• Annals of Rehabilitation Medicine
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• 제41권6호
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• pp.924-934
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• 2017

Objective To investigate the anatomical correlates of the neuropsychological deficits in patients with the cerebellar stroke. Methods We screened patients who were admitted to the National Rehabilitation Center with the cerebellar stroke between October 2012 and November 2016. The patients with the cerebellar stroke who underwent neuropsychological testing for which the Seoul Neuropsychological Screening Battery (SNSB) or the SNSB-II were enrolled. The neuropsychological function capacities were compared in accordance with the stroke type (hemorrhagic vs. ischemic) and the location (right/left anterior, right/left posterior intermediate, right/left posterior lateral lobe, and vermis). Mean z-scores were computed to compare the patient performances with the population averages. Results Twenty-six patients (15 with ischemic stroke and 11 with hemorrhagic stroke) with a mean age of $54.8{\pm}16.6$ years were assessed $8.8{\pm}9.2$ months after the stroke. Differences in the neuropsychological functioning according to the stroke type were not observed. All of the numerical subtests of the stroke patients showed significantly poorer performances compared with the population averages (mean z-score <0), and some of the subtests revealed abnormal performances in attention-, visuospatial function-, memory-, and frontal/executive function-related tasks (mean z-score <-1). The patients with the presence of a lesion in the right posterior intermediate lobe of the cerebellum showed a poorer performance in the subtests evaluating the executive function including the Korean-version Stroop Test (p=0.04), the Digit Symbol Coding Test (p=0.01), and the Korean-version Trail Making Test (p=0.02) compared with the patients without that lesion. Conclusion The present study confirms that the cerebellar stroke affects the neuropsychological functioning which is associated with the anatomical site of stroke.

• Journal of Gynecologic Oncology
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• 제29권6호
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• pp.87.1-87.4
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• 2018

Objective: Upper paraaortic lymph node dissection (UPALD) to the infrarenal level is one of the most challenging robotic procedures. Because robotic system has the limitation in robotic arm mobility. This surgical video introduces a novel robotic approach, lower pelvic port placement (LP3), to perform optimally and simultaneously both UPALD and pelvic procedures in gynecologic cancer patients using da Vinci Xi system. Methods: The patient presented with high-grade endometrial cancer. She underwent robotic surgical staging operation. For the setup of the LP3, a line was drown between both anterior superior iliac spines. At 3 cm below this line, another line was drown and four robotic ports were placed on this line. Results: After paraaortic lymph node dissection (PALD) was completed, the boom of robotic system was rotated $180^{\circ}$ to retarget for the pelvic lateral displacement. Robotic ports were placed and docked again. The operation was completed robotically without any complication. Conclusion: The LP3 was feasible for performing simultaneously optimal PALD as well as procedures in pelvic cavity in gynecologic cancer patients. The advantage of LP3 technique is the robotic port placement that affords for multi-quadrant surgery, abdominal and pelvic dissection. The LP3 is facilitated by utilizing advanced technology of Xi system, including the patient clearance function, the rotating boom, and 'port hopping' that allows using every ports for a camera. The LP3 will enable surgeons to extend the surgical indication of robotic surgical system in the gynecologic oncologic field.

• 대한한방내과학회지
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• 제42권5호
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• pp.931-938
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• 2021

Objective: This study addressed a case of central post-stroke pain described as right arm painful with coldness and left lateral medullary infarction. Methods: A patient, 71 years old female with medullary infarction, was treated with a Korean herbal medication (BackJun-pill). The improvement of symptoms was evaluated using the Numeral Rating Scale and reports of coldness and pain in the affected areas. We also measured the body temperature difference between the left and right arms using digital infrared thermographic imaging (DITI). Results: After six weeks of treatment with Korean medicine, the patient's pain and sensation of coldness decreased. Conclusions: This clinical case study suggests that BackJun-pill may be effective for alleviating pain and coldness due to central post-stroke pain.

• Physical Therapy Rehabilitation Science
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• 제10권1호
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• pp.1-9
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• 2021

Objective: Joint mobilization for arthrokinematics altered by the positional fault of chronic ankle instability (CAI) is an effective intervention for stabilization. In this study, we compared the effects of ankle dorsi flexion range of motion (DFROM) and dynamic balance ability (DBA) in CAI patients via passive joint mobilization (PJM), a method traditionally performed in previous studies, and active joint mobilization (AJM), a method that can have a greater effect on cortical excitability with spontaneous movements. Design: Single-blind two-arm randomized controlled trial Methods: A total of 30 participants were registered: 15 each to the PJM and AJM groups. Each participant received a total of 10 intervention sessions, 10 minutes per session, 5 times a week for 2 weeks. PJM used Maitland's mobilization method to apply joint mobilization with talus in the posterior direction and AJM used an angular joint motion to induce patient's voluntary motion of medial malleolus anterior gliding and lateral malleolus posterior gliding, respectively. DFROM of the ankle was measured by using tape and DBA was evaluated by using the balance system. Results: Significant improvement was observed after intervention in both the PJM and AJM groups except for the DBA-anterior and DBA-right variables of the PJM group. There were statistically significant differences between the AJM and PJM groups in the DFROM, DBA-anterior, DBA-posterior, and DBA-right variables. Conclusions: The overall improvement of DFROM and DBA was found to be more effective in joint mobilization including voluntary movement. When it is accompanied by voluntary movement, it further affects the neuromuscular system of the ankle.

