• 대한정형외과 초음파학회지
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• 제4권2호
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• pp.111-122
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• 2011

혈소판 풍부 혈장은 자가 혈액으로부터 농축된 혈소판을 이용하여 성장 인자들을 제공함으로써 손상된 조직의 재생과 치유를 도모한다는 이론적 근거를 배경으로, 근골격계 손상의 치료를 위해 최근 많이 사용되고 있다. 성장 인자를 통한 조직 치유 효과는 여러 기초 과학적 연구를 통해 규명되어 왔고, 혈소판 풍부 혈장을 이용한 동물 연구 및 임상 연구들도 좋은 결과를 보고하고 있다. 그러나, 대부분의 연구들이 혈소판 풍부 혈장의 적용 방법 및 결과 측정 방법 등에서 문헌 별로 차이가 커서 서로 비교가 어렵고, 연구 대상 환자 수가 너무 적거나 대조 군이 없는 등 연구로서의 한계가 있다. 특히 잘 디자인 된 전향적 무작위 대조 연구들은 거의 없는 상황이다. 따라서, 현재까지의 결과를 확증하고 혈소판 풍부 혈장의 임상적 사용에 대한 과학적 근거를 제시하기 위해서는 좀 더 높은 수준의 잘 디자인 된 전향적 무작위 연구가 필요하다 할 수 있다. 결론적으로, 혈소판 풍부 혈장의 임상적 적용은 아직 과학적 근거가 부족한 상황이고, 따라서 혈소판 풍부 혈장을 사용하여 근골격계 질환을 치료할 때는 신중을 기해야 할 것이다.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.380-384
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• 2009

Purpose: Autologous vessels remain the gold standard for vascular grafts in microanastomoses. However, they are sometimes unavailable and have a limited long - term patency. Synthetic vessels have high success rates in large - diameter reconstructions but failed when used as small - diameter grafts due to graft occlusion. It has been proved that endothelial cell seeding improves prosthesis performance and long - term patency. Among polyurethane, PET and ePTFE, polyurethane has the best affinity to endothelial cells and mechanical properties closest to human vessels. We examined the ability of endothelial cells to attach to a polyurethane graft manufactured by the electrospinning method. Methods: Endothelial cells, which were cultured from porcine internal jugular veins, were attached to polyurethane grafts with an internal diameter of 3 mm. The same cells were attached to allogeneic decellularized porcine internal carotid artery grafts as controls. Both of the 10 mm - long grafts were exposed to endothelial cells in a well for 1 hour. Each well contained $2{\times}10^5$ endothelial cells. The graft materials were rotated through 90 degrees every 15 minutes in order to minimize the effect of gravity. The extent of cell attachment was examined with the MTT assay. Results: The MTT assay showed good incorporation of endothelial cells into both grafts. For the evaluation of affinity, the number of attached cells was counted at 10 fields of microscopic examination with ${\times}40$ magnification. Endothelial cells adhered more to polyurethane grafts (mean, $127.4{\pm}6.2cells$) compared to porcine artery grafts (mean $45.8{\pm}5.1cells$)(p<0.05,Mann - Whitney test). Conclusion: In this study, we attached porcine endothelial cells to polyurethane grafts, manufactured by electrospinning. The grafts exhibited a better affinity to endothelial cells than allogeneic decellularized porcine internal carotid artery grafts. It is suggested that the time required for endothelial cells to attach to decellulized artery grafts may be longer than that which is required for attachment to polyurethane grafts.

• Archives of Plastic Surgery
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• 제32권1호
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• pp.12-18
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• 2005

The Transverse rectus abdominis musculocutaneous (TRAM) flap has been commonly used for autologous breast reconstruction. Despite these clinical usefulness, the TRAM flap is prone to partial flap or fat necrosis in especially pedicled flap. To improve flap survival, the surgical delay procedures and pharmacological treatments have been developed. In many studies for the pharmacological treatment, Lipo-$PGE_1$ has demonstrated a marked ability to improve flap survival and it's effect has been proved similar to surgical delay procedure. The purpose of this study is to determine the most effective route of Lipo-$PGE_1$ administration as a pharmacological treatment in TRAM flap of the rat. Fifty male Sprague-Dawley rats weighing 300-350 gm were divided into five groups, One week before flap elevation, Lipo-$PGE_1$($2{\mu}g/kg$) was injected three times in a week and than the left inferior epigastric vessel based TRAM flap ($5.0{\times}3.0cm$) elevated; group I: no procedure before flap elevation; group II: intraperitoneal injection; group III: intravenous injection; group IV: subcutaneous injection; group V: topical application. A flap was assessed at postoperative 7 days by comparison of flap survival rate, vessel counts(H-E stain), and vascular endothelial growth factor(VEGF) protein expressed by Western blot. The results demonstrated that the mean percentages of the flap survival area in group III were significantly higher than that of any other group(p<0.05). The vessel counts of all experimental groups were statistically higher than that of control group(p<0.05). Only in group III, the VEGF protein expression was increased significantly than control group and there are no difference in other experimental groups. In conclusion, the intravenous administration of the Lipo-$PGE_1$ is the most effective on flap survival, and the VEGF induced by Lipo-$PGE_1$ has some positive effects on new vessel formation and flap survival.

