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Lim EJ, Cho JW, Shon OJ, Oh JK, Hwang KT, Lee GC. Far cortical locking constructs for fixation of distal femur fractures in an Asian population: A prospective observational study. J Orthop Sci 2024:S0949-2658(24)00052-6. [PMID: 38570286 DOI: 10.1016/j.jos.2024.03.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/07/2024] [Accepted: 03/16/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The stiffness of locked plates suppresses healing process, prompting the introduction of far cortical locking to address this issue. This study aimed to demonstrate the clinical efficacy of far cortical locking constructs in treating distal femoral fractures in an Asian population. METHODS This multicenter prospective observational study was conducted at four university hospitals between February 2018 and February 2021. Demographic data, the presence of metaphyseal comminution, and surgical fixation details were recorded. Clinical outcomes, including single-leg standing, EQ-5D, and EQ-VAS scores, and radiologic outcomes, including the RUST score of each cortex, were evaluated and compared according to the presence of metaphyseal comminution. RESULTS There were 37 patients (14 men and 23 women) with a mean age of 67.3 ± 11.8 years. Twenty-two patients had metaphyseal comminution (59%), and 15 presented simple fractures in metaphyseal areas. Four patients (13%) could stand on one leg >10s at 6 weeks, and 24 patients (92%) at 1 year. EQ-5D increased from 0.022 ± 0.388 to 0.692 ± 0.347, and the mean EQ-VAS 51.1 ± 13.1 to 74.1 ± 24.1 between discharge (n = 37) and post-operative 1 year (n = 33), respectively. RUST score presented increment for time, from 6.2 ± 1.8 at 6 week to 11.6 ± 1.1 at 1 year. Radiological healing demonstrated rapid increase from week 6 (16/28, 43%) to month 3 (27/31, 87%), with no obvious increase was observed in 6 months (23/26, 89%) or 12 months (25/28, 89%). Simple metaphyseal fractures presented significantly higher RUST scores at 6 weeks and 3 months, but there was no difference in RUST scores at 6 months or 1 year according to metaphyseal comminution. CONCLUSIONS Plate constructs with far cortical locking screws provided safe and effective fixation for distal femoral fractures, with consistent radiological and clinical results, regardless of metaphyseal comminution.
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Affiliation(s)
- Eic Ju Lim
- Department of Orthopaedic Surgery, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jae-Woo Cho
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Oog-Jin Shon
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Kyu Tae Hwang
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, Republic of Korea.
| | - Gwang Chul Lee
- Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Republic of Korea.
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Baek EB, Lee J, Hwang JH, Park H, Lee BS, Kim YB, Jun SY, Her J, Son HY, Cho JW. Application of multiple-finding segmentation utilizing Mask R-CNN-based deep learning in a rat model of drug-induced liver injury. Sci Rep 2023; 13:17555. [PMID: 37845356 PMCID: PMC10579263 DOI: 10.1038/s41598-023-44897-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023] Open
Abstract
Drug-induced liver injury (DILI) presents significant diagnostic challenges, and recently artificial intelligence-based deep learning technology has been used to predict various hepatic findings. In this study, we trained a set of Mask R-CNN-based deep algorithms to learn and quantify typical toxicant induced-histopathological lesions, portal area, and connective tissue in Sprague Dawley rats. We compared a set of single-finding models (SFMs) and a combined multiple-finding model (MFM) for their ability to simultaneously detect, classify, and quantify multiple hepatic findings on rat liver slide images. All of the SFMs yielded mean average precision (mAP) values above 85%, suggesting that the models had been successfully established. The MFM showed better performance than the SFMs, with a total mAP value of 92.46%. We compared the model predictions for slide images with ground-truth annotations generated by an accredited pathologist. For the MFM, the overall and individual finding predictions were highly correlated with the annotated areas, with R-squared values of 0.852, 0.952, 0.999, 0.990, and 0.958 being obtained for portal area, infiltration, necrosis, vacuolation, and connective tissue (including fibrosis), respectively. Our results indicate that the proposed MFM could be a useful tool for detecting and predicting multiple hepatic findings in basic non-clinical study settings.
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Affiliation(s)
- Eun Bok Baek
- College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon, 34134, Republic of Korea
| | - Jaeku Lee
- Research and Development Team, LAC Inc, Seoul, Republic of Korea
| | - Ji-Hee Hwang
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, 141 Gajeong-ro, Yuseong-gu, Daejeon, 34114, Republic of Korea
| | - Heejin Park
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, 141 Gajeong-ro, Yuseong-gu, Daejeon, 34114, Republic of Korea
| | - Byoung-Seok Lee
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, 141 Gajeong-ro, Yuseong-gu, Daejeon, 34114, Republic of Korea
| | - Yong-Bum Kim
- Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114, Republic of Korea
| | - Sang-Yeop Jun
- Research and Development Team, LAC Inc, Seoul, Republic of Korea
| | - Jun Her
- Research and Development Team, LAC Inc, Seoul, Republic of Korea
| | - Hwa-Young Son
- College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon, 34134, Republic of Korea.
| | - Jae-Woo Cho
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, 141 Gajeong-ro, Yuseong-gu, Daejeon, 34114, Republic of Korea.
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Cho WT, Sakong S, Sunwoo J, Choi W, Ryu YK, Choi JS, Oh JK, Kim BS, Cho JW. Clinical outcome of rim-plate-augmented separate vertical wiring with supplementary fixation for the treatment of patellar fracture associated comminuted inferior pole. Sci Rep 2023; 13:13430. [PMID: 37596315 PMCID: PMC10439214 DOI: 10.1038/s41598-023-40417-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
Despite the variety of treatment methods, comminuted inferior pole fractures of the patella remain difficult and technically demanding to achieve stable internal fixation. The purpose of this study is to evaluate the clinical outcomes of rim plate-augmented separate vertical wiring with supplementary fixation in the management of comminuted inferior pole fractures, AO/OTA 34-A1, C2, and C3, which has the secondary horizontal fracture line on lower articular boundary. From our study, bony union was achieved in all patients at an average of 3.1 ± 1.4 months after surgery. There was no patient with loss of reduction, fixation failure, or infection during follow-up. The average final range of motion was 131.6° ± 7.2°. Lysholm knee scores gradually increased over 3, 6, 9, and 12 months postoperatively by 58.7, 74.0, 82.9, and 89.4, respectively. Isokinetic peak torque deficit of the knee extensor muscles in 3, 6, 9, and 12 months postoperatively was 59.9%, 49.7%, 35.7%, and 28.1%, respectively. The rim plate-augmented separate vertical wiring with supplementary fixation for the treatment of patellar fracture associated comminuted inferior pole is effective and can be safely applied AO/OTA 34-C2 or C3 with favorable outcomes.
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Affiliation(s)
- Won-Tae Cho
- Department of Orthopaedic Surgery, Ajou University Hospital, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Seungyeob Sakong
- Department of Orthopaedic Surgery, Ajou University Hospital, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Jung Sunwoo
- Department of Orthopaedic Surgery, Ajou University Hospital, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Wonseok Choi
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea
| | - Yun-Ki Ryu
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea
| | - Jeong-Seok Choi
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea
| | - Beom-Soo Kim
- Department of Orthopaedic Surgery, Keimyung University Dongsan Hospital, School of Medicine, Keimyung University, 1035, Dalgubeol‑daero, Dalseo‑gu, Daegu, 42601, Republic of Korea.
| | - Jae-Woo Cho
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea.
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Sakong SY, Cho JW, Kim BS, Park SJ, Lim EJ, Oh JK. The Clinical Efficacy of Contouring Periarticular Plates on a 3D Printed Bone Model. J Pers Med 2023; 13:1145. [PMID: 37511758 PMCID: PMC10381594 DOI: 10.3390/jpm13071145] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
We report our experience of preoperative plate contouring for periarticular fractures using three-dimensional printing (3DP) technology and describe its benefits. We enrolled 34 patients, including 11 with humerus midshaft fractures, 12 with tibia plateau fractures, 2 with pilon fractures, and 9 with acetabulum fractures. The entire process of plate contouring over the 3DP model was videotaped and retrospectively analyzed. The total time and number of trials for the intraoperative positioning of precontoured plates and any further intraoperative contouring events were prospectively recorded. The mismatch between the planned and postoperative plate positions was evaluated. The average plate contouring time was 9.2 min for humerus shaft, 13.8 min for tibia plateau fractures, 8.8 min for pilon fractures, and 11.6 min for acetabular fractures. Most precontoured plates (88%, 30/34) could sit on the planned position without mismatch. In addition, only one patient with humerus shaft fracture required additional intraoperative contouring. Preoperative patient specific periarticular plate contouring using a 3DP model is a simple and efficient method that may alleviate the surgical challenges involved in plate contouring and positioning.
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Affiliation(s)
- Seung-Yeob Sakong
- Department of Orthopaedic SurgeryAjou University Hospital, Ajou University College of Medicine, Suwon 16499, Republic of Korea
| | - Jae-Woo Cho
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul 08308, Republic of Korea
| | - Beom-Soo Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University Medicine, Daegu 41931, Republic of Korea
| | - Sung-Jun Park
- Department of Mechanical Engineering, Korea National University of Transportation, Chungbuk 27469, Republic of Korea
| | - Eic-Ju Lim
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul 08308, Republic of Korea
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Hwang JH, Lim M, Han G, Park H, Kim YB, Park J, Jun SY, Lee J, Cho JW. A comparative study on the implementation of deep learning algorithms for detection of hepatic necrosis in toxicity studies. Toxicol Res 2023; 39:399-408. [PMID: 37398569 PMCID: PMC10313597 DOI: 10.1007/s43188-023-00173-5] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 07/04/2023] Open
Abstract
Deep learning has recently become one of the most popular methods of image analysis. In non-clinical studies, several tissue slides are generated to investigate the toxicity of a test compound. These are converted into digital image data using a slide scanner, which is then studied by researchers to investigate abnormalities, and the deep learning method has been started to adopt in this study. However, comparative studies evaluating different deep learning algorithms for analyzing abnormal lesions are scarce. In this study, we applied three algorithms, SSD, Mask R-CNN, and DeepLabV3+, to detect hepatic necrosis in slide images and determine the best deep learning algorithm for analyzing abnormal lesions. We trained each algorithm on 5750 images and 5835 annotations of hepatic necrosis including validation and test, augmented with 500 image tiles of 448 × 448 pixels. Precision, recall, and accuracy were calculated for each algorithm based on the prediction results of 60 test images of 2688 × 2688 pixels. The two segmentation algorithms, DeepLabV3+ and Mask R-CNN, showed over 90% of accuracy (0.94 and 0.92, respectively), whereas SSD, an object detection algorithm, showed lower accuracy. The trained DeepLabV3+ outperformed all others in recall while also successfully separating hepatic necrosis from other features in the test images. It is important to localize and separate the abnormal lesion of interest from other features to investigate it on a slide level. Therefore, we suggest that segmentation algorithms are more appropriate than object detection algorithms for use in the pathological analysis of images in non-clinical studies. Supplementary Information The online version contains supplementary material available at 10.1007/s43188-023-00173-5.
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Affiliation(s)
- Ji-Hee Hwang
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114 Republic of Korea
| | - Minyoung Lim
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114 Republic of Korea
| | - Gyeongjin Han
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114 Republic of Korea
| | - Heejin Park
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114 Republic of Korea
| | - Yong-Bum Kim
- Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114 Republic of Korea
| | - Jinseok Park
- Research & Development Team, LAC Inc, Seoul, 07807 Republic of Korea
| | - Sang-Yeop Jun
- Research & Development Team, LAC Inc, Seoul, 07807 Republic of Korea
| | - Jaeku Lee
- Research & Development Team, LAC Inc, Seoul, 07807 Republic of Korea
| | - Jae-Woo Cho
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114 Republic of Korea
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Hwang JH, Lim M, Han G, Park H, Kim YB, Park J, Jun SY, Lee J, Cho JW. Segmentation algorithm can be used for detecting hepatic fibrosis in SD rat. Lab Anim Res 2023; 39:16. [PMID: 37381051 DOI: 10.1186/s42826-023-00167-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Liver fibrosis is an early stage of liver cirrhosis. As a reversible lesion before cirrhosis, liver failure, and liver cancer, it has been a target for drug discovery. Many antifibrotic candidates have shown promising results in experimental animal models; however, due to adverse clinical reactions, most antifibrotic agents are still preclinical. Therefore, rodent models have been used to examine the histopathological differences between the control and treatment groups to evaluate the efficacy of anti-fibrotic agents in non-clinical research. In addition, with improvements in digital image analysis incorporating artificial intelligence (AI), a few researchers have developed an automated quantification of fibrosis. However, the performance of multiple deep learning algorithms for the optimal quantification of hepatic fibrosis has not been evaluated. Here, we investigated three different localization algorithms, mask R-CNN, DeepLabV3+, and SSD, to detect hepatic fibrosis. RESULTS 5750 images with 7503 annotations were trained using the three algorithms, and the model performance was evaluated in large-scale images and compared to the training images. The results showed that the precision values were comparable among the algorithms. However, there was a gap in the recall, leading to a difference in model accuracy. The mask R-CNN outperformed the recall value (0.93) and showed the closest prediction results to the annotation for detecting hepatic fibrosis among the algorithms. DeepLabV3+ also showed good performance; however, it had limitations in the misprediction of hepatic fibrosis as inflammatory cells and connective tissue. The trained SSD showed the lowest performance and was limited in predicting hepatic fibrosis compared to the other algorithms because of its low recall value (0.75). CONCLUSIONS We suggest it would be a more useful tool to apply segmentation algorithms in implementing AI algorithms to predict hepatic fibrosis in non-clinical studies.
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Affiliation(s)
- Ji-Hee Hwang
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114, Korea
| | - Minyoung Lim
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114, Korea
| | - Gyeongjin Han
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114, Korea
| | - Heejin Park
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114, Korea
| | - Yong-Bum Kim
- Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114, Korea
| | - Jinseok Park
- Research and Development Team, LAC Inc., 07807, Seoul, Korea
| | - Sang-Yeop Jun
- Research and Development Team, LAC Inc., 07807, Seoul, Korea
| | - Jaeku Lee
- Research and Development Team, LAC Inc., 07807, Seoul, Korea
| | - Jae-Woo Cho
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114, Korea.
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Hwang JH, Lim M, Han G, Park H, Kim YB, Park J, Jun SY, Lee J, Cho JW. Preparing pathological data to develop an artificial intelligence model in the nonclinical study. Sci Rep 2023; 13:3896. [PMID: 36890209 PMCID: PMC9994413 DOI: 10.1038/s41598-023-30944-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/09/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023] Open
Abstract
Artificial intelligence (AI)-based analysis has recently been adopted in the examination of histological slides via the digitization of glass slides using a digital scanner. In this study, we examined the effect of varying the staining color tone and magnification level of a dataset on the result of AI model prediction in hematoxylin and eosin stained whole slide images (WSIs). The WSIs of liver tissues with fibrosis were used as an example, and three different datasets (N20, B20, and B10) were prepared with different color tones and magnifications. Using these datasets, we built five models trained Mask R-CNN algorithm by a single or mixed dataset of N20, B20, and B10. We evaluated their model performance using the test dataset of three datasets. It was found that the models that were trained with mixed datasets (models B20/N20 and B10/B20), which consist of different color tones or magnifications, performed better than the single dataset trained models. Consequently, superior performance of the mixed models was obtained from the actual prediction results of the test images. We suggest that training the algorithm with various staining color tones and multi-scaled image datasets would be more optimized for consistent remarkable performance in predicting pathological lesions of interest.
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Affiliation(s)
- Ji-Hee Hwang
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114, Korea
| | - Minyoung Lim
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114, Korea
| | - Gyeongjin Han
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114, Korea
| | - Heejin Park
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114, Korea
| | - Yong-Bum Kim
- Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114, Korea
| | - Jinseok Park
- Research and Development Team, LAC Inc., Seoul, 07807, Korea
| | - Sang-Yeop Jun
- Research and Development Team, LAC Inc., Seoul, 07807, Korea
| | - Jaeku Lee
- Research and Development Team, LAC Inc., Seoul, 07807, Korea
| | - Jae-Woo Cho
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, 34114, Korea.
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Kim HJ, Baek EB, Hwang JH, Lim M, Jung WH, Bae MA, Son HY, Cho JW. Application of convolutional neural network for analyzing hepatic fibrosis in mice. J Toxicol Pathol 2023; 36:21-30. [PMID: 36683726 PMCID: PMC9837472 DOI: 10.1293/tox.2022-0066] [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: 06/22/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022] Open
Abstract
Recently, with the development of computer vision using artificial intelligence (AI), clinical research on diagnosis and prediction using medical image data has increased. In this study, we applied AI methods to analyze hepatic fibrosis in mice to determine whether an AI algorithm can be used to analyze lesions. Whole slide image (WSI) Sirius Red staining was used to examine hepatic fibrosis. The Xception network, an AI algorithm, was used to train normal and fibrotic lesion identification. We compared the results from two analyses, that is, pathologists' grades and researchers' annotations, to observe whether the automated algorithm can support toxicological pathologists efficiently as a new apparatus. The accuracies of the trained model computed from the training and validation datasets were greater than 99%, and that obtained by testing the model was 100%. In the comparison between analyses, all analyses showed significant differences in the results for each group. Furthermore, both normalized fibrosis grades inferred from the trained model annotated the fibrosis area, and the grades assigned by the pathologists showed significant correlations. Notably, the deep learning algorithm derived the highest correlation with the pathologists' average grade. Owing to the correlation outcomes, we conclude that the trained model might produce results comparable to those of the pathologists' grading of the Sirius Red-stained WSI fibrosis. This study illustrates that the deep learning algorithm can potentially be used for analyzing fibrotic lesions in combination with Sirius Red-stained WSIs as a second opinion tool in non-clinical research.
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Affiliation(s)
- Hyun-Ji Kim
- Toxicological Pathology Research Group, Department of
Advanced Toxicology Research, Korea Institute of Toxicology, 141 Gajeong-ro, Yuseong-gu,
Daejeon 34114, Republic of Korea,College of Veterinary Medicine, Chungnam National
University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea,†These authors contributed equally to this work
| | - Eun Bok Baek
- College of Veterinary Medicine, Chungnam National
University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea
| | - Ji-Hee Hwang
- Toxicological Pathology Research Group, Department of
Advanced Toxicology Research, Korea Institute of Toxicology, 141 Gajeong-ro, Yuseong-gu,
Daejeon 34114, Republic of Korea
| | - Minyoung Lim
- Toxicological Pathology Research Group, Department of
Advanced Toxicology Research, Korea Institute of Toxicology, 141 Gajeong-ro, Yuseong-gu,
Daejeon 34114, Republic of Korea
| | - Won Hoon Jung
- Therapeutics & Biotechnology Division, Korea Research
Institute of Chemical Technology, 141 Gajeong-ro, Yuseong-gu, Daejeon 34114, Republic of
Korea
| | - Myung Ae Bae
- Therapeutics & Biotechnology Division, Korea Research
Institute of Chemical Technology, 141 Gajeong-ro, Yuseong-gu, Daejeon 34114, Republic of
Korea
| | - Hwa-Young Son
- College of Veterinary Medicine, Chungnam National
University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea,*Corresponding authors: JW Cho (e-mail: ); HY Son (e-mail: )
| | - Jae-Woo Cho
- Toxicological Pathology Research Group, Department of
Advanced Toxicology Research, Korea Institute of Toxicology, 141 Gajeong-ro, Yuseong-gu,
Daejeon 34114, Republic of Korea,*Corresponding authors: JW Cho (e-mail: ); HY Son (e-mail: )
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Shon HC, Yang JY, Lee Y, Cho JW, Oh JK, Lim EJ. Iatrogenic radial nerve palsy in the surgical treatment of humerus shaft fracture -anterolateral versus posterior approach: A systematic review and meta-analysis. J Orthop Sci 2023; 28:244-250. [PMID: 34716068 DOI: 10.1016/j.jos.2021.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/03/2021] [Accepted: 09/28/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Although many studies have investigated iatrogenic radial nerve palsy (RNP) in humerus shaft fracture, there is inconsistent evidence on which approach leads to iatrogenic RNP. Moreover, no meta-analysis has directly compared the anterolateral and posterior approaches regarding iatrogenic RNP. METHODS In this systematic review and meta-analysis, the MEDLINE, Embase, and Cochrane Library databases were searched systematically for studies published before March 30, 2021. We included studies that (1) assessed the RNP in the surgical treatment of humerus shaft fracture and (2) directly compared the anterolateral and posterior approaches regarding the RNP. We performed synthetic analyses of the incidence of iatrogenic RNP and the recovery rate of iatrogenic RNP in humerus shaft fracture between the anterolateral and posterior approaches. RESULTS Our study enrolled nine studies, representing 1303 patients who underwent surgery for humerus shaft fracture. After exclusion of traumatic RNP, iatrogenic RNP was reported in 35 out of 678 patients in the anterolateral approach and in 69 out of 497 patients in the posterior approach. Pooled analysis revealed that the incidence of iatrogenic RNP was significantly higher in the posterior approach than in the anterolateral approach (OR = 2.72; 95% confidence interval (CI), 1.70-4.35; P < 0.0001, I2 = 0%), but there was no significant difference in the recovery rates of iatrogenic RNP between the two approaches (OR = 1.55; 95% CI, 0.26-9.18; P = 0.63, I2 = 0%). CONCLUSION In this meta-analysis, the posterior approach showed a higher incidence of iatrogenic RNP than the anterolateral approach in the surgical treatment of humerus shaft fracture. With limited studies, it is difficult to anticipate if any particular approach favors the recovery of iatrogenic RNP.
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Affiliation(s)
- Hyun-Chul Shon
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University, Cheongju, Republic of Korea
| | - Jae Young Yang
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University, Cheongju, Republic of Korea
| | - Yohan Lee
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University, Cheongju, Republic of Korea
| | - Jae-Woo Cho
- Department of Orthopaedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Eic Ju Lim
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University, Cheongju, Republic of Korea.
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Baek EB, Hwang JH, Park H, Lee BS, Son HY, Kim YB, Jun SY, Her J, Lee J, Cho JW. Artificial Intelligence-Assisted Image Analysis of Acetaminophen-Induced Acute Hepatic Injury in Sprague-Dawley Rats. Diagnostics (Basel) 2022; 12:diagnostics12061478. [PMID: 35741291 PMCID: PMC9222125 DOI: 10.3390/diagnostics12061478] [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: 05/26/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Although drug-induced liver injury (DILI) is a major target of the pharmaceutical industry, we currently lack an efficient model for evaluating liver toxicity in the early stage of its development. Recent progress in artificial intelligence-based deep learning technology promises to improve the accuracy and robustness of current toxicity prediction models. Mask region-based CNN (Mask R-CNN) is a detection-based segmentation model that has been used for developing algorithms. In the present study, we applied a Mask R-CNN algorithm to detect and predict acute hepatic injury lesions induced by acetaminophen (APAP) in Sprague-Dawley rats. To accomplish this, we trained, validated, and tested the model for various hepatic lesions, including necrosis, inflammation, infiltration, and portal triad. We confirmed the model performance at the whole-slide image (WSI) level. The training, validating, and testing processes, which were performed using tile images, yielded an overall model accuracy of 96.44%. For confirmation, we compared the model’s predictions for 25 WSIs at 20× magnification with annotated lesion areas determined by an accredited toxicologic pathologist. In individual WSIs, the expert-annotated lesion areas of necrosis, inflammation, and infiltration tended to be comparable with the values predicted by the algorithm. The overall predictions showed a high correlation with the annotated area. The R square values were 0.9953, 0.9610, and 0.9445 for necrosis, inflammation plus infiltration, and portal triad, respectively. The present study shows that the Mask R-CNN algorithm is a useful tool for detecting and predicting hepatic lesions in non-clinical studies. This new algorithm might be widely useful for predicting liver lesions in non-clinical and clinical settings.
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Affiliation(s)
- Eun Bok Baek
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea; (E.B.B.); (H.-Y.S.)
| | - Ji-Hee Hwang
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon 34114, Korea; (J.-H.H.); (H.P.); (B.-S.L.)
| | - Heejin Park
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon 34114, Korea; (J.-H.H.); (H.P.); (B.-S.L.)
| | - Byoung-Seok Lee
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon 34114, Korea; (J.-H.H.); (H.P.); (B.-S.L.)
| | - Hwa-Young Son
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea; (E.B.B.); (H.-Y.S.)
| | - Yong-Bum Kim
- Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon 34114, Korea;
| | - Sang-Yeop Jun
- Research & Development Team, LAC Inc., Seoul 07807, Korea; (S.-Y.J.); (J.H.); (J.L.)
| | - Jun Her
- Research & Development Team, LAC Inc., Seoul 07807, Korea; (S.-Y.J.); (J.H.); (J.L.)
| | - Jaeku Lee
- Research & Development Team, LAC Inc., Seoul 07807, Korea; (S.-Y.J.); (J.H.); (J.L.)
| | - Jae-Woo Cho
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon 34114, Korea; (J.-H.H.); (H.P.); (B.-S.L.)
- Correspondence: ; Tel.: +82-42-610-8023
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Lim EJ, Kent WT, Sakong S, Son WS, Cho JW, Oh JK. Stress fracture after implant removal from the tibia reconstructed by the induced membrane technique: A case report. Trauma Case Rep 2022; 39:100647. [PMID: 35571579 PMCID: PMC9092251 DOI: 10.1016/j.tcr.2022.100647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background The induced membrane technique promotes vascularization and corticalization of the grafted bone and has become one of the mainstays in treatment of segmental bone defects. However, there are clinical concerns regarding the quality of bony consolidation using the induced membrane technique including a thin cortex formation and cortical notching after consolidation. We present the case of a tibial stress fracture in the bone reconstructed by the induced membrane technique after implant removal. Case A 49-year-old male presented post-traumatic osteomyelitis of the right tibia and was treated with staged segmental bone resection leading to an 11 cm defect which was reconstructed using the induced membrane technique. The patient requested implant removal at 33 months after bony consolidation. Four months after implant removal, he developed acute, atraumatic leg pain due to a tibial stress fracture caused by small notching in the reconstructed tibial segment. His stress fracture treated with intramedullary nailing and later healed uneventfully. Conclusion Caution is warranted prior to implant removal from bone reconstructed by the induced membrane technique as cortical notching may result in stress fractures.
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Hwang JH, Kim HJ, Park H, Lee BS, Son HY, Kim YB, Jun SY, Park JH, Lee J, Cho JW. Implementation and Practice of Deep Learning-Based Instance Segmentation Algorithm for Quantification of Hepatic Fibrosis at Whole Slide Level in Sprague-Dawley Rats. Toxicol Pathol 2022. [PMID: 34866512 DOI: 10.1177/01926233211057128.35] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Exponential development in artificial intelligence or deep learning technology has resulted in more trials to systematically determine the pathological diagnoses using whole slide images (WSIs) in clinical and nonclinical studies. In this study, we applied Mask Regions with Convolution Neural Network (Mask R-CNN), a deep learning model that uses instance segmentation, to detect hepatic fibrosis induced by N-nitrosodimethylamine (NDMA) in Sprague-Dawley rats. From 51 WSIs, we collected 2011 cropped images with hepatic fibrosis annotations. Training and detection of hepatic fibrosis via artificial intelligence methods was performed using Tensorflow 2.1.0, powered by an NVIDIA 2080 Ti GPU. From the test process using tile images, 95% of model accuracy was verified. In addition, we validated the model to determine whether the predictions by the trained model can reflect the scoring system by the pathologists at the WSI level. The validation was conducted by comparing the model predictions in 18 WSIs at 20× and 10× magnifications with ground truth annotations and board-certified pathologists. Predictions at 20× showed a high correlation with ground truth (R2 = 0.9660) and a good correlation with the average fibrosis rank by pathologists (R2 = 0.8887). Therefore, the Mask R-CNN algorithm is a useful tool for detecting and quantifying pathological findings in nonclinical studies.
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Affiliation(s)
- Ji-Hee Hwang
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, Korea
| | - Hyun-Ji Kim
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, Korea.,College of Veterinary Medicine, Chungnam National University, Daejeon, Korea
| | - Heejin Park
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, Korea
| | - Byoung-Seok Lee
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, Korea
| | - Hwa-Young Son
- College of Veterinary Medicine, Chungnam National University, Daejeon, Korea
| | - Yong-Bum Kim
- Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, Korea
| | | | | | - Jaeku Lee
- Research & Development Team, LAC Inc, Seoul, Korea
| | - Jae-Woo Cho
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, Korea
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Lee J, Choi SJ, Jeong JS, Kim SY, Lee SJ, Baek SK, Kwon N, Lee SH, Kim W, Cho JW, Koh EM, Lee K, Jeong EJ, Nam SY, Yu WJ. Adverse postnatal developmental effects in offspring from humidifier disinfectant biocide inhaled pregnant rats. Chemosphere 2022; 286:131636. [PMID: 34358894 DOI: 10.1016/j.chemosphere.2021.131636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/22/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 06/13/2023]
Abstract
Inhalation exposure to polyhexamethylene guanidine phosphate (PHMG-P), one of the primary biocides used in humidifier disinfectants, caused a fatal pulmonary disease in Korea. Pregnant women were also exposed to PHMG-P, and subsequent studies showed that PHMG-P inhalation during pregnancy adversely affects their health and embryo-fetal development. However, the postnatal developmental effects after birth on prenatally PHMG-P-exposed offspring have not yet been investigated. Therefore, in this study, we aimed to examine the postnatal development of prenatally PHMG-P-exposed offspring. Pregnant rats (22 or 24 females per group) were exposed to PHMG-P during pregnancy in a whole-body inhalation chamber at the target concentrations of 0, 0.14, 1.60, and 3.20 mg/m3. After parturition, the prenatally exposed offspring were transferred to non-exposed surrogate mothers to minimize the secondary effects of severe maternal toxicities. Postnatal development of offspring was then examined with a modified extended one-generation reproductive toxicity study design. At 3.20 mg/m3 PHMG-P, increased perinatal death rates and decreased viability index (postnatal survival of offspring between birth and postnatal day 4) were observed. In addition, F1 offspring had lower body weight at birth that persisted throughout the study. PHMG-P-exposed pregnant rats also had severe systemic toxicities and increased gestation period. At 1.60 mg/m3 PHMG-P, a decreased viability index was also observed with systemic toxicities of PHMG-P-exposed pregnant rats. These results indicate that prenatal PHMG-P exposure adversely affects the offspring's future health and could be used for human risk assessment.
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Affiliation(s)
- Jinsoo Lee
- Developmental and Reproductive Toxicology Research Group, Korea Institute of Toxicology, Daejeon, Republic of Korea; College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Seong-Jin Choi
- Department of Chemical Assessment, Korea Environment Corporation, Incheon, Republic of Korea
| | - Ji-Seong Jeong
- Developmental and Reproductive Toxicology Research Group, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Sang Yun Kim
- Developmental and Reproductive Toxicology Research Group, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Seung-Jin Lee
- Developmental and Reproductive Toxicology Research Group, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Sang-Ki Baek
- Developmental and Reproductive Toxicology Research Group, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Nayun Kwon
- Developmental and Reproductive Toxicology Research Group, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Sang-Hyub Lee
- Department of Chemical Assessment, Korea Environment Corporation, Incheon, Republic of Korea
| | - Woojin Kim
- Toxicologic Pathology Research Group, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Jae-Woo Cho
- Toxicologic Pathology Research Group, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Eun Mi Koh
- Bioanalytical and Immunoanalytical Research Group, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Kyuhong Lee
- Inhalation Toxicology Research Group, Korea Institute of Toxicology, Jeongeup, Republic of Korea; Department of Human and Environmental Toxicology, University of Science & Technology, Daejeon, Republic of Korea
| | - Eun Ju Jeong
- Chemical Risk Assessment Research Committee, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Sang-Yoon Nam
- College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Wook-Joon Yu
- Developmental and Reproductive Toxicology Research Group, Korea Institute of Toxicology, Daejeon, Republic of Korea.
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Hwang JH, Kim HJ, Park H, Lee BS, Son HY, Kim YB, Jun SY, Park JH, Lee J, Cho JW. Implementation and Practice of Deep Learning-Based Instance Segmentation Algorithm for Quantification of Hepatic Fibrosis at Whole Slide Level in Sprague-Dawley Rats. Toxicol Pathol 2021; 50:186-196. [PMID: 34866512 DOI: 10.1177/01926233211057128] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Exponential development in artificial intelligence or deep learning technology has resulted in more trials to systematically determine the pathological diagnoses using whole slide images (WSIs) in clinical and nonclinical studies. In this study, we applied Mask Regions with Convolution Neural Network (Mask R-CNN), a deep learning model that uses instance segmentation, to detect hepatic fibrosis induced by N-nitrosodimethylamine (NDMA) in Sprague-Dawley rats. From 51 WSIs, we collected 2011 cropped images with hepatic fibrosis annotations. Training and detection of hepatic fibrosis via artificial intelligence methods was performed using Tensorflow 2.1.0, powered by an NVIDIA 2080 Ti GPU. From the test process using tile images, 95% of model accuracy was verified. In addition, we validated the model to determine whether the predictions by the trained model can reflect the scoring system by the pathologists at the WSI level. The validation was conducted by comparing the model predictions in 18 WSIs at 20× and 10× magnifications with ground truth annotations and board-certified pathologists. Predictions at 20× showed a high correlation with ground truth (R 2 = 0.9660) and a good correlation with the average fibrosis rank by pathologists (R 2 = 0.8887). Therefore, the Mask R-CNN algorithm is a useful tool for detecting and quantifying pathological findings in nonclinical studies.
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Affiliation(s)
- Ji-Hee Hwang
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, Korea
| | - Hyun-Ji Kim
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, Korea.,College of Veterinary Medicine, Chungnam National University, Daejeon, Korea
| | - Heejin Park
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, Korea
| | - Byoung-Seok Lee
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, Korea
| | - Hwa-Young Son
- College of Veterinary Medicine, Chungnam National University, Daejeon, Korea
| | - Yong-Bum Kim
- Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, Korea
| | | | | | - Jaeku Lee
- Research & Development Team, LAC Inc, Seoul, Korea
| | - Jae-Woo Cho
- Toxicologic Pathology Research Group, Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon, Korea
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Choi W, Kim H, Son WS, Sakong S, Cho JM, Choi NJ, Noh TW, Kim N, Cho JW, Oh JK. The Impact of Coronavirus Disease 2019 on Trauma Patients and Orthopedic Trauma Operations at a Single Focused Training Center for Trauma in South Korea. J Trauma Inj 2021. [DOI: 10.20408/jti.2021.0078] [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: 11/05/2022] Open
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Cho JW, Kim BS, Yeo DH, Lim EJ, Sakong S, Lim J, Park S, Jeong YH, Jung TG, Choi H, Oh CW, Kim HJ, Park JW, Oh JK. 3D-printed, bioactive ceramic scaffold with rhBMP-2 in treating critical femoral bone defects in rabbits using the induced membrane technique. J Orthop Res 2021; 39:2671-2680. [PMID: 33580542 DOI: 10.1002/jor.25007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 12/02/2020] [Accepted: 02/10/2021] [Indexed: 02/04/2023]
Abstract
Although autogenous bone grafts are an optimal filling material for the induced membrane technique, limited availability and complications at the harvest site have created a need for alternative graft materials. We aimed to investigate the effect of an rhBMP-2-coated, 3D-printed, macro/microporous CaO-SiO2 -P2 O5 -B2 O3 bioactive ceramic scaffold in the treatment of critical femoral bone defects in rabbits using the induced membrane technique. A 15-mm segmental bone defect was made in the metadiaphyseal area of the distal femur of 14 rabbits. The defect was filled with polymethylmethacrylate cement and stabilized with a 2.0 mm locking plate. After the membrane matured for 4 weeks, the scaffold was implanted in two randomized groups: Group A (3D-printed bioceramic scaffold) and Group B (3D-printed, bioceramic scaffold with rhBMP-2). Eight weeks after implantation, the radiographic assessment showed that the healing rate of the defect was significantly higher in Group B (7/7, 100%) than in Group A (2/7, 29%). The mean volume of new bone formation around and inside the scaffold doubled in Group B compared to that in Group A. The mean static and dynamic stiffness were significantly higher in Group B. Histological examination revealed newly formed bone in both groups. Extensive cortical bone formation along the scaffold was found in Group B. Successful bone reconstruction in critical-sized bone defects could be obtained using rhBMP-2-coated, 3D-printed, macro/microporous bioactive ceramic scaffolds. This grafting material demonstrated potential as an alternative graft material in the induced membrane technique for reconstructing critical-sized bone defects.
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Affiliation(s)
- Jae-Woo Cho
- Department of Orthopaedic Surgery, Korea University Medical Center, Seoul, Republic of Korea
| | - Beom-Soo Kim
- Department of Orthopaedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Do-Hyun Yeo
- Department of Orthopaedic Surgery, Korea University Medical Center, Seoul, Republic of Korea
| | - Eic Ju Lim
- Department of Orthopaedic Surgery, Korea University Medical Center, Seoul, Republic of Korea
| | - Seungyeob Sakong
- Department of Orthopaedic Surgery, Korea University Medical Center, Seoul, Republic of Korea
| | - Junyoung Lim
- 3D Innovation Center, R&D of 3D Printing Medical Devices on Bio-ceramics, CGBIO, Gyeonggi-do, Republic of Korea
| | - SungNam Park
- 3D Innovation Center, R&D of 3D Printing Medical Devices on Bio-ceramics, CGBIO, Gyeonggi-do, Republic of Korea
| | - Yong-Hoon Jeong
- Department of Medical Device Development Center, Osong Medical Innovation Foundation, Cheongju-si, Republic of Korea
| | - Tae-Gon Jung
- Department of Medical Device Development Center, Osong Medical Innovation Foundation, Cheongju-si, Republic of Korea
| | - Hyuk Choi
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul, Republic of Korea
| | - Chang-Wug Oh
- Department of Orthopedic Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Medical Center, Seoul, Republic of Korea
| | - Jong Woong Park
- Department of Orthopaedic Surgery, Korea University Medical Center, Seoul, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, Korea University Medical Center, Seoul, Republic of Korea
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Cho JW, Samal P, Sakong S, Lim EJ, Choi W, Son WS, Kim H, Kim HG, Oh JK. Proximal tibia with an inserted nail can be an available donor site for harvesting cancellous bone. Orthop Traumatol Surg Res 2021; 107:103084. [PMID: 34583015 DOI: 10.1016/j.otsr.2021.103084] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 05/06/2021] [Accepted: 07/16/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION A pre-existing implant at the harvesting site might dissuade the surgeon from considering the site as available for bone harvesting. This study aimed to investigate the quantity of cancellous bone graft that can be harvested from a proximal tibia with an inserted nail and to report the clinical outcomes of this bone graft harvesting technique. HYPOTHESIS Our hypothesis was that a certain amount of cancellous bone graft could be harvested from a proximal tibia with an inserted nail without compromising the surrounding environment and outcome of nonunion treatment. MATERIAL AND METHODS Bone grafting from an ipsilateral proximal tibia with an inserted nail was performed in 32 patients for treating defect nonunion. The amount of harvested bone was measured using three parameters (weight, height, and volume). The effects of the proximal locking screw position on the quantity and location of bone graft harvest were analyzed. Clinical outcomes were evaluated by assessing the radiologic healing of the bone graft site and by assessing the donor site complications. RESULTS The mean bone defect volume in the nonunion site was 31.1±18.3 (range, 10.6-87.0) cm3. The mean quantity of harvested bone from proximal tibias with an inserted nail was 21.2g, height was 3.9cm, and volume was 26.3 cm3. A positive correlation was found between the quantity of harvested bone and the level of the lateral oblique interlocking screw hole in the tibial nail. All grafted bone successfully consolidated in all cases at an average of 5.8 months postoperatively. However, joint penetration during bone harvesting occurred in one case. DISCUSSION The bony defect, which measured about 14.3 cm3 could be filled with cancellous bone from a PT with an existing IM nail, without additional bone graft requirements. Even if an intramedullary nail exists inside the proximal tibia, harvesting cancellous bone at this site can be a viable option without serious complications. LEVEL OF EVIDENCE IV; Retrospective descriptive study.
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Affiliation(s)
- Jae-Woo Cho
- Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, 08308 Seoul, Republic of Korea
| | - Puspak Samal
- SUM Ultimate Medicare, IMS & SUM Hospital, 751003 Odisha, India
| | - Seungyeob Sakong
- Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, 08308 Seoul, Republic of Korea
| | - Eic Ju Lim
- Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Wonseok Choi
- Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, 08308 Seoul, Republic of Korea
| | - Whee Sung Son
- Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, 08308 Seoul, Republic of Korea
| | - Hanju Kim
- Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, 08308 Seoul, Republic of Korea
| | - Hyun-Gon Kim
- Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, 08308 Seoul, Republic of Korea.
| | - Jong-Keon Oh
- Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, 08308 Seoul, Republic of Korea.
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Cho JW, Yang Z, Lim EJ, Sakong S, Choi W, Son WS, Kim H, Chang AS, Lim DY, Kim Y, Kim BS, Oh JK. Multifragmentary patellar fracture has a distinct fracture pattern which makes coronal split, inferior pole, or satellite fragments. Sci Rep 2021; 11:22836. [PMID: 34819572 PMCID: PMC8613236 DOI: 10.1038/s41598-021-02215-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/29/2021] [Indexed: 12/28/2022] Open
Abstract
The present study aimed to map the location and frequency of fracture lines on the coronal articular and sagittal planes in multifragmentary patellar fractures. 66 multifragmentary patellar fractures were digitally reconstructed using the 3D CT mapping technique. The coronal articular surface and midsagittal fracture maps were produced by superimposing each case over a single template. Each fracture line was classified based on the initial displacement and orientation. We evaluated the frequency and direction of the fracture line, coronal split fragment area, and satellite and inferior pole fragment presence. Coronal articular surface fracture mapping identified primary horizontal fracture lines between the middle and inferior one-third of the articular surface in 63 patients (95.4%). Secondary horizontal fracture lines running on the inferior border of the articular facet were confirmed (83.3%). Secondary vertical fracture lines creating satellite fragments were mostly located on the periphery of the bilateral facet. Midsagittal fracture mapping of primary and secondary horizontal fracture lines with the main coronal fracture line revealed a predominantly X-shaped fracture map. The consequent coronal split fragment and inferior pole fracture were combined in most cases. In conclusion, the multifragmentary patellar fracture has a distinct pattern which makes coronal split, inferior pole, or satellite fragments.
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Affiliation(s)
- Jae-Woo Cho
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Zepa Yang
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Eic Ju Lim
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Seungyeob Sakong
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Wonseok Choi
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Whee Sung Son
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Hanju Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - An Seong Chang
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Do-Young Lim
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Youngwoo Kim
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Beom-Soo Kim
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University Daegu, Daegu, Republic of Korea.
- Department of Orthopaedic Surgery, Keimyung University School of Medicine, 1035, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea.
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
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Son WS, Cho JW, Kim NR, Cho JM, Choi NJ, Oh JK, Kim H. Percutaneous Two Unilateral Iliosacral S1 Screw Fixation for Pelvic Ring Injuries: A Retrospective Review of 38 Patients. J Trauma Inj 2021. [DOI: 10.20408/jti.2021.0075] [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: 11/05/2022] Open
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Abstract
Background The management of an infected nonunion of long bones is difficult and challenging. A staged procedure comprising radical debridement followed by definitive internal fixation was favored. However, no standard treatment has been established to determine the appropriate waiting period between initial debridement and definitive internal fixation. We propose a management method that incorporates early definitive internal fixation in infected nonunion of the lower limb. Methods Thirty-four patients (28 men and 6 women; mean age 46.09 years; range 25–74 years) with infected nonunion of the tibia or femur were included. Initial infected bone resection and radical debridement were performed in each patient in accordance with the preoperative plans. Definitive surgery was performed 2–3 weeks after the resection (4 weeks after flap surgery was required), and a third surgery was performed to fill the bone defect through bone grafting or transport (three-stage surgery). In cases of unplanned additional surgery, the reason for the requirement was analyzed, and radiological and functional results were investigated in accordance with the Association for the Study and Application of the Method of Ilizarov criteria. Results Bone union was achieved in all patients, and treatment was conducted as planned preoperatively in 28 patients (28/34, 82.35%). The mean interval between primary debridement and secondary definitive fixation was 2.76 weeks (range 2–4 weeks). Six unplanned additional surgeries were performed, and the infection relapsed in two cases. The radiological and functional outcomes were good or better in 32 and 31 patients, respectively. Conclusions Early definitive surgery can be performed to treat infected nonunion by thorough planning and implementation of radical resection, active response to infection, restoration of defective bones, and soft tissue healing through a systemic approach.
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Affiliation(s)
- Yong-Cheol Yoon
- Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, Namdong-gu, Incheon, Republic of Korea
| | - Chang-Wug Oh
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Jung-gu, Daegu, Republic of Korea
| | - Jae-Woo Cho
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, 148, Gurodong-ro, Guro-gu, 08308, Seoul, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, 148, Gurodong-ro, Guro-gu, 08308, Seoul, Republic of Korea.
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Song J, Jung KJ, Cho JW, Park T, Han SC, Park D. Transcriptomic Analysis of Polyhexamethyleneguanidine-Induced Lung Injury in Mice after a Long-Term Recovery. Toxics 2021; 9:toxics9100253. [PMID: 34678949 PMCID: PMC8540838 DOI: 10.3390/toxics9100253] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/02/2021] [Accepted: 10/03/2021] [Indexed: 02/06/2023]
Abstract
Polyhexamethyleneguanidine phosphate (PHMG-P) is one of the causative agents of humidifier disinfectant-induced lung injury. Direct exposure of the lungs to PHMG-P causes interstitial pneumonia with fibrosis. Epidemiological studies showed that patients with humidifier disinfectant-associated lung injuries have suffered from restrictive lung function five years after the onset of the lung injuries. We investigated whether lung damage was sustained after repeated exposure to PHMG-P followed by a long-term recovery and evaluated the adverse effects of PHMG-P on mice lungs. Mice were intranasally instilled with 0.3 mg/kg PHMG-P six times at two weeks intervals, followed by a recovery period of 292 days. Histopathological examination of the lungs showed the infiltration of inflammatory cells, the accumulation of extracellular matrix in the lung parenchyma, proteinaceous substances in the alveoli and bronchiolar–alveolar hyperplasia. From RNA-seq, the gene expression levels associated with the inflammatory response, leukocyte chemotaxis and fibrosis were significantly upregulated, whereas genes associated with epithelial/endothelial cells development, angiogenesis and smooth muscle contraction were markedly decreased. These results imply that persistent inflammation and fibrotic changes caused by repeated exposure to PHMG-P led to the downregulation of muscle and vascular development and lung dysfunction. Most importantly, this pathological structural remodeling induced by PHMG-P was not reversed even after long-term recovery.
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Affiliation(s)
- Jeongah Song
- Animal Model Research Group, Korea Institute of Toxicology, Jeongeup 56212, Korea
- Correspondence: (J.S.); (D.P.); Tel.: +82-63-850-8553 (J.S.); +82-42-610-8844 (D.P.)
| | - Kyung-Jin Jung
- Bioanalytical and Immunoanalytical Research Group, Korea Institute of Toxicology, Daejeon 34114, Korea;
| | - Jae-Woo Cho
- Toxicologic Pathology Research Group, Korea Institute of Toxicology, Daejeon 34114, Korea;
| | - Tamina Park
- Department of Predictive Toxicology, Korea Institute of Toxicology, Daejeon 34114, Korea;
- Department of Human and Environmental Toxicology, University of Science and Technology, Daejeon 34113, Korea
| | - Su-Cheol Han
- Jeonbuk Department of Inhalation Research, Korea Institute of Toxicology, Jeongeup 56212, Korea;
| | - Daeui Park
- Department of Predictive Toxicology, Korea Institute of Toxicology, Daejeon 34114, Korea;
- Department of Human and Environmental Toxicology, University of Science and Technology, Daejeon 34113, Korea
- Correspondence: (J.S.); (D.P.); Tel.: +82-63-850-8553 (J.S.); +82-42-610-8844 (D.P.)
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Choi S, Jo HS, Song H, Kim HJ, Oh JK, Cho JW, Park K, Kim SE. Multifunctional Tannic Acid-Alendronate Nanocomplexes with Antioxidant, Anti-Inflammatory, and Osteogenic Potency. Nanomaterials (Basel) 2021; 11:nano11071812. [PMID: 34361198 PMCID: PMC8308329 DOI: 10.3390/nano11071812] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 12/12/2022]
Abstract
In the current study, we fabricated tannic acid-alendronate (TA-ALN) nanocomplexes (NPXs) via self-assembly. These TA-ALNs were characterized by dynamic light scattering, zeta potential, transmission electron microscopy, and FT-IR spectroscopy. The TA-ALNs were evaluated for antioxidant, anti-inflammatory, and osteogenesis-accelerating abilities in osteoblast-like cells (MC3T3-E1 cells). All TA-ALNs displayed nano-sized beads that were circular in form. Treatment with TA-ALN (1:0.1) efficiently removed reactive oxygen species in cells and protected osteoblast-like cells from toxic hydrogen peroxide conditions. Moreover, TA-ALN (1:0.1) could markedly decrease the mRNA levels of pro-inflammatory mediators in lipopolysaccharide-stimulated cells. Furthermore, cells treated with TA-ALN (1:1) exhibited not only significantly greater alkaline phosphatase activity and calcium collection, but also outstandingly higher mRNA levels of osteogenesis-related elements such as collagen type I and osteocalcin. These outcomes indicate that the prepared TA-ALNs are excellent for antioxidant, anti-inflammatory, and osteogenic acceleration. Accordingly, TA-ALN can be used latently for bone renovation and regeneration in people with bone fractures, diseases, or disorders.
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Affiliation(s)
- Somang Choi
- Department of Orthopedic Surgery and Nano-Based Disease Control Institute, Korea University Guro Hospital, #148, Gurodong-ro, Guro-gu, Seoul 08308, Korea; (S.C.); (H.-S.J.); (H.-J.K.); (J.-K.O.)
| | - Han-Saem Jo
- Department of Orthopedic Surgery and Nano-Based Disease Control Institute, Korea University Guro Hospital, #148, Gurodong-ro, Guro-gu, Seoul 08308, Korea; (S.C.); (H.-S.J.); (H.-J.K.); (J.-K.O.)
| | - Heegyeong Song
- Department of Systems Biotechnology, Chung-Ang University, Anseong 17546, Korea;
| | - Hak-Jun Kim
- Department of Orthopedic Surgery and Nano-Based Disease Control Institute, Korea University Guro Hospital, #148, Gurodong-ro, Guro-gu, Seoul 08308, Korea; (S.C.); (H.-S.J.); (H.-J.K.); (J.-K.O.)
| | - Jong-Keon Oh
- Department of Orthopedic Surgery and Nano-Based Disease Control Institute, Korea University Guro Hospital, #148, Gurodong-ro, Guro-gu, Seoul 08308, Korea; (S.C.); (H.-S.J.); (H.-J.K.); (J.-K.O.)
| | - Jae-Woo Cho
- Department of Orthopedic Surgery and Nano-Based Disease Control Institute, Korea University Guro Hospital, #148, Gurodong-ro, Guro-gu, Seoul 08308, Korea; (S.C.); (H.-S.J.); (H.-J.K.); (J.-K.O.)
- Correspondence: (J.-W.C.); (K.P.); (S.-E.K.); Tel.: +82-2-2626-1869 (J.-W.C.); +82-31-670-3357 (K.P.); +82-2-6738-4514 (S.-E.K.)
| | - Kyeongsoon Park
- Department of Systems Biotechnology, Chung-Ang University, Anseong 17546, Korea;
- Correspondence: (J.-W.C.); (K.P.); (S.-E.K.); Tel.: +82-2-2626-1869 (J.-W.C.); +82-31-670-3357 (K.P.); +82-2-6738-4514 (S.-E.K.)
| | - Sung-Eun Kim
- Department of Orthopedic Surgery and Nano-Based Disease Control Institute, Korea University Guro Hospital, #148, Gurodong-ro, Guro-gu, Seoul 08308, Korea; (S.C.); (H.-S.J.); (H.-J.K.); (J.-K.O.)
- Correspondence: (J.-W.C.); (K.P.); (S.-E.K.); Tel.: +82-2-2626-1869 (J.-W.C.); +82-31-670-3357 (K.P.); +82-2-6738-4514 (S.-E.K.)
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Lim EJ, Sakong S, Son WS, Kim H, Cho JW, Oh JK. Usefulness of the obturator hook technique for guiding the initial trajectory control in infra-acetabular screw placement. J Orthop Surg (Hong Kong) 2021; 29:2309499021996838. [PMID: 33641537 DOI: 10.1177/2309499021996838] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Proper placement of infra-acetabular screws is technically demanding; there is a limited safe zone for screw fixation because of the complexity of the bone anatomy around the hip joint and the vulnerability of the major neurovascular bundles in the pelvic cavity. We aimed to present the obturator hook technique as a surgical technique for infra-acetabular screw placement in acetabular and pelvic fractures and report its radiological outcomes. METHODS Patients treated with infra-acetabular screw placement using the obturator hook technique between January 2015 and August 2020 were enrolled in this study. We collected data on demographics, surgical approach, reduction status, complications, and outcomes. The radiological outcomes of infra-acetabular screw placement based on computed tomography findings were evaluated as follows: success, articular penetration, or out of the bone. RESULTS Thirty-five patients underwent infra-acetabular screw placement (26 men, 9 women; mean age, 55 years; range, 27-90 years). One patient underwent bilateral infra-acetabular screw placement; therefore, 36 infra-acetabular screws were inserted in all patients. An ideal placement was achieved with 27 infra-acetabular screws (27/36, 75%). Seven infra-acetabular screws (7/36, 19%) showed articular penetration, and two infra-acetabular screws (2/36, 6%) were placed outside the bone. One patient with articular penetration and mechanical symptoms of the hip joint required screw replacement. No other complications, including obturator nerve and vascular injuries, were observed. CONCLUSION The obturator hook technique could be a favorable and individualized method for infra-acetabular screw placement in patients with acetabular and pelvic fractures. LEVEL OF EVIDENCE IV, retrospective descriptive study.
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Affiliation(s)
- Eic Ju Lim
- Department of Orthopaedic Surgery, 58934Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Seungyeob Sakong
- Department of Orthopaedic Surgery, 58934Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Whee Sung Son
- Department of Orthopaedic Surgery, 58934Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - HanJu Kim
- Department of Orthopaedic Surgery, 58934Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Jae-Woo Cho
- Department of Orthopaedic Surgery, 58934Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, 58934Guro Hospital, Korea University Medical Center, Seoul, Korea
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Sakong S, Lim EJ, Cho JM, Choi NJ, Cho JW, Oh JK. The Effects of a Trauma Team Approach on the Management of Open Extremity Fractures in Polytrauma Patients: A Retrospective Comparative Study. J Trauma Inj 2021. [DOI: 10.20408/jti.2020.0043] [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: 11/05/2022] Open
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25
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Lim EJ, Sakong S, Choi W, Oh JK, Cho JW. Which radiograph is most accurate for assessing hip joint penetration in infra-acetabular screw placement? Medicine (Baltimore) 2021; 100:e26392. [PMID: 34128903 PMCID: PMC8213270 DOI: 10.1097/md.0000000000026392] [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] [Received: 11/08/2020] [Accepted: 05/26/2021] [Indexed: 01/04/2023] Open
Abstract
Although infra-acetabular screws have been used for anterior and posterior column transfixation, a screw penetrating the hip joint can result in harmful complications. However, the most accurate intraoperative radiologic imaging tool for identifying articular penetration has not been established. The purpose of the present study was, therefore, to evaluate the consistency with which standard pelvic radiographs compared with computed tomography (CT) can be used for demonstrating articular penetration.This retrospective review was performed between January 2015 and December 2020. We evaluated the records of patients with acetabular or pelvic fractures who underwent open reduction and internal fixation with infra-acetabular screw placement. We collected demographic data and described infra-acetabular screw placement as follows: ideal placement, articular penetration, and out of the bone. Articular penetration was assessed independently on each pelvic radiograph and compared statistically with the CT scans. Sensitivity, specificity, correct interpretation rate, and prevalence-adjusted bias-adjusted kappa (PABAK) were calculated for each radiograph.Thirty-nine patients underwent infra-acetabular screw placement. The mean age of patients was 55 years (range, 27-90 years); there were 29 men and 10 women. One patient underwent bilateral infra-acetabular screw placement; therefore, 40 infra-acetabular screws were included in total. Six (6/40, 15%) infra-acetabular screws showed articular penetration on CT and two (2/40, 5%) showed infra-acetabular screws extending out of the bone. Hip joint penetration was correctly identified at a rate of 92.5% (95% confidence interval [CI], 79.6-98.4%) on the outlet view and 87.5% (95% CI, 73.2-95.8%) on the anteroposterior (AP) view. The PABAK for the agreement between pelvic radiographs and CT scans was 0.85 in the outlet view and 0.75 in the AP view.The outlet view is an accurate method for detecting articular penetration of infra-acetabular screws. We recommend the insertion of an infra-acetabular screw under fluoroscopic outlet view to avoid articular penetration intraoperatively.
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Affiliation(s)
- Eic Ju Lim
- Department of Orthopedic Surgery, Chungbuk National University Hospital, Chungbuk National University, Cheongju
| | - Seungyeob Sakong
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Wonseok Choi
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Jae-Woo Cho
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
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26
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Han JS, Back SM, Cho JW, Park HJ, Kim WJ, Park SH, Noh JH, Kim YB, Lee BS. Genotoxicity and subchronic general toxicity assessments of Lactobacillus curvatus WiKim 38 using Sprague-Dawley rats. Food Chem Toxicol 2021; 152:112199. [PMID: 33865936 DOI: 10.1016/j.fct.2021.112199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/28/2020] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 01/08/2023]
Abstract
Lactobacillus curvatus WiKim 38 (LCW), isolated from kimchi, has shown novel immunomodulatory and anti-inflammatory properties. In the present study, to obtain data on the safety of LCW, we performed three genotoxicity (bacterial reverse mutation, chromosome aberration, and micronucleus) and two general toxicity (single-dosing and 13-week repeated-dosing) studies. In the genotoxicity assessment, LCW showed no increased reverse mutation for 4 strains of Salmonella typhimurium and a strain of Escherichia coli. In addition, LCW did not induce chromosome aberrations at concentrations up to 5000 μg/mL in cultured Chinese hamster lung (CHL) cells and did not induce an increased frequency of micronuclei in the bone marrow cells of rats at concentrations up to 2000 mg/kg. In the acute toxicity study using Sprague-Dawley (SD) rats, the approximate lethal dose of LCW was determined to be over 5000 mg/kg body weight (b.w.) in both sexes. Finally, in the subchronic toxicity study, no LCW-related adverse effects were observed at concentrations up to 5000 mg/kg b.w./day. Consequently, LCW is considered not to have mutagenic effects, and its no-observed-adverse-effect-level (NOAEL) is 5000 mg/kg b.w., equivalent to approximately 4.71 × 109 CFU/kg b.w., suggesting the LCW could be a potential probiotic for humans based on its safety profile.
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Affiliation(s)
- Ji-Seok Han
- Toxicologic Pathology Research Group, Korea Institute of Toxicology (KIT), 141 Gajeong-ro, Yuseong-gu, Daejeon, Republic of Korea
| | - Seng-Min Back
- Genetic Toxicology Research Group, Korea Institute of Toxicology (KIT), 141 Gajeong-ro, Yuseong-gu, Daejeon, Republic of Korea
| | - Jae-Woo Cho
- Toxicologic Pathology Research Group, Korea Institute of Toxicology (KIT), 141 Gajeong-ro, Yuseong-gu, Daejeon, Republic of Korea
| | - Hee Jin Park
- Toxicologic Pathology Research Group, Korea Institute of Toxicology (KIT), 141 Gajeong-ro, Yuseong-gu, Daejeon, Republic of Korea
| | - Woo-Jin Kim
- Toxicologic Pathology Research Group, Korea Institute of Toxicology (KIT), 141 Gajeong-ro, Yuseong-gu, Daejeon, Republic of Korea
| | - Seong-Hoon Park
- Genetic Toxicology Research Group, Korea Institute of Toxicology (KIT), 141 Gajeong-ro, Yuseong-gu, Daejeon, Republic of Korea
| | - Jung-Ho Noh
- Organ Toxicology Research Group, Korea Institute of Toxicology (KIT), 141 Gajeong-ro, Yuseong-gu, Daejeon, Republic of Korea
| | - Yong-Bum Kim
- Department of Advanced Toxicology Research, Korea Institute of Toxicology (KIT), 141 Gajeong-ro, Yuseong-gu, Daejeon, Republic of Korea
| | - Byoung-Seok Lee
- Toxicologic Pathology Research Group, Korea Institute of Toxicology (KIT), 141 Gajeong-ro, Yuseong-gu, Daejeon, Republic of Korea.
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Cho JW, Cho WT, Sakong S, Lim EJ, Choi W, Kang S, Kim BS, Kim JK, Oh CW, Oh JK. Mapping of acetabular posterior wall fractures using a three-dimensional virtual reconstruction software. Injury 2021; 52:1403-1409. [PMID: 33827775 DOI: 10.1016/j.injury.2021.03.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 03/20/2021] [Accepted: 03/27/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to analyze and describe the fracture patterns of the acetabular posterior wall based on quantitative measurements of the fracture characteristics. MATERIALS AND METHODS Computed tomography images of 51 patients with acetabular posterior wall fractures from an initial cohort of 216 acetabular fractures were imported into a three-dimensional (3D) virtual software. The reconstructed 3D images were utilized to evaluate the following: (i) fracture line mapping on the inner articular and retro-acetabular surfaces, (ii) common zones of fracture and marginal impaction, and (iii) categorization by location and pattern of comminution. The clock-face position was applied for description: the midpoint of the transverse acetabular ligament served as the +180° reference point, and the 0° reference point was set perpendicular to the ligament. The fracture angle on the articular surface was defined as the intersection between the start and end points. The fracture span on the retro-acetabular surface was defined as the ratio of the perpendicular distance, which is between the fracture beak and acetabular rim, to the entire length, which is from the edge to the rim. Quantitative measurements were performed, and the fracture patterns were analyzed. A color scale bar was used to visualize the common and marginal impaction zones. RESULTS The articular surface mapping of all the cases demonstrated that the average starting point of the fracture line was +6.2° (±12.8°) and the endpoint was 96.7° (±13.3°), and the average fracture angle was 119.6° (±7.6°) with 80.6% of the fragments having angles within 18.7-117°. The retro-acetabular surface mapping demonstrated that the average fracture span was 0.65 ±0.20, and 61.7 % of the fracture lines were located within 0.6 to 0.9. Marginal impaction was found in 21 cases (21/51, 41.2%; range: between +7° and +105°). CONCLUSION The fracture maps showed fracture patterns and recurrent fracture zones on the articular and retro-acetabular surfaces. However, there was no remarkable pattern of marginal impaction. LEVEL OF EVIDENCE Retrospective cohort study.
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Affiliation(s)
- Jae-Woo Cho
- Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Won-Tae Cho
- Ajou University School of Medicine, Suwon, Republic of Korea.
| | - Seungyeob Sakong
- Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Eic Ju Lim
- Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Wonseok Choi
- Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Seonghyun Kang
- Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Beom-Soo Kim
- Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Jin-Kak Kim
- Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chang-Wug Oh
- Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jong-Keon Oh
- Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea.
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Park EJ, Kim SN, Yoon C, Cho JW, Lee GH, Kim DW, Park J, Choi I, Lee SH, Song J, Lim HJ, Kang MS, Lee HS. Repeated intratracheal instillation of zinc oxide nanoparticles induced pulmonary damage and a systemic inflammatory response in cynomolgus monkeys. Nanotoxicology 2021; 15:621-635. [PMID: 33870832 DOI: 10.1080/17435390.2021.1905899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Recently, some researchers have demonstrated that inhaled zinc oxide nanoparticles (ZnONPs) induce an acute systemic inflammatory response in workers. Considering nonhuman primates are preferably considered an animal model for translational research due to their proven similarity with humans in terms of genetics and physiology, we intratracheally instilled ZnONPs to cynomolgus monkey for 14 days and identified the toxic mechanism and bioaccumulation. ZnONPs were rapidly ionized or aggregated in a simulated pulmonary fluid, and they attracted neutrophils to the lungs and increased the pulmonary level of inflammatory mediators. Additionally, thickened alveolar walls, fibrin clots, and hemorrhages were observed in the lungs of the monkeys instilled with the higher dose accompanied by cell debris in the alveolar ducts and alveoli. Dark-field microscopy images revealed translocation of ZnONPs into other tissues accompanied by an increase in the relative weight of livers to body weight. In addition, when instilled at the higher dose, the albumin/globulin ratio notably decreased compared to the control, whereas the C-reactive protein (CRP) level was significantly elevated. ZnONPs also clearly induced apoptotic cell death in a 24 h exposure to alveolar macrophages. Taken together, part of inhaled ZnONPs may be ionized in the lung, resulting in acute toxic effects, including cell death and tissue damage, and the rest may move to other tissues in the form of particles, causing a systemic inflammatory response. Based on the proven evidence among workers, we also suggest that the CRP level can be recommended as a biomarker for ZnONPs-induced adverse health effects.
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Affiliation(s)
- Eun-Jung Park
- East-West Medical Science Research Institute, Kyung Hee Medical Science Research Institute, Kyung Hee University, Seoul, Republic of Korea.,Human Health and Environmental Toxins Research Center, Kyung Hee Medical Science Research Institute, Kyung Hee University, Seoul, Republic of Korea.,Department of Biomedical Science and Technology, Graduate school, Kyung Hee University, Seoul, South Korea
| | - Soo Nam Kim
- Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongeup, Republic of Korea.,Bio-Health Convergence Institute GLP Lab, Korea Testing Certification Institute, Cheongju, Republic of Korea
| | - Cheolho Yoon
- Ochang Center, Korea Basic Science Institute, Seoul, South Korea
| | - Jae-Woo Cho
- Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongeup, Republic of Korea.,Toxicologic Pathology Research Group, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Gwang-Hee Lee
- School of Civil, Environmental, and Architectural Engineering, Korea University, Seoul, South Korea
| | - Dong-Wan Kim
- School of Civil, Environmental, and Architectural Engineering, Korea University, Seoul, South Korea
| | - Junhee Park
- Department of Life Science, University of Seoul, Seoul, South Korea
| | - Inhee Choi
- Department of Life Science, University of Seoul, Seoul, South Korea
| | - Seung Hyeun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jeongah Song
- Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongeup, Republic of Korea
| | - Hyun-Ji Lim
- Department of Biomedical Science and Technology, Graduate school, Kyung Hee University, Seoul, South Korea
| | - Min-Sung Kang
- Department of Biomedical Science and Technology, Graduate school, Kyung Hee University, Seoul, South Korea.,Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongeup, Republic of Korea
| | - Hong-Soo Lee
- Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongeup, Republic of Korea
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Lim EJ, Oh JK, Cho JW, Sakong S, Cho JM. Hemorrhagic Shock in a Patient with a Morel-Lavallée Lesion Combined with Active Arterial Bleeding without Fracture. J Trauma Inj 2021. [DOI: 10.20408/jti.2020.0013] [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: 11/05/2022] Open
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30
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Kim H, Kar AK, Kaja A, Lim EJ, Choi W, Son WS, Oh JK, Sakong S, Cho JW. More weighted cancellous bone can be harvested from the proximal tibia with less donor site pain than anterior iliac crest corticocancellous bone harvesting: retrospective review. J Orthop Surg Res 2021; 16:220. [PMID: 33771180 PMCID: PMC7995739 DOI: 10.1186/s13018-021-02364-y] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/18/2021] [Indexed: 01/28/2023] Open
Abstract
Background Iliac crest is the most preferred autogenous bone graft harvesting donor site while it has sorts of complications like prolonged pain, hematoma, and fracture. Harvesting cancellous bone from proximal tibia is also increasingly being used because of lower complications and less donor site pain. However, there are lack of studies to compare these two donor sites in detail. Thus, we proposed to investigate the available amount of autogenous bone graft from the proximal tibia. Methods Fifty-one patients who underwent simultaneous bone graft harvest from the PT and the AIC to fill up the given critical sized bone defects were enrolled in this study. We prospectively collected data including the weight of the harvested bone, donor site pain using the visual analog scale (VAS) score, and complications between the two sites. Results The mean weight of cancellous bone harvested from the PT was greater than AIC (33.2g vs. 27.4g, p = 0.001). The mean VAS score was significantly lesser in the PT up to 60 days after harvesting (p < 0.001). There was persistent pain up to 90 days in four PT patients and in seven AIC patients. The major complication was reported only in AIC patients (11.8%). Conclusions Harvesting cancellous bone from the PT is an acceptable alternative to the AIC for autogenous bone grafting owing to availability of more weighted graft bone and less donor site pain.
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Affiliation(s)
- Hanju Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Ajit Kumar Kar
- Department of Orthopedic Surgery, Shanti memorial Hospital, Cuttack, India
| | - Aditya Kaja
- Department of Orthopedic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Eic Ju Lim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Wonseok Choi
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Whee Sung Son
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Seungyeob Sakong
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
| | - Jae-Woo Cho
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
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Park EJ, Kim SN, Lee GH, Jo YM, Yoon C, Kim DW, Cho JW, Han JS, Lee SJ, Seong E, Park EJ, Oh I, Lee HS. Inhaled underground subway dusts may stimulate multiple pathways of cell death signals and disrupt immune balance. Environ Res 2020; 191:109839. [PMID: 32810496 DOI: 10.1016/j.envres.2020.109839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/23/2019] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
In this study, we aimed to identify a toxic mechanism and the potential health effects of ambient dusts in an underground subway station. At 24 h exposure to human bronchial epithelial (BEAS-2B) cells (0, 2.5, 10, and 40 μg/mL), dusts located within autophagosome-like vacuoles, whereas a series of autophagic processes appeared to be blocked. The volume, potential and activity of mitochondria decreased in consistent with a condensed configuration, and the percentage of late apoptotic cells increased accompanying S phase arrest. While production of reactive oxygen species, expression of ferritin (heavy chain) protein, secretion of IL-6, IL-8 and matrix metalloproteinases, and the released LDH level notably increased in dust-treated cells (40 μg/mL), intracellular calcium level decreased. At day 14 after a single instillation to mice (0, 12.5, 50, and 200 μg/head), the total number of cells increased in the lungs of dust-treated mice with no significant change in cell composition. The pulmonary levels of TGF-β, GM-CSF, IL-12 and IL-13 clearly increased following exposure to dusts, whereas that of CXCL-1 was dose-dependently inhibited. Additionally, the population of cytotoxic T cells in T lymphocytes in the spleen increased relative to that of helper T cells, and the levels of IgA and IgM in the bloodstream were significantly reduced in the dust-treated mice. Subsequently, to improve the possibility of extrapolating our findings to humans, we repeatedly instilled dusts (1 time/week, 4 weeks, 0.25 and 1.0 mg/head) to monkeys. The total number of cells, the relative portion of neutrophils, the level of TNF-α significantly increased in the lungs of dust-treated monkeys, and the expression of cytochrome C was enhanced in the lung tissues. Meanwhile, the pulmonary level of MIP-α was clearly reduced, and the expression of caveolin-1 was inhibited in the lung tissues. More importantly, inflammatory lesions, such as granuloma, were seen in both mice and monkeys instilled with dusts. Taken together, we conclude that dusts may impair the host's immune function against foreign bodies by inhibiting the capacity for production of antibodies. In addition, iron metabolism may be closely associated with dust-induced cell death and inflammatory response.
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Affiliation(s)
- Eun-Jung Park
- East-West Medical Research Institute, Kyung Hee University, Seoul, 02447, South Korea.
| | - Soo-Nam Kim
- Bio-Health Convergence Institute GLP Lab, Korea Testing Certification Institute, Cheongju, 28115, South Korea
| | - Gwang-Hee Lee
- School of Civil, Environmental, and Architectural Engineering, Korea University, Seoul, 02841, South Korea
| | - Young-Min Jo
- Department of Environmental Science and Engineering, Global Campus, Kyung Hee University, Yongin-Si, 17104, South Korea
| | - Cheolho Yoon
- Seoul Center, Korea Basic Science Institute, Seoul, 126-16, South Korea
| | - Dong-Wan Kim
- School of Civil, Environmental, and Architectural Engineering, Korea University, Seoul, 02841, South Korea
| | - Jae-Woo Cho
- Toxicologic Pathology Research Group, Korea Institute of Toxicology, Daejeon, South Korea
| | - Ji-Seok Han
- Toxicologic Pathology Research Group, Korea Institute of Toxicology, Daejeon, South Korea
| | - Sang Jin Lee
- Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongeup, South Korea
| | - Eunsol Seong
- East-West Medical Research Institute, Kyung Hee University, Seoul, 02447, South Korea
| | - Eun-Jun Park
- East-West Medical Research Institute, Kyung Hee University, Seoul, 02447, South Korea
| | - Inkyung Oh
- Department of Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Hong-Soo Lee
- Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongeup, South Korea.
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Yoon YC, Kim J, Cho JW, Cho WT, Kim HJ, Oh JK. Simple guidelines for evaluating intraoperative alignment after the reduction of intertrochanteric fractures. Asian J Surg 2020; 44:66-71. [PMID: 33262045 DOI: 10.1016/j.asjsur.2020.10.010] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/14/2020] [Accepted: 10/19/2020] [Indexed: 11/19/2022] Open
Abstract
The incidence of intertrochanteric femoral fractures has rapidly increased with the extended lifespan of the elderly population. Surgery enables early ambulation by achieving anatomic reduction and stable internal fixation. However, reduction usually involves postoperative evaluation. Here, we present reliable parameters obtained from analyses of three-dimensional computed tomography images from cadavers to serve as guidelines during the reduction of intertrochanteric fractures. We included 184 three-dimensional modeling samples from cadavers placed in two standardized positions, similar to C-arm imaging. We recorded the level of the orthogonal line from the greater trochanter (GT) tip to the femoral head (GT orthogonal line [GTOL]) in the anteroposterior view and the line along the anterior femoral cortex passing through the femoral head (anterior cortical line) in the axial view. Correlations between these lines and angular alignments were statistically determined. The GTOL passed above the femoral head center at mean 2.36 mm in all patients; 77.17% of such instances were in the upper second quadrant of the femoral head. The anterior cortical line passed under the femoral head center at mean 10.82 mm; 73.37% of such instances were in the inferior one-third of the femoral head. Consistent correlations were found between the GTOL and neck-shaft angle and between the anterior cortical line and anteversion. The GTOL and anterior cortical line passed through a constant level of the femoral head in most samples and were correlated with angular alignments. The intraoperative use of these simple imaginary lines improves the intertrochanteric fracture reduction quality.
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Affiliation(s)
- Yong-Cheol Yoon
- Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jinil Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jae-Woo Cho
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Won-Tae Cho
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Gyeonggi-do, Republic of Korea
| | - Hyung-Jin Kim
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.
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Cho JW, Kim BS, Yeo DH, Kang SH, Lim EJ, Sakong S, Cho WT, Oh JK. Clinical outcome of AO/OTA type C fracture of the distal humerus using the expanded paratricipital approach and cadaveric comparison of the exposure of the paratricipital and expanded paratricipital approaches to the distal humerus. J Shoulder Elbow Surg 2020; 29:1554-1563. [PMID: 32713465 DOI: 10.1016/j.jse.2020.03.001] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/20/2020] [Accepted: 03/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND We investigated the overall clinical outcome of the expanded paratricipital approach in complex articular fractures of the distal humerus and the effect of lack of visualization in the surgical field. In addition, we performed a cadaveric study to investigate the expansion or limitation of articular access in the expanded paratricipital approach. METHODS Forty-one AO/OTA type 13C fracture cases treated using the expanded paratricipital approach at a single trauma center from 2013 to 2017 were enrolled in this study. We evaluated the overall clinical outcome and analyzed the effect of lack of visualization in the surgical field with the expanded paratricipital approach by comparing outcomes between 2 groups classified by the location of the main articular fracture (group 1, limited visualization; group 2, without limited visualization). The length of inaccessible and accessible articular segments were analyzed using 40 matched-pair elbows. RESULTS The average duration of follow-up was 15.1 months. All fractures (type C1 in 11 cases, type C2 in 21, and type C3 in 9) were radiologically healed at 3.2 months after surgery. No cases required additional surgery because of implant irritation. The average Mayo Elbow Performance Score was 90.5. The mean Disabilities of the Arm, Shoulder and Hand score was 18.5. Among the 41 cases, the limited visualization group (group 1, n = 21) had a longer surgical time and higher percentage of nonanatomic reduction than group 2. Although the expanded paratricipital approach allowed more articular exposure than the conventional approach, there was still a 20mm inaccessible articular segment (30% of transepicondylar width) in cadaveric dissection. CONCLUSIONS The expanded paratricipital approach can be used in type C1, type C2, and selective type C3 articular fractures of the distal humerus with favorable results. Relative to surgical times and achieving anatomic reduction, it is more successful in a fracture with a main articular fragment and with good visualization.
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Affiliation(s)
- Jae-Woo Cho
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medicine, Seoul, Republic of Korea
| | - Beom-Soo Kim
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Do-Hyun Yeo
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medicine, Seoul, Republic of Korea
| | - Seong Hyun Kang
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medicine, Seoul, Republic of Korea
| | - Eic Ju Lim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medicine, Seoul, Republic of Korea
| | - Seungyeob Sakong
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medicine, Seoul, Republic of Korea
| | - Won-Tae Cho
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea.
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medicine, Seoul, Republic of Korea.
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Cho JW, Kent WT, Oh CW, Kim BS, Cho WT, Oh JK. Bone-Graft Resorption Reduced by the Induced Membrane Technique and Factors Affecting Volumetric Changes: An Analysis of 120 Serial Computed Tomographic Scans in 40 Patients. J Bone Joint Surg Am 2020; 102:1269-1278. [PMID: 32675677 DOI: 10.2106/jbjs.19.00804] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about the volumetric changes of grafted bone over time when using the induced membrane technique. This study investigates the volumetric changes of bone graft using serial computed tomographic (CT) scans following the induced membrane technique. METHODS Patients with critical-sized bone defects had serial CT scans after undergoing bone-grafting using the induced membrane technique. CT scans to evaluate the volume of bone graft were obtained immediately postoperatively and at 6 and 12 months. The change in the volume of bone graft was determined at 6 and 12 months postoperatively. Patient demographic characteristics, the location and composition of the bone graft, and the type of fixation construct were analyzed. RESULTS Forty patients met inclusion criteria. There were 27 tibiae and 13 femora with a mean size defect of 8.6 cm (range, 2.5 to 20.6 cm). Of these patients, 21 received autograft with cancellous bone graft and 19 received mixed autogenous bone with demineralized bone matrix (DBM) at a mean time of 17 weeks after the membrane formation. For the first 6 months, there was an overall osseous resorption of -9.9%. The overall graft volume from 6 to 12 months demonstrated an increase of osseous volume by +1.6%. For the entire 12-month period, there was a mean graft volume resorption of -8.3%. A correlation was found between the early volumetric changes of grafted bone and the percentage of DBM in the graft mixture. A correlation was also found between the late volumetric changes and the location of defect or the type of fixation. CONCLUSIONS At 1 year after use of the induced membrane technique for the treatment of a critical-sized bone defect, resorption of the grafted bone averaged -8.3%. The volumetric changes were influenced by the property of the grafted bone, the fixation construct, and the location of the defect. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jae-Woo Cho
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - William T Kent
- Department of Orthopedic Surgery, University of California, San Diego, San Diego, California
| | - Chang-Wug Oh
- Department of Orthopedic Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Beom-Soo Kim
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Won-Tae Cho
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
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Jeon WY, Seo CS, Ha H, Shin HK, Cho JW, Kim DH, Lee MY. Subchronic toxicological evaluation of Bojungikki-tang water extract: 13-Week oral repeated-dose toxicity study in Crl:CD (SD) rats. J Ethnopharmacol 2020; 252:112551. [PMID: 31923540 DOI: 10.1016/j.jep.2020.112551] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/04/2020] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Bojungikki-tang is a traditional herbal medicine used to boost immunity and reduce fatigue. However, there is not enough scientific evidence about its toxicological safety profile to support its continued clinical application. AIM OF THE STUDY The objective of this study was to investigate the subchronic toxicity profile of Bojungikki-tang water extract (BITW) in Sprague Dawley rats who were exposed to it in multiple doses and various concentrations. MATERIALS AND METHODS BITW was administered to rats orally, once daily at doses of 0, 500, 1000, or 2000 mg/kg/day for 13 weeks. We checked toxicological parameters including general observations, organ/body weights, food consumption, ophthalmological signs, hematological and serum biochemical values, urinalysis values and histopathological findings. RESULTS The 13 week repeated oral administration of BITW to rats at doses at doses levels of less than or equal to 2000 mg/kg/day caused no significant toxicological changes and only minor nonsignificant changes. CONCLUSIONS Our findings indicate that administration of BITW for up to 13 weeks may be safe and nontoxic, with a no-observed-adverse-effect-level of >2000 mg/kg/day for both male and female rats.
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Affiliation(s)
- Woo-Young Jeon
- Herbal Medicine Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea.
| | - Chang-Seob Seo
- Herbal Medicine Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea.
| | - Hyekyung Ha
- Herbal Medicine Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea.
| | - Hyeun-Kyoo Shin
- Herbal Medicine Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea.
| | - Jae-Woo Cho
- Korea Institute of Toxicology, 30 Baekhak 1-Gil, Jeongeup-si, Jeollabuk-do, 56212, Republic of Korea.
| | - Da Hee Kim
- Korea Institute of Toxicology, 30 Baekhak 1-Gil, Jeongeup-si, Jeollabuk-do, 56212, Republic of Korea.
| | - Mee-Young Lee
- Herbal Medicine Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea.
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Han HY, Cho JW, Seong E, Park EJ, Lee GH, Kim DW, Yang YS, Oh JH, Yoon S, Lee TG, Kim TW, Park EJ. Amorphous silica nanoparticle-induced pulmonary inflammatory response depends on particle size and is sex-specific in rats. Toxicol Appl Pharmacol 2020; 390:114890. [PMID: 31972177 DOI: 10.1016/j.taap.2020.114890] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 08/26/2019] [Revised: 01/14/2020] [Accepted: 01/18/2020] [Indexed: 12/11/2022]
Abstract
Due to mass production and extensive use, the potential adverse health effects of amorphous silica nanoparticles (ASiNPs) have received a significant attention from the public and researchers. However, the relationship between physicochemical properties of ASiNPs and their health effects is still unclear. In this study, we manufactured two types of ASiNPs of different diameters (20 and 50 nm) and compared the toxic response induced in rats after intratracheal instillation (75, 150 or 300 μg/rat). There were no dose-related differences in mortality, body weight gain or organ weight between the groups. However both types of ASiNPs significantly decreased the proportion of neutrophils in male rats, whereas the levels of hemoglobin and hematocrit were markedly reduced only in female rats instilled with 20 nm-ASiNPs. ASiNPs-induced lung tissue damage seemed to be more evident in the 20 nm ASiNP-treated group and in female rats than male rats. Similarly, expression of caveolin-1 and matrix metalloproteinase-9 seemed to be most notably enhanced in female rats treated with 20 nm-ASiNPs. The total number of bronchial alveolar lavage cells significantly increased in rats instilled with 20 nm-ASiNPs, accompanying a decrease in the proportion of macrophages and an increase in polymorphonuclear leukocytes. Moreover, secretion of inflammatory mediators clearly increased in human bronchial epithelial cells treated with 20 nm-ASiNPs, but not in those treated with 50 nm-ASiNPs. These results suggest that pulmonary effects of ASiNPs depend on particle size. Sex-dependent differences should also be carefully considered in understanding nanomaterial-induced adverse health effects.
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Affiliation(s)
- Hyoung-Yun Han
- Korea Institute of Toxicology, 141 Gajeong-ro, Yuseong-gu, Daejeon 34114, Republic of Korea; College of Veterinary Medicine & Institute of Veterinary Science, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea
| | - Jae-Woo Cho
- Korea Institute of Toxicology, 141 Gajeong-ro, Yuseong-gu, Daejeon 34114, Republic of Korea
| | - Eunsol Seong
- Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea
| | - Eun-Jun Park
- Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea
| | - Gwang-Hee Lee
- School of Civil, Environmental, and Architectural Engineering, Korea University, Seoul 136-713, Republic of Korea
| | - Dong-Wan Kim
- School of Civil, Environmental, and Architectural Engineering, Korea University, Seoul 136-713, Republic of Korea
| | - Young-Su Yang
- Korea Institute of Toxicology, 141 Gajeong-ro, Yuseong-gu, Daejeon 34114, Republic of Korea
| | - Jung-Hwa Oh
- Korea Institute of Toxicology, 141 Gajeong-ro, Yuseong-gu, Daejeon 34114, Republic of Korea
| | - Seokjoo Yoon
- Korea Institute of Toxicology, 141 Gajeong-ro, Yuseong-gu, Daejeon 34114, Republic of Korea
| | - Tae Geol Lee
- Korea Research Institute of Standards and Science, 267 Gajeong-ro, Yuseong-gu, Daejeon 34114, Republic of Korea
| | - Tae-Won Kim
- College of Veterinary Medicine & Institute of Veterinary Science, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea
| | - Eun-Jung Park
- Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea.
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Park SJ, Park J, Lee MJ, Seo JS, Ahn JY, Cho JW. Time series analysis of delta neutrophil index as the predictor of sepsis in patients with acute poisoning. Hum Exp Toxicol 2019; 39:86-94. [PMID: 31558056 DOI: 10.1177/0960327119878244] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Delta neutrophil index (DNI), which reflects the fraction of immature granulocytes, is used to detect infection and sepsis from noninfectious conditions, but few studies have evaluated in the early stage of acute poisoning. This retrospective observational study was performed on acute poisoning patients who visited to the emergency department (ED) and were consecutively admitted in intensive care units over 18-month period. The serial DNI, conventional inflammatory biomarkers, and culture results were obtained in the ED and after admission. The outcomes were the identification of sepsis, bacteremia, and 30-day mortality. Of 166 patients (mean age, 56.0 years) in this cohort, 59 (35.5%) had sepsis and 29 (17.5%) had bacteremia. Initial and peak DNI fractions 24 h after ED admission were strong independent predictors of sepsis development. Analysis of the area under the curve according to multiple receiver operating characteristics showed that DNI had a higher capability to predict sepsis than other parameters (0.815 for DNI, 0.700 for procalcitonin, 0.681 for C-reactive protein, and 0.741 for white blood cell). Using multivariable logistic regression analysis, it was found that DNI was an independent predictor of sepsis (95% confidence interval (CI) of odds: 1.03-1.18) and bacteremia (95% CI: 1.01-1.14). Therefore, initial and serial measurement of DNI may serve as useful risk predictor for development of sepsis or bacteremia in acute poisoning.
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Affiliation(s)
- S J Park
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - J Park
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - M J Lee
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - J S Seo
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Seoul, Republic of Korea
| | - J Y Ahn
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - J W Cho
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Lim WJ, Kim KH, Kim JY, Kim HJ, Kim M, Park JL, Yoon S, Oh JH, Cho JW, Kim YS, Kim N. Investigation of Gene Expression and DNA Methylation From Seven Different Brain Regions of a Crab-Eating Monkey as Determined by RNA-Seq and Whole-Genome Bisulfite Sequencing. Front Genet 2019; 10:694. [PMID: 31428131 PMCID: PMC6690020 DOI: 10.3389/fgene.2019.00694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/29/2019] [Accepted: 07/02/2019] [Indexed: 01/04/2023] Open
Abstract
The crab-eating monkey is widely used in biomedical research for pharmacological experiments. Epigenetic regulation in the brain regions of primates involves complex patterns of DNA methylation. Previous studies of methylated CpG-binding domains using microarray technology or peak identification of sequence reads mostly focused on developmental stages or disease, rather than normal brains. To identify correlations between gene expression and DNA methylation levels that may be related to transcriptional regulation, we generated RNA-seq and whole-genome bisulfite sequencing data from seven different brain regions from a single crab-eating monkey. We identified 92 genes whose expression levels were significantly correlated, positively or negatively, with DNA methylation levels. Among them, 11 genes exhibited brain region-specific characteristics, and their expression patterns were strongly correlated with DNA methylation level. Nine genes (SLC2A5, MCM5, DRAM1, TTC12, DHX40, COR01A, LRAT, FLVCR2, and PTER) had effects on brain and eye function and development, and two (LHX6 and MEST) were previously identified as genes in which DNA methylation levels change significantly in the promoter region and are therefore considered brain epigenetic markers. Furthermore, we characterized DNA methylation of repetitive elements at the whole genome through repeat annotation at single-base resolution. Our results reveal the diverse roles of DNA methylation at single-base resolution throughout the genome and reflect the epigenetic variations in adult brain tissues.
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Affiliation(s)
- Won-Jun Lim
- Genome Editing Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon, South Korea.,Department of Bioinformatics, KRIBB School of Bioscience, University of Science and Technology (UST), Daejeon, South Korea
| | - Kyoung Hyoun Kim
- Genome Editing Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon, South Korea.,Department of Bioinformatics, KRIBB School of Bioscience, University of Science and Technology (UST), Daejeon, South Korea
| | - Jae-Yoon Kim
- Genome Editing Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon, South Korea.,Department of Bioinformatics, KRIBB School of Bioscience, University of Science and Technology (UST), Daejeon, South Korea
| | - Hee-Jin Kim
- Genome Editing Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon, South Korea
| | - Mirang Kim
- Genome Editing Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon, South Korea
| | - Jong-Lyul Park
- Genome Editing Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon, South Korea
| | - Seokjoo Yoon
- Predictive Toxicity Department, Korea Institute of Toxicology (KIT), Daejeon, South Korea
| | - Jung-Hwa Oh
- Predictive Toxicity Department, Korea Institute of Toxicology (KIT), Daejeon, South Korea
| | - Jae-Woo Cho
- Predictive Toxicity Department, Korea Institute of Toxicology (KIT), Daejeon, South Korea
| | - Yong Sung Kim
- Genome Editing Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon, South Korea
| | - Namshin Kim
- Genome Editing Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon, South Korea.,Department of Bioinformatics, KRIBB School of Bioscience, University of Science and Technology (UST), Daejeon, South Korea
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Min BW, Lee KJ, Oh JK, Cho CH, Cho JW, Kim BS. The Treatment Strategies for Failed Fixation of Intertrochanteric Fractures. Injury 2019; 50:1339-1346. [PMID: 31151758 DOI: 10.1016/j.injury.2019.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/18/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Despite the generally successful outcome of intertrochanteric fracture fixation, the treatment is challenging when fixation failure occurs. Some studies have reported a systemic treatment strategy for salvaging failed intertrochanteric fracture fixation. This prospective study with a retrospective review of data aimed to evaluate and validate the efficacy of an evidence-based protocol developed for the treatment of failed intertrochanteric fractures. PATIENTS AND METHODS Between 1997 and 2016, 83 patients who could be followed up for more than 1 year after treatment were enrolled at an academic medical centre. An evidence-based protocol was established in July 2008 and was implemented prospectively. The treatment protocol was determined keeping in mind the condition of the femoral head, the deformation of the fracture site and the bone defect. Clinical results were evaluated, and fracture union and femoral neck-shaft angle were evaluated radiographically for patients in valgus osteotomy and re-fixation subgroups. RESULTS The Pain score, leg length discrepancy, Koval score for ambulatory levels and modified Harris Hip Score showed statistically significant improvement after the implementation of the new protocol. The radiographic success rate was 73% (27 of 37 patients) in the pre-protocol group and 91% (42 of 46 patients) in the post-protocol group, which shows statistically significantly improvement. CONCLUSION The new treatment strategy for failed intertrochanteric fracture fixation based on the condition of the femoral head, deformation of the fracture site and bone defect is successful based on clinical and radiographic results. Restoration of NSA of failed intertrochanteric fractures is a key factor for obtaining successful results.
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Affiliation(s)
- Byung-Woo Min
- Department of Orthopedic Surgery, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Republic of Korea
| | - Kyung-Jae Lee
- Department of Orthopedic Surgery, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, 148 Gurodong-ro, Guro-gu, Seoul, Republic of Korea
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Republic of Korea
| | - Jae-Woo Cho
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, 148 Gurodong-ro, Guro-gu, Seoul, Republic of Korea
| | - Beom-Soo Kim
- Department of Orthopedic Surgery, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Republic of Korea.
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Affiliation(s)
- Gi Ho Moon
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Jae-Woo Cho
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Beom Soo Kim
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Do Hyun Yeo
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Korea
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Kim BS, Oh JK, Cho JW, Yeo DH, Cho JM. Minimally Invasive Stabilization with Percutaneous Screws Fixation of APC-3 Pelvic Ring Injury. Journal of Trauma and Injury 2019. [DOI: 10.20408/jti.2018.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Beom-Soo Kim
- Departments of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Jong-Keon Oh
- Departments of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Jae-Woo Cho
- Departments of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Do-Hyun Yeo
- Departments of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Jun-Min Cho
- Departments of General Surgery, Korea University Guro Hospital, Seoul, Korea
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Yeo DH, Oh JK, Cho JW, Kim BS. Management and Outcome of Patients with Acetabular Fractures: Associated Injuries and Prognostic Factors. Journal of Trauma and Injury 2019. [DOI: 10.20408/jti.2018.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Do-Hyun Yeo
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Jae-Woo Cho
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Beom-Soo Kim
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Korea
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Cho JW, Kim J, Cho WT, Kent WT, Kim HJ, Oh JK. Antibiotic coated hinged threaded rods in the treatment of infected nonunions and intramedullary long bone infections. Injury 2018; 49:1912-1921. [PMID: 30060889 DOI: 10.1016/j.injury.2018.07.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 10/25/2017] [Revised: 05/14/2018] [Accepted: 07/23/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Local delivery of high dose antibiotics in the form of antibiotic impregnated polymethyl methacrylate (PMMA) cement beads or coated rods is commonly used in the management of long bone infections. The downsides of antibiotic cement beads for intramedullary long bone infections are associated with difficulty in removal from the medullary canal, bead breakage, and lack of stability. Antibiotic cement-coated smooth flexible guide wires, rods and nails can have complications such as delamination or debonding of the cement. In addition, the current techniques for cement rod insertion have a risk of iatrogenic joint contamination. To improve upon this technique and decrease potential complications, we propose the use of an antibiotic cement-coated hinged threaded rod as a temporary intramedullary spacer. This technique utilizes both an antegrade and retrograde insertion of the threaded rod into the medullary canal through the bony defect site with connection at the hinge to treat intramedullary long bone infections and infected nonunions. MATERIAL AND METHODS A total of 40 patients were included in the study. The details in making the cement rod were well documented. The shape of cement rod and the integrity of the cement at the time of rod insertion and rod removal were compared to identify any cement debonding or delamination. Potential postoperative complications including iatrogenic joint infection, displacement or breakage of the threaded cement rods, and fracture displacement were all carefully documented. The preliminary biological effect of the initial debridement and antibiotic cement rod placement was determined using the negative conversion rate of intraoperative cultures. RESULTS A single antibiotic coated threaded rod was inserted in 18 cases. Two separate antibiotic coated threaded rods were inserted and connected via hinge in 22 cases. There were zero cases of rod breakage and no secondary loss of reduction from antibiotic rod placement to the definitive staged operation. There were zero iatrogenic joint infections. There were zero cases of cement debonding or delamination from the rod. The conversion rate to a negative culture after initial debridement and antibiotic rod placement was 85% (34/40 cases). CONCLUSIONS The use of an antibiotic coated cement threaded rod with a hinge as an intramedullary spacer provides the benefits of local antibiotic delivery, offers improved construct stability, makes implant removal easier without delamination of the cement mantle, and utilizes the versatility of a hinge to prevent violation of native joints when treating infected nonunions and intramedullary long bone infections.
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Affiliation(s)
- Jae-Woo Cho
- Department of Orthopaedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, South Korea
| | - Jinil Kim
- Department of Orthopaedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, South Korea
| | - Won-Tae Cho
- Department of Orthopaedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, South Korea
| | - William T Kent
- Department of Orthopaedic Surgery, UC Sandiego Medical Center, Sandiego, CA, USA
| | - Hyung-Jin Kim
- Department of Orthopedic Surgery Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 40, Seokwoo-dong, Hwaseong, Gyeonggi-do, South Korea.
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, South Korea.
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Kim BS, Cho JW, Yeo DH, Oh JK. Surgical Treatment of Ipsilateral Multi-Level Femoral Fracture Treated Using Antegrade Intramedullary Nail. J Trauma Inj 2018. [DOI: 10.20408/jti.2018.31.2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Beom-Soo Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Jae-Woo Cho
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Do-Hyun Yeo
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Korea
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Son HY, Koo BI, Lee JB, Kim KR, Kim W, Jang J, Yoon MS, Cho JW, Nam YS. Tannin-Titanium Oxide Multilayer as a Photochemically Suppressed Ultraviolet Filter. ACS Appl Mater Interfaces 2018; 10:27344-27354. [PMID: 30039969 DOI: 10.1021/acsami.8b09200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UV filters can initiate redox reactions of oxygen and water when exposed to sunlight, generating reactive oxygen species (ROS) that deteriorate the products containing them and cause biological damages. This photochemical reactivity originates from the high chemical potential of UV filters, which also determines the optical properties desirable for sunscreen applications. We hypothesize that this dilemma can be alleviated if the photochemical pathway of UV filters is altered to coupling with redox active molecules. Here, we employ tannic acid (TA) as a key molecule for controlling the photochemical properties of titanium dioxide nanoparticles (TiO2 NPs). TA provides an unusual way for layer-by-layer assembly of TiO2 NPs by the formation of a ligand-to-metal charge transfer complex that alters the nature of UV absorption of TiO2 NPs. The galloyl moieties of TA efficiently scavenge ROS due to the stabilization of ROS by intramolecular hydrogen bonding while facilitating UV screening through direct charge injection from TA to the conduction band of TiO2. The TiO2-TA multilayers assembled in open porous polymer microspheres substantially increased sun protection while dramatically reducing ROS under UV exposure. The assembled structure exhibits excellent in vivo anti-UV skin protection against epidermal hyperplasia, inflammation, and keratinocyte apoptosis without long-term toxicity.
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Affiliation(s)
| | | | - Jun Bae Lee
- Innovation Lab , Cosmax Research & Innovation Center , 662 Sampyong-dong , Bundang-gu, Seongnam 13486 , Gyeonggi-do , Republic of Korea
| | | | - Woojin Kim
- Pathology Research Center, Department of Jeonbuk Inhalation Research , Korea Institute of Toxicology , 30 Baekhak-1-gil , Jeongup 56212 , Jeonbuk , Republic of Korea
| | - Jihui Jang
- Innovation Lab , Cosmax Research & Innovation Center , 662 Sampyong-dong , Bundang-gu, Seongnam 13486 , Gyeonggi-do , Republic of Korea
| | - Moung Seok Yoon
- Innovation Lab , Cosmax Research & Innovation Center , 662 Sampyong-dong , Bundang-gu, Seongnam 13486 , Gyeonggi-do , Republic of Korea
| | - Jae-Woo Cho
- Pathology Research Center, Department of Jeonbuk Inhalation Research , Korea Institute of Toxicology , 30 Baekhak-1-gil , Jeongup 56212 , Jeonbuk , Republic of Korea
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Seah GL, Yu JH, Yang MY, Kim WJ, Kim JH, Park K, Cho JW, Kim JS, Nam YS. Low-power and low-drug-dose photodynamic chemotherapy via the breakdown of tumor-targeted micelles by reactive oxygen species. J Control Release 2018; 286:240-253. [PMID: 30071252 DOI: 10.1016/j.jconrel.2018.07.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 05/02/2018] [Revised: 07/27/2018] [Accepted: 07/29/2018] [Indexed: 12/31/2022]
Abstract
Tumor-targeted delivery of anticancer agents using nanocarriers has been explored to increase the therapeutic index of cancer chemotherapy. However, only a few nanocarriers are clinically available because the physiological complexity often compromises their ability to target, penetrate, and control the release of drugs. Here, we report a method which dramatically increases in vivo therapeutic drug efficacy levels through the photodynamic degradation of tumor-targeted nanocarriers. Folate-decorated poly(ethylene glycol)-polythioketal micelles are prepared to encapsulate paclitaxel and porphyrins. Photo-excitation generates reactive oxygen species within the micelles to cleave the polythioketal backbone efficiently and facilitate drug release only at the illuminated tumor site. Intravenous injection of a murine xenograft model with a low dose of paclitaxel within the micelles, one-milligram drug per kg (mouse), corresponding to an amount less than that of Taxol by one order of magnitude, induces dramatic tumor regression without any acute systemic inflammation responses or organ toxicity under low-power irradiation (55 mW cm-2) at 650 nm.
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Affiliation(s)
- Geok Leng Seah
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Jeong Heon Yu
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Moon Young Yang
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Woo Jin Kim
- Pathology Research Center, Department of Jeonbuk Inhalation Research, Korea Institute of Toxicology, 30 Baekhak-1-gil, Jeongup, Jeonbuk 56212, Republic of Korea
| | - Jin-Ho Kim
- Samsung Medical Center, Samsung Biomedical Research Institute, Irwon-dong, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Keunchil Park
- Samsung Medical Center, Samsung Biomedical Research Institute, Irwon-dong, Gangnam-gu, Seoul 06351, Republic of Korea; Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Jae-Woo Cho
- Pathology Research Center, Department of Jeonbuk Inhalation Research, Korea Institute of Toxicology, 30 Baekhak-1-gil, Jeongup, Jeonbuk 56212, Republic of Korea
| | - Jee Seon Kim
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea.
| | - Yoon Sung Nam
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea; KAIST Institute for the NanoCentury, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea.
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Cho JW, Kim J, Cho WT, Gujjar PH, Oh CW, Oh JK. Comminuted inferior pole fracture of patella can be successfully treated with rim-plate-augmented separate vertical wiring. Arch Orthop Trauma Surg 2018; 138:195-202. [PMID: 29058078 DOI: 10.1007/s00402-017-2807-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION We present the surgical technique of rim-plate-augmented separate vertical wiring for comminuted inferior pole fracture of the patella and report the clinical outcomes. MATERIALS AND METHODS Between July 2013 and January 2016, 13 patients (7 male and 6 female) who were diagnosed with comminuted inferior pole fracture of the patella in preoperative computed tomography and underwent a minimum of 1 year of follow-up were enrolled in this study. Mean patient age was 57.7 years (range 28-72 years). All patients underwent open reduction and internal fixation by rim-plate-augmented separate vertical wiring. Bony union, complications, range of motion and Bostman score were the clinical outcomes. RESULTS Bony union was achieved in all cases at an average of 10 weeks after surgery (range 8-12). There was no loss of reduction and fixative failure during follow-up. The average range of motion was 127° (range 120°-130°). The mean Bostman score at last follow-up was 29.6 points (range 27-30) and graded excellent in 12 patients. CONCLUSION Rim-plate-augmented separate vertical wiring demonstrated secure fixation and favorable clinical outcomes. This study provides evidence for its effectiveness as a fixation method for treating displaced, comminuted inferior pole fracture of the patella.
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Affiliation(s)
- Jae-Woo Cho
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, 148, Gurodong-ro, Guro-gu, 152-703, Seoul, Korea
| | - Jinil Kim
- Department of Orthopedic Surgery, Wonju Severance Christian Hospital, Wonju, Korea
| | - Won-Tae Cho
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, 148, Gurodong-ro, Guro-gu, 152-703, Seoul, Korea
| | - Pranay H Gujjar
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, 148, Gurodong-ro, Guro-gu, 152-703, Seoul, Korea
| | - Chang-Wug Oh
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, 148, Gurodong-ro, Guro-gu, 152-703, Seoul, Korea.
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Kim JK, Song JH, Lee K, Cho JW, Moon KH, Yeo DH, Kim BS, Oh JK. Proximal Tibia Fracture after Proximal Tibia Autograft Harvest. Journal of Trauma and Injury 2017. [DOI: 10.20408/jti.2017.30.4.247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jin-Kak Kim
- Department of Orthopaedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jong-Hyeop Song
- Department of Orthopaedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyungbum Lee
- Department of General Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jae-Woo Cho
- Department of Orthopaedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ki-Ho Moon
- Department of Orthopaedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Do-Hyun Yeo
- Department of Orthopaedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Beom-Soo Kim
- Department of Orthopaedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Le Kim TH, Yu JH, Jun H, Yang MY, Yang MJ, Cho JW, Kim JW, Kim JS, Nam YS. Polyglycerolated nanocarriers with increased ligand multivalency for enhanced in vivo therapeutic efficacy of paclitaxel. Biomaterials 2017; 145:223-232. [DOI: 10.1016/j.biomaterials.2017.08.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/08/2017] [Accepted: 08/28/2017] [Indexed: 12/15/2022]
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Cho JW, Kim J, Cho WT, Kim JK, Song JH, Kim HJ, Masquelet AC, Oh JK. Circumferential bone grafting around an absorbable gelatin sponge core reduced the amount of grafted bone in the induced membrane technique for critical-size defects of long bones. Injury 2017; 48:2292-2305. [PMID: 28802745 DOI: 10.1016/j.injury.2017.08.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/05/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The objectives of the study were to introduce a circumferential bone graft around an absorbable gelatin sponge core using an induced membrane technique, to assess its ability to reduce the required amount of graft and to maintain the bone graft, and to evaluate the clinical outcomes in the management of critical-size bone defects. PATIENTS AND METHODS Circumferential bone grafting using a staged induced membrane technique for managing critical-size bone defects was performed in 21 patients. Postoperative computed tomography scans were performed 7days after Hemovac drain removal and 3 months after bone grafting. Volumetric measurements of the defect size, gelatin sponge proportion, and amount of grafted bone were performed by two independent observers using three-dimensional (3D) software. RESULTS The critical-size defects were located at the metadiaphyseal area of 11 tibias, eight femurs, and two humeri. The average defect size was 8.9cm in length and 65.2cm3 in volume. The absorbable gelatin sponge core replaced 21.4% (average) of the defect volume. There was no significant deterioration in the shape of the grafted bone among the serial 3D models. Eighteen patients (86%) were healed radiographically at 9.1 months (average). CONCLUSION Our study suggests that circumferential bone grafting in association with the induced membrane technique could reduce the required amount of bone graft and adequately maintain graft position and shape, with favourable clinical outcomes.
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Affiliation(s)
- Jae-Woo Cho
- Department of Orthopedic Surgery, Korea University Medical Center, 148 Gurodong-ro, Guro-gu, Seoul, Republic of Korea
| | - Jinil Kim
- Department of Orthopedic Surgery, Korea University Medical Center, 148 Gurodong-ro, Guro-gu, Seoul, Republic of Korea
| | - Won-Tae Cho
- Department of Orthopedic Surgery, Korea University Medical Center, 148 Gurodong-ro, Guro-gu, Seoul, Republic of Korea
| | - Jin-Kak Kim
- Department of Orthopedic Surgery, Korea University Medical Center, 148 Gurodong-ro, Guro-gu, Seoul, Republic of Korea
| | - Jong Hoon Song
- Department of Orthopedic Surgery, Hanyang University Medical Center, 153, Kyoungchun-ro, Guri-si, Gyeonggi-do, Republic of Korea
| | - Hyung-Jin Kim
- Department of Orthopedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Alain C Masquelet
- Reconstructive & Hand Surgery Unit, Orthopaedic Department, Hopital Saint-Antoine, 184, rue du Faubourg, Saint Antoine, Paris, France
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Korea University Medical Center, 148 Gurodong-ro, Guro-gu, Seoul, Republic of Korea.
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