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Paul J. Park,Fthimnir M. Hassan,Xavier E. Ferrer,Cole Morrissette,Nathan J. Lee,Meghan Cerpa,Zeeshan M. Sardar,Michael P. Kelly,Stephane Bourret,Kazuhiro Hasegawa,Hee-Kit Wong,Gabriel Liu,Hwee Weng De 대한척추신경외과학회 2023 Neurospine Vol.20 No.3
Objective: To define a novel radiographic measurement, the posterior cranial vertical line (PCVL), in an asymptomatic adult population to better understand global sagittal alignment. Methods: We performed a multicenter retrospective review of prospectively collected radiographic data on asymptomatic volunteers aged 20–79. The PCVL is a vertical plumb line drawn from the posterior-most aspect of the occiput. The horizontal distances of the PCVL to the thoracic apex (TA), posterior sagittal vertical line (PSVL, posterosuperior endplate of S1), femoral head center, and tibial plafond were measured. Classification was either grade 1 (PCVL posterior to TA and PSVL), grade 2 (PCVL anterior to TA and posterior to PSVL), or grade 3 (PCVL anterior to TA and PSVL). Results: Three hundred thirty-four asymptomatic patients were evaluated with a mean age of 41 years. Eighty-three percent of subjects were PCVL grade 1, 15% were grade 2, and 3% were grade 3. Increasing PCVL grade was associated with increased age (p < 0.001), C7–S1 sagittal vertical axis (SVA) (p < 0.001), C2–7 SVA (p < 0.001). Additionally, it was associated with decreased SS (p = 0.045), increased PT (p < 0.001), and increased knee flexion (p < 0.001). Conclusion: The PCVL is a radiographic marker of global sagittal alignment that is simple to implement and interpret. Increasing PCVL grade was significantly associated with expected changes and compensatory mechanisms in the aging population. Most importantly, it incorporates cervical alignment parameters such as C2–7 SVA. The PCVL defines global sagittal alignment in adult volunteers and naturally distributes into 3 grades, with only 3% being grade 3 where the PCVL lies anterior to the TA and PSVL.
Paul J. Park,김아름,Yangkyo P. Salch,송택선,신성재,한승정,조상래 한국미생물학회 2014 The journal of microbiology Vol.52 No.10
Mycobacterium tuberculosis-specific antigens would be ofgreat value in developing immunodiagnostic tests for tuberculosis(TB), but regional differences in molecular types ofthe organism may result in antigenic variation, which in turnaffects the outcome of the tests. For example, the Beijingstrains of M. tuberculosis are prevalent in East Asia, and inparticular, the K strain and related strains of the Beijingfamily, are most frequently isolated during school outbreaksof TB in South Korea. From comparison of genome sequencesbetween M. tuberculosis K strain and the H37Rv strain, anon-Beijing type, we identified a K strain-specific gene, InsB,which has substantial homology with the ESAT-6-like proteins. This study was, therefore, initiated to characterize theInsB protein for its immunogenicity in mice and to confirmits expression in TB patients by detecting antibodies to theprotein. The InsB gene was cloned from M. tuberculosis Kstrain and expressed in Escherichia coli. The recombinantInsB protein was used for immunization of mice. All miceshowed strong antibody responses to the InsB protein, andsplenocytes stimulated with InsB showed strong IFN-γ andIL-17 responses and a weak IL-2 response, all of which havebeen implicated in disease expression and used for the immunodiagnosisof TB. Serum samples from TB patients alsoshowed significant antibody responses to the InsB protein ascompared to healthy control samples. These results indicatethat the InsB protein is an M. tuberculosis K-strain-specificantigen that could further improve the current immunodiagnosticmethods, especially for the South Korean population.
Paul J. Park,Joe M. Lombardi,Lawrence G. Lenke 대한척추신경외과학회 2021 Neurospine Vol.18 No.1
Proximal junctional kyphosis (PJK) is a difficult complication to manage following adult spinal deformity surgery. Particularly in spinal fusions from the lower thoracic spine down to pelvis, PJK is a major consideration. While the open posterior approach allows for excellent visualization and preparation of bony surfaces for fusion, disruption of posterior soft tissue structures increases risk of PJK postoperatively. Minimally invasive approaches, on the other hand, preserve posterior ligamentous structures and musculature at the proximal fusion levels however prevent the access afforded by an open approach. We describe here the hybrid open muscle-sparing approach—a technique that allows for decortication of bony surfaces as well as clear exposure of anatomic landmarks for freehand pedicle screw placement, while protecting the posterior soft tissue structures to reduce risk of PJK.
Paul J. Park,James D. Lin,Melvin C. Makhni,Meghan Cerpa,Ronald A. Lehman,Lawrence G. Lenke 대한척추신경외과학회 2020 Neurospine Vol.17 No.2
To illustrate the safe placement of a 5-screw/5-rod construct across the spinopelvic junction in a complex revision case utilizing 4 S2 alar-iliac (S2AI) screws as well as an iliac screw for a kickstand rod. The S2AI screws are often used for lumbosacral fixation at the base of long spinal deformity constructs. In severe spinal deformities, additional pelvic fixation beyond the standard 2 screws may help achieve and maintain correction, and also increase the rigidity of the construct. With a thorough understanding of pelvic anatomy, multiple pelvic screws, such as bilateral dual S2AI screws, may be placed safely to achieve stability and accommodate additional rods to perform powerful correction techniques. We illustrate the safe use of multiple rods across the lumbosacral junction in this case, by using both a hook rod construct and domino connectors – ultimately though these additional rods rely on the integrity of the pelvic fixation to provide their support. We recommend at least 3 rods across the lumbosacral junction in any adult spinal deformity case requiring pelvic fixation, and would recommend considering more than 3 rods, especially across 3-column osteotomy sites. For long spinal constructs in patients with significant adult spinal deformity, we believe the use of multiple pelvic screws to a multirod construct is a safe and effective way to provide long-term correction and clinical success.
( Chan Jae Park ),( Moon Young Lee ),( Paul J Park ),( Se Eun Ha ),( Robyn M Berent ),( Robert Fuchs ),( Joseph M Miano ),( Laren S Becker ),( Kenton M Sanders ),( Seung Il Ro ) 대한소화기기능성질환·운동학회 2015 Journal of Neurogastroenterology and Motility (JNM Vol.21 No.4
Background/Aims Smooth muscle cells (SMCs) characteristically express serum response factor (SRF), which regulates their development. The role of SRF in SMC plasticity in the pathophysiological conditions of gastrointestinal (GI) tract is less characterized. Methods We generated SMC-specific Srf knockout mice and characterized the prenatally lethal phenotype using ultrasound biomicroscopy and histological analysis. We used small bowel partial obstruction surgeries and primary cell culture using cell-specific enhanced green fluorescent protein (EGFP) mouse lines to study phenotypic and molecular changes of SMCs by immunofluorescence, Western blotting, and quantitative polymerase chain reaction. Finally we examined SRF change in human rectalprolapse tissue by immunofluorescence. Results Congenital SMC-specific Srf knockout mice died before birth and displayed severe GI and cardiac defects. Partial obstruction resulted in an overall increase in SRF protein expression. However, individual SMCs appeared to gradually lose SRF in the hypertrophic muscle. Cells expressing low levels of SRF also expressed low levels of platelet-derived growth factor receptor alpha (PDGFRalow) and Ki67. SMCs grown in culture recaptured the phenotypic switch from differentiated SMCs to proliferative PDGFRalow cells. The immediate and dramatic reduction of Srf and Myh11 mRNA expression confirmed the phenotypic change. Human rectal prolapse tissue also demonstrated significant loss of SRF expression. Conclusions SRF expression in SMCs is essential for prenatal development of the GI tract and heart. Following partial obstruction, SMCs down-regulate SRF to transition into proliferative PDGFRalow cells that may represent a phenotype responsible for their plasticity. These findings demonstrate that SRF also plays a critical role in the remodeling process following GI injury. (J Neurogastroenterol Motil 2015;21:589-602)