• Molecules and Cells
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• 제39권12호
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• pp.898-908
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• 2016

Despite recent groundbreaking advances in multiple myeloma (MM) treatment, most MM patients ultimately experience relapse, and the relapse biology is not entirely understood. To define altered gene expression in MM relapse, gene expression profiles were examined and compared among 16 MM patients grouped by 12 months progression-free survival (PFS) after autologous stem cell transplantation. To maximize the difference between prognostic groups, patients at each end of the PFS spectrum (the four with the shortest PFS and four with the longest PFS) were chosen for additional analyses. We discovered that integrin-${\alpha}8$ (ITGA8) is highly expressed in MM patients with early relapse. The integrin family is well known to be involved in MM progression; however, the role of integrin-${\alpha}8$ is largely unknown. We functionally overexpressed integrin-${\alpha}8$ in MM cell lines, and surprisingly, stemness features including $HIF1{\alpha}$, VEGF, OCT4, and Nanog, as well as epithelial mesenchymal transition (EMT)-related phenotypes, including N-cadherin, Slug, Snail and CXCR4, were induced. These, consequently, enhanced migration and invasion abilities, which are crucial to MM pathogenesis. Moreover, the gain of integrin-${\alpha}8$ expression mediated drug resistance against melphalan and bortezomib, which are the main therapeutic agents in MM. The cBioPortal genomic database revealed that ITGA8 have significant tendency to co-occur with PDGFRA and PDGFRB and their mRNA expression were up-regulated in ITGA8 overexpressed MM cells. In summary, integrin-${\alpha}8$, which was up-regulated in MM of early relapse, mediates EMT-like phenotype, enhancing migration and invasion; therefore, it could serve as a potential marker of MM relapse and be a new therapeutic target.

• Archives of Plastic Surgery
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• 제35권4호
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• pp.385-392
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• 2008

Purpose: The most effective methods of harvesting, preparing, and injecting autologous fat grafts have been inconsistent and conflicting. With its limitation as resorption in fat grafting, handling various techniques affect adipocyte survival, and is crucial to optimizing its long-term survival. To improve graft survival, re-implantation of cryopreserved adipocytes was developed. In addition, adipocytes do not induce immune rejection in response to non-self lymphocytes in a mixed lymphocyte reaction. The purpose of this study is to analyze the changes in cryopreserved adipocytes so as to determine the most efficient long-term storage period, and to analyze the changes in cryopreserved allografted adipocytes so as to determine the efficacy of cryopreserved adipocytes allografting. Methods: Fat tissues were harvested from the inguinal and retroperitoneal fat pad of mice. After the centrifugation of the harvested fat tissues, they were disintegrated with collagenase. The adipocytes were obtained by centrifugation of the disintegrated fat tissues. The adipocytes were treated as follows: (1) They were examined for weight and then frozen at $-20^{\circ}C$(n=25). For four months, each five frozen samples were taken and examined for weight and histologic changes in the 1st week, the 1st month, the 2nd month, the 3rd month, and the 4th month, respectively. (2) The adipocytes were immediately frozen at $-20^{\circ}C$(n=125). For four months, five frozen samples were taken, and allografted in the same time period as above. Finally, for four months, five cryopreserved allografted adipocytes were taken and examined for histologic changes in the same time period as above. Results: (1) Significant weight changes and histologic findings with inflammatory and destructive changes were observed in the cryopreserved adipocytes in three months. (2) Significant fat necrotic changes in the histologic changes with Hematoxylin and eosin stain were observed in the cryopreserved allografted adipocytes since the first week, independent of the freezing period. Conclusion: The study results show that the adipocytes that were cryopreserved for more than three months underwent obvious weight reductions and necrotic changes, and the adipocytes that were allografted without freezing were viable for four months, but the cryopreserved allografted adipocytes had obvious necrotic changes since the first week regardless of the freezing period.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.530-535
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• 2013

