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Value of Additional Instrumented Fusion in the Treatment of Thoracic Ossification of the Ligamentum Flavum

  • Hwang, Sung Hwan;Chung, Chun Kee;Kim, Chi Heon;Yang, Seung Heon;Choi, Yunhee;Yoon, Joonho
    • Journal of Korean Neurosurgical Society
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    • v.65 no.5
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    • pp.719-729
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    • 2022
  • Objective : The ossification of the ligamentum flavum (OLF) is one of the major causes of thoracic myelopathy. Surgical decompression with or without instrumented fusion is the mainstay of treatment. However, few studies have reported on the added effect of instrumented fusion. The objective of this study was to compare clinical and radiological outcomes between surgical decompression without instrumented fusion (D-group) and that with instrumented fusion (F-group). Methods : A retrospective review was performed on 28 patients (D-group, n=17; F-group, n=11) with thoracic myelopathy due to OLF. The clinical parameters compared included scores of the Japanese Orthopedic Association (JOA), the Visual analogue scale of the back and leg (VAS-B and VAS-L), and the Korean version of the Oswestry disability index (K-ODI). Radiological parameters included the sagittal vertical axis (SVA), the pelvic tilt (PT), the sacral slope (SS), the thoracic kyphosis angle (TKA), the segmental kyphosis angle (SKA) at the operated level, and the lumbar lordosis angle (LLA; a negative value implying lordosis). These parameters were measured preoperatively, 1 year postoperatively, and 2 years postoperatively, and were compared with a linear mixed model. Results : After surgery, all clinical parameters were significantly improved in both groups, while VAS-L was more improved in the F-group than in the D-group (-3.4±2.5 vs. -1.3±2.2, p=0.008). Radiological outcomes were significantly different in terms of changes in TKA, SKA, and LLA. Changes in TKA, SKA, and LLA were 2.3°±4.7°, -0.1°±1.4°, and -1.3°±5.6° in the F-group, which were significantly lower than 6.8°±6.1°, 3.0°±2.8°, and 2.2°±5.3° in the D-group, respectively (p=0.013, p<0.0001, and p=0.037). Symptomatic recurrence of OLF occurred in one patient of the D-group at postoperative 24 months. Conclusion : Clinical improvement was achieved after decompression surgery for OLF regardless of whether instrumented fusion was added. However, adding instrumented fusion resulted in better outcomes in terms of lessening the progression of local and regional kyphosis and improving leg pain. Decompression with instrumented fusion may be a better surgical option for thoracic OLF.

Usefulness Evaluation of Artifacts by Bone Cement of Percutaneous Vertebroplasty Performed Patients and CT Correction Method in Spine SPECT/CT Examinations (척추 뼈 SPECT/CT검사에서 경피적 척추성형술 시행 환자의 골 시멘트로 인한 인공물과 CT보정방법의 유용성 평가)

  • Kim, Ji-Hyeon;Park, Hoon-Hee;Lee, Juyoung;Nam-Kung, Sik;Son, Hyeon-Soo;Park, Sang-Ryoon
    • The Korean Journal of Nuclear Medicine Technology
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    • v.18 no.1
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    • pp.49-61
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    • 2014
  • Purpose: With the aging of the population, the attack rate of osteoporotic vertebral compression fracture is in the increasing trend, and percutaneous vertebroplasty (PVP) is the most commonly performed standardized treatment. Although there is a research report of the excellence of usefulness of the SPECT/CT examination in terns of the exact diagnosis before and after the procedure, the bone cement material used in the procedure influences the image quality by forming an artifact in the CT image. Therefore, the objective of the research lies on evaluating the effect the bone cement gives to a SPECT/CT image. Materials and Methods: The images were acquired by inserting a model cement to each cylinder, after setting the background (3.6 kBq/mL), hot cylinder (29.6 kBq/mL) and cold cylinder (water) to the NEMA-1994 phantom. It was reconstructed with Astonish (Iterative: 4 Subset: 16), and non attenuation correction (NAC), attenuation correction (AC+SC-) and attenuation and scatter correction (AC+SC+) were used for the CT correction method. The mean count by each correction method and the count change ratio by the existence of the cement material were compared and the contrast recovery coefficient (CRC) was obtained. Additionally, the bone/soft tissue ratio (B/S ratio) was obtained after measuring the mean count of the 4 places including the soft tissue(spine erector muscle) after dividing the vertebral body into fracture region, normal region and cement by selecting the 20 patients those have performed PVP from the 107 patients diagnosed of compression fracture. Results: The mean count by the existence of a cement material showed the rate of increase of 12.4%, 6.5%, 1.5% at the hot cylinder of the phantom by NAC, AC+SC- and AC+SC+ when cement existed, 75.2%, 85.4%, 102.9% at the cold cylinder, 13.6%, 18.2%, 9.1% at the background, 33.1%, 41.4%, 63.5% at the fracture region of the clinical image, 53.1%, 61.6%, 67.7% at the normal region and 10.0%, 4.7%, 3.6% at the soft tissue. Meanwhile, a relative count reduction could be verified at the cement adjacent part at the inside of the cylinder, and the phantom image on the lesion and the count increase ratio of the clinical image showed a contrary phase. CRC implying the contrast ratio and B/S ratio was improved in the order of NAC, AC+SC-, AC+SC+, and was constant without a big change in the cold cylinder of the phantom. AC+SC- for the quantitative count, and AC+SC+ for the contrast ratio was analyzed to be the highest. Conclusion: It is considered to be useful in a clinical diagnosis if the application of AC+SC+ that improves the contrast ratio is combined, as it increases the noise count of the soft tissue and the scatter region as well along with the effect of the bone cement in contrast to the fact that the use of AC+SC- in the spine SPECT/CT examination of a PVP performed patient drastically increases the image count and enables a high density of image of the lesion(fracture).