• PNF and Movement
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• 제18권3호
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• pp.305-313
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• 2020

Purpose: The aim of this study was to investigate the relationship between a functional evaluation model and the Fugl-Meyer assessment (FMA) scale in evaluating the upper extremities of stroke patients Methods: Thirty-eight stroke patients were evaluated using the FMA and performed reaching and grasping motions using a three-dimensional motion analysis (Qquas 1 series, Qualisys AB, Sweden). The participants sat on a chair with a backrest. The position of the cup was located at a distance of 80% to the front arm length. The markers were attached to the sternum, acromion, elbow lateral epicondyle, ulnar styloid process, three metacarpal heads, and the distal phalanges of the thumb and index finger. The variables of the correlation between the functional evaluation model and the FMA scale were analyzed. Multiple regression (stepwise) was used to investigate the effect of the kinematic variables. Results: A significant negative correlation was found between the movement time (p < 0.05), movement unit (p < 0.05), and trunk displacement values (p < 0.05) in the FMA total scores, while a positive correlation was found between the peak velocity (p < 0.05) and maximum grip aperture values (p < 0.05). As a result of the multiple regression analysis, the most significant factor was the movement unit, followed by the general movement assessment and trunk displacement. The explained FMA total score value was 62%. Conclusion: This study presents a new functional evaluation model for assessing the reaching and grasping ability of stroke patients. The factors of the proposed functional evaluation model showed significant correlations with the FMA scale scores and confirmed that the new functional evaluation model explained the FMA by 67%. This suggests a new functional evaluation model for reaching and grasping stroke patients.

• Archives of Plastic Surgery
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• 제49권1호
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• pp.61-69
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• 2022

Background Single free flaps are a commonly used reconstructive method for multiple soft tissue defects in digits. We analyzed the flap size, division timing, and degree of necrosis in cases with various types of flap division. Methods We conducted a retrospective review of the medical charts of patients who had undergone single free flap reconstruction for multiple soft tissue defects across their digits from 2011 to 2020. The flap types included were the lateral arm free flap, venous forearm free flap, thenar free flap, hypothenar free flap, anterolateral thigh free flap, medial plantar free flap, and second toe pulp free flap. Flap size, anastomosed vessels, division timing, and occurrence of flap necrosis were retrospectively investigated and then analyzed using the t-test. Results In total, 75 patients were included in the analysis. The success rate of the free flaps was 97.3%. All flaps were successfully divided after at least 17 days, with a mean of 47.17 days (range, 17-243 days) for large flaps and 42.81 days (range, 20-130 days) for the medium and small flaps (P=0.596). The mean area of flap necrosis was 2.38% in the large flaps and 2.58% in the medium and small flaps (P=0.935). Severe necrosis of the divided flap developed in two patients who had undergone flap division at week 6 and week 34. Conclusions In cases where blood flow to the flap has been stable for more than 3 weeks, flap division can be safely attempted regardless of the flap size.

• Wind and Structures
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• 제34권2호
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• pp.199-213
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• 2022

The current study investigates the dynamic effects in the tornado-structure response of an aeroelastic self-supported lattice transmission tower model tested under laboratory simulated tornado-like vortices. The aeroelastic model is designed for a geometric scale of 1:65 and tested under scaled down tornadoes in the Wind Engineering, Energy and Environment (WindEEE) Research Institute. The simulated tornadoes have a similar length scale of 1:65 compared to the full-scale. An extensive experimental parametric study is conducted by offsetting the stationary tornado center with respect to the aeroelastic model. Such aeroelastic testing of a transmission tower under laboratory tornadoes is not reported in the literature. A multiaxial load cell is mounted underneath the base plate to measure the base shear forces and overturning moments applied to the model in three perpendicular directions. A three-axis accelerometer is mounted at the level of the second cross-arm to measure response accelerations to evaluate the natural frequencies through a free-vibration test. Radial, tangential, and axial velocity components of the tornado wind field are measured using cobra probes. Sensitivity analyses are conducted to assess the variation of the structural dynamic response associated with the location of the tornado relative to the lattice transmission tower. Three different layouts representing the change in the orientation of the tower model relative to the components of the tornado-induced loads are considered. The structural responses of the aeroelastic model in terms of base shear forces, overturning moments, and lateral accelerations are measured. The results are utilized to understand the dynamic response of self-supported transmission towers to the tornado-induced loads.