Background Platelet-rich plasma (PRP) has more concentrated platelets than normal plasma (approximately 150-400${\times}10^3$ cell/dL). Platelets excrete several growth factors and cytokines that are associated with the healing and regeneration process. However, even though PRP is widely used, the mechanism or actual effect is presently unclear. Therefore, this study was performed to investigate the levels of growth factors and platelet concentration rate. Methods Autologous blood for preparing PRP was obtained from healthy subjects aged 25 to 35 years. The samples were divided into 4 experimental groups (inactivated whole blood, inactivated PRP, activated whole blood with thrombin and calcium chloride, and activated PRP). The platelet counts in the blood were analyzed and the growth factors were quantitatively measured. A statistical analysis was performed by using Dunn's multiple comparison test. Results In the blood cell analysis, the platelet count of the PRP group was approximately 4.25 times higher than that of the whole blood group. In the quantitative analysis of growth factors, the platelet-derived growth factor (PDGF)-AB, PDGF-BB, and transforming growth factor-${\beta}$ of the inactivated and activated PRP groups were higher than those of the inactivated and activated whole blood groups (P<0.05). Conclusions In this study, the platelet count and the levels of PDGF-AB and PDGF-BB in the PRP were determined. Further, more research is required on the bioactivity level of the growth factors secreted during the process of PRP preparation and the potency of growth factors that can be exerted physiologically in vivo.

• Journal of Chest Surgery
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• 제31권1호
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• pp.28-31
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• 1998

개심술시 출혈에 따른 동종수혈은 응혈이상증, 간염, 후천성면역결핍증, 과민반응 등의 부작용을 초래할 수 있다. 동종수혈을 줄이는 한 방법으로 자가수혈기의 사용이 보편화 되어있다. 계명대학교 흉부외과학 교실에서는 1993년 7월부터 1996년 7월까지 개심술을 받은 40명의 환자를 대상으로 cell saver를 이용하여 자가수혈을 받은 실험군 20명과 대조군 20명으로 나누어 수혈량, 흉관을 통한 출혈량, 혈액학적 소견, 혈액응고상태 등을 비교하였다. 술후 출혈량은 양군 간의 유의한 차이가 없었고, 수혈량은 실험군에서 2.91$\pm$1.72 units로 대조군의 4.82$\pm$1.72 units에 비해 의미있게 감소하였다. cell saver를 이용하여 얻어진 처리혈의 구성성분은 hemoglobin 17.4gm%, hematocrit 56.4%, RBC 5,780,000/ul, WBC 9,900/ul, platelet 33,000/ul, sodium 147.4mEq/L, potassium 2.9mEq/L로 나타났다. 처리혈을 세균배양한 결과 20례중 1 례에서 staphylococcus epidermidis가 배양되었으나 감염에 따른 합병증은 없었다. 그리고 자가수혈기 사용에 따른 합병증예도 없었다.

• 생명과학회지
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• 제30권7호
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• pp.651-659
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• 2020

허혈성 심혈관질환은 전 세계적으로 치사율이 높은 질병 중 하나이다. 이를 치료하기 위해 수술적 방법이 시행되고 있으나, 손상된 심근조직 회복의 어려움과 수술 후 부작용의 한계가 남아있다. 이러한 한계점을 극복하기 위해, 최근 줄기세포를 기반으로 한 심혈관질환의 세포치료제가 각광받고 있는데 그 중에서도 특히 혈관내피전구세포(EPC)는 높은 증식능과 분화능을 기반으로 손상된 혈관을 재생하고, 주변 조직의 재생을 돕는다는 장점이 있다. 또, EPC는 임상적으로 안전하며, 환자의 심근 기능을 회복시켜주기에 잠재적인 심혈관질환 치료제로서의 가능성이 대두되었다. 하지만, 환자 유래 EPC를 이용한 치료법은, 고령, 흡연 여부, 기저질환 등의 이유로 환자의 EPC 기능이 저하되어 있어, 그 치료 효능을 기대하기 어렵다. 따라서, 최근에는 세포 프라이밍 기법, 오가노이드 배양법과 같이 EPC의 생리학적 활성도를 올리는 체외 배양법의 개발과 3D 바이오프린팅 기법을 이용한 EPC의 이식 효율을 높여 치료 효능을 개선시킬 수 있는 새로운 접근법이 연구되고 있다. 본 연구에서는 EPC의 특징과 세포치료제로서의 임상적용 가능성에 대해 살펴보고자 한다.

• 혜화의학회지
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• 제4권2호
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• pp.335-336
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• 1996

Artemisinin, a new antimalarial to treat patients infected with strains of Plasmodium jalciparum, derived from the plant Artemisia annua Linn, has immunopharmacologic actions such as enhence the PHA -induced lymphocyte transformation rate, increased the weight of spleen but reduced the weight of thymus, reduced phagocytic function of peritoneal macrophage, remarkably reduced the level of serum IgG and hemolysin fonning capacity (sentitized with SRBC), inhibited the activity of Ts cells of donor mice by supraoptimal immunuization(SOI), but enhenced activity of Ts cells of recipient mice by SOI. These results suggested that Ts cells may be the target cells of artemisinin. To the serum complement C3 level of plasmodium berghei-infeted mice, artemisinin (i. m,) could remarkly increase it. The artemisinin also obviously reduced the prostaglandin E(PGE) in the mouse hind paw swelling induced by carrageenin. Numerous studies have demonstrated that pharmacologic doses of PGE attenuate the development of immunocomplex nephritis. Some autologous immune mechanisms may be invoolved In the pathogensis of some types of glomurulonephritis. Glomerular abnormalities can be induced in animals by variety of immunological manipulations. The resulting disorder has many clinical and pathogical similarities to the disease in human. Our purpose was therefore to test the ability of the artemisinin to lessen the severity of rabbit IgG accelerated nephrotoxic serum glomerulonephritis in mice model. Mice which had treated with rabbit IgG and NTS, administrated with saline, showed Significant inceases of urinary protein, cholesterol level, and decrease of serum albumin in NS group. On the contrary, By i.g. adminstration of artemisinin at dose of 12.5, 25 and 50 mg/kg for 14 days after NTS injection, shown that artemisinin inhibited the nephritic changes in some parameters by means of urinary protein(p<0.05, p<0.01) and serum choleterol(p<0.05, p<0.01) and albumin (p<0.05, p<0.01), blood urea nitrogen (p<0.05, p<0.01), serum albumin(p<0.05, p<0.01); Cyclophosphamide(i.p. 10mg/kg for 14d) had almost same effect as the artemisinin had. Morphological studies shown that The picture of kidney from the mouse with NTS-nephritis accerated with rabbit IgG, treated with i.g. saline as the control, the mesangiocapillary were enlarged and proliferated; There were inflammatory cells infiltrating around the glomeruli; The ethelial cell were proliferated in the wall of Bowman's capsule. Histopatholological picture of kidney from the NTS-nephritis accerated with rabbit IgG mouse treated with i.p. 10mg/kg cyclophosphamide as the positive control. No siginicant histopathological evidence were found. Treaded with i.p. 12.5mg/kg artemisinine, the picture shown that mesangiocapillary were lightly proliferated; There were inflammatory cells infiltrating around the glomeruli; Treaded with i.p. 25mg/kg artemisinine, The picture shown that the mesangiocapillary were lightly proliferated; Treaded with i.p. 50mg/kg artemisinine, The picture shown that both the mesangiocapillary proliferated and the inflammatory cells infiltrating around the glomeruli are less than treated with saline, 12.5 and 25 mg/kg artemisinine. On the basis of these studies we conclude that the artemisinin can relieve pathological change caused by NTS-nephritis aacerated with rabbit IgG.

• 대한족부족관절학회지
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• 제23권4호
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• pp.189-195
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• 2019

Purpose: The aim of this study is to evaluate if the Ilizarov external fixation procedure with axial compression can help to obtain fusion across the ankle joint in patients with a high risk of nonunion. Materials and Methods: From January 2006 to December 2015, the study reviewed 17 patients who underwent ankle arthropathy with a high risk of nonunion and who underwent ankle fusion using the Ilizarov external fixator with axial compression and auto bone grafting. After the lateral surface of the ankle joint was exposed through a lateral trans-fibular approach, massive removal of the articular cartilage and excision of any loose or avascular bone were done. With the cortical bone harvested from the pelvis as corticocancellous bone blocks, we inserted the two cortical blocks longitudinally into the anterior and posterior part of the free ankle space from lateral to medial to make the rectangular chamber to fill the cancellous bones. After the Ilizarov external fixator was equipped, we tightened the frame by 5 mm to compress the bone graft space. We accessed the American Orthopaedic Foot and Ankle Society (AOFAS) AnkleHindfoot score both preoperatively and postoperatively. Results: The average age at the time of operation was 63.4 years (range, 47~78 years). The mean frame time was 17.4 weeks (range, 15~23 weeks). The average follow-up period was 3.7 years (range, 2~6 years). Osseous fusion was obtained in 15 patients (88.2%). There were two stable pseudarthroses among the rheumatoid arthritis patients, and we continued their follow-up. The mean AOFAS AnkleHindfoot score improved from 48.5 to 73.7 points. Conclusion: Ankle arthrodesis using the Ilizarov external fixation with axial compression and auto bone grafting on the ankle arthropathy that had difficult conditions to achieve union is considered one of the useful methods with a correspondingly low incidence of complications.