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The Study on the Marine Eco-toxicity and Ecological Risk of Treated Discharge Water from Ballast Water Management System Using Electrolysis (전기분해원리를 이용한 선박평형수관리장치의 배출수에 대한 해양생태독성 및 해양환경위해성에 관한 연구)

  • Shon, M.B.;Son, M.H.;Lee, J.;Son, Y.J.;Lee, G.H.;Moon, C.H.;Kim, Y.S.
    • Journal of the Korean Society for Marine Environment & Energy
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    • v.16 no.2
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    • pp.88-101
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    • 2013
  • The International Convention for the Control and Management of Ship's Ballast Water and Sediments was adopted at 2004 and then various BWMS (ballast water management system) have been developed. In this study, WET (whole effluent toxicity) test with algae (diatom) Skeletonema costatum as primary producer, invertebrate (rotifera) Brachionus plicatilis as 1st consumer and fish (olive flounder) Paralichthys olivaceus as predator, chemical analysis and ERA (environmental risk assessment) were conducted to assess the unacceptable effect on marine ecosystem by emitting the discharge water treated with AquaStar$^{TM}$ BWMS using electrolysis as main treatment equipment for removing the marine organisms in the ship's ballast water. The most sensitive test organism on discharge water treated with AquaStar$^{TM}$ BWMS was S. costatum that gave the NOEC value of 25.00%, LOEC value of 50.00% and 72hr-$EC_{50}$ value of 69.97% from WET test result for 20 psu salinity treated discharge water. NOEC and LOEC value of B. plicatilis and P. olivaceus exposed at 20 psu salinity treated discharge water were 50.00% and 100.00%, respectively. In the chemical analysis results, total number of substances produced by AquaStar$^{TM}$ BWMS was 18 which were bromate, 7 volatile halogenated organic compounds, 7 halogenated acetic acids, 3 halogenated acetonitriles and chloropicrin. Eighteen substances did not consider as persistence and bioaccumulative chemicals. Uncertainty of toxic property of 18 substances was high. PECs of 18 substances calculated by MAMPEC model were ranged from $4.58{\times}10^{-4}$ to $4.87{\mu}g\;L^{-1}$, PNECs of them were ranged from $1.6{\times}10^{-2}$ to $3.2{\times}10^2{\mu}g\;L^{-1}$. And, the PEC/PNEC ratio of 18 substances did not exceed 1. Therefore, ERA for produced substances indicate that the discharge water treated with AquaStar$^{TM}$ BWMS does not pose unacceptable effect on marine life. And $EC_{50}$ value of S. costatum on discharge water treated by BWMS using the electrolysis had positive correlation with initial TRO concentration, concentration and kind & level of HAAs.

