract 20: Novel chair to measure lumbar spine extensors strength in adultsPresentation P11. Abstract 95: Error measurement between human spine, 3D scans, CT-based models, and 3D-printed modelsPresentation P12. Abstract 52: The diagnostic precision of computed tomography for traumatic cervical spine injury: an in vitro investigationPresentation P13. Abstract 94: Epidural abscess causing spinal cord infarctionPresentation P14. Abstract 83: The nerve root sedimentation sign on magnetic resonance imaging is not only correlated with neurogenic claudication: association with all types of leg-dominant mechanical painPresentation P15. Abstract 3: Accuracy of robot-assisted compared with freehand pedicle screw placement in spine surgery: a meta-analysis of randomized controlled trialsPresentation P16. Abstract 82: A positive nerve root sedimentation sign on magnetic resonance imaging is associated with improved surgical outcomes in patients with back dominant painPresentation P17. Abstract 16: Thoracolumbar burst fracture: McCormack load-sharing classification —systematic review and single-arm meta-analysisPresentation P18. Abstract 86: Morphological features of thoracolumbar burst fractures associated with neurologic recovery after thoracolumbar traumatic spinal cord injuryPresentation P19. Abstract 89: Radiographic parameters of listhesis and instability are not associated with health status or clinical outcomes in grade 1 degenerative spondylolisthesisPresentation P20. Abstract 37: Predictive socioeconomic factors following lumbar disk arthroplasty: a Canadian Spine Outcomes and Research Network (CSORN) studyPresentation P21. Abstract 25: Effect of in situ fusion in lumbar spondylolisthesis on clinical outcomes and spino-pelvic sagittal balancingPresentation P22. Abstract 10: Sex differences in the surgical management of lumbar degenerative disease: a systematic reviewPresentation P23. Abstract 35: Two-year results of lumbar disk arthroplasty: a Canadian Spine Outcomes and Research Network (CSORN) studyPresentation P24. Abstract 78: Does disc morphology affect the success of nonoperative treatment of chronic sciatica from a lumbar disc herniation?Presentation P25. Abstract 141: Opioid prescribing patterns: preliminary investigationPresentation P26. Abstract 133: Frailty is a better predictor of complications than age alone after surgical treatment of degenerative cervical myelopathy: an ambispective study of 5107 elderly patients from the National Surgical Quality Improvement Program databasePresentation P27. Abstract 26: Pathway analysis in spine surgery: a model for evaluating length of stayPresentation P29. Abstract 156: Patients with adolescent idiopathic scoliosis (AIS) have different cervical lordosis than the normal populationPresentation P31. Abstract 64: Investigation of thoracic spinal muscle morphology with upright magnetic resonance imagingPresentation P32. Abstract 80: Postoperative complication prediction between spinal surgeons and a machine learning model: a comparative studyPresentation P33. Abstract 81: Is using a simplified procedural classification as accurate as using current procedural terminology codes to predict future complications in spinal surgery?Presentation P34. Abstract 88: Preoperative patient performance status and frailty phenotype as predictive factors of outcome in surgically treated patients with metastatic spinal disease: a systematic literature reviewPresentation P35. Abstract 101: The measurements of frailty and their application to spine surgeryPresentation P36. Abstract 131: The effect of prolonged sitting on muscle reflexes of the low backPresentation P37. Abstract 87: Implementing a rapid discharge pathway for adolescent idiopathic scoliosis in Canada. Can J Surg 2020. [DOI: 10.1503/cjs.014720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hung CH, Ko JY, Liao PS, Yeh CW, Hsu CC, Lin MC, Hsu HC, Kuo SJ. Epidemiology of fatal/non-fatal suicide among patients with chronic osteomyelitis (COM): a nationwide population-based study. J Int Med Res 2020; 48:300060520919238. [PMID: 32605410 PMCID: PMC7331771 DOI: 10.1177/0300060520919238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective Chronic osteomyelitis (COM) can induce systemic inflammation, and systemic inflammation may be associated with suicide tendency. However, no studies have investigated the correlation between COM and suicide tendency. Methods The aim of this population-based study was to determine the epidemiology of fatal/non-fatal suicide among COM patients. Subjects with at least two outpatient visits or one course of inpatient care diagnosed with COM were recruited into a COM cohort. The control/COM subject ratio was approximately 4:1 matched by age, sex, major depression coding and index year (COM patients). Subjects with suicide attempts before COM diagnosis and subjects aged <20 years were excluded. Results COM patients had 1.93 (95% confidence interval [CI]: 1.11–3.36) times the risk of fatal/non-fatal suicide as control subjects. Considering death as the competing event of fatal/non-fatal suicide, COM patients had 1.76 (95% CI: 1.03–3.01) times the risk of fatal/non-fatal suicide (competing risk regression model). The effect of COM on fatal/non-fatal suicide was more prominent among diabetic patients. COM severity also correlated with the risk of fatal/non-fatal suicide. Conclusions More attention must be paid to suicide tendency among COM patients.
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Affiliation(s)
- Chih-Hung Hung
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Jih-Yang Ko
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Pei-Shao Liao
- Department of Education, China Medical University Hospital, Taichung, Taiwan
| | - Chen-Wei Yeh
- Department of Education, China Medical University Hospital, Taichung, Taiwan
| | - Chieh-Cheng Hsu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Shu-Jui Kuo
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
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Peng YN, Tsai LC, Hsu HC, Kao CH. Accuracy of robot-assisted versus conventional freehand pedicle screw placement in spine surgery: a systematic review and meta-analysis of randomized controlled trials. Ann Transl Med 2020; 8:824. [PMID: 32793669 PMCID: PMC7396236 DOI: 10.21037/atm-20-1106] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This systematic review and meta-analysis investigated differences in accuracy, operation time, and radiation exposure time between robot-assisted and freehand techniques for pedicle screw insertion. Two investigators independently searched for articles on randomized controlled trials (RCTs) published from 2012 to 2019. The final meta-analysis included seven RCTs. We compared the accuracy of pedicle screw placement, operation time, and radiation exposure time between robot-assisted and conventional freehand groups. Seven RCTs included 540 patients and placement of 2,476 pedicle screws, of which 1,220 were inserted using the robot-assisted technique and 1,256 were inserted using the conventional freehand technique. The pedicle screw positions were classified using the Gertzbein and Robbins classification (grade A-E). The combined results of Grade A [odds ratio (OR) =1.68; 95% confidence intervals (CI): 0.82-3.44; P=0.16), Grade A+B (OR =1.70; 95% CI: 0.47-6.13; P=0.42), and Grade C+D+E (OR =0.59; 95% CI: 0.16-2.12; P=0.42) for the accuracy rate revealed no significant difference between the two groups. Subgroup analysis results revealed that the TiRobot-assisted technique presented a significantly improved pedicle screw insertion accuracy rate compared with that of the conventional freehand technique, based on Grade A, Grade A+B, and Grade C+D+E classifications. The SpineAssist-assisted technique presented an inferior pedicle screw insertion accuracy rate compared with that of the conventional freehand technique, based on Grade A, Grade A+B, and Grade C+D+E classifications. No difference between the Renaissance-assisted and conventional freehand techniques was noted for pedicle screw insertion accuracy rates, based on both Grade A (OR =1.58; 95% CI: 0.85-2.96; P=0.15), Grade A+B (OR =2.20; 95% CI: 0.39-12.43; P=0.37), and Grade C+D+E (OR =0.45; 95% CI: 0.08-2.56; P=0.37) classifications. Regarding operation time, robot-assisted surgery had significantly longer operation time than conventional freehand surgery. The robot-assisted group had significantly shorter radiation exposure time. Regarding the pedicle screw insertion accuracy rate, the TiRobot-assisted technique was superior, the SpineAssist-assisted technique was inferior, and Renaissance was similar to the conventional freehand technique.
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Affiliation(s)
- Yu-Ning Peng
- Department of Medicine, China Medical University Hospital, Taichung
| | - Li-Cheng Tsai
- Department of Medicine, China Medical University Hospital, Taichung
| | - Horng-Chaung Hsu
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung.,Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung
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Chen KJ, Ko CY, Ho TY, Chen HT, Hsu HC, Hung CH. A combination of bimalleolar fracture and fracture on talar body and neck: A rare case report. Medicine (Baltimore) 2020; 99:e20862. [PMID: 32590787 PMCID: PMC7328999 DOI: 10.1097/md.0000000000020862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Talar fracture accompanied with malleolar fracture is rare, and its management is complex. Ankle soft tissue is much thinner than other parts of the human body, and the shape of the ankle makes wounds difficult to close immediately after surgery, which may result in poor skin condition if the wound tension is too high. However, joint congruity and osteonecrosis are the main concerns of talar fracture. PATIENT CONCERNS A 57-year-old man presented at the emergency department following a motorcycle accident. DIAGNOSES Physical examination revealed swelling and tenderness of the left ankle and midfoot. The patient had comminuted talar fracture and was indicated for dual-screw fixation or even plate with screw fixation. INTERVENTIONS We performed single screw fixation after assessing the soft tissue condition and employed a technique of using continuous longitudinal force to bring together fracture fragments (ankle ligamentotaxis) during surgery. Open reduction with a mini-hook plate and tension band wire was used for bimalleolar fracture repair using the combined anteromedial and anterolateral approach with extension of the incision. Kirschner wire for temporary fixation was performed using ligamentotaxis, and a 2.4 headless screw was inserted from the posteromedial to the anterolateral direction. OUTCOMES The patient was discharged with a standard short leg splint and was instructed not to bear weight on the affected ankle for 2 months. The patient walked well without discomfort, and the Hawkins sign was clearly visible. Single screw fixation preserves the integrity of the talus bone as minimal space is used for this operative technique. Single screw fixation preserves more bony stock when most of the internal fixator is located within the bone. Additionally, surgery time is shorter than multiple implantations even when performing the same procedure; as a result, there was less ankle soft tissue swelling. LESSONS This case provides evidence of using the single screw fixation technique for addressing both malleolar and talar fractures, and that talar fracture management can be less aggressive with limited weight bearing and initial limited range of motion given the presence of malleolar fracture. The alignment and stability of bony fragments also benefit from ankle ligamentotaxis.
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Affiliation(s)
- Kuan-Ju Chen
- Department of Orthopedic Surgery, China Medical University Hospital
| | - Chih-Yuan Ko
- Department of Orthopedic Surgery, China Medical University Hospital
| | - Tsung-Yu Ho
- Department of Orthopedic Surgery, China Medical University Hospital
| | - Hsien-Te Chen
- Department of Orthopedic Surgery, China Medical University Hospital
- Spine Center, China Medical University Hospital
- Department of Sport Medicine, College of Health Care
| | - Horng-Chaung Hsu
- Department of Orthopedic Surgery, China Medical University Hospital
- Department of Orthopedic Surgery, School of Medicine, China Medical University, Taichung, Taiwan, R.O.C
| | - Chih-Hung Hung
- Department of Orthopedic Surgery, China Medical University Hospital
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Lin CW, Chang CC, Chen HT, Chen YJ, Lin CS, Hsu HC, Tsou HK. 3D Real-Time Image-Guided Navigation Spine Corpectomy with Ultrasonic Bone Cutter: Technical Note. World Neurosurg 2019; 135:197-204. [PMID: 31706972 DOI: 10.1016/j.wneu.2019.10.186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Surgical interventions for congenital scoliosis are challenging for spine surgeons. The coordination of 3-dimensional (3D), real-time, image-guided navigation with an ultrasonic bone cutter allows surgeons to localize the affected area of the spine accurately and remove the lesion without damaging soft tissue structures. The goal of this technical paper is to report a previously undescribed method of hemivertebrectomy that combines 3D, real-time, image-guided navigation and an ultrasonic bone cutter. We highlight the feasibility and safety of this method in spinal surgery. METHODS Three patients with congenital scoliosis were treated with this technique. We present three illustrative cases comprising hemivertebrectomies for congenital scoliosis. Intraoperative photos demonstrating the technique are also provided. RESULTS All surgeries were completed without complications. The hemivertebrae were completely removed, and marked correction of congenital scoliosis was noted. CONCLUSIONS We believe that the combination of 3D, real-time image navigation and an ultrasonic bone cutter improves hemivertebrectomy by increasing accuracy and avoiding dura laceration, major organ damage, or potential vessel damage.
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Affiliation(s)
- Chung-Wei Lin
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City, Taiwan (R.O.C.)
| | - Chien-Chun Chang
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City, Taiwan (R.O.C.); Department of Biological Science and Technology, National Chiao Tung University, Hsinchu City, Taiwan (R.O.C.); Ph.D. Degree Program of Biomedical Science and Engineering, National Chiao Tung University, Hsinchu City, Taiwan (R.O.C.); Spine Center, China Medical University Hospital, China Medical University, Taichung City, Taiwan (R.O.C.)
| | - Hsien-Te Chen
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City, Taiwan (R.O.C.); Department of Sports Medicine, College of Health Care, China Medical University, Taichung City, Taiwan (R.O.C.); Spine Center, China Medical University Hospital, China Medical University, Taichung City, Taiwan (R.O.C.).
| | - Yen-Jen Chen
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City, Taiwan (R.O.C.); Spine Center, China Medical University Hospital, China Medical University, Taichung City, Taiwan (R.O.C.); School of Medicine, China Medical University, Taichung City, Taiwan (R.O.C.)
| | - Chih-Sheng Lin
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu City, Taiwan (R.O.C.); Ph.D. Degree Program of Biomedical Science and Engineering, National Chiao Tung University, Hsinchu City, Taiwan (R.O.C.)
| | - Horng-Chaung Hsu
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City, Taiwan (R.O.C.); School of Medicine, China Medical University, Taichung City, Taiwan (R.O.C.)
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung City, Taiwan (R.O.C.); Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan (R.O.C.)
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Lin CY, Chang CC, Chen YJ, Tsai CH, Tsou HK, Lin CS, Ho MW, Chen HT, Hsu HC. New Strategy for Minimally Invasive Endoscopic Surgery to Treat Infectious Spondylodiscitis in the Thoracolumbar Spine. Pain Physician 2019; 22:281-293. [PMID: 31151336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Eradicating infection, protecting neurologic function, and maintaining structural alignment are the 3 objectives of treatment for infectious spondylodiscitis. For some patients, surgery may be necessary to achieve these goals; however, open surgeries are associated with high morbidity and mortality in elderly patients and those with multiple comorbidities. Endoscopic surgery provides a minimally invasive surgical option for obtaining a culture sample to aid identification of pathogens, while also providing a route for adequate decompression and drainage. The clinical results of this study were analyzed. OBJECTIVES To evaluate the efficacy and safety of spinal endoscopic surgery, the basic characteristics of patients analyzed and their inflammatory markers, pain levels, and local kyphotic angles were recorded before surgery and at regular intervals after surgery. The patients' cultured pathogens and previous antibiotic treatments were also recorded and analyzed. STUDY DESIGN Retrospective observational study (institutional review board: CMUH 105-REC2-101). SETTING Inpatient surgery center. METHODS From October 2006 to March 2017, of 508 patients who received spinal endoscopic surgery, 60 with infectious spondylodiscitis were treated using this new strategy. All 60 patients underwent plain film radiography and enhanced magnetic resonance imaging of the affected region to obtain evidence of infectious spondylodiscitis. The role of a computed tomography-guided biopsy and some indications for open surgery were replaced with endoscopic surgery. RESULTS All the patients reported rapid pain relief after endoscopic surgery and antibiotic treatment. No significant changes in sagittal alignment were observed in final follow-up radiography images. Causative pathogens were identified in 34 patients (culture rate: 77.27%) without previous antibiotic treatment. The patients' erythrocyte sedimentation rates and C-reactive protein levels had decreased significantly 3 months after endoscopic surgery. Two patients (3.3%) experienced infection relapse following initial endoscopic surgery; both of them were efficiently resolved through a second round of endoscopic surgery. No surgery-related complications were observed and no open spinal surgery was required during the follow-up period. LIMITATIONS This was a retrospective study; bias was unavoidable because of the single-center nature of the study design. CONCLUSIONS Regarding the culture rate, recurrence rate, kyphotic change, and surgery-related complications, this new strategy for endoscopic surgery is safe and effective for treating infectious spondylodiscitis in the thoracic or lumbar spine and may be considered a new trend in treating diseases of this type. KEY WORDS Spine, endoscopic, discectomy, spondylodiscitis, minimally invasive surgery.
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Affiliation(s)
- Chia-Yu Lin
- Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
| | - Chien-Chun Chang
- Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C.; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Yen-Jen Chen
- Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C.; School of Medicine, China Medical University, Taichung, Taiwan, R.O.C
| | - Chun-Hao Tsai
- Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C.; Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan, R.O.C
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.; Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan, R.O.C
| | - Chih-Sheng Lin
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Mao-Wang Ho
- Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
| | - Hsien-Te Chen
- Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C.; Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan, R.O.C
| | - Horng-Chaung Hsu
- Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C.; School of Medicine, China Medical University, Taichung, Taiwan, R.O.C
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Abstract
UNLABELLED Osteoporosis is a well-known bone disorder affecting people worldwide. Patients with osteoporosis have an increased risk of bone fracture. This study provides new information on the risk of developing osteoporosis post burn injury and the risk of fracture among those with osteoporosis developed. INTRODUCTION The relationship between burn injury and hip fracture risk is unclear. Population-based evaluation on relationships between burn injury and osteoporosis development and subsequent fractures is limited. We conducted a retrospective cohort study as the investigation. METHODS From the insurance data of Taiwan, we established a cohort of 43,532 patients with a burn injury in 2000-2012 and a comparison cohort of 174,124 individuals without such an injury, frequency matched by sex, age, and diagnosis date. Both cohorts were followed up to the end of 2013 to evaluate the occurrence of osteoporosis and hip fracture. RESULTS The incidence of osteoporosis was greater in the burn cohort than in the comparison cohort (6.40 vs. 4.75 per 1,000 person-years) with an adjusted IRR of 1.35 (95% confidence interval = 1.32-1.39). The incidence rates in both cohorts were greater in women than in men, increased with age, income, and Charlson comorbidity index. Patients with burns involving 20%-49% of total body surface area and with burns confined to the lower/upper limbs had the greatest incidence rates, 8.32 and 8.58 per 1,000 person-years, respectively. Osteoporosis incidence increased further to 22.7 per 1,000 person-years for burn victims with comorbid diabetes. The risk of fracture was over five-fold greater for burn victims with osteoporosis developed than for comparisons without osteoporosis. CONCLUSION Patients who have a burn injury deserve prevention intervention to reduce the risk of osteoporosis and fracture.
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Affiliation(s)
- O Kaewboonchoo
- Department of Public Health Nursing, Mahidol University Faculty of Public Health, Bangkok, Thailand
| | - F C Sung
- Department of Public Health Nursing, Mahidol University Faculty of Public Health, Bangkok, Thailand
- Department of Health Services Administration, China Medical University College of Public Health, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - C L Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - H C Hsu
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - C T Kuo
- Department of Public Health Nursing, Mahidol University Faculty of Public Health, Bangkok, Thailand.
- Department of Public Health, China Medical University College of Public Health, 91 Hseuh Shis Road, Taichung, 404, Taiwan.
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13
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Lin TH, Wang HC, Cheng WH, Hsu HC, Yeh ML. Osteochondral Tissue Regeneration Using a Tyramine-Modified Bilayered PLGA Scaffold Combined with Articular Chondrocytes in a Porcine Model. Int J Mol Sci 2019; 20:ijms20020326. [PMID: 30650528 PMCID: PMC6359257 DOI: 10.3390/ijms20020326] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 12/28/2022] Open
Abstract
Repairing damaged articular cartilage is challenging due to the limited regenerative capacity of hyaline cartilage. In this study, we fabricated a bilayered poly (lactic-co-glycolic acid) (PLGA) scaffold with small (200–300 μm) and large (200–500 μm) pores by salt leaching to stimulate chondrocyte differentiation, cartilage formation, and endochondral ossification. The scaffold surface was treated with tyramine to promote scaffold integration into native tissue. Porcine chondrocytes retained a round shape during differentiation when grown on the small pore size scaffold, and had a fibroblast-like morphology during transdifferentiation in the large pore size scaffold after five days of culture. Tyramine-treated scaffolds with mixed pore sizes seeded with chondrocytes were pressed into three-mm porcine osteochondral defects; tyramine treatment enhanced the adhesion of the small pore size scaffold to osteochondral tissue and increased glycosaminoglycan and collagen type II (Col II) contents, while reducing collagen type X (Col X) production in the cartilage layer. Col X content was higher for scaffolds with a large pore size, which was accompanied by the enhanced generation of subchondral bone. Thus, chondrocytes seeded in tyramine-treated bilayered scaffolds with small and large pores in the upper and lower parts, respectively, can promote osteochondral regeneration and integration for articular cartilage repair.
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Affiliation(s)
- Tzu-Hsiang Lin
- Department of Biomedical Engineering, National Cheng Kung University, 1 University Rd., Tainan 701, Taiwan.
| | - Hsueh-Chun Wang
- Department of Biomedical Engineering, National Cheng Kung University, 1 University Rd., Tainan 701, Taiwan.
| | - Wen-Hui Cheng
- Department of Biomedical Engineering, National Cheng Kung University, 1 University Rd., Tainan 701, Taiwan.
| | - Horng-Chaung Hsu
- Department of Orthopedics, China Medical University Hospital, 2 Yude Rd., Taichung 40447, Taiwan.
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, 1 University Rd., Tainan 701, Taiwan.
- Medical Device Innovation Center, National Cheng Kung University, 1 University Rd., Tainan 701, Taiwan.
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14
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Wang HC, Lin YT, Lin TH, Chang NJ, Lin CC, Hsu HC, Yeh ML. Intra-articular injection of N-acetylglucosamine and hyaluronic acid combined with PLGA scaffolds for osteochondral repair in rabbits. PLoS One 2018; 13:e0209747. [PMID: 30596714 PMCID: PMC6312252 DOI: 10.1371/journal.pone.0209747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 12/11/2018] [Indexed: 01/08/2023] Open
Abstract
Repairing damaged articular cartilage is particularly challenging because of the limited ability of cartilage to perform self-repair. Intra-articular injections of N-acetylglucosamine (GlcNAc) comprise a method of repairing full-thickness articular cartilage defects in the rabbit knee joint model. To date, the effects of administration of GlcNAc and hyaluronic acid (HA) have been investigated only in the context of osteoarthritis treatment. Therefore, we evaluated the therapeutic effects of using cell-free porous poly lactic-co-glycolic acid (PLGA) graft implants and intra-articular injections of GlcNAc or HA in a rabbit model of osteochondral regeneration to investigate whether they have the potential for inducing osteochondral regeneration when used alone or simultaneously. Twenty-four rabbits were randomized into one of four groups: the scaffold-only group (PLGA), the scaffold with intra-articular injections of GlcNAc (PLGA+G) group, twice per week for four weeks; the scaffold with intra-articular injections of HA group (PLGA+HA) group, once per week for three weeks; and the scaffold with intra-articular injections of GlcNAc and HA (PLGA+G+HA) group, once per week for three weeks. Knees were evaluated at 4 and 12 weeks after surgery. At the end of testing, only the PLGA+G+HA group exhibited significant bone reconstruction, chondrocyte clustering, and good interactions with adjacent surfaces at 4 weeks. Additionally, the PLGA+G+HA group demonstrated essentially original hyaline cartilage structures that appeared to have sound chondrocyte orientation, considerable glycosaminoglycan levels, and reconstruction of the bone structure at 12 weeks. Moreover, the PLGA+G+HA group showed organized osteochondral integration and significantly higher bone volume per tissue volume and trabecular thickness. However, there were no significant differences between the PLGA+G and PLGA+HA groups except for gap formation on subchondral bone in the PLGA+G group. This study demonstrated that PLGA implantation combined with intra-articular injections of GlcNAc and HA allowed for cartilage and bone regeneration and significantly promoted osteochondral regeneration in rabbits without supplementation of exogenous growth factors. And the combination of this two supplements with PLGA scaffold could also prolong injection interval and better performance than either of them alone for the reconstruction of osteochondral tissue in the knee joints of rabbits.
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Affiliation(s)
- Hsueh-Chun Wang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Lin
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Hsiang Lin
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Jen Chang
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Chan Lin
- Laboratory Animal Center, Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
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15
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Huang BR, Bau DT, Chen TS, Chuang IC, Tsai CF, Chang PC, Hsu HC, Lu DY. Pro-Inflammatory Stimuli Influence Expression of Intercellular Adhesion Molecule 1 in Human Anulus Fibrosus Cells through FAK/ERK/GSK3 and PKCδ Signaling Pathways. Int J Mol Sci 2018; 20:ijms20010077. [PMID: 30585203 PMCID: PMC6337379 DOI: 10.3390/ijms20010077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/06/2018] [Accepted: 12/22/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Intervertebral disc (IVD) degeneration and disc herniation are major causes of lower back pain, which involve the presence of inflammatory mediators and tissue invasion by immune cells. Intercellular adhesion molecule 1 (ICAM1, also termed CD54) is an adhesion molecule that mediates cell-cell interactions, particularly between immune cells and target tissue. The aim of this study was to examine the intracellular signaling pathways involved in inflammatory stimuli-induced ICAM1 expression in human anulus fibrosus (AF) cells. METHODS Quantitative reverse transcription-polymerase chain reaction (qPCR), western blotting, and flow cytometry were performed to dissect the roles of different signaling pathways in inflammatory stimuli-mediated ICAM1 expression. RESULTS Using qPCR and western blot analyses, a significant increase in ICAM1 expression was observed in AF cells after stimulation of lipopolysaccharide (LPS) plus interferon-gamma (IFNγ) in a time-dependent manner. Flow cytometry revealed ICAM1 upregulation on the surface of AF cells. Importantly, LPS plus IFNγ treatment also significantly promoted Chemokine ligand (CCL)2 expression, but not CCL3. The enhanced ICAM1 expression was abolished after incubation with antibody against CCL2. In AF cells, treatment with LPS plus IFNγ activated the FAK/ERK/GSK3 signaling pathways, promoted a time-dependent increase in PKCδ phosphorylation, and promoted PKCδ translocation to the nucleus. Treatment with the pharmacological PKCδ inhibitor; rottlerin, effectively blocked the enhanced productions of ICAM1 and CCL2. CONCLUSIONS Inflammatory stimuli in AF cells are part of a specific pathophysiology in IVD degeneration and disc herniation that modulates CCL2/ICAM1 activation through the FAK/ERK/GSK3 and PKCδ signaling pathways in AF cells.
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Affiliation(s)
- Bor-Ren Huang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 40402, Taiwan.
- Neurosurgery Department, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 42743, Taiwan.
- School of Medicine, Tzu Chi University, Hualien 97002, Taiwan.
| | - Da-Tian Bau
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 40402, Taiwan.
| | - Tzu-Sheng Chen
- Department of Pathology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 42743, Taiwan.
| | - I-Chen Chuang
- Department of Pharmacology, School of Medicine, China Medical University, Taichung 40402, Taiwan.
| | - Cheng-Fang Tsai
- Department of Biotechnology, Asia University, Taichung 41354, Taiwan.
| | - Pei-Chun Chang
- Department of Bioinformatics, Asia University, Taichung 41354, Taiwan.
| | - Horng-Chaung Hsu
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 40402, Taiwan.
| | - Dah-Yuu Lu
- Department of Pharmacology, School of Medicine, China Medical University, Taichung 40402, Taiwan.
- Department of Photonics and Communication Engineering, Asia University, Taichung 41354, Taiwan.
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Tsai CH, Tsai HC, Huang HN, Hung CH, Hsu CJ, Fong YC, Hsu HC, Huang YL, Tang CH. Correction: Resistin promotes tumor metastasis by down-regulation of miR-519d through the AMPK/p38 signaling pathway in human chondrosarcoma cells. Oncotarget 2018; 9:35598. [PMID: 30473753 PMCID: PMC6238971 DOI: 10.18632/oncotarget.26303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Chun-Hao Tsai
- Department of Medicine and Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Hsiao-Chi Tsai
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan
| | - Ho-Ning Huang
- Department of Biotechnology, College of Health Science, Asia University, Taichung, Taiwan
| | - Chih-Hung Hung
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Chin-Jung Hsu
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Yi-Chin Fong
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Horng-Chaung Hsu
- Department of Medicine and Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yuan-Li Huang
- Department of Biotechnology, College of Health Science, Asia University, Taichung, Taiwan
| | - Chih-Hsin Tang
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan.,Department of Biotechnology, College of Health Science, Asia University, Taichung, Taiwan.,Department of Pharmacology, School of Medicine, China Medical University, Taichung, Taiwan
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Chiu YC, Tsai MT, Hsu CE, Hsu HC, Huang HL, Hsu JT. New fixation approach for transverse metacarpal neck fracture: a biomechanical study. J Orthop Surg Res 2018; 13:183. [PMID: 30045774 PMCID: PMC6060459 DOI: 10.1186/s13018-018-0890-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/12/2018] [Indexed: 11/18/2022] Open
Abstract
Background Fifth metacarpal neck fracture, also known as boxer’s fracture, is the most common metacarpal fracture. Percutaneous Kirschner-wire (K-wire) pinning has been shown to produce favorable clinical results. However, the fixation power of K-wires is a major concern. Plate fixation is also a surgical option, but it has the disadvantages of tendon adhesion, requirement of secondary surgery for removal of the implant, and postoperative joint stiffness. A fixation method that causes little soft tissue damage and provides high biomechanical stability is required for patients with fifth metacarpal neck fracture for whom surgical intervention is indicated. The present study proposed fixation using K-wires and a cerclage wire to treat fifth metacarpal neck fracture. The fixation power of this new method was compared with that of K-wires alone and plates. Methods We used a saw blade to create transverse metacarpal neck fractures in 16 artificial metacarpal bone specimens, which were then treated with four types of fixation as follows: (1) locking plate with five locking bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two K-wires (K group), and (4) two K-wires and a figure-of-eight cerclage wire (KW group). The specimens were tested by using cantilever bending testing on a material testing system. The stiffness of the four fixation types was determined by observing force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the Mann–Whitney exact test was performed to conduct paired comparison between the fixation types. Results The fixation strength levels of the four fixation approaches for treating fifth metacarpal neck fracture were ranked in a descending order of LP group (24.6 ± 5.1 N/mm, median ± interquartile range) > RP group (22.2 ± 5.8 N/mm) ≅ KW group (20.1 ± 3.2 N/mm) > K group (16.9 ± 3.0 N/mm). Conclusion The fixation strength of two K-wires was significantly higher when reinforcement was provided using a figure-of-eight cerclage wire. The strength of the proposed approach is similar to that of a regular plate with five bicortical screws but weaker than that of a locking plate with the same amount of bicortical screws. Cerclage wire-integrated K-wires can be an alternative method that avoids the excessive soft tissue dissection required for plating in open reduction internal fixation for fifth metacarpal neck fracture.
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Affiliation(s)
- Yung-Cheng Chiu
- School of Medicine, China Medical University, Taichung, 404, Taiwan.,Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan, Republic of China
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, 433, Taiwan
| | - Cheng-En Hsu
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung, 407, Taiwan.,Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, 407, Taiwan
| | - Horng-Chaung Hsu
- School of Medicine, China Medical University, Taichung, 404, Taiwan.,Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan, Republic of China
| | - Heng-Li Huang
- School of Dentistry, College of Dentistry, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 413, Taiwan
| | - Jui-Ting Hsu
- School of Dentistry, College of Dentistry, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 413, Taiwan.
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Lin CC, Li JD, Lu TW, Kuo MY, Kuo CC, Hsu HC. A model-based tracking method for measuring 3D dynamic joint motion using an alternating biplane x-ray imaging system. Med Phys 2018; 45:3637-3649. [PMID: 29889983 DOI: 10.1002/mp.13042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/10/2018] [Accepted: 06/05/2018] [Indexed: 11/10/2022] Open
Abstract
PURPOSES To propose a new model-based tracking method for measuring three-dimensional (3D) dynamic joint kinematics using a clinical alternating biplane x-ray imaging system; and to quantify in vitro its errors in measuring ankle and knee motions at different motion speeds. METHODS A new model-based tracking method based on motion component partition and interpolation (MCPI) was developed for measuring 3D dynamic joint kinematics based on a clinical alternating biplane x-ray imaging system. Two detectors of the biplane imaging system placed perpendicular to each other were operated to collect alternating fluoroscopic images of the targeted joint during tasks. The CT data of the joint were also acquired for the reconstruction of volumetric and surface models of each of the associated bones. The CT-based models of the bones were first registered to the alternating images using a model-to-single-plane fluoroscopic image registration method, and the resulting bone poses were then refined using a two-level optimization with motion component partition and model vertex trajectory interpolation. The MCPI method was evaluated in vitro for measurement errors for an ankle and a knee specimen moving at different speeds against a standard reference provided by a highly accurate motion capture system. The positional and rotational errors of the measured bone poses were quantified in terms of the bias, precision, and root-mean-squared errors (RMSE), as well as the mean target registration error (mTRE), a final mTRE less than 2.5 mm indicating a successful registration. RESULTS The new method was found to have RMSE of bone pose measurements of less than 0.18 mm for translations and 0.72° for rotations for the ankle, and 0.33 mm and 0.74° for the knee with a high successful registration rate (>97%), and did not appear to be affected by joint motion speeds. Given the same alternating fluoroscopic images, the MCPI method outperformed the typical biplane analysis method assuming zero time offset between the two fluoroscopic views. The differences in performance between the methods were increased with increased joint motion speed. With the accurate bone pose data, the new method enabled talocrural, subtalar, and tibiofemoral kinematics measurements with submillimeter and subdegree accuracy, except for an RMSE of 1.04° for the internal/external rotation of the talocrural joint. CONCLUSIONS A new model-based tracking method based on MCPI has been developed for measuring dynamic joint motions using an alternating biplane x-ray imaging system widely available in medical centers. The MCPI method has been demonstrated in vitro to be highly accurate in determining the 3D kinematics of the bones of both the ankle joint complex and the knee. The current results suggest that the MCPI method would be an effective approach for measuring in vivo 3D kinematics of dynamic joint motion in a clinical setting equipped with an alternating biplane x-ray imaging system.
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Affiliation(s)
- Cheng-Chung Lin
- Department of Electrical Engineering, Fu Jen Catholic University, New Taipei City, 24205, Taiwan
| | - Jia-Da Li
- Institute of Biomedical Engineering, National Taiwan University, Taipei, 10051, Taiwan
| | - Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, Taipei, 10051, Taiwan
- Department of Orthopaedic Surgery, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan
| | - Mei-Ying Kuo
- Department of Physical Therapy, China Medical University, Taichung, 40402, Taiwan
| | - Chien-Chung Kuo
- Department of Orthopaedic Surgery, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopaedic Surgery, China Medical University Hospital, Taichung, 40447, Taiwan
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Kuo SJ, Hsu HC, Wang CJ, Siu KK, Hsu YH, Ko JY, Tang CH. Effects of computer-assisted navigation versus conventional total knee arthroplasty on the levels of inflammation markers: A prospective study. PLoS One 2018; 13:e0197097. [PMID: 29758073 PMCID: PMC5951551 DOI: 10.1371/journal.pone.0197097] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 03/13/2018] [Indexed: 01/06/2023] Open
Abstract
Total knee arthroplasty (TKA) is a well-established modality for the treatment of advanced knee osteoarthritis (OA). However, the detrimental effects of intramedullary reaming used in conventional TKA for distal femur cutting are of concern. Avoiding intramedullary reaming with the use of computer-assisted navigation TKA can not only provide superior prosthetic alignment, but also mitigate perioperative blood loss and the dissipation of marrow emboli. We quantified local and systemic concentrations of inflammation markers for both techniques. Forty-four participants undergoing computer-assisted navigation and 53 receiving conventional TKA for advanced knee OA were recruited between 2013/02/08 and 2015/12/09. Blood samples were collected from all participants at baseline then again at 24 and 72 hours postoperatively and analyzed by ELISA for interleukin 6 (IL-6), IL-10, tumor necrosis factor alpha (TNF-α) and transforming growth factor beta 1 (TGF-β1); these markers were also measured in Hemovac drain fluid collected at 24 and 72 hours. Serum levels of IL-6, IL-10, TNF-α and TGF-β1(unit for all markers: pg/mL) were increased from baseline by smaller increments in the navigation TKA cohort compared with the conventional TKA group at 24 hours (17.06 vs 29.39, p = 0.02; 0.51 vs 0.83, p = 0.16; -0.04 vs 0.36, p < 0.01 and -48.18 vs 63.24, p< 0.01, respectively) and at 72 hours (12.27 vs 16.87, p = 0.01; -0.40 vs 0.48, p < 0.01; 0.58 vs 0.98, p = 0.07 and -55.16 vs 63.71, p < 0.01, respectively). IL-10 levels in drainage fluids collected 24 hours after TKA were also significantly lower in the navigation group versus the conventional TKA group (8.55 vs 12.32, p < 0.01). According to our evidence, the merits of computer-assisted navigation TKA are augmented by low levels of inflammation markers.
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Affiliation(s)
- Shu-Jui Kuo
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Horng-Chaung Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Jen Wang
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ka-Kit Siu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ya-Hung Hsu
- Core lab for phenomics and diagnostics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Center for shockwave medicine and tissue engineering, department of medical research, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jih-Yang Ko
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Core lab for phenomics and diagnostics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Center for shockwave medicine and tissue engineering, department of medical research, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of orthopedic surgery, Xiamen Chang Gung Hospital, Fujian, China
- * E-mail: (JYK); (CHT)
| | - Chih-Hsin Tang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Chinese Medicine Research Center, China Medical University, Taichung, Taiwan
- Department of Pharmacology, School of Medicine, China Medical University, Taichung, Taiwan
- Department of Biotechnology, College of Health Science, Asia University, Taichung, Taiwan
- * E-mail: (JYK); (CHT)
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20
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Kaewboonchoo O, Sung FC, Lin CL, Hsu HC, Kuo CT. Hip fracture risk in patients with burn injury: a retrospective cohort study in Taiwan. Osteoporos Int 2017; 28:3415-3420. [PMID: 28875313 DOI: 10.1007/s00198-017-4209-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 08/22/2017] [Indexed: 11/25/2022]
Abstract
UNLABELLED This work aimed to evaluate the hip fracture risk for patients with burn injury. A total of 16,430 patients with burn injury had an adjusted hazard ratio of 1.54 to encounter a hip fracture, compared with controls without the injury. These results encourage future studies focusing on mechanisms leading to fracture associated with burn injury. INTRODUCTION The relationship between burn injury and hip fracture risk is unclear. We conducted a retrospective cohort study to investigate this relationship. METHODS From insurance data of Taiwan, we identified a cohort with 16,430 burn patients in 2000-2010 and a comparison cohort of 65,716 persons without the history of burn, frequency matched by sex, age, and diagnosis date. Both cohorts were followed up to the end of 2011 to evaluate the risk of hip fracture. RESULTS Patients with burn injury were 1.62-fold more likely than comparisons to encounter a hip fracture (6.95 vs. 4.28 per 1000 person-years), with an adjusted hazard ratio (aHR) of 1.54 (95% confidence interval (CI) = 1.40-1.68). The fracture incidence increased with age and is slightly greater for women than for men in both cohorts. The fracture risk was greater for patients with burn in the eyes, face, and head with an incidence of 7.14 per 1000 person-years, or an aHR of 2.09 (95% CI = 1.53, 2.86). Diabetes and osteoporosis were also associated with an increased hip fracture risk. CONCLUSION Burn injury is associated with an increased risk of hip fracture. Diabetes and osteoporosis are associated with an enhanced risk.
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Affiliation(s)
- O Kaewboonchoo
- Department of Public Health Nursing, Mahidol University Faculty of Public Health, Khet Ratchathewi, Thailand
| | - F C Sung
- Department of Public Health Nursing, Mahidol University Faculty of Public Health, Khet Ratchathewi, Thailand
- Department of Health Services Administration, China Medical University College of Public Health, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - C L Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - H C Hsu
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - C T Kuo
- Department of Public Health Nursing, Mahidol University Faculty of Public Health, Khet Ratchathewi, Thailand.
- Department of Public Health, China Medical University College of Public Health, 91 Hseuh Shih Road, Taichung, 404, Taiwan.
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Lee YH, Wu HC, Yeh CW, Kuan CH, Liao HT, Hsu HC, Tsai JC, Sun JS, Wang TW. Enzyme-crosslinked gene-activated matrix for the induction of mesenchymal stem cells in osteochondral tissue regeneration. Acta Biomater 2017; 63:210-226. [PMID: 28899816 DOI: 10.1016/j.actbio.2017.09.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/26/2017] [Accepted: 09/02/2017] [Indexed: 11/18/2022]
Abstract
The development of osteochondral tissue engineering is an important issue for the treatment of traumatic injury or aging associated joint disease. However, the different compositions and mechanical properties of cartilage and subchondral bone show the complexity of this tissue interface, making it challenging for the design and fabrication of osteochondral graft substitute. In this study, a bilayer scaffold is developed to promote the regeneration of osteochondral tissue within a single integrated construct. It has the capacity to serve as a gene delivery platform to promote transfection of human mesenchymal stem cells (hMSCs) and the functional osteochondral tissues formation. For the subchondral bone layer, the bone matrix with organic (type I collagen, Col) and inorganic (hydroxyapatite, Hap) composite scaffold has been developed through mineralization of hydroxyapatite nanocrystals oriented growth on collagen fibrils. We also prepare multi-shell nanoparticles in different layers with a calcium phosphate core and DNA/calcium phosphate shells conjugated with polyethyleneimine to act as non-viral vectors for delivery of plasmid DNA encoding BMP2 and TGF-β3, respectively. Microbial transglutaminase is used as a cross-linking agent to crosslink the bilayer scaffold. The ability of this scaffold to act as a gene-activated matrix is demonstrated with successful transfection efficiency. The results show that the sustained release of plasmids from gene-activated matrix can promote prolonged transgene expression and stimulate hMSCs differentiation into osteogenic and chondrogenic lineages by spatial and temporal control within the bilayer composite scaffold. This improved delivery method may enhance the functionalized composite graft to accelerate healing process for osteochondral tissue regeneration. STATEMENT OF SIGNIFICANCE In this study, a gene-activated matrix (GAM) to promote the growth of both cartilage and subchondral bone within a single integrated construct is developed. It has the capacity to promote transfection of human mesenchymal stem cells (hMSCs) and the functional osteochondral tissues formation. The results show that the sustained release of plasmids including TGF-beta and BMP-2 from GAM could promote prolonged transgene expression and stimulate hMSCs differentiation into the osteogenic and chondrogenic lineages by spatial control manner. This improved delivery method should enhance the functionalized composite graft to accelerate healing process in vitro and in vivo for osteochondral tissue regeneration.
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Affiliation(s)
- Yi-Hsuan Lee
- Institute of Biomedical Engineering, National Tsing Hua University, Taiwan
| | - Hsi-Chin Wu
- Department of Materials Engineering, Tatung University, Taiwan
| | - Chia-Wei Yeh
- Department of Materials Science and Engineering, National Tsing Hua University, Taiwan
| | - Chen-Hsiang Kuan
- Department of Plastic and Reconstructive Surgery, National Taiwan University Hospital, Taiwan
| | - Han-Tsung Liao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopedics, China Medical University Hospital, Taiwan
| | - Jui-Che Tsai
- Department of Materials Engineering, Tatung University, Taiwan
| | - Jui-Sheng Sun
- Institute of Biomedical Engineering, National Tsing Hua University, Taiwan; Department of Orthopedic Surgery, National Taiwan University Hospital, Taiwan.
| | - Tzu-Wei Wang
- Institute of Biomedical Engineering, National Tsing Hua University, Taiwan; Department of Materials Science and Engineering, National Tsing Hua University, Taiwan.
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22
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Abstract
The modulation instability (MI) is a universal mechanism that is responsible for the disintegration of weakly nonlinear narrow-banded wave fields and the emergence of localized extreme events in dispersive media. The instability dynamics is naturally triggered, when unstable energy sidebands located around the main energy peak are excited and then follow an exponential growth law. As a consequence of four wave mixing effect, these primary sidebands generate an infinite number of additional sidebands, forming a triangular sideband cascade. After saturation, it is expected that the system experiences a return to initial conditions followed by a spectral recurrence dynamics. Much complex nonlinear wave field motion is expected, when the secondary or successive sideband pair that is created is also located in the finite instability gain range around the main carrier frequency peak. This latter process is referred to as higher-order MI. We report a numerical and experimental study that confirms observation of higher-order MI dynamics in water waves. Furthermore, we show that the presence of weak dissipation may counterintuitively enhance wave focusing in the second recurrent cycle of wave amplification. The interdisciplinary weakly nonlinear approach in addressing the evolution of unstable nonlinear waves dynamics may find significant resonance in other nonlinear dispersive media in physics, such as optics, solids, superfluids, and plasma.
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Affiliation(s)
- O Kimmoun
- Aix-Marseille University, CNRS, Centrale Marseille, IRPHE, Marseille, France
| | - H C Hsu
- Department of Marine Environment and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - B Kibler
- Laboratoire Interdisciplinaire Carnot de Bourgogne-UMR 6303 CNRS/Université Bourgogne Franche-Comté, 21078 Dijon, France
| | - A Chabchoub
- Department of Mechanical Engineering, Aalto University, 02150 Espoo, Finland
- School of Civil Engineering, The University of Sydney, Sydney, NSW 2006, Australia
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Hsu HC, Lee SY, Lai CM, Tsai WL, Chiu HT. 0820 LINKING STRESS TO PARENTING COMPETENCE AMONG TAIWANESE MOTHERS OF PRETERM INFANTS: THE MEDIATING ROLE OF SLEEP. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hsu HC, Lee SY. 0981 SLEEP AND PSYCHOLOGICAL DISTRESS: A CROSS-CULTURAL ANALYSIS COMPARING AMERICAN AND TAIWANESE MOTHERS OF LOW-BIRTH WEIGHT PRETERM INFANTS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hsu HC, Enosawa S, Yamazaki T, Tohyama S, Fujita J, Fukuda K, Kobayashi E. Enhancing Survival of Human Hepatocytes by Neonatal Thymectomy and Partial Hepatectomy in Micro-miniature Pigs. Transplant Proc 2017; 49:153-158. [PMID: 28104124 DOI: 10.1016/j.transproceed.2016.11.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND With the goal of in vivo cultivation of human hepatocytes that have not been sufficient in full differentiation in vitro, the advantage of neonatal thymectomy was verified on expansion of xenogeneic human hepatocyte in the micro-miniature pig (MMP). METHODS The thymus was excised immediately after the birth of the MMPs via cesarean section. Newborns were fed by artificial feeding under specific pathogen-free conditions. The thymectomized and nonthymectomized littermates were transplanted with human hepatocytes via a portal vein with or without partial hepatectomy at the MMP adult stage. RESULTS The growth of thymectomized MMPs and the sham operated littermates was not significantly different; the former weighed 1.98 ± 0.30 kg (average ± standard deviation, n = 4) and the latter weighed 2.28 ± 0.39 kg (n = 4) at 1 month of age, and 17.48 ± 1.92 kg and 16.75 ± 2.68 kg at 12 months of age. Blood thymosin α1 concentrations in the thymectomy group were significantly lower than in the control group (0.22 ± 0.05 ng/mL vs 0.46 ± 0.16 ng/mL; n = 4, 12 months old, P = .029). After human hepatocyte transplantation, human albumin levels were detectable on day 28 in the peripheral blood of the thymectomy plus hepatectomy group (14.3 ± 4.9 ng/mL [± range, n = 2]) but were not detectable even on day 21 in the control group. CONCLUSIONS Neonatal thymectomy was successfully achieved in infantile MMPs born via cesarean section. These pigs were considered to be an ideal in vivo bioreactor for human hepatocytes.
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Affiliation(s)
- H C Hsu
- Department of Organ Fabrication, Keio University School of Medicine, Tokyo, Japan; Division of Advanced Medical Sciences, National Center for Child Health and Development, Tokyo, Japan
| | - S Enosawa
- Department of Organ Fabrication, Keio University School of Medicine, Tokyo, Japan; Division of Advanced Medical Sciences, National Center for Child Health and Development, Tokyo, Japan
| | - T Yamazaki
- Division of Advanced Medical Sciences, National Center for Child Health and Development, Tokyo, Japan; Kohno Clinical Medicine Research Institute, Tokyo, Japan
| | - S Tohyama
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - J Fujita
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - K Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - E Kobayashi
- Department of Organ Fabrication, Keio University School of Medicine, Tokyo, Japan.
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Li JD, Lu TW, Lin CC, Kuo MY, Hsu HC, Shen WC. Soft tissue artefacts of skin markers on the lower limb during cycling: Effects of joint angles and pedal resistance. J Biomech 2017; 62:27-38. [PMID: 28410738 DOI: 10.1016/j.jbiomech.2017.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/20/2017] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
Abstract
Soft tissue artefacts (STA) are a major error source in skin marker-based measurement of human movement, and are difficult to eliminate non-invasively. The current study quantified in vivo the STA of skin markers on the thigh and shank during cycling, and studied the effects of knee angles and pedal resistance by using integrated 3D fluoroscopy and stereophotogrammetry. Fifteen young healthy adults performed stationary cycling with and without pedal resistance, while the marker data were measured using a motion capture system, and the motions of the femur and tibia/fibula were recorded using a bi-plane fluoroscopy-to-CT registration method. The STAs with respect to crank and knee angles over the pedaling cycle, as well as the within-cycle variations, were obtained and compared between resistance conditions. The thigh markers showed greater STA than the shank ones, the latter varying linearly with adjacent joint angles, the former non-linearly with greater within-cycle variability. Both STA magnitudes and within-cycle variability were significantly affected by pedal resistance (p<0.05). The STAs appeared to be composed of one component providing the stable and consistent STA patterns and another causing their variations. Mid-segment markers experienced smaller STA ranges than those closer to a joint, but tended to have greater variations primarily associated with pedal resistance and muscle contractions. The current data will be helpful for a better choice of marker positions for data collection, and for developing methods to compensate for both stable and variation components of the STA.
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Affiliation(s)
- Jia-Da Li
- Institute of Biomedical Engineering, National Taiwan University, Taiwan, ROC
| | - Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, Taiwan, ROC; Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taiwan, ROC.
| | - Cheng-Chung Lin
- Institute of Biomedical Engineering, National Taiwan University, Taiwan, ROC; Department of Electrical Engineering, Fu Jen Catholic University, Taiwan, ROC
| | - Mei-Ying Kuo
- Department of Physical Therapy, China Medical University, Taiwan, ROC
| | - Horng-Chaung Hsu
- Department of Orthopaedics, China Medical University, Taiwan, ROC; Department of Orthopaedic Surgery, School of Medicine, China Medical University, Taiwan, ROC
| | - Wu-Chung Shen
- Department of Radiology, China Medical University Hospital, Taichung, Taiwan, ROC; Department of Biomedical Imaging and Radiological Science, College of Health Care, China Medical University, Taichung, Taiwan, ROC
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Chen YJ, Chen HY, Chen HT, Lin RM, Hsu HC. Diagnosis of painful cemented vertebrae from failed vertebroplasty: modified dynamic radiographs play an important role. Eur Spine J 2017; 26:1953-1960. [PMID: 28364334 DOI: 10.1007/s00586-017-5056-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 02/10/2017] [Accepted: 03/21/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The diagnosis of painful cemented vertebrae resulting from failed PV is not clearly defined in literature. This report evaluates the effectiveness of modified dynamic radiographs in diagnosing painful cemented vertebrae resulting from failed PV. METHODS From January 2011 to June 2015, 345 patients with a total of 399 VCFs underwent PV at our institution. Among the 345 patients, 27 patients underwent repeated PV at the cemented vertebrae because of persisting or recurrent pain after vertebroplasty. The prevertebroplasty examinations included routine radiographs, modified dynamic radiographs, and MRI. Kyphotic angles and the anterior vertebral body height (AVBH) were measured. The image findings in routine radiographs, modified dynamic radiographs, and MRI were compared. Finally, a visual analog scale was used to measure the outcome. RESULTS The patients ranged in age from 67 to 90 years. MRI revealed a moderate amount of fluid (definite diagnosis of refracture) in the cemented vertebrae in seven patients, bone edema without fluid in nine patients, and bone edema with minimal fluid in ten patients. The rate of diagnosis of painful cemented vertebrae according to MRI was 27% (7/26). The difference in the kyphotic angle between sitting and supine cross-table lateral radiographs was -9.36° ± 5.20° (P < 0.001). The difference in AVBH was 8.08 ± 3.21 mm (P < 0.001). All 27 patients were confirmed to have dynamic mobility according to the modified dynamic radiographs. CONCLUSIONS When the diagnosis of painful cemented vertebrae is questionable, modified dynamic radiographs can help diagnose painful cemented vertebrae resulting from failed PV.
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Affiliation(s)
- Yen-Jen Chen
- Department of Orthopedic Surgery, School of Medicine, China Medical University, No. 91, Hsueh-Shuh Road, Taichung, 40402, Taiwan. .,Department of Orthopedic Surgery, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, 40402, Taiwan. .,Department of Public Health, China Medical University, No. 91, Hsueh-Shuh Road, Taichung, 40402, Taiwan. .,Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shuh Road, Taichung, 40402, Taiwan.
| | - Hui-Yi Chen
- Department of Radiology, Children's Hospital, China Medical University Hospital, China Medical University, No. 2, Yuh-Der Road, Taichung, 40402, Taiwan
| | - Hsien-Te Chen
- Department of Orthopedic Surgery, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, 40402, Taiwan.,School of Chinese Medicine, College of Chinese Medicine, China Medical University, No. 91, Hsueh-Shuh Road, Taichung, 40402, Taiwan
| | - Ruey-Mo Lin
- Department of Orthopedic Surgery, Tainan Municipal An-Nan Hospital, No. 66, Sec. 2, Changhe Rd., Annan Dist., Tainan, 709, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopedic Surgery, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, 40402, Taiwan.,School of Medicine, China Medical University, No. 91, Hsueh-Shuh Road, Taichung, 40402, Taiwan
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Kimmoun O, Hsu HC, Branger H, Li MS, Chen YY, Kharif C, Onorato M, Kelleher EJR, Kibler B, Akhmediev N, Chabchoub A. Modulation Instability and Phase-Shifted Fermi-Pasta-Ulam Recurrence. Sci Rep 2016; 6:28516. [PMID: 27436005 PMCID: PMC4951648 DOI: 10.1038/srep28516] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/20/2016] [Indexed: 11/09/2022] Open
Abstract
Instabilities are common phenomena frequently observed in nature, sometimes leading to unexpected catastrophes and disasters in seemingly normal conditions. One prominent form of instability in a distributed system is its response to a harmonic modulation. Such instability has special names in various branches of physics and is generally known as modulation instability (MI). The MI leads to a growth-decay cycle of unstable waves and is therefore related to Fermi-Pasta-Ulam (FPU) recurrence since breather solutions of the nonlinear Schrödinger equation (NLSE) are known to accurately describe growth and decay of modulationally unstable waves in conservative systems. Here, we report theoretical, numerical and experimental evidence of the effect of dissipation on FPU cycles in a super wave tank, namely their shift in a determined order. In showing that ideal NLSE breather solutions can describe such dissipative nonlinear dynamics, our results may impact the interpretation of a wide range of new physics scenarios.
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Affiliation(s)
- O Kimmoun
- Aix-Marseille University, CNRS, Centrale Marseille, IRPHE, Marseille, France
| | - H C Hsu
- Tainan Hydraulics Laboratory, National Cheng Kung University, Taiwan
| | - H Branger
- Aix-Marseille University, CNRS, Centrale Marseille, IRPHE, Marseille, France
| | - M S Li
- Tainan Hydraulics Laboratory, National Cheng Kung University, Taiwan
| | - Y Y Chen
- Tainan Hydraulics Laboratory, National Cheng Kung University, Taiwan
| | - C Kharif
- Aix-Marseille University, CNRS, Centrale Marseille, IRPHE, Marseille, France
| | - M Onorato
- Dipartimento di Fisica Generale, Universita degli Studi di Torino, Torino, Italy
| | - E J R Kelleher
- Femtosecond Optics Group, Department of Physics, Imperial College London, London, UK
| | - B Kibler
- Laboratoire Interdisciplinaire Carnot de Bourgogne, UMR 6303 CNRS UBFC, Dijon, France
| | - N Akhmediev
- Optical Sciences Group, Research School of Physics and Engineering, Institute of Advanced Studies, The Australian National University, Canberra ACT 020, Australia
| | - A Chabchoub
- Department of Ocean Technology Policy and Environment, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba 277-8563, Japan.,Department of Mechanical Engineering, Aalto University, 02150 Espoo, Finland
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Tsai CH, Muo CH, Hung CH, Lin TL, Wang TI, Fong YC, Hsu HC. Disorder-related risk factors for revision total hip arthroplasty after hip hemiarthroplasty in displaced femoral neck fracture patients: a nationwide population-based cohort study. J Orthop Surg Res 2016; 11:66. [PMID: 27277082 PMCID: PMC4897902 DOI: 10.1186/s13018-016-0400-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 05/19/2016] [Indexed: 01/01/2023] Open
Abstract
Background The choice of primary hip hemiarthroplasty or total hip arthroplasty for displaced femoral neck fracture is still controversial. Revision hip arthroplasty not only increases risk and cost but also could result in worse outcome. Determining the risk factors for revision can help inform medical decision-making and aid in risk stratification of publicly reported outcomes. Therefore, we conducted a nationwide population-based study to identify the disease-related risk factors and construct a risk score nomogram to predict revision surgery. Methods Records of all 68,030 femoral neck fracture patients receiving partial hemiarthroplasty (HA) in 2000–2010, with no total hip arthroplasty (THA) or revision HA history, were collected from the National Health Insurance Research Database. Cox proportional hazard regression was used to estimate the risk of revision hip replacement (RHA). The score of each risk factor was the quotient of the regression coefficient of the variable by the regression coefficient for a 10-year increase in age. The predictive accuracy was tested using the area under the receiver operating characteristic curve (AUROC). Results The revision risk for hemiarthroplasty increased in male, those with schizophrenia and end-stage renal disease patients had 1.58-, 1.88-, and 1.74-fold revision HA risk (95 % confidence interval (CI) = 1.40–1.78, 1.26–2.79, and 1.29–2.34, respectively). In a predictive model, the cumulative risk score ranged from 0 to 13 with a 5.08 to 91.82 % 10-year predicted RHA risk. The percentage of AUROC for 10-year RHA risk in nomogram was 61.9 (95 % CI = 60.0–63.4). Conclusions Males, schizophrenia and end-stage renal disease patients have higher risk of revision surgery after hemiarthroplasty for femoral neck fracture.
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Affiliation(s)
- Chun-Hao Tsai
- Department of Orthopedic Surgery, China Medical University Hospital, #91 Hsueh-Shih Road, Taichung, 404, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan.,Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hung Hung
- Tainan Municipal An-Nan Hospital-China Medical University, Tainan, Taiwan
| | - Tsung-Li Lin
- Department of Orthopedic Surgery, China Medical University Hospital, #91 Hsueh-Shih Road, Taichung, 404, Taiwan
| | - Ta-Ii Wang
- Department of Orthopedic Surgery, China Medical University Hospital, #91 Hsueh-Shih Road, Taichung, 404, Taiwan
| | - Yi-Chin Fong
- Department of Orthopedic Surgery, China Medical University Hospital, #91 Hsueh-Shih Road, Taichung, 404, Taiwan.,China Medical University Beigang Hospital, Yunlin, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopedic Surgery, China Medical University Hospital, #91 Hsueh-Shih Road, Taichung, 404, Taiwan. .,School of Medicine, China Medical University, Taichung, Taiwan. .,Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan.
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Hsieh HJ, Hu CC, Lu TW, Lu HL, Kuo MY, Kuo CC, Hsu HC. Evaluation of three force-position hybrid control methods for a robot-based biological joint-testing system. Biomed Eng Online 2016; 15:62. [PMID: 27268070 PMCID: PMC4897923 DOI: 10.1186/s12938-016-0195-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 05/23/2016] [Indexed: 12/02/2022] Open
Abstract
Background Robot-based joint-testing systems (RJTS) can be used to perform unconstrained laxity tests, measuring the stiffness of a degree of freedom (DOF) of the joint at a fixed flexion angle while allowing the other DOFs unconstrained movement. Previous studies using the force-position hybrid (FPH) control method proposed by Fujie et al. (J Biomech Eng 115(3):211–7, 1993) focused on anterior/posterior tests. Its convergence and applicability on other clinically relevant DOFs such as valgus/varus have not been demonstrated. The current s1tudy aimed to develop a 6-DOF RJTS using an industrial robot, to propose two new force-position hybrid control methods, and to evaluate the performance of the methods and FPH in controlling the RJTS for anterior/posterior and valgus/varus laxity tests of the knee joint. Methods An RJTS was developed using an industrial 6-DOF robot with a 6-component load-cell attached at the effector. The performances of FPH and two new control methods, namely force-position alternate control (FPA) and force-position hybrid control with force-moment control (FPHFM), for unconstrained anterior/posterior and valgus/varus laxity tests were evaluated and compared with traditional constrained tests (CT) in terms of the number of control iterations, total time and the constraining forces and moments. Results As opposed to CT, the other three control methods successfully reduced the constraining forces and moments for both anterior/posterior and valgus/varus tests, FPHFM being the best followed in order by FPA and FPH. FPHFM had root-mean-squared constraining forces and moments of less than 2.2 N and 0.09 Nm, respectively at 0° flexion, and 2.3 N and 0.14 Nm at 30° flexion. The corresponding values for FPH were 8.5 N and 0.33 Nm, and 11.5 N and 0.45 Nm, respectively. Given the same control parameters including the compliance matrix, FPHFM and FPA reduced the constraining loads of FPH at the expense of additional control iterations, and thus increased total time, FPA taking about 10 % longer than FPHFM. Conclusions The FPHFM would be the best choice among the methods considered when longer total time is acceptable in the intended clinical applications. The current results will be useful for selecting a force-position hybrid control method for unconstrained laxity tests using an RJTS.
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Affiliation(s)
- Hong-Jung Hsieh
- Institute of Biomedical Engineering, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Taipei, 100, Taiwan, R.O.C.,Department of Mechanical and Automation Engineering, Kao Yuan University, Kaohsiung, Taiwan
| | - Chih-Chung Hu
- Institute of Biomedical Engineering, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Taipei, 100, Taiwan, R.O.C.,Department of Mechanical Engineering, Ming Chi University of Technology, Taipei, Taiwan
| | - Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Taipei, 100, Taiwan, R.O.C. .,Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Hsuan-Lun Lu
- Institute of Biomedical Engineering, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Taipei, 100, Taiwan, R.O.C
| | - Mei-Ying Kuo
- Department of Physical Therapy, China Medical University, Taichung, Taiwan
| | - Chien-Chung Kuo
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
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Pan HF, Hsu HC, Chang WN, Renn JH, Wu HW. Strategies for obstacle crossing in older adults with high and low risk of falling. J Phys Ther Sci 2016; 28:1614-20. [PMID: 27313384 PMCID: PMC4905923 DOI: 10.1589/jpts.28.1614] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/06/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Tripping is a frequent cause of falls among aging adults. Appropriate limb
movements while negotiating obstacles are critical to trip avoidance. The aim of our study
was to investigate the mechanics of obstacle crossing in older adults at low or high risk
of falling. [Subjects and Methods] Twenty community-dwelling adults aged ≥55 years, were
evaluated with the Tinetti Balance and Gait scale and classified as being at high or low
risk of falling. Between-group comparisons of kinematics were evaluated for obstacle
heights of 10%, 20%, and 30% of leg length. [Results] The high-risk group demonstrated
greater toe-obstacle clearance of the leading leg. Increasing obstacle height led to
increased maximal toe-obstacle clearance, toe-obstacle distance, and shortened swing phase
of the leading limb. Adaptation of clearance height was greater for the trailing leg.
Individuals at high risk of falling demonstrated less symmetry between the leading and
trailing legs and a narrower step width, features that increase the likelihood of
tripping. [Conclusion] Kinematic parameters of obstacle clearance, including the symmetry
index described in our study, could provide clinicians with a quick screening tool to
identify patients at risk of falling and to evaluate outcomes of training programs.
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Affiliation(s)
- Hui-Fen Pan
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopaedics, China Medical University Hospital, Taiwan
| | - Wei-Ning Chang
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Taiwan
| | - Jenn-Huei Renn
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Taiwan
| | - Hong-Wen Wu
- Department of Physical Education, National Taiwan University of Sport, Taiwan
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Hsu HC, Tan CD, Chang CW, Chu CW, Chiu YC, Pan CJ, Huang HM. Evaluation of nasal patency by visual analogue scale/nasal obstruction symptom evaluation questionnaires and anterior active rhinomanometry after septoplasty: a retrospective one-year follow-up cohort study. Clin Otolaryngol 2016; 42:53-59. [PMID: 27102375 DOI: 10.1111/coa.12662] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the efficacy of septoplasty and the correlation between the subjective evaluations of a visual analogue scale (VAS) and the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire and active anterior rhinomanometry of the nasal airway after septoplasty. DESIGN A retrospective, individual cohort study. SETTING Ear, Nose and Throat Department, Taipei City Hospital, Taipei, Taiwan. PARTICIPANTS Fifty patients with chronic nasal obstruction were enrolled in the study. All 50 patients underwent septoplasty because of nasal septal deviation. Another 28 patients without nasal symptoms served as controls. MAIN OUTCOME MEASURES VAS, NOSE and active anterior rhinomanometry were used to measure the sensation of nasal obstruction. All measurements were performed in both groups preoperatively and then repeated on three postoperative visits (3, 6 and 12 months). RESULTS The mean VAS score, NOSE score and the nasal resistance in the narrow side of the nose in the study group showed reduced symptoms at 3, 6 and 12 months postoperatively compared with the respective preoperative measurements (P < 0.001, all). The VAS and NOSE scores did not significantly correlate with total nasal resistance preoperatively or postoperatively. The VAS and nasal resistance in the obstructed nasal cavity correlated significantly preoperatively (P < 0.05), but not postoperatively. CONCLUSIONS The subjective and objective symptoms of nasal obstruction had improved 1 year after septoplasty. A significant correlation between VAS scores and nasal resistance in the narrow side of the nose was found before surgery. The subjective and objective measurements of nasal obstruction lacked significant correlation postoperatively.
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Affiliation(s)
- H C Hsu
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan
| | - C D Tan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taiwan National University, Taipei, Taiwan
| | - C W Chang
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan
| | - C W Chu
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan
| | - Y C Chiu
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan
| | - C J Pan
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan
| | - H M Huang
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan.,Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Kuo SJ, Huang PH, Chang CC, Kuo FC, Wu CT, Hsu HC, Lin CC. Hepatitis B Virus Infection Is a Risk Factor for Periprosthetic Joint Infection Among Males After Total Knee Arthroplasty: A Taiwanese Nationwide Population-Based Study. Medicine (Baltimore) 2016; 95:e3806. [PMID: 27258517 PMCID: PMC4900725 DOI: 10.1097/md.0000000000003806] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Periprosthetic joint infection (PJI) is a grave complication that can affect patients undergoing total knee arthroplasty (TKA). In this study, we aim to determine whether hepatitis B virus (HBV) infection is a risk factor for PJIs.All patients (1184 males, 3435 females) undergoing primary TKA in Taiwan from 2001 to 2010 were recruited for analysis.The incidence of PJI was 523 among the males with HBV infection and 110 among the males without HBV (per 10,000 person-years, P < 0.001). The males with HBV infection had a 4.32-fold risk of PJI compared with the males without HBV. HBV infection and diabetes were the risk factors for PJI among males. The incidence of PJI was 58.8 among the females with HBV infection and 75.2 among the females without HBV (per 10,000 person-years, P = 0.67). The risk of PJI was higher for the males with HBV infection than for the males without 0.5 to 1 year after TKA (hazard ratio [HR] = 18.7, 95% confidence interval (CI) = 1.90-184) and >1 year after TKA (HR = 4.80, 95% CI = 1.57-14.7).HBV infection is a risk factor for PJI after TKA among males.
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Affiliation(s)
- Shu-Jui Kuo
- From the Graduate Institute of Clinical Medical Science, China Medical University (S-JK, H-CH); Department of Orthopedic Surgery, China Medical University Hospital, Taichung (S-JK, P-HH, C-CC, H-CH); Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung (F-CK, C-TW); and Management Office for Health Data, China Medical University Hospital (C-CL), Taichung, Taiwan
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Wang TI, Chen HY, Tsai CH, Hsu HC, Lin TL. Distances between bony landmarks and adjacent nerves: anatomical factors that may influence retractor placement in total hip replacement surgery. J Orthop Surg Res 2016; 11:31. [PMID: 26984637 PMCID: PMC4794908 DOI: 10.1186/s13018-016-0365-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 03/10/2016] [Indexed: 11/10/2022] Open
Abstract
Background Retractor placement is a leading cause of intraoperative nerve injury during total hip replacement (THR) surgery. The sciatic nerve, femoral nerve, and superior gluteal nerve are most commonly affected. This study aimed to identify the distances from bony landmarks in the hip to the adjacent nerves on magnetic resonance imaging (MRI) and the associations between anatomical factors and these distances that would guide the placement of retractors during THR surgery, in order to minimize the risk of nerve injury. Methods We reviewed hip MRIs of 263 adults and recorded the distances from (1) the anterior acetabular rim to the femoral nerve; (2) the superior acetabular rim to the superior gluteal nerve; (3) the posterior acetabular rim to the sciatic nerve; and (4) the greater trochanter to the sciatic nerve. The effects of anatomical factors (i.e., gender, age, body height, body mass index (BMI), pelvic width, and acetabular version and morphology) on these distances were analyzed. Results Distances from bony landmarks to adjacent nerves (in cm) were 2.06 ± 0.44, 2.23 ± 0.28, 1.94 ± 0.81, and 4.83 ± 0.26 for the anterior acetabular rim, superior acetabular rim, posterior acetabular rim, and greater trochanter, respectively, and were shorter in women than in men (P < 0.001). Multivariate analysis identified body height as the most influential factor (P < 0.001). Linear regression demonstrated a strong positive linear correlation between body height and these distances (Pearson’s r = 0.808, 0.823, 0.818, and 0.792, respectively (P < 0.001)). Conclusions The distances from bony landmarks to adjacent nerves provide useful information for placing retractors without causing nerve injury during THR surgery. Shorter patients will have shorter distances from bony landmarks to adjacent nerves, prompting more careful placement of retractors.
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Affiliation(s)
- Ta-I Wang
- Department of Orthopedics, China Medical University Hospital, China Medical University, Taichung, 40447, Taiwan
| | - Hui-Yi Chen
- Department of Radiology, China Medical University Hospital, China Medical University, Taichung, 40447, Taiwan
| | - Chun-Hao Tsai
- Department of Orthopedics, China Medical University Hospital, China Medical University, Taichung, 40447, Taiwan.,Graduate Institute of Clinical Medicine, School of Medicine, China Medical University, Taichung, 40447, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopedics, China Medical University Hospital, China Medical University, Taichung, 40447, Taiwan.,Graduate Institute of Clinical Medicine, School of Medicine, China Medical University, Taichung, 40447, Taiwan
| | - Tsung-Li Lin
- Department of Orthopedics, China Medical University Hospital, China Medical University, Taichung, 40447, Taiwan.
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Chang NJ, Lin YT, Lin CC, Wang HC, Hsu HC, Yeh ML. The repair of full-thickness articular cartilage defect using intra-articular administration of N-acetyl-D-glucosamine in the rabbit knee: randomized controlled trial. Biomed Eng Online 2015; 14:105. [PMID: 26582033 PMCID: PMC4652361 DOI: 10.1186/s12938-015-0100-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/06/2015] [Indexed: 01/13/2023] Open
Abstract
Background Although various alterative models of therapy are used for cartilage repair, no definite conclusion has been reached. Glucosamine (GlcN) is widely used as a nutritional supplement. However, the clinical- evidence-based outcome of GlcN administration remains controversial. N-acetyl-d-glucosamine (GlcNAc), a derivative of GlcN, shows chondroprotective activity and mediates the activation of articular chondrocytes. Therefore, we investigated the effect of intra-articular administration of GlcNAc in rabbits’ knee joints with experimental full-thickness articular cartilage (FTAC) defects. Methods Twelve male adult New Zealand white rabbits, providing 24 knees, were used in this study. FTAC defects were created in the high-weight-bearing area of the medial femoral condyles of bilateral knees. All rabbits were randomly allocated to analysis at postsurgical week 4 or postsurgical week 12. In the week 4 group, rabbits’ knees (six per group) were intra-articularly injected with normal saline or with GlcNAc twice per week for 3 weeks, beginning 1 week postoperatively. In the week 12 group, the rabbits’ knees (six in each group) were intra-articularly injected with normal saline or with GlcNAc twice per week for 4 weeks, beginning 1 week postoperatively. Rabbits were sacrificed at 4 or 12 weeks after surgery for macroscopic, histological and radiological examinations of the knee joints. Results All rabbits had no systemic or local adverse effects. The saline and GlcNAc groups showed visible differences in healing of the FTAC defect at the end of testing. At week 4, the GlcNAc group had a higher level of collagen type II (COL II) and showed up-regulated production of transforming growth factor (TGF)-β2 and TGF-β3, suggesting the involvement of endogenous growth factors. At week 12, the GlcNAc group displayed formation of hyaline-like cartilage regeneration with mature chondrocytes (SOX9+), robust glycosaminoglycan (GAG) content, and positive COL II content in both the adjacent cartilage and reparative sites. However, the saline group demonstrated mainly fibrocartilage scar tissue, indicating COL I expression. Furthermore, the GlcNAc group had significantly higher bone volume per tissue volume and higher trabecular thickness than the saline group. Conclusions Intra-articular GlcNAc may promote the repair of experimental FTAC defects in the rabbit knee joint model.
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Affiliation(s)
- Nai-Jen Chang
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Yi-Ting Lin
- Department of Biomedical Engineering, National Cheng Kung University, 1 University Rd., Tainan, 701, Taiwan.
| | - Chih-Chan Lin
- Laboratory Animal Center, Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
| | - Hsueh-Chun Wang
- Department of Biomedical Engineering, National Cheng Kung University, 1 University Rd., Tainan, 701, Taiwan.
| | - Horng-Chaung Hsu
- Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan.