• 대한치과교정학회지
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• 제31권3호
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• pp.311-323
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• 2001

편측성 II급 부정교합의 치료 시 다양한 mechanics가 사용되어지는데 그중 한가지가 asymmetric face-bow를 가진 head gear이다. 이 asymmetric head gear의 편측 효과에 대해 다양한 연구결과를 보고하고 있는데 이에 저자는 편측성 II급 부정교합의 상악 치열 모델링과 임상에서 자주 사용되는 Power arm asymmetric face-bow를 모델링하고, 견인력을 달리하여 유한 요소법을 통해 치근막에서 발생되는 응력의 분포와 그에 따른 각 방향의 반력, 그리고 그로 인한 변위를 관찰하여 역계를 이해하고 치료효과를 예견하고자 실험을 고안하였다. 발치나 교정치료의 경험이 없는 25세 남자 정상 교합자를 대상으로 컴퓨터 단층 촬영을 시행하여 얻은 방사선필름을 기초로 하여 유한 요소 상악 모델과 치주인대 모델을 제작하고 그후 다시 좌측 제 1 대구치가 근심 편위되어있는 편측성 상악 II급 부정교합 모델로 제작하고, RMO 사의 Face-bow (Penta-$^{TM}$/Medium size)를 기본 모델로 0.045 inch 직경의 inner-bow와 0.072 inch 직경의 outer-bow를 가지는 asymmetric face-bow를 우측을 25mm 짧게 하여 모델링한 후, 좌우측 제 1 대구치에 각각, 250g, 300g, 350g 씩 견인력을 부여하여 다음과 같은 결론을 얻었다. 1. 양쪽 제1 대구치가 받는 힘의 총합은 견인력이 증가함에 따라 증가하는 경향을 보였는데 대체로 근심위치된 치아가 정상 위치한 치아보다 더 많은 힘을 받는 것으로 나타났으며, 두치아 모두 윈심으로의 힘을 받으며, 원심으로 이동하는 양상을 보여주었다. 2. 측방력은 두 치아 모두 협측으로의 힘을 받는 것으로 나타났는데, 힘의 성분을 분석하여 보면 견인력이 증가함에 따라 X축으로의 힘이 근심 위치된 치아에서 점점 작아지며, 정상 위치한 치아에서 점점 증가하여 측방력의 성분이 힘을 많이 받는 쪽에서 적게 받는 쪽으로 이동하는 양상을 보여주었다. 3. 원심으로의 이동과 동시에 회전과 경사이동 양상을 보여주었는데 견인력의 증가시 함께 증가하는 양상을 보였고, 힘을 많이 받는 쪽, 즉 근심 위치된 치아가 더 많은 회전과 경사이동을 보였으며 적은 양이나마 정상 위치된 치아에 서도 같은 양상의 변위를 보였다.

• 한국방사선학회논문지
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• 제11권2호
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• pp.139-144
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• 2017

경피적 추체 성형술은 최소 침습적 척추 수술로 골다공증성 압박골절, 골수종 그리고 암에 의한 척추 전이 등에 치료방법으로 많이 사용되어 왔다. 이러한 최소침습적 시술은 환자에게 작은 수술 흉터, 통증, 출혈, 짧은 회복시간등 여러가지 장점이 많으나, 환자와 시술자가 방사선의 위험으로부터 벗어날 수 없다. 이에 본 연구의 목적은 경피적 추체 성형술을 하는 동안 방사선 조사시간의 측정과 함께 시술자와 환자의 방사선 피폭선량을 측정해 보았다. 본원에 내원한 경피적 추체 성형술 시행 대상인 환자를 3명의 마취통증의학과 전문의가 동일한 방법으로 총 20명의 환자에게 경피적 추체 성형술을 실시하였다. 방사선 조사시간을 측정하고 전자선량측정계를 이용하여 총 6군데의 방사선 피폭량을 측정해 보았다. 환자는 직접 엑스선을 측정하였으며, 전 후면과 옆면 부위에 전자선량측정계를 위치하였고, 시술자는 환자로부터 산란되는 산란선을 측정하였으며, 납가운 바깥쪽에 위치한 갑상선, 왼쪽 가슴, 왼쪽 허벅지 그리고 납가운 안쪽에 위치한 왼쪽 가슴부위에 전자선량측정계를 위치하였다. 총 시술 시간은 $19.3{\pm}3.88min$이며, 방사선에 의한 노출 시간은 $3.6{\pm}0.71min$ 이었다. 환자의 피폭선량은 전후면 일 때 $121.4{\pm}48.15{\mu}Sv$ 였으며, 측면 일 때 피폭선량은 $614.7{\pm}177.14{\mu}Sv$ 이다. 시술자가 받은 피폭선량은 납가운 바깥쪽의 갑상선 부분이 $33.7{\pm}7.30{\mu}Sv$ 이고, 왼쪽 가슴 부위가 $49.2{\pm}15.09{\mu}Sv$ 이고, 왼쪽 허벅지 부위가 $12.8{\pm}3.80{\mu}Sv$ 이며, 납가운의 안쪽 가슴에 위치한 부위의 선량계는 $4.2{\pm}1.44Sv$ 이였다. 경피적 추체 성형술 시행 시 방사선의 위험으로부터 벗어나기 위해 C-arm 튜브에서 환자에게 엑스선이 도달하여 산란되는 거리를 최대한 멀게 유지하여야 하며, 방사선이 조사되는 시간을 줄이고, 납가운등 보호장구를 적절히 착용하여 방사선 피폭을 줄임으로써 시술자와 환자 모두 안전한 시술이 되도록 노력하여야 할 것이다.

• The Korean Journal of Pain
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• 제1권1호
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• pp.106-119
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• 1988

For the relief of pain in 3 cases of whiplash syndromes (case I, II and IV) and in one of reflex sympathetic dystrophy (case III), we have carried out six intentional. total spinal blocks (TSB) which attempted two times in case I, three in case II and one in carte III whoso various symptoms were chronically unresponsive to the usual conservative treatments, and a time of cervical epidural and right suprascapular nerve block in case W whose acute symptom lasted 4 drys following the cervical injury (see fables from 1 to 9). During the 753, we have observed clinically the sequential charges of respiration, lid and pupil reflexes, body motion and consciousness. And checked the blood pressure, pulse rate and arterial Pco2. The effectiveness of those blocks has been assessed by using the Visual Analog Scale which is designed to measure the patient$\acute{s}$ subjective intensity of pain and also we have found out the sequelae following those blocks. The methods of the blocks were as the following: 1. Under the N.P.O. for 8~10 hours, the preparations of immediate cardiopulmonary resuscitation and premedication with atropine 0.5mg at thirty minutes before the TSB, it was performed by injecting the mixture of 2% mepivacaine 10 or 15ml and normal saline 10 or 5ml through No. 23 G. spinal needle into the subarachnoid space of $C_7-T_1$ interspinous region with fully flexed neck on the lateral posture. Immediately after the injection of the local anesthetic in the lateral position, the patient$\acute{s}$ were hasten to change Trendelenburg$\acute{s}$ position in order to act the drugs cephalad and to make easy controlled respiration with oxygen. 2. The cervical epidural block was done by injecting the mixture of 0.5% bupivacaine 4ml, normal saline 4ml and triamcinolone 15mg through No. 18 G. Tuohy needle into the epidural space on the same region and posture as the above without premedication.7he suprascapular nerve block was done by injecting of 0.5% bupivacaine 3ml only into the right suprascapular fossa on the sitting posture. The results were as the following: 1. The cessation of respiration was seen within 5 minutes following the subarachnoidal injection of the above 20ml mixture in 2 to 3 minutes and then soon the consciousness began to disappear. The loss of Lid and pupil reflexes noted between 5 to 10 minutes and the size of the dilated pupils was equal between 5 to 20 minutes, but the pupil of the dependent side on tile lateral position was dilated 1 to 3 minutes earlier than that of the independent. The patients had r=ever responded to any stimulations during the TSB except their heart funtion. 2. The recovery of the TSB was as the following, firstly the ankle and lower limb of the independent side began to move slightly with in 34 to 75 minutes after the injection and then that of the dependent Secondly the neck and upper limb moved 6 to 15 minutes later than the lower limb. Thirdly the self respiration began to appear between 40 to 80 minutes from the block. The lid and pupil reacted to touch and light respectively between 40 to 80 minutes but the pupil of the independent side responded earlier than that of the depends. Lastly the consciousness recovered completely between 80 to 125 minutes from the block. 3. In the cardiopulmonary function during the TSB, the blood pressure were stable except the 210/130 tory at the and block of case I. There were bradycardias between 65 to 85 minutes in case I and II but no arrythmia on the EKG. The level of the arterial Pco2 was maintained to 43~45 torr during the TSB. 4. The effectiveness of the above blocks was no pain(0%) in case IV, and light (10~20%) in case I and II but no improvement in case III. 5. The right arm weakness has been complicated as to be Injected accidently the "COLD" local anesthetic at the End block of case I.