A Study on the Hull-dimension of 89 ton class Stow-net Vessel with Stern-fishing (89톤급 선미식 안강망어선의 선형치수에 관한 연구)

  • Park, Je-Ung;Lee, Hyeon-Sang
    • Journal of the Korean Society of Fisheries and Ocean Technology
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    • v.33 no.3
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    • pp.159-165
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    • 1997
  • This paper presents the optimum dimension of 89 ton class stow-net vessel with stern-fishing. The model of basic design is developed by using the optimization techniques referring to objective function and numerous constraints as follows; speed, fishing quantity, fishing days, catch per unit effort(CPUE), and weight/ratio of main dimensions, etc. Thus, the basic design of stow-net fishing vessel is built up by using the optimization of the design variables called the economic optimization criteria, and the objective function represents the criterion which is cost benefit ratio(CBR). The main conclusions are as follows. 1. S/W for decision of optimum hull size is developed in 89 ton class stow-net fishing vessel which is constructed with optimization of the design variables called the economic optimization criteria. 2. For optimum ship dimensions in 89 ton class stow-net fishing vessel, the hull dimensions can be obtained in the range of L= 27.3m, B = 6.6m, D = 2.80m, Cb = 0.695, T/D = 0.80, $\Delta$(displacement)=281.7ton with 10 knots.

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The influence of composite resin restoration on the stress distribution of notch shaped noncarious cervical lesion A three dimensional finite element analysis study (복합레진 수복물이 쐐기형 비우식성 치경부 병소의 응력 분포에 미치는 영향에 관한 3차원 유한요소법적 연구)

  • Lee, Chae-Kyung;Park, Jeong-Kil;Kim, Hyeon-Cheol;Woo, Sung-Gwan;Kim, Kwang-Hoon;Son, Kwon;Hur, Bock
    • Restorative Dentistry and Endodontics
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    • v.32 no.1
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    • pp.69-79
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    • 2007
  • The purpose of this study was to investigate the effects of composite resin restorations on the stress distribution of notch shaped noncarious cervical lesion using three-dimensional (3D) finite element analysis (FEA). Extracted maxillary second premolar was scanned serially with Micro-CT (SkyScan1072 ; SkyScan, Aartselaar, Belgium). The 3D images were processed by 3D-DOCTOR (Able Software Co., Lexington, MA, USA). ANSYS (Swanson Analysis Systems, Inc., Houston, USA) was used to mesh and analyze 3D FE model. Notch shaped cavity was filled with hybrid or flowable resin and each restoration was simulated with adhesive layer thickness ($40{\mu}m$) A static load of 500 N was applied on a point load condition at buccal cusp (loading A) and palatal cusp (loading B). The principal stresses in the lesion apex (internal line angle of cavity) and middle vertical wall were analyzed using ANSYS. The results were as follows 1. Under loading A, compressive stress is created in the unrestored and restored cavity. Under loading B, tensile stress is created. And the peak stress concentration is seen at near mesial corner of the cavity under each load condition. 2. Compared to the unrestored cavity, the principal stresses at the cemeto-enamel junction (CEJ) and internal line angle of the cavity were more reduced in the restored cavity on both load con ditions. 3. In teeth restored with hybrid composite, the principal stresses at the CEJ and internal line angle of the cavity were more reduced than flowable resin.

A STUDY OF INTRAORAL ANATOMIC LANDMARKS OF KOREAN ADULT-UPPER JAW (성인 유치악자 상악골의 악궁과 치열궁의 형태에 관한 조사)