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, 1 University Rd., Tainan, 701, Taiwan. .,Medical Device Innovation Center, National Cheng Kung University, Tainan, 701, Taiwan.
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Chen PC, Chien KL, Su TC, Jeng JS, Hsu HC, Lee YT. Carotid Atherosclerosis Progression and Risk of Cardiovascular Events in a Community in Taiwan. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lin PL, Huang PW, Huang PY, Hsu HC. Alveolar bone-loss area localization in periodontitis radiographs based on threshold segmentation with a hybrid feature fused of intensity and the H-value of fractional Brownian motion model. Comput Methods Programs Biomed 2015; 121:117-126. [PMID: 26078207 DOI: 10.1016/j.cmpb.2015.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 05/11/2015] [Accepted: 05/19/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Periodontitis involves progressive loss of alveolar bone around the teeth. Hence, automatic alveolar bone-loss (ABL) measurement in periapical radiographs can assist dentists in diagnosing such disease. In this paper, we propose an effective method for ABL area localization and denote it as ABLIfBm. METHOD ABLIfBm is a threshold segmentation method that uses a hybrid feature fused of both intensity and texture measured by the H-value of fractional Brownian motion (fBm) model, where the H-value is the Hurst coefficient in the expectation function of a fBm curve (intensity change) and is directly related to the value of fractal dimension. Adopting leave-one-out cross validation training and testing mechanism, ABLIfBm trains weights for both features using Bayesian classifier and transforms the radiograph image into a feature image obtained from a weighted average of both features. Finally, by Otsu's thresholding, it segments the feature image into normal and bone-loss regions. RESULTS Experimental results on 31 periodontitis radiograph images in terms of mean true positive fraction and false positive fraction are about 92.5% and 14.0%, respectively, where the ground truth is provided by a dentist. The results also demonstrate that ABLIfBm outperforms (a) the threshold segmentation method using either feature alone or a weighted average of the same two features but with weights trained differently; (b) a level set segmentation method presented earlier in literature; and (c) segmentation methods based on Bayesian, K-NN, or SVM classifier using the same two features. CONCLUSION Our results suggest that the proposed method can effectively localize alveolar bone-loss areas in periodontitis radiograph images and hence would be useful for dentists in evaluating degree of bone-loss for periodontitis patients.
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Affiliation(s)
- P L Lin
- Department of Computer Science and Information Engineering, Providence University, Shalu, Taichung 43301, Taiwan.
| | - P W Huang
- Department of Computer Science and Engineering, National Chung Hsing University, Taichung 40227, Taiwan.
| | - P Y Huang
- Department of Computer Science and Engineering, National Chung Hsing University, Taichung 40227, Taiwan.
| | - H C Hsu
- College of Oral Medicine, Chung Shan Medical University and Chung Shan Medical University Hospital, Taichung 40201, Taiwan.
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Chen YJ, Chen HT, Hsu HC. Preoperative palsy score has no significant association with survival in non-small-cell lung cancer patients with spinal metastases who undergo spinal surgery. J Orthop Surg Res 2015; 10:149. [PMID: 26381378 PMCID: PMC4573298 DOI: 10.1186/s13018-015-0291-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 09/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Survival is a key factor physicians consider when selecting a treatment modality for the treatment of spinal metastases. Various assessment systems can predict length of survival and facilitate selection of the most appropriate treatment. Spinal palsy is a prognostic parameter in the Tokuhashi scoring system but not in the Tomita scoring system. A limitation of these scoring systems is that studies of them have included different tumor types. The aim of this study was to evaluate the usefulness of preoperative neurological status as a prognostic factor in non-small-cell lung cancer patients with spinal metastases who underwent surgical treatment. METHODS From November 2000 to March 2010, 50 patients with symptomatic metastatic spinal cord compression secondary to non-small-cell lung cancer underwent palliative surgery. Data collected included patient age and sex, tumor histology, date of surgery, death or last follow-up, preoperative and postoperative ambulatory status according to the Frankel grading system, body mass index (BMI), number of vertebra involved, number of other bone metastasis, visceral metastasis, and preoperative Karnofsky performance status. Log-rank test and multivariate Cox proportional hazard regressions were used to evaluate possible prognostic factors. RESULTS The mean patient age was 61.6 years (range, 20-87 years), and 34 were male and 16 were female. The median postoperative survival time was 7.5 months. The median survival was 2.5 months (95% confidence interval (CI): 1.22-16.3 months) in the Frankel A + B group and 8.0 months (95% CI: 5.52-9.89 months) in the Frankel C + D group (p = 0.87). Multivariate Cox proportional hazard regressions showed that preoperative performance status was significantly associated with survival. Preoperative palsy score had no statistically significant association with survival. CONCLUSIONS Preoperative palsy score had no statistically significant association with survival in non-small-cell lung cancer patients with spinal metastases who underwent spinal surgery in this study.
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Affiliation(s)
- Yen-Jen Chen
- Department of Orthopedic Surgery, China Medical University Hospital Taichung, Taiwan, No. 2, Yuh-Der Road, Taichung, 404, Taiwan. .,Department of Orthopedic Surgery, School of Medicine, China Medical University, Taichung, Taiwan. .,Department of Public Health and Department of Health Services Administration, China Medical University, Taiwan, No. 91, Hsueh-Shuh Road, Taichung, 404, Taiwan.
| | - Hsien-Te Chen
- Department of Orthopedic Surgery, China Medical University Hospital Taichung, Taiwan, No. 2, Yuh-Der Road, Taichung, 404, Taiwan.
| | - Horng-Chaung Hsu
- Department of Orthopedic Surgery, China Medical University Hospital Taichung, Taiwan, No. 2, Yuh-Der Road, Taichung, 404, Taiwan. .,Department of Orthopedic Surgery, School of Medicine, China Medical University, Taichung, Taiwan.
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Tsai CH, Tsai HC, Huang HN, Hung CH, Hsu CJ, Fong YC, Hsu HC, Huang YL, Tang CH. Resistin promotes tumor metastasis by down-regulation of miR-519d through the AMPK/p38 signaling pathway in human chondrosarcoma cells. Oncotarget 2015; 6:258-70. [PMID: 25404641 PMCID: PMC4381593 DOI: 10.18632/oncotarget.2724] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/1969] [Accepted: 11/06/2014] [Indexed: 12/28/2022] Open
Abstract
Resistin is a recently discovered adipocyte-secreting adipokine, which may play a critical role in modulating cancer pathogenesis. Chondrosarcoma is a highly malignant tumor known to frequently metastasize; however, the role of resistin in the metastasis of human chondrosarcoma is largely unknown. Here, we found that the expression of resistin was higher in chondrosarcoma biopsy tissues than in normal cartilage. Moreover, treatment with resistin increased matrix metalloproteinase (MMP)-2 expression and promoted cell migration in human chondrosarcoma cells. Co-transfection with microRNA (miR)-519d mimic resulted in reversed resistin-mediated cell migration and MMP-2 expression. Additionally, AMP-activated protein kinase (AMPK) and p38 inhibitors or siRNAs reduced the resistin-increased cell migration and miR-519d suppression, and inhibition of resistin expression resulted in suppression of MMP-2 expression and lung metastasis in vivo. Taken together, our results indicate that resistin promotes chondrosarcoma metastasis and MMP-2 expression through activation of the AMPK/p38 signaling pathway and down-regulation of miR-519d expression. Therefore, resistin may represent a potential novel molecular therapeutic target in chondrosarcoma metastasis.
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Affiliation(s)
- Chun-Hao Tsai
- Department of Medicine and Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan. Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Hsiao-Chi Tsai
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan
| | - Ho-Ning Huang
- Department of Biotechnology, College of Health Science, Asia University, Taichung, Taiwan
| | - Chih-Hung Hung
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Chin-Jung Hsu
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan. School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Yi-Chin Fong
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan. School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Horng-Chaung Hsu
- Department of Medicine and Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan. Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yuan-Li Huang
- Department of Biotechnology, College of Health Science, Asia University, Taichung, Taiwan
| | - Chih-Hsin Tang
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan. Department of Biotechnology, College of Health Science, Asia University, Taichung, Taiwan. Department of Pharmacology, School of Medicine, China Medical University, Taichung, Taiwan
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Amloy S, Karlsson KF, Eriksson MO, Palisaitis J, Persson POÅ, Chen YT, Chen KH, Hsu HC, Hsiao CL, Chen LC, Holtz PO. Excitons and biexcitons in InGaN quantum dot like localization centers. Nanotechnology 2014; 25:495702. [PMID: 25410551 DOI: 10.1088/0957-4484/25/49/495702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Indium segregation in a narrow InGaN single quantum well creates quantum dot (QD) like exciton localization centers. Cross-section transmission electron microscopy reveals varying shapes and lateral sizes in the range ∼1-5 nm of the QD-like features, while scanning near field optical microscopy demonstrates a highly inhomogeneous spatial distribution of optically active individual localization centers. Microphotoluminescence spectroscopy confirms the spectrally inhomogeneous distribution of localization centers, in which the exciton and the biexciton related emissions from single centers of varying geometry could be identified by means of excitation power dependencies. Interestingly, the biexciton binding energy (E(b)xx) was found to vary from center to center, between 3 to -22 meV, in correlation with the exciton emission energy. Negative binding energies are only justified by a three-dimensional quantum confinement, which confirms QD-like properties of the localization centers. The observed energy correlation is proposed to be understood as variations of the lateral extension of the confinement potential, which would yield smaller values of E(b)xx for reduced lateral extension and higher exciton emission energy. The proposed relation between lateral extension and E(b)xx is further supported by the exciton and the biexciton recombination lifetimes of a single QD, which suggest a lateral extension of merely ∼3 nm for a QD with strongly negative E(b)xx = -15.5 meV.
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Affiliation(s)
- S Amloy
- Department of Physics, Chemistry, and Biology (IFM), Linköping University, SE-58183 Linköping, Sweden. Department of Physics, Faculty of Science, Thaksin University, Phattalung 93110, Thailand.
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Tsai CH, Tzeng HE, Juang WK, Chu PG, Fann P, Fong YC, Hsu HC, Yen Y. Curative use of forequarter amputation for recurrent breast cancer over an axillary area: a case report and literature review. World J Surg Oncol 2014; 12:346. [PMID: 25407045 PMCID: PMC4246546 DOI: 10.1186/1477-7819-12-346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 08/16/2014] [Indexed: 11/28/2022] Open
Abstract
Axillary recurrence of breast cancer that involves the brachial neurovascular bundle is uncommon. However, for many patients with such recurrence, forequarter amputation can play a palliative role in relieving excruciating pain and paralysis of the upper limb. Further, for those patients who do not have distant metastasis or other local-regional recurrence, forequarter amputation provides a chance for a cure. Only a few case reports of curative amputations for recurrent breast cancer are present in the literature. Here, we report a case of forequarter amputation for curative treatment of axillary recurrent breast cancer, together with a literature review. To date, we have followed the patient for three years after amputation, during which there has been no evidence of recurrence or metastasis. Although radical resection is feasible, it can be accompanied by surgical wound complications and psychosocial stress. Therefore, an organized multidisciplinary approach is needed to ensure the success of radical resection.
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Affiliation(s)
| | | | | | | | | | | | | | - Yun Yen
- Department of Molecular Pharmacology, City of Hope National Medical Center and Beckman Research Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
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Chen YJ, Chen HY, Hsu HC. Re: Infection after vertebroplasty or kyphoplasty. A series of nine cases and review of literature. Spine J 13:1809-17. Spine J 2014; 14:1366. [PMID: 24938910 DOI: 10.1016/j.spinee.2014.01.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 01/29/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Yen-Jen Chen
- Department of Orthopedic Surgery, China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung, Taiwan 404, Republic of China; School of Medicine, China Medical University, No. 91, Hsueh-Shuh Rd, Taichung, Taiwan 40402, Republic of China
| | - Hui-Yi Chen
- Department of Radiology, China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung, Taiwan 404, Republic of China
| | - Horng-Chaung Hsu
- Department of Orthopedic Surgery, China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung, Taiwan 404, Republic of China; School of Medicine, China Medical University, No. 91, Hsueh-Shuh Rd, Taichung, Taiwan 40402, Republic of China
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Huang BR, Chang PC, Yeh WL, Lee CH, Tsai CF, Lin C, Lin HY, Liu YS, Wu CYJ, Ko PY, Huang SS, Hsu HC, Lu DY. Anti-neuroinflammatory effects of the calcium channel blocker nicardipine on microglial cells: implications for neuroprotection. PLoS One 2014; 9:e91167. [PMID: 24621589 PMCID: PMC3951295 DOI: 10.1371/journal.pone.0091167] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 02/11/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/OBJECTIVE Nicardipine is a calcium channel blocker that has been widely used to control blood pressure in severe hypertension following events such as ischemic stroke, traumatic brain injury, and intracerebral hemorrhage. However, accumulating evidence suggests that inflammatory processes in the central nervous system that are mediated by microglial activation play important roles in neurodegeneration, and the effect of nicardipine on microglial activation remains unresolved. METHODOLOGY/PRINCIPAL FINDINGS In the present study, using murine BV-2 microglia, we demonstrated that nicardipine significantly inhibits microglia-related neuroinflammatory responses. Treatment with nicardipine inhibited microglial cell migration. Nicardipine also significantly inhibited LPS plus IFN-γ-induced release of nitric oxide (NO), and the expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2). Furthermore, nicardipine also inhibited microglial activation by peptidoglycan, the major component of the Gram-positive bacterium cell wall. Notably, nicardipine also showed significant anti-neuroinflammatory effects on microglial activation in mice in vivo. CONCLUSION/SIGNIFICANCE The present study is the first to report a novel inhibitory role of nicardipine on neuroinflammation and provides a new candidate agent for the development of therapies for inflammation-related neurodegenerative diseases.
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Affiliation(s)
- Bor-Ren Huang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Neurosurgery Department, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Pei-Chun Chang
- Department of Bioinformatics, Asia University, Taichung, Taiwan
| | - Wei-Lan Yeh
- Department of Cell and Tissue Engineering, Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Hao Lee
- Department of Genetics and Complex Diseases, Harvard School of Public Health, Boston, United States of America
| | - Cheng-Fang Tsai
- Department of Biotechnology, Asia University, Taichung, Taiwan
| | - Chingju Lin
- Department of Physiology, School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiao-Yun Lin
- Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Yu-Shu Liu
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan
| | - Caren Yu-Ju Wu
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan
| | - Pei-Ying Ko
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
| | - Shiang-Suo Huang
- Department of Pharmacology and Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Horng-Chaung Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Dah-Yuu Lu
- Graduate Institute of Neural and Cognitive Sciences, China Medical University, Taichung, Taiwan
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Hsiao SF, Chou PH, Hsu HC, Lue YJ. Changes of Muscle Mechanics Associated With Anterior Cruciate Ligament Deficiency and Reconstruction. J Strength Cond Res 2014; 28:390-400. [DOI: 10.1519/jsc.0b013e3182986cc1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lin PL, Huang PY, Huang PW, Hsu HC, Chen CC. Teeth segmentation of dental periapical radiographs based on local singularity analysis. Comput Methods Programs Biomed 2014; 113:433-445. [PMID: 24252317 DOI: 10.1016/j.cmpb.2013.10.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 09/12/2013] [Accepted: 10/22/2013] [Indexed: 06/02/2023]
Abstract
Teeth segmentation for periapical raidographs is one of the most critical tasks for effective periapical lesion or periodontitis detection, as both types of anomalies usually occur around tooth boundaries and dental radiographs are often subject to noise, low contrast, and uneven illumination. In this paper, we propose an effective scheme to segment each tooth in periapical radiographs. The method consists of four stages: image enhancement using adaptive power law transformation, local singularity analysis using Hölder exponent, tooth recognition using Otsu's thresholding and connected component analysis, and tooth delineation using snake boundary tracking and morphological operations. Experimental results of 28 periapical radiographs containing 106 teeth in total and 75 useful for dental examination demonstrate that 105 teeth are successfully isolated and segmented, and the overall mean segmentation accuracy of all 75 useful teeth in terms of (TP, FP) is (0.8959, 0.0093) with standard deviation (0.0737, 0.0096), respectively.
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Affiliation(s)
- P L Lin
- Department of Computer Science and Information Engineering, Providence University, Shalu, Taichung 43301, Taiwan.
| | - P Y Huang
- Department of Computer Science and Engineering, National Chung Hsing University, Taichung 40227, Taiwan.
| | - P W Huang
- Department of Computer Science and Engineering, National Chung Hsing University, Taichung 40227, Taiwan.
| | - H C Hsu
- College of Oral Medicine, Chung Shan Medical University and Chung Shan Medical University Hospital, Taichung 40201, Taiwan.
| | - C C Chen
- College of Oral Medicine, Chung Shan Medical University and Chung Shan Medical University Hospital, Taichung 40201, Taiwan.
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Tsai CH, Hsu HC, Lin CJ. Treatment of Chronic Wounds With the Silver-Containing Activated Carbon Fiber Dressing: Three Cases. J Med Cases 2014. [DOI: 10.14740/jmc1960w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kuo CC, Lu HL, Lu TW, Lin CC, Leardini A, Kuo MY, Hsu HC. Effects of positioning on radiographic measurements of ankle morphology: a computerized tomography-based simulation study. Biomed Eng Online 2013; 12:131. [PMID: 24359413 PMCID: PMC3879435 DOI: 10.1186/1475-925x-12-131] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 12/10/2013] [Indexed: 11/30/2022] Open
Abstract
Background Measurements of the morphology of the ankle joint, performed mostly for surgical planning of total ankle arthroplasty and for collecting data for total ankle prosthesis design, are often made on planar radiographs, and therefore can be very sensitive to the positioning of the joint during imaging. The current study aimed to compare ankle morphological measurements using CT-generated 2D images with gold standard values obtained from 3D CT data; to determine the sensitivity of the 2D measurements to mal-positioning of the ankle during imaging; and to quantify the repeatability of the 2D measurements under simulated positioning conditions involving random errors. Method Fifty-eight cadaveric ankles fixed in the neutral joint position (standard pose) were CT scanned, and the data were used to simulate lateral and frontal radiographs under various positioning conditions using digitally reconstructed radiographs (DRR). Results and discussion In the standard pose for imaging, most ankle morphometric parameters measured using 2D images were highly correlated (R > 0.8) to the gold standard values defined by the 3D CT data. For measurements made on the lateral views, the only parameters sensitive to rotational pose errors were longitudinal distances between the most anterior and the most posterior points of the tibial mortise and the tibial profile, which have important implications for determining the optimal cutting level of the bone during arthroplasty. Measurements of the trochlea tali width on the frontal views underestimated the standard values by up to 31.2%, with only a moderate reliability, suggesting that pre-surgical evaluations based on the trochlea tali width should be made with caution in order to avoid inappropriate selection of prosthesis sizes. Conclusions While highly correlated with 3D morphological measurements, some 2D measurements were affected by the bone poses in space during imaging, which may affect surgical decision-making in total ankle arthroplasty, including the amount of bone resection and the selection of the implant sizes. The linear regression equations for the relationship between 2D and 3D measurements will be helpful for correcting the errors in 2D morphometric measurements for clinical applications.
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Affiliation(s)
| | | | - Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, No, 1, Sec, 1, Jen-Ai Road, Taipei 100, Taiwan, ROC.
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Hsu CJ, Wu MH, Chen CY, Tsai CH, Hsu HC, Tang CH. AMP-activated protein kinase activation mediates CCL3-induced cell migration and matrix metalloproteinase-2 expression in human chondrosarcoma. Cell Commun Signal 2013; 11:68. [PMID: 24047437 PMCID: PMC3851317 DOI: 10.1186/1478-811x-11-68] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 09/03/2013] [Indexed: 01/26/2023] Open
Abstract
Chemokine (C-C motif) ligand 3 (CCL3), also known as macrophage inflammatory protein-1α, is a cytokine involved in inflammation and activation of polymorphonuclear leukocytes. CCL3 has been detected in infiltrating cells and tumor cells. Chondrosarcoma is a highly malignant tumor that causes distant metastasis. However, the effect of CCL3 on human chondrosarcoma metastasis is still unknown. Here, we found that CCL3 increased cellular migration and expression of matrix metalloproteinase (MMP)-2 in human chondrosarcoma cells. Pre-treatment of cells with the MMP-2 inhibitor or transfection with MMP-2 specific siRNA abolished CCL3-induced cell migration. CCL3 has been reported to exert its effects through activation of its specific receptor, CC chemokine receptor 5 (CCR5). The CCR5 and AMP-activated protein kinase (AMPK) inhibitor or siRNA also attenuated CCL3-upregulated cell motility and MMP-2 expression. CCL3-induced expression of MMP-2 and migration were also inhibited by specific inhibitors, and inactive mutants of AMPK, p38 mitogen activated protein kinase (p38 or p38-MAPK), and nuclear factor κB (NF-κB) cascades. On the other hand, CCL3 treatment demonstrably activated AMPK, p38, and NF-κB signaling pathways. Furthermore, the expression levels of CCL3, CCR5, and MMP-2 were correlated in human chondrosarcoma specimens. Taken together, our results indicate that CCL3 enhances the migratory ability of human chondrosarcoma cells by increasing MMP-2 expression via the CCR5, AMPK, p38, and NF-κB pathways.
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Affiliation(s)
- Chin-Jung Hsu
- Graduate Institute of Basic Medical Science, China Medical University, No, 91, Hsueh-Shih Road, Taichung, Taiwan.
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Kuo CC, Lu HL, Leardini A, Lu TW, Kuo MY, Hsu HC. Three-dimensional computer graphics-based ankle morphometry with computerized tomography for total ankle replacement design and positioning. Clin Anat 2013; 27:659-68. [PMID: 23960000 DOI: 10.1002/ca.22296] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 04/05/2013] [Accepted: 06/13/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Chien-Chung Kuo
- Institute of Biomedical Engineering; National Taiwan University; Taipei Taiwan Republic of China
- Department of Orthopedics; China Medical University Hospital; Taichung Taiwan Republic of China
| | - Hsuan-Lun Lu
- Institute of Biomedical Engineering; National Taiwan University; Taipei Taiwan Republic of China
| | - Alberto Leardini
- Movement Analysis Laboratory; Istituto Ortopedico Rizzoli; Bologna Italy
| | - Tung-Wu Lu
- Institute of Biomedical Engineering; National Taiwan University; Taipei Taiwan Republic of China
- Department of Orthopaedic Surgery; School of Medicine; National Taiwan University; Taipei Taiwan Republic of China
| | - Mei-Ying Kuo
- Department of Physical Therapy; China Medical University; Taichung Taiwan Republic of China
| | - Horng-Chaung Hsu
- Department of Orthopedics; China Medical University Hospital; Taichung Taiwan Republic of China
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Tsai CH, Chiang YC, Chen HT, Huang PH, Hsu HC, Tang CH. High glucose induces vascular endothelial growth factor production in human synovial fibroblasts through reactive oxygen species generation. Biochim Biophys Acta Gen Subj 2013; 1830:2649-58. [PMID: 23274526 DOI: 10.1016/j.bbagen.2012.12.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/03/2012] [Accepted: 12/16/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diabetes is an independent risk factor of osteoarthritis (OA). Angiogenesis is essential for the progression of OA. Here, we investigated the intracellular signaling pathways involved in high glucose (HG)-induced vascular endothelial growth factor (VEGF) expression in human synovial fibroblast cells. METHODS HG-mediated VEGF expression was assessed with qPCR and ELISA. The mechanisms of action of HG in different signaling pathways were studied using Western blotting. Knockdown of proteins was achieved by transfection with siRNA. Chromatin immunoprecipitation assays were used to study in vivo binding of c-Jun to the VEGF promoter. RESULTS Stimulation of OA synovial fibroblasts (OASF) with HG induced concentration- and time-dependent increases in VEGF expression. Treatment of OASF with HG increased reactive oxygen species (ROS) generation. Pretreatment with NADPH oxidase inhibitor (APO or DPI), ROS scavenger (NAC), PI3K inhibitor (Ly294002 or wortmannin), Akt inhibitor, or AP-1 inhibitor (curcumin or tanshinone IIA) blocked the HG-induced VEGF production. HG also increased PI3K and Akt activation. Treatment of OASF with HG increased the accumulation of phosphorylated c-Jun in the nucleus, AP-1-luciferase activity, and c-Jun binding to the AP-1 element on the VEGF promoter. CONCLUSIONS Our results suggest that the HG increases VEGF expression in human synovial fibroblasts via the ROS, PI3K, Akt, c-Jun and AP-1 signaling pathway. GENERAL SIGNIFICANCE We link high glucose on VEGF expression in osteoarthritis.
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Affiliation(s)
- Chun-Hao Tsai
- Department of Orthopaedic Surgery, China Medical University Hospital, Taichung, Taiwan
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