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Aim: Bone healing becomes problematic during certain states, such as trauma. This study verifies whether the application of c-myb with gelatin promotes bone healing during bone injuries. Materials & methods: A biodegradable membrane was modified with adenoviral vector c-myb ( Ad/c-myb) and gelatin and applied in the bone injury site of rat tibia. Results: c-myb enhanced osteogenic differentiation and mineralization in bone marrow stromal cells after induction with osteogenic media. In vivo examination of rat tibia after application of the biodegradable membrane with Ad/c-myb and a gelatin layer demonstrated increased bone volume, bone mineral density, new bone formation and osteogenic molecules, compared with Ad/LacZ. Conclusion: c-myb has the potential to assist bone healing and may be applicable to the treatment of bone during injury.

Study Design: Level III retrospective study.Purpose: We investigated the impact of short-segment lumbar fusion on the restoration of global sagittal alignment and the correlations between spino-pelvic parameters and clinical outcomes.Overview of Literature: Sagittal imbalance leads to energy consumption and pain in maintaining a standing position. For adult spinal deformity, it is critical to create optimal lumbar lordosis (LL) in order to achieve restoration of sagittal imbalance. However, surgeons do not pay attention to correcting LL in short-segment lumbar fusion.Methods: A total of 69 patients with transforaminal lumbar interbody fusion (TLIF) for degenerative spinal disease were evaluated with a minimum 2-year follow-up. All patients underwent TLIF with hyper-lordotic angle cages to achieve higher LL. Radiological spino-pelvic parameters including sagittal vertical axis (SVA) and clinical outcomes using the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) were evaluated.Results: The average LL was 35.8°±9.9° before surgery, 42.3°±9.3° 1 year after surgery, and 40.3°±10.2° 2 years after surgery (p p p

Exercise and healthy diet consumption support healthy aging. Schisandra chinensis (Turcz.) also known as "Baill." has anti-inflammatory and antioxidant properties. However, the role of S. chinensis as an antiaging compound has yet to be demonstrated. This study elucidated the antiaging effect of S. chinensis ethanol-hexane extract (C1) and the effect of C1 treatment on muscle and bone following physical exercise in ovariectomized (OVX) rats. RAW 264.7, human diploid fibroblasts (HDFs), C2C12 myoblasts, bone marrow macrophages, and MC3T3-E1 cells were used for in vitro, and muscle and bone of OVX rats were used for in vivo study to demonstrate the effect of C1. The C1 significantly inhibited the expression of inflammatory molecules, β-galactosidase activity, and improved antioxidant activity via down-regulation of reactive oxygen species in RAW 264.7 and aged HDF cells. The C1 with exercise improved muscle regeneration in skeletal muscle of OVX rats by promoting mitochondrial biogenesis and autophagy. C1 induced osteoblast differentiation, and C1 + exercise modulated the bone formation and bone resorption in OVX rats. C1 exhibited anti-inflammatory, antioxidant, myogenic, and osteogenic effects. C1 with exercise improved age-related muscle wasting and bone loss. Therefore, S. chinensis may be a potential prevent agent for age-related diseases such as sarcopenia and osteoporosis.

PURPOSE The purpose of this study was to determine the effect of exercise types on the Wnt/BMP signaling and the response to myogenic mechanism by downhill and uphill training in the aged rat skeletal muscles. METHODS Young and old rats were randomly assigned to control groups; young (YC) and old (OC), and two types of running training groups: old downhill exercise (ODE) and old uphill exercise (OUE). Training was progressively carried out on a treadmill at a speed of 21 m/min with a slope of +10° for uphill training vs 16 m/min with a slope of -16° for downhill training: 60 min/day, 5 days/week for 8 weeks respectively. RESULTS Downhill and uphill training significantly increased the protein levels of Wnt3a, β-catenin and LEF-1 in aged rats. On the contrary, GSK3β was reduced by running training. In addition, the expression patterns of Wnt7a, Fzd7, PKC, p-AKT, and p-mTOR in extensor digitorum longus (EDL) and soleus (SOL) muscle were significantly increased in both ODE and OUE groups. Expression patterns of BMP-2, BMP-7, and p-Smad-1/5/8 in EDL and SOL muscles were significantly increased in both ODE and OUE groups. Especially, ODE group showed more increased expression pattern than OUE group. The expression patterns of MyoD, Myf5, and Myogenin were significantly increased in both DOE and OUE groups. Myf5 and Myogenin showed more increased expression pattern in ODE group than OUE group. CONCLUSIONS The downhill and uphill exercise training may play a mediating role in increasing the expression of these reduced myogenesis related factors. Furthermore, the formation process and hypertrophy of skeletal muscle weakened due to aging can be improved and maintained.

New findings What is the central question of this study? What is the effect and mechanism of interval running training on age-related muscle wasting and bone loss in an ovariectomized rat model? What is the main finding and its importance? Interval running training improved muscle growth and osteogenic differentiation by enhancing the expression of bone morphogenic proteins and sirtuins in ageing-induced ovariectomized rats. Therefore, the repetition of low and high intensities within a single exercise bout, such as interval running training, may be recommended as a practical intervention to prevent skeletal muscle wasting and bone loss in the elderly. Abstract Effective prophylactic strategies are needed for the suppression of age-related muscle wasting and bone loss after menopause. Exercise training is attractive due to its potential for improving energy metabolism, as well as age-related muscle wasting and bone loss. In particular, interval running (IR) training involves a repetition of low and high intensities within a single exercise bout. Therefore, this study elucidated the effect of interval training on muscle and bone health, as well as anti-ageing, in ovariectomized (OVX) rats. The anti-ageing effect of IR on muscle and bone was tested using western blotting and micro-computed tomography analysis, tartrate-resistant acid phosphatase and immunohistochemical staining. IR significantly inhibited the expression of inflammatory molecules, and improved antioxidant activity via down-regulation of mitogen-activated protein kinases (MAPKs) in the ageing-induced OVX rats skeletal muscle. IR compared with continuous running (CR) improved muscle mass and growth in OVX rats by the promotion of muscle growth-related factors including MyoD, myogenin, phospho-mechanistic target of rapamycin (p-mTOR), sirtuins (SIRTs), and bone morphogenic proteins (BMPs). IR also effectively recovered OVX-induced bone loss via the down-regulation of bone resorption and osteoclast formation in receptor activator of nuclear factor κB ligand (RANKL)-treated bone marrowmacrophages (BMMs). In particular, IR led to high expression of SIRT1 and 6, which promoted osteogenic differentiation and bone formation via modulating the BMP signalling pathway compared with CR training. The in vivo effect of IR was confirmed by immunohistochemical staining with the improvement of bone formation molecules such as BMPs and SIRTs. These results suggested that IR training affected myogenic and osteogenic formation. So, IR training may be considered for prevention of muscle wasting and bone loss for the elderly.

In this study, we sought to describe a novel imaging apparatus that is lightweight, inexpensive, and highly effective for use in colorectal diagnostic and treatment settings. Typical probes for use in colorectal ultrasonic imaging applications are developed for surgeons to diagnose and stage rectal tumors and image the rectum and anus. Here we outline a new technique and use it for colorectal imaging in an animal. This technique involves use of an ultrasound array module positioned along the axis of rotation such that improved rotation is possible. This module is in the shape of a linear rod with a rotary linear component that allows for emission of focused ultrasonic echo signals from a linear section of the probe. The usability of the transducer and rectal image quality are satisfactory in a porcine model with the technique proposed here, axial/lateral resolution as 0.96/2.24 mm with 6 dB applied through the contour map using the point spread function. When compared to currently available methods, this technique provides superior diagnostic 3D volumetric image quality with reduced acquisition time. Given this, the ultrasound device proposed here may prove a viable and preferable method to those currently available for urology and colorectal imaging applications.

[Purpose] Recent evidence suggests that regular exercise training plays a decisive role in maintaining homeostasis and promoting muscle and skeletal formation. However, the effect of downhill exercise training on osteogenesis-related factors is not well understood. [Methods] Thus, we investigated the effect of uphill and downhill training on ovariectomy (OVX)-induced bone loss. After ovary removal, the exercise method performed included uphill (16 m/min, +15°) and downhill training (16 m/min, –15°) for 60 min/day and 5 days/week, respectively, for 8 weeks. [Results] Our results showed that both uphill and downhill training significantly decreased the body weight, total cholesterol, and creatine kinase (CK) levels in the context of OVX-induced bone loss. On the contrary, levels of an osteogenesis indicator, osteocalcin and alkaline phosphatase were elevated. Consequently, the uphill and downhill training reduced OVX- induced bone loss in the distal femoral metaphysis. Likewise, the bone microstructure in OVX-induced bone loss was enhanced upon training. In particular, the inhibition of RANKL-induced osteoclast formation and osteoclast-specific gene expression improved upon downhill training compared to uphill training. [Conclusion] These results suggest that the uphill and downhill exercise types appeared to positively affect the expression of osteogenesis-related factors along with bone density and microstructure. Particularly, the downhill training has more beneficial effects on the maintenance of homeostasis during bone formation.

Diabetes mellitus (DM) has a detrimental effect on osseointegration, stability and longevity of implants due to osteoporosis. In this study, PPARγ-loaded dental implants were investigated for the improvement of osseointegration and peri-implantitis. Chitosan gold nanoparticles conjugated with PPARγ cDNA were introduced on titanium mini-implant surfaces for PPARγ release to rat mandibular. DM-induced rat mandible showed structural changes such as decreased bone mass and increased inflammatory molecules, and diminution of PPARγ expression and bone formation molecules compared to normal rats. PPARγ induced bone formation via reduction of inflammatory molecules even under glucose oxidative stress. Furthermore, PPARγ strongly activated mitochondrial biogenesis and cell viability via p-AMK and Wnt/β-catenin signaling. Consequently, PPARγ gene delivery on regional dental implants contributed osseointegration, new bone formation and mineralization in DM-induced rats. This study demonstrates that PPARγ can be used as a therapeutic gene with dental implantation in diabetic patients since regional PPARγ expression enhances osseointegration and implant longevity.

NEW FINDINGS What is the central question of this study? Exercise training by running has an effect on age-related muscle and bone wasting that improves physical activity and quality of life in the elderly. However, the effect of downhill running on age-related muscle and bone wasting, and its mechanisms, are unclear. What is the main finding and its importance? Gradual downhill running can improve skeletal muscle growth and bone formation by enhancing autophagy and bone morphogenetic protein signalling in aged rats. Therefore, downhill running exercise might be a practical intervention to improve skeletal muscle and bone protection in the elderly. Recent evidence suggests that autophagy and the bone morphogenetic protein (BMP) signalling pathway regulate skeletal muscle growth and bone formation in aged rats. However, the effect of downhill running on muscle growth and bone formation is not well understood. Thus, we investigated the effect of downhill and uphill running on age-related muscle and bone weakness. Young and late middle-aged rats were randomly assigned to control groups (young, YC; and late middle-aged, LMC) and two types of running training groups (late middle-aged downhill, LMD; and late middle-aged uphill, LMU). Training was progressively carried out on a treadmill at a speed of 21 m min-1 with a slope of +10 deg for uphill training versus 16 m min-1 with a slope of -16 deg for downhill training, both for 60 min day-1 , 5 days week-1 for 8 weeks. Downhill and uphill training increased autophagy-related protein 5, microtubule-associated protein light chain, Beclin-1 and p62 proteins in aged rats. In addition, superoxide dismutase, haem oxygenase-1 and the BMP signalling pathway were elevated. Phosphorylation of mammalian target of rapamycin and myogenic differentiation were increased significantly in the LMD and LMU groups. Consequently, in the femur, BMP-2, BMP-7 and autophagy molecules were highly expressed in the LMD and LMU groups. These results suggest that both downhill and uphill training appear to have a positive effect on expression of autophagy molecules and BMPs. In particular, these physiological adaptations from gradual downhill exercise have an effect on bone morphological changes and muscle quality similar to gradual uphill training interventions in ageing.

Aging is characterized by the progressive decline in mass and function of the skeletal muscle along with increased susceptibility to inflammation, oxidative stress, and atrophy. In this study, we investigate the effect of intermittent bout and single bout exercise training on inflammatory molecules in young (3 months) and old (22 months) male Sprague-Dawley rats. The rats were divided into 6 groups. Young and old rats were randomly assigned for control and two exercise training groups, single bout (S type): 30 min/day, 5 days/week for 6 weeks and intermittent bout (I type): three times for 10 min/day, 5 days/week for 6 weeks respectively. The exercise training was carried out by a treadmill at a speed of 15m/min (young) or 10 m/min (old) with a slope of 5°. After 48 h of the final exercise bout, muscle samples were collected for biochemical assay. I type exercise training reduced the serum levels of inflammatory molecules such as interleukin-1β (IL-1β), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and malondialdehyde (MDA) in old rats. By contrast, interleukin-4 (IL-4) and superoxide dismutase (SOD) were elevated. Consequently in skeletal muscles, inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) were decreased significantly in the old group of I type. However, the matrix metalloproteinase-2 (MMP-2) level had no positive effects. Also, phosphorylation of mammalian target of rapamycin (p-mTOR) and myogenic differentiation (MyoD) were increased markedly in S and I types of old rats. These results suggest that I type exercise training appears more effective to reduce age-associated inflammatory molecules, and may recommend in regulating against chronic complicated disease induced by aging.

Palate carcinoma often challenges to the treatment options. It depends on the histologic type, local invasion, and nodal or distant metastasis. Hard palate tumors that invade the nasal cavity can be operated by midfacial degloving approach, lateral rhinotomy approach, and lip splitting incision with infrastructure maxillectomy. These approaches inevitably coincide with facial scars, nerve injuries, facial swelling, and long hospital stay. Transoral robotic assisted surgery can be applied; however, this needs high price and has a weakness of accurate handling about intranasal lesion. The authors have performed transoral and intranasal endoscopic-assisted palatal removal of recurrent palatal carcinoma for a patient and herein report their technique and result.

Biological repair of cartilage lesions remains a significant clinical challenge. A wide variety of methods involving mesenchymal stem cells (MSCs) have been introduced. Because of the limitation of the results, most of the treatment methods have not yet been approved by the Food and Drug Administration (FDA). However, bone marrow aspirate concentrate (BMAC) and human umbilical cord blood derived mesenchymal stem cells (hUCB-MSCs) implantation were approved by Korea FDA. The aim of this study was to evaluate clinical and magnetic resonance imaging (MRI) outcomes after two different types of MSCs implantation in knee osteoarthritis. Fifty-two patients (52 knees) who underwent cartilage repair surgery using the BMAC (25 knees) and hUCB-MSCs (27 knees) were retrospectively evaluated for 2 years after surgery. Clinical outcomes were evaluated according to the score of visual analogue scale (VAS), the International Knee Documentation Committee (IKDC) subjective, and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Cartilage repair was assessed according to the modified Magnetic Resonance Observation of Cartilage Repair Tissue (M-MOCART) score and the International Cartilage Repair Society (ICRS) cartilage repair scoring system. At 2-year follow-up, clinical outcomes including VAS, IKDC, and KOOS significantly improved ( P < 0.05) in both groups; however, there were no differences between two groups. There was no significant difference in M-MOCART [1-year ( P = 0.261), 2-year ( P = 0.351)] and ICRS repair score ( P = 0.655) between two groups. Both groups showed satisfactory clinical and MRI outcomes. Implantation of MSCs from BMAC or hUCB-MSCs is safe and effective for repairing cartilage lesion. However, large cases and a well-controlled prospective design with long-term follow-up studies are needed.

Osseointegration of dental implants is affected by osteoporosis. The purpose of this study was overcome the implant failure and facilitate the osseointegration of dental implants by c-myb in ovariectomized (OVX)-induced osteoporosis. c-myb is a transcription factor and supports bone formation. Plasmid DNA/c-myb conjugated with chitosan-gold nanoparticles (Ch-GNPs/c-myb) promoted osteogenesis and inhibited osteoclastogenesis in MC-3T3 E1 cells. Ch-GNPs/c-myb involved the reduction of the nuclear factor of activated T-cells 1, c-Fos, and tartrate-resistant acid phosphatase-positive multinucleated osteoclasts in receptor activator of nuclear factor-κB ligand (RANKL) stimulated bone marrow macrophages. In vivo results of rat mandibles demonstrated Ch-GNP/c-myb-coated titanium (Ti) implants increased the volume and density of newly formed bone and the osseointegration of dental implant with bone by micro computed tomography examination after OVX-induced osteoporosis. Immunohistochemical analysis showed increased c-myb expression and upregulation of bone morphogenic proteins, osteoprotegerin and EphB4, as well as the downregulation of RANKL by Ch-GNP/c-myb-coated Ti implants. Hematoxylin and Eosin staining expressed new bone formation by Ch-GNP/c-myb-coated Ti implants. Our findings indicated that c-myb delivered by Ch-GNPs supports osseointegration of dental implant even in osteoporotic condition. c-myb may be applicable to support dental implant integration and treatment in age-dependent bone destruction disease.

Poor bone quality and osteolysis are the major causes of implant failure in dentistry. Here, this study tested the effect of phelligridin D-loaded nanotubes titanium (Ti) for bone formation around the dental implants. The purpose of this study was to enhance osseointegration of phelligridin D-loaded implant into the bone for bone formation and prevention of osteolysis. Cell viability, crystal violet staining, Western blot, alizarin red S staining, alkaline phosphatase activity, tartrate-resistant acid phosphatase staining, micro-computed tromography (μ-CT), hematoxylin and eosin (H&E) and immunohistochemical staining were used in vitro and in vivo to test the biocompatibility of phelligridin D. Phelligridin D enhanced osteoblast differentiation and mineralization by increasing bone morphogenic protein-2/7 (BMP-2/7), Osterix, Runx-2, osteoprotegerin (OPG), alkaline phosphatase and inhibited osteoclast differentiation by decreasing receptor activator of nuclear factor kappa-B ligand (RANKL) in MC-3T3 E1 cells. Further, phelligridin D promoted bone regeneration around nanotube Ti implant surface by increasing the levels of BMP-2/7 and OPG in a rat model. Phelligridin D also inhibited osteolysis by suppressing the expression of RANKL. These findings strongly suggest that phelligridin D is a new compound representing a potential therapeutic candidate for implant failure caused by osteolysis and poor bone quality of teeth.

This study investigated whether multiple bioactivity of terrein such as anti-inflammatory and anti-oxidant inhibits age-related inflammation by promoting an antioxidant response in aged human diploid fibroblast (HDF) cells. HDF cells were cultured serially for in vitro replicative senescence. To create the ageing cell phenotype, intermediate stage (PD31) HDF cells were brought to stress-induced premature senescence (SIPS) using hydrogen peroxide (H2 O2). Terrein increased cell viability even with H2O2 stress and reduced inflammatory molecules such as intracellular adhesion molecule-1 (ICAM-1), cyclooxygenase-2 (COX-2), interleukin-1beta (IL-1β) and tumour necrosis factor-alpha (TNF-α). Terrein reduced also phospho-extracellular kinase receptor1/2 (p-EKR1/2) signalling in aged HDF cells. SIPS cells were attenuated for age-related biological markers including reactive oxygen species (ROS), senescence associated beta-galactosidase (SA β-gal.) and the aforementioned inflammatory molecules. Terrein induced the induction of anti-oxidant molecules, copper/zinc-superoxide defence (Cu/ZnSOD), manganese superoxide dismutase (MnSOD) and heme oxygenase-1 (HO-1) in SIPS cells. Terrein also alleviated reactive oxygen species formation through the Nrf2/HO-1/p-ERK1/2 pathway in aged cells. The results indicate that terrein has an alleviative function of age-related inflammation characterized as an anti-oxidant. Terrein might be a useful nutraceutical compound for anti-ageing.

The molecular study of muscles is needed to overcome chronic inflammation and maintenance of muscles in the human body. Schisandrin C is a pharmacological compound derived from the fruit of Schisandra chinensis and has many characteristics including anti-inflammation, anti-tumor, and anti-oxidation. However, the cellular and molecular mechanisms of Schisandrin C are still not well understood especially in skeletal muscle. Therefore, the present study was evaluated whether the properties of Schisandrin C in C2C12 skeletal muscle cells involved maintenance of cellular homeostasis and protection against oxidative damage. Differentiated C2C12 cells were exposed to H2O2 to induce oxidative stress. The characteristics of anti-oxidants, anti-inflammation, autophagy, and mitochondrial biogenesis were tested by Western blotting. Confocal microscopy was also used to observe mitochondrial activity. Schisandrin C inhibited inflammatory molecules with enhancing anti-oxidant activity and reducing reactive oxygen species (ROS) even in the presence of H2O2. The dual anti-inflammation and anti-oxidant roles of Schisandrin C regulated the translocation of nuclear factor kappa B (NF-κB) and nuclear factor erythroid 2-related factor-2 (Nrf-2) to nucleus followed by inhibition of the mitogen-activated protein kinase (MAPK) pathway. Schisandrin C promoted the expression of autophagy and mitochondrial biogenesis molecules. Furthermore, the effect of Schisandrin C increased the mitochondrial activity against oxidative stress. Consequently, the action of Schisandrin C enhanced the regulation of autophagy and mitochondrial biogenesis with potential involvement of anti-oxidative mechanisms including the MAPKs/Nrf-2/heme oxygenase-1 signaling pathway in C2C12 skeletal muscle cells exposed to oxidative stress. Therefore, Schisandrin C may be considered as a beneficial compound for several muscle inflammations.

[Purpose] The purpose of this study was to investigate the effect that muscle contraction induced NAD metabolism via NAMPT has on mitochondrial biogenesis. [Methods] Primary skeletal muscle cells were isolated from the gastrocnemius in C57BL/6 mice. The muscle cells were stimulated by electrical current at 1Hz for 3 minutes in conditions of normal or NAD metabolism related inhibitor treatment. NAD/NADH level, Sirt1 and mitochondria biogenesis related signal factor’s changes were examined in normal or NAD metabolism related inhibitor treated cells. [Results] Electrical stimulation (ES) induced muscle contractions significantly increased NAD/NADH levels, NAMPT inhibitor FK-866 inhibited ES-induced NAD formation, which caused SIRT1 expression and PGC-1α deacetylation to decrease. Moreover, NAMPT inhibition decreased mitochondrial biogenesis related mRNA, COX-1 and Tfam levels. Along with AMPK inhibitor, compound C decreases SIRT1 expression, PGC-1α deacetylation and muscle contraction induced mitochondrial biogenesis related mRNA increment. These results indicated that the AMPK-NAMPT signal is a key player for muscle contraction induced SIRT1 expression and PGC-1α deacetylation, which influences mitochondrial biogenesis. Inhibition of the AMPK upregulator, Camkkβ, STO-609 decreased AMPK phosphorylation and SIRT1 expression but did not decrease PGC-1α deacetylation. However, CAMKII inhibition via AIP decreased PGC-1α deacetylation. [Conclusion] In conclusion, the results indicate that NAMPT plays an important role in NAD metabolism and mitochondrial biogenesis. However, mitochondrial biogenesis is also controlled by different calcium binding protein signals including Camkkβ and CAMKII. [Keyword] Muscle contraction, NAD metabolism, SIRT1, PGC-1 α, mitochondria biogenesis.

The study investigated the effect of high-and low-intensity exercise training on inflammatory reaction of blood and skeletal muscle in streptozotocin (STZ)-induced diabetic male Sprague-Dawley rats (243 +/- 7 g, 8 weeks). The rats completed treadmill running in either high-intensity exercise (6 weeks of exercise training, acute bouts of exercise) or low-intensity exercise (6 weeks of exercise training). Non-running, sedentary rats served as controls. To induce diabetes mellitus, rats received a peritoneal injection of STZ (50 mg . kg(-1)). Rats were sacrificed immediately after an acute bout of exercise and 6 weeks of exercise training. Inflammatory factors were analyzed by ELISA and by immune blotting from the soleus and extensor digitorum longus muscles. In the serum, inflammatory cytokines (IL-1 beta, TNF-alpha, IL-6, IL-4) and reactive oxygen species (ROS) (nitric oxide and nnalondialdehyde) increased in diabetic rats. However, all exercise training groups displayed reduced inflammatory cytokines and reactive oxygen species. In skeletal muscles, low-intensity exercise training, but not high intensity exercise, reduced the levels of COX-2, iNOS, and MMP-2, which were otherwise markedly elevated in the presence of STZ. Moreover, the levels of GLUT-4 and MyoD were effectively increased by different exercise intensity and exercise duration. Low-intensity exercise training appeared most effective to reduce diabetes-related inflammation. However, high-intensity training also reduced inflammatory factors in tissue-specific muscles. The data implicate regular exercise in protecting against chronic inflammatory diseases, such as diabetes.

Background: Selective lumbar nerve root block (SNRB) is generally accepted as an effective treatment method for back pain with sciatica. However, it requires devices producing radioactive materials such as C-arm fluoroscopy. This study evaluated the useful ness of the longitudinal view of transverse process and needles for medial branch block as landmarks under ultrasonography. Methods: We performed selective nerve root block for 96 nerve roots in 61 patients under the guidance of ultrasound. A curved probe was used to identify the facet joints and transverse processes. Identifying the lumbar nerve roots under the skin surface and ultrasound landmarks, the cephalad and caudal medial branch blocks were undertaken under the transverse view of sonogram first. A needle for nerve root block was inserted between the two transverse processes under longitudinal view, while estimating the depth with the needle for medial branch block. We then injected 1.0 mL of contrast medium and checked the distribution of the nerve root with C-arm fluoroscopy to evaluate the accuracy. The visual analog scale (VAS) was used to access the clinical results. Results: Seven SNRBs were performed for the L2 nerve root, 15 for L3, 49 for L4, and 25 for L5, respectively. Eighty-six SNRBs (89.5%) showed successful positioning of the needles. We failed in the following cases: 1 case for the L2 nerve root; 2 for L3; 3 for L4; and 4 for L5. The failed needles were positioned at wrong leveled segments in 4 cases and inappropriate place in 6 cases. VAS was improved from 7.6 ± 0.6 to 3.5 ± 1.3 after the procedure. Conclusions: For SNRB in lumbar spine, the transverse processes under longitudinal view as the ultrasound landmark and the needles of medial branch block to the facet joint can be a promising guidance.

Excessive exercise induces an inflammatory response caused by oxidative stress, which delays recovery of damaged muscle fibers. The reduction of inflammatory response is important for skeletal muscle homeostasis. Peroxisome proliferator-activated receptor gamma (PPARγ) is an anti-inflammatory molecule, but the role of PPARγ in skeletal muscle as anti-inflammatory activity is not clear. Thus, this study examined the anti-inflammatory role of PPARγ against H2O2-induced oxidative stress in skeletal muscle. Sprague Dawley (SD) rats were exercised on a treadmill to induce oxidative stress. In vitro oxidative stress was evaluated in differentiated C2C12 cells stimulated using 200 μM H2O2. Inflammation-related molecules were determined by immunohistochemistry and Western blot analysis. Expressions of the inflammatory molecules tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), cyclooxygenase-2 (COX-2), and matrix metalloproteinase-2 (MMP-2) in muscles of the acute exercise group were highly increased. PPARγ was also highly expressed in these muscles. These inflammatory molecules were also markedly increased in C2C12 cells with H2O2 stimulation. However, PPARγ overexpression in C2C12 transfected by Ad/PPARγ dramatically reduced the inflammatory molecules. PPARγ also enhanced the anti-oxidants molecules like Cu/Zn-SOD, Mn-SOD, and hemeoxygenase-1 by reducing the generation of ROS, even in the presence of H2O2. PPARγ displayed dual anti-inflammatory and anti-oxidant roles by inhibiting the mitogen-activated protein kinase (MAPK) pathway and translocation of nuclear transcriptional factor-κB (NF-κB) from the cytosol to the nucleus. These results demonstrate a potential role of PPARγ in protecting muscle fibers against oxidative stress caused by excessive acute exercise due to its anti-inflammatory and anti-oxidant activity exerted by inhibition of the MAPK/NF-κB pathway.

Multi-modality imaging is beneficial for both preclinical and clinical applications as it enables complementary information from each modality to be obtained in a single procedure. In this paper, we report the design, fabrication, and testing of a novel tri-modal in vivo imaging system to exploit molecular/functional information from fluorescence (FL) and photoacoustic (PA) imaging as well as anatomical information from ultrasound (US) imaging. The same ultrasound transducer was used for both US and PA imaging, bringing the pulsed laser light into a compact probe by fiberoptic bundles. The FL subsystem is independent of the acoustic components but the front end that delivers and collects the light is physically integrated into the same probe. The tri-modal imaging system was implemented to provide each modality image in real time as well as co-registration of the images. The performance of the system was evaluated through phantom and in vivo animal experiments. The results demonstrate that combining the modalities does not significantly compromise the performance of each of the separate US, PA, and FL imaging techniques, while enabling multi-modality registration. The potential applications of this novel approach to multi-modality imaging range from preclinical research to clinical diagnosis, especially in detection/localization and surgical guidance of accessible solid tumors.

STUDY DESIGN Retrospective study. PURPOSE To investigate the influence of fat infiltration at low back extensor muscles on osteoporotic vertebral fracture. OVERVIEW OF LITERATURE In persons with stronger back muscles, the risk of osteoporotic vertebral fractures will likely be lower than in those persons with weaker back muscles. However, the degree of influence of fat infiltration of the back extensor muscle on osteoporotic vertebral fracture remains controversial. METHODS Two hundred and thirty-seven patients who had undergone lumbar spine magnetic resonance imaging and bone mineral density (BMD) were enrolled in this study. The amount of low back extensor muscle was determined using the pseudocoloring technique on an axial view of the L3 level. The patients were divided into two groups: osteoporotic vertebral fracture group (group A) and non-fracture group (group B). The amount of low back extensor muscle is compared with BMD, degenerative change of disc, osteophyte grade of facet joint and promontory angle to reveal the association between these factors. RESULTS A negative correlation is found between age and the amount of low back extensor muscle (p=0.001). The amount of low back extensor muscle in group A and group B was 60.3%±14.5% and 64.2%±9.3% respectively, thus showing a significantly smaller amount of low back extensor muscle in the osteoporotic vertebral fracture group (p=0.015). CONCLUSIONS Fat infiltration of low back extensor muscle was increased in osteoporotic vertebral fracture patients. Therefore, fat infiltration of low back extensor muscle in an elderly person may be a risk factor of osteoporotic vertebral fracture.

This paper introduces single crystal transducer using high mechanical quality factor material (Qm) for Elastography application. Because the coercive filed of this new material is almost double comparing with normal single crystal used for transducer, it is possible to make high frequency with fine pitch is possible. This new type transducer shows better sensitivity and reliability when it is used for imaging application not only using normal pulse driving but also long pulse driving.

The acupoint, GB34, located in the back of the knee, is known to be effective in recovering motor function after a stroke. This study uses a functional magnetic resonance imaging (fMRI) study with 3T scanner to investigate whether or not acupuncture of GB34 produces a significant response of the modulation of somatomotor areas. A fMRI of the whole brain was performed in ten normal healthy subjects during two task stimulations of acupuncture manipulation on GB34 and sham points, inserting and twisting the needle for 25 seconds at a rate of approximately 120 times per minute; the needle manipulation was paused for a duration of 25 seconds as a control state. The process was repeated four times to have four epochs of stimulation. Bilateral sensorimotor areas (BA 3, 4, 6 and 7) showed approximately 6% of stimulation-related BOLD signal contrast, whereas very few areas were activated when sham stimulation was given. Acupuncture stimulation in GB34 modulates the cortical activities of the somatomotor area in humans. The present findings may shed light on the CNS mechanism of motor function by acupuncture, and form a basis for future investigations of motor modulation circuits in stroke patients.

목적: 무시멘트형 대퇴 삽입물을 이용하여 인공 고관절 재치환술을 시행한 후 임상적 및 방사선학적 결과를 알아보고자 하였다. 대상 및 방법: 2000년 1월부터 2010년 5월까지 본원에서 무시멘트형 대퇴 삽입물을 이용하여 인공 고관절 재치환술을 시행하고 2년 이상 추시가 가능하였던 26예를 대상으로 하였다. 재치환술 당시 나이는 평균 63.8세이었다. 추시 기간은 평균 45개월이었다. 재치환술의 원인은 무균성 해리 11예, 골절 6예, 골용해 6예, 감염 3예이었다. 방사선학적 결과는 삽입물의 침강, 해리, 응력 방패 현상을 관찰하였으며, 임상적 결과는 대퇴부 동통과 해리스 고관절 점수를 이용하여 평가하였다. 결과: 재치환술 전 해리스 고관절 점수는 평균 41.2점에서 최종 추시시 평균 85.8점이었으며 18예(69%)에서 양호 이상의 결과를 얻었다. 5예에서 대퇴부 동통을 호소하였다. 대퇴골 삽입물 침강은 3예에서 10 mm 이상 발생하였으며 평균 14 mm이었다. 2예에서 최종 추시시 해리 소견이 관찰되었다. 응력 방패 현상은 6예에서 관찰되었다. 지주 동종골 이식을 시행한 3예는 숙주골과 골유합 소견이 관찰되었다. 합병증은 2예에서 수술 중 발생한 대퇴 삽입물 주위 골절로 금속판과 강선을 이용하여 고정하였고, 3예에서 수술 후 탈구가 발생하여 정복 후 보조기를 착용시켰다. 결론: 무시멘트형 대퇴 삽입물을 이용한 인공 고관절 재치환술에서 임상적 및 방사선학적으로 만족할 만한 결과를 얻을 수 있었다. 그러나 직경이 너무 큰 삽입물을 사용한 경우에서 대퇴부 동통과 응력방패가 발생하였다.

Purpose: To assess the usefulness of T2-weighted oblique coronal MR imaging (T2OCI) in the differential diagnosis of complete and partial tears of the anterior cruciate ligament (ACL) of the knee. Materials and Methods: Thirty-three patients with ACL tear (16 complete and 17 partial tears), comfirmed by arthroscopy, were included in this study. Conventional MR imaging and T2OCI were performed, and the findings were retrospectively reviewed by two radiologists in terms of continuity, shape, axis and internal signal intensity of the ligament. Each finding was tested if there were stastistically significant differences in its prevalence between partial and complete tears. The diagnostic accuracy of T2OCI and conventional MR imaging in the detection of partial and complete tears of the ACL were compared. Results: Conventional MR imaging revealed no statistically significant finding for differential diagnosis of complete and partial ACL tears. The reliable and statistically significant (p

Purpose: Percutaneous microwave coagulation therapy (PMCT) uses a new energy source, microwave, in the treatment of solid neoplasms. We evaluated the efficacy of PMCT for nodular hepatic tumors in nine patients. Materials and Methods: Between December 1998 and June 1999, we performed PMCT in six patients with hepatocellular carcinoma (HCC), two with one and three metastatic nodules each from colon cancer, and one with adenomatous hyperplasia. Four patients were female and five were male, and their age ranged between 44 and 71 (mean, 58.8) years. Under sonographic guidance a 14-gauge guiding needle was inserted percutaneously toward the lesion, and within it a needle electrode was precisely positioned. Microwave 2450MHz in frequency and with 60 or 80 watt emission was generated for 80~90 seconds. We evaluated the ultrasound findings obtained during the procedure, pre-PMCT and follow-up CT images, changes in tumor marker(AFP or CA19-9) levels and the results of liver function tests, and complications arising during the six-month period following PMCT. Results: Immediately after microwave emission, characteristic hyperechogenicity appeared on the realtime sonogram. Two patients with HCC underwent CT before PMCT, and typical enhancement during the arterial phase and washout during the portovenous phase was observed. In one patient, two metastatic lesions from colon cancer showed delayed enhancement on pre-PMCT CT. Initial follow-up CT, performed between 1 and 4 weeks after the PMCT procedure, showed that eight lesions-including two HCCs which were highly enhanced on CT before PMCT-showed no contrast enhancement, and three others showed delayed enhancement. Two of the eight lesions which showed no contrast enhancement at initial follow-up CT were markedly decreased in size (from 2.9 and 4.0 cm to 1.0 and 2.0 cm, respectively) at subseqent follow-up 3 months and 6 months later, respectively. One of the three lesions showing delayed enhancement had increased in size from 4.1 to 5.5 cm at subsequent follow-up CT, 2 months later. Serum AFP or CA19-9 levels decreased in four of six patients (66.7%) who were followed up for 6 months. Transient elevation of aspartate aminotransferase(AST) levels were noted in all patients. PMCT-related complications included intrahepatic arterioportal shunt in two patients, pleural effusion in one, skin burn in one, intraperitoneal hemorrhage in one, and mild fever, abdominal pain and nausea in seven. No complications were serious, however.Conclusion: Our preliminary experiences suggest that PMCT is a safe and effective treatment modality for nodular hepatic tumors.

Compared with the stomach and small intestine, the colon and rectum are uncommon sites of lymphomatous involvement. Primary colorectal lymphoma is diagnosed when the lesion is confined to the colorectal area and regional lymph nodes, without involvement of other organs including the upper gastrointestinal tract, bone marrow, and distant lymph nodes. The radiologic appearance of primary lymphoma of the stomach and small bowel is well known, but in cases involving the colorectal area, this is not so. In this article, we categorize and illustrate the radiologic manifestations of primary colorectal lymphoma according to the findings of double-contrast barium enema and CT images, and describe the pathologic findings.

Background : Forceps biopsy, bronchial brushing, and bronchial washing are used in conjunction with bronchoscopy to provide specimens for histologic and cytologic analysis in patients with suspected lung cancer. This study was performed to evaluate how many times brushing should be done and how much fluid should be used during bronchial washing for increasing diagnostic yield, and to evaluate which combination of these procedures gives the highest diagnostic yield. Methods : Forty patients, with suspected lung cancer, who had bronchoscopically visible lesions were enrolled in this prospective study. During one bronchoscopic examination four forceps biopsies, four bronchial brushings, and bronchial washing were done in all patients. The patients were divided into four groups by the amount of normal saline used for bronchial washing; group I, 10 ml ; group II, 20ml ; group III 30ml, and group IV, 40ml. We analyzed the results in 36 patients confirmed as lung cancer. Results : The diagnostic sensitivity of bronchial washing before and after forceps biopsy and bronchial brushing were 36% and 28%, respectively. The cumulative diagnostic sensitivity of bronchial washing was 47% and significantly higher than that of bronchial washing before or after forceps biopsy and bronchial brushing (p

Background : Cigarette smoking is closely related to both lung cancer and chronic obstructive pulmonary disease. The incidence of lung cancer is higher in patients with obstructive ventilatory impairment than in patients without obstructive ventilatory impairment regardless of smoking. So, obstructive ventilatory impairment is suspected as an independent risk factor of lung cancer. Methods: For the evaluation of the role of obstructive ventilatory impairment as a risk factor of lung cancer, a total of 73 cases comprising 47 cases of malignant and 26 benign solitary pulmonary nodule were analyzed retrospectively. A comparative study of analysis of forced expiratory volume curves and frequencies of obstructive ventilatory impairment were made between cases with malignant and benign nodules. Results: In comparison of vital capacity and parameters derived from forced expiratory volume curve between two groups. VC, FVC and were not significantly different. whereas and FEF 25-75% showed a significant decrease in the cases with malignant nodule. The frequency of obstructive ventilatory impairment determined by pulmonary function test was significantly higher in the cases with malignant nodule(23.4%) than in benign nodule(3.8%). When the risk for lung cancer was examined by the presence or absence of obstructive ventilatory impairment using the logistic regression analysis, the unadjusted relative risk for the lung cancer of obstructive ventilatory impairment was 17.17. When the effect of smoking and age were considered, the relative risk was to 8.13. Conclusion: These findings suggest that an obstructive ventilatory impairment is a risk factor of lung cancer.

Background: Little information is available concerning the value of bronchoscopy in patients with a lymphocytic exudative pleural effusion in which percutaneous pleural biopsy have been regarded as cornerstone in investigating the etiology. Recently, a few reports suggest that bronchoscopy may be more effective diagnostic method in patients with unexplained pleural effusion accompanied by hemoptysis or other roentgenographic abnormalities, such as mass, infiltrate, atelectasis. Method: Mter initial examinations of sputum and pleural fluid through thoracentesis in 112 patients(male 75 cases, female 37 cases, mean age 53.2 years) who were admitted for evaluation of the cause of pleural effusion, we performed bronchoscopy and closed pleural biology in most patients with undiagnosed lymphocytic exudate and compared the diagnostic yield of both invasive methods according to hemoptysis or other roentgenographic abnormalities, and investigated the sole diagnostic contribution of bronchoscopy. Results: Tuberculosis(57 cases, 51%) was the most common cause of pleural effusion. Percutaneous pleural biopsy showed more diagnostic yield than bronchoscopy regardless of presence or absence of other clinical or radiologic abnormalities. In 25 cases with unknown etiology after pleural biopsy, additional diagnostic yield by bronchoscopy was 36 % (4/11) in patients with associated features and only 7 % (1/14) with lone effusion, and, as the sole mean for diagnsosis in all patients with pleural effusion, was only 4.5%(5/12). Conclusion : In a region of high prevalence of tuberculosis as a cause of pleural effusion, percutaneous pleural biospy is more effective method when invasive method is required for confirmative diagnosis of unexplained lymphocytic exudative pleural effusion, and bronchoscopy is unlikely to aid in the diagnosis of lone pleural effusion.

Background: Accurate staging is important to determine treatment modalities and to predict prognosis for the patients with lung cancer. The simple two-stage system of the Veteran's Administration Lung Cancer study Group has been used for staging of small cell lung cancer(SCLC) because treatment usually consists of chemotherapy with or without radiotherapy. However, this system does not accurately reflect segregation of patients into homogenous prognostic groups. Therefore, a variety of new staging system have been proposed as more intensive treatments including either intensive radiotherapy or surgery enter clinical trials. We evaluate the prognostic importance of TNM staging, which has the advantage of providing a uniform detailed classification of tumor spread, in patients with SCLC. Methods: The medical records of 166 patients diagnosed with SCLC between January 1989 and December 1996 were reviewed retrospectively. The influence of TNM stage on survival was analyzed in 147 patients, among 166 patients, who had complete TNM staging data. Results: Three patients were classified in stage I / II, 15 in stage III a, 78 in stage IIIb and 48 in stage IV. Survival rate at 1 and 2 years for these patients were as follows: stage I / II, 75% and 37.5% ; stage IIIa, 46.7% and 25.0% ; stage III b, 34.3% and 11.3% ; and stage IV, 2.6% and 0%. The 2-year survival rates for 84 patients who received chemotherapy(more than 2 cycles) with or without radiotherapy were as follows: stage I / II, 37.5% ; stage rna, 31.3% ; stage IIIb 13.5% ; and stage IV 0%. Overall outcome according to TNM staging was significantly different whether or not received treatment. However, there was no significant difference between stage IIIa and stage IIIb though median survival and 2-year survival rate were higher in stage IIIa than stage IIIb. Conclusion: These results suggest that the TNM staging system may be helpful for predicting the prognosis of patients with SCLC.

Background: Mucoepidermoid carcinoma of the lung arises from submucosal gland of tracheobronchial tree. Histologically, the tumor is composed of mucin-secreting cells, squamous cells, and intermediated cells, which show no particular differentiating characteristics, in varying proportions. The tumor is divided into low grade and high grade depending on the proportion of cells, and the degree of the mitotic activity, cellular necrosis and nuclear pleomorphism. While favorable prognosis of low grade tumor, high grade tumor, which is very difficult to differentiate from adenosquamous carcinoma, has an aggressive clinical course. The tumor is rare, comprising 0.1 to 0.2% of primary lung cancers and 1 to 5% of bronchial adenomas. Method: A retrospective clinical study was done on 17 cases of mucoepidermoid carcinoma. The study investigated the clinical features, radiologic findings, bronchoscopic findings, histology and clinical courses. Results: Age ranged between second to seventh decade with a mean age of 42 years. Twelve out of 17 cases were male. Five out of 17 cases were smokers with a mean 11 pack-years. Common symptoms included dyspnea, cough, hemoptysis, and wheezing. Two out of 17 cases was asymptomatic. Atelectasis or mass was common radiologic finding. Plain chest radiography was normal in one patient whom the tumor was located in upper trachea. Bonchoscopy revealed exophytic mass in 12 cases and nodular infiltrations in 4 cases. One case having solitary pulmonary nodule in the right lower lung was normal on bronchoscopy. Histologically, ten out of 17 cases were low grade, and seven out of 17 cases were high grade. Among 10 patients with low grade tumor,9 patients were performed operation and have been alive without recurrence during a mean follow-up of 30 months. Two out of 7 patients with high grade tumor were performed pneumonectomy and have been alive during a follow-up of 3 and 8 months, respectively. Conclusion: Most of mucoepidermoid carcinoma is located at central airway and is presented symptoms by mucosal irirtation. Although atelectasis or mass is common radiologic finding. chest X -ray can be normal. The histologic grading and the extent of tumor are two most important factors for prognosis.