  • Oh, Yu-Ree;Lee, Sung-Bok;Park, Nam-Soo;Choi, Dae-Gyun
    • The Journal of Korean Academy of Prosthodontics
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    • v.33 no.4
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    • pp.753-768
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    • 1995
  • For accurate impression taking of dental patient and esthetic denture treatment of ednetulous patient, measuring between intraoral anatomic landmarks is useful.In this study the subjects selected at a random were two-jundred forty persons with a mean age 22.5(range 21-24) and were taken impression of by irreversible hydrocolloid impression material(Alginate). On the study model made by dental stone, each individual tray was made and final impresion was taken by border moilding. On final model measurings were performed with 3-dimensional measuring device and the values were analyzed by t-test The results is following : ABOUT THE MEASURED VALUES. 1. The width between maxillary right and left canine cusp tip was average 36.44mm(s.d. 2.48), man 36.67mm, woman 35.83mm(p<0.05). 2. The width between labial height of contour of maxillary right and left canine was average 40.08mm(s.d. 2.42), man 40.29mm, woman 39.52mm(p<0.05). 3. The width between mesio-lingual cusps of maxillary first molar was average 43.14mm(s.d. 3.33), man 43.56mm, woman 42.05mm(p<0.05). 4. The width between buccal alveolar ridge on axis of mesiolingual cusp of right and left maxillary first molar was average 64.89mm(s.d. 3.88), man 65.58mm, woman 62.92mm(p<0.05). 5. The width between buccal alveolar ridge on axis of mesiolingual cusp of right and left maxillary second molar was average 68.58mm(s.d. 3.91), man 69.29mm, woman 66.30mm (p<0.05). 6. The width between right and left hamular notch was average 49.80mm(s.d. 3.96), man 50.70mm, woman 48.20mm(p<0.05). 7. The length from labial heigth of contour of maxillary central incisor to center of incisive papilla was average 9.52mm(s.d. 1.18), man 9.46mm, woman 9.63mm(p>0.05). 8. The length from labial heigth of contour of maxillary central incisor to palatine fovea was average 53.27mm(s.d. 2.93), man 53.93mm, woman 52.08mm(p<0.05). 9. The center of incisive papilla ws located posterior to intercanine line at 0.40mm(s.d. 1.16), man 0.51mm, woman 0.11mm(p<0.05). 10. The height from incisal edge of maxillary central incisor to the labial vestibule was average 21.84mm(s.d. 1.38), man 22.01mm, woman 21.00mm(p<0.05). 11. The height from mesiolingual cusp of maxillary first molar to buccalvestible was average 17.45mm(s.d. 1.42), man 17.56mm, woman 17.08mm(p>0.05). 12. The height from hamular notch to standard occlusal plane was average 6.84mm(s.d. 1.06), man 6.91mm, woman 6.70mm(p>0.05). 13. The height from the deepest point of palatal vault to standard occlsalplane was average 19.95 mm(s.d. 2.03), man 20.19mm, woman 19.12mm(p<0.05). ABOUT THE ARCH FORM 1. The arch form was able to classify into four typr by the rate of the measured values. Each arch form distribution was that the 1 group had 32.46% the 2 group 2.19%, the 3 group 52.83%, the 4 group 12.72%. The sexual composition was that in 1 group man had 73.5%, woman 26.5%, in 2 group man had 40.0%, woman 60.0%, in 3 group man had 83.3%, woman 16.7%, and in 4 group man had 55.17%, woman 44.83%. 2. When canine cusp tip was marked as point O, the intersection point between labial height of contour of maxillary central incisor and intermaxillary suture as point A, height of contour of maxillary second molar buccal alveolar ridge as B point, ${\angle}$AOB was measured $133.8^{\circ}$for the 1 group, $133.0^{\circ}$for the 2 group, $132.3^{\circ}$for the 3 group, $128.9^{\circ}$for the 4 group.

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A Study on Forecasting Accuracy Improvement of Case Based Reasoning Approach Using Fuzzy Relation (퍼지 관계를 활용한 사례기반추론 예측 정확성 향상에 관한 연구)

  • Lee, In-Ho;Shin, Kyung-Shik
    • Journal of Intelligence and Information Systems
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    • v.16 no.4
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    • pp.67-84
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    • 2010
  • In terms of business, forecasting is a work of what is expected to happen in the future to make managerial decisions and plans. Therefore, the accurate forecasting is very important for major managerial decision making and is the basis for making various strategies of business. But it is very difficult to make an unbiased and consistent estimate because of uncertainty and complexity in the future business environment. That is why we should use scientific forecasting model to support business decision making, and make an effort to minimize the model's forecasting error which is difference between observation and estimator. Nevertheless, minimizing the error is not an easy task. Case-based reasoning is a problem solving method that utilizes the past similar case to solve the current problem. To build the successful case-based reasoning models, retrieving the case not only the most similar case but also the most relevant case is very important. To retrieve the similar and relevant case from past cases, the measurement of similarities between cases is an important key factor. Especially, if the cases contain symbolic data, it is more difficult to measure the distances. The purpose of this study is to improve the forecasting accuracy of case-based reasoning approach using fuzzy relation and composition. Especially, two methods are adopted to measure the similarity between cases containing symbolic data. One is to deduct the similarity matrix following binary logic(the judgment of sameness between two symbolic data), the other is to deduct the similarity matrix following fuzzy relation and composition. This study is conducted in the following order; data gathering and preprocessing, model building and analysis, validation analysis, conclusion. First, in the progress of data gathering and preprocessing we collect data set including categorical dependent variables. Also, the data set gathered is cross-section data and independent variables of the data set include several qualitative variables expressed symbolic data. The research data consists of many financial ratios and the corresponding bond ratings of Korean companies. The ratings we employ in this study cover all bonds rated by one of the bond rating agencies in Korea. Our total sample includes 1,816 companies whose commercial papers have been rated in the period 1997~2000. Credit grades are defined as outputs and classified into 5 rating categories(A1, A2, A3, B, C) according to credit levels. Second, in the progress of model building and analysis we deduct the similarity matrix following binary logic and fuzzy composition to measure the similarity between cases containing symbolic data. In this process, the used types of fuzzy composition are max-min, max-product, max-average. And then, the analysis is carried out by case-based reasoning approach with the deducted similarity matrix. Third, in the progress of validation analysis we verify the validation of model through McNemar test based on hit ratio. Finally, we draw a conclusion from the study. As a result, the similarity measuring method using fuzzy relation and composition shows good forecasting performance compared to the similarity measuring method using binary logic for similarity measurement between two symbolic data. But the results of the analysis are not statistically significant in forecasting performance among the types of fuzzy composition. The contributions of this study are as follows. We propose another methodology that fuzzy relation and fuzzy composition could be applied for the similarity measurement between two symbolic data. That is the most important factor to build case-based reasoning model.

Power Optimization of Organic Rankine-cycle System with Low-Temperature Heat Source Using HFC-134a (저온 열원 HFC-134a 유기랭킨사이클의 출력 극대화)

  • Baik, Young-Jin;Kim, Min-Sung;Chang, Ki-Chang;Lee, Young-Soo;Ra, Ho-Sang
    • Transactions of the Korean Society of Mechanical Engineers B
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    • v.35 no.1
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    • pp.53-60
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    • 2011
  • In this study, an organic Rankine-cycle system using HFC-134a, which is a power cycle corresponding to a low-temperature heat source, such as that for geothermal power generation, was investigated from the view point of power optimization. In contrast to conventional approaches, the heat transfer and pressure drop characteristics of the working fluid within the heat exchangers were taken into account by using a discretized heat exchanger model. The inlet flow rates and temperatures of both the heat source and the heat sink were fixed. The total heat transfer area was fixed, whereas the heat-exchanger areas of the evaporator and the condenser were allocated to maximize the power output. The power was optimized on the basis of three design parameters. The optimal combination of parameters that can maximize power output was determined on the basis of the results of the study. The results also indicate that the evaporation process has to be optimized to increase the power output.

The Effects of Rotational Correlation Time of Paramagnetic Contrast Agents on Relaxation Enhancement: Partial Binding to Macromolecules (거대분자에 부분적으로 결합한 상자성 자기공명 조영제의 회전속도가 이완증강에 미치는 영향)

  • 장용민
    • Investigative Magnetic Resonance Imaging
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    • v.3 no.2
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    • pp.159-166
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    • 1999
  • Purpose : To evaluate the effect of rotational correlation time (${\tau}_R$) and the possible related changes of other parameters, ${\tau}_M,{\;}{\tau}_S,{\;}and{\;}(\tau}_V$ of gadolinium (Gd) chelate on T1 relaxation enhancement in two pool model. Materials and Methods : The NMRD (Nuclear Magnetic Relaxation Dispersion) profiles were simulated from 0.02 MHz to 800 MHz proton Larmor frequency for different values of rotational correlation times based on Solomon-Bloembergen equation for inner-sphere relaxation enhancement. To include both unbound pool (pool A) and bound pool (pool B), the relaxivity was divided by contribution from unbound pool and bound pool. The rotational correlation time for pool A was fixed at the value of 0.1 ns, which is a typical value for low molecular weight complexes such as Gd-DTPA in solution and ${\tau}_R$ for pool B was changed from 0.1 ns to 20 ns to allow the slower rotation by binding to macromolecule. The fractional factor of was also adjusted from 0 to 1.0 to simulate different binding ratios to macromolecule. Since the binding of Gd-chelate to macromolecule cab alter the electronic environment of Gd ion and also the degree of bulk water access to hydration site of Gd-chelate, the effects of these parameters were also included. Results : The result shows that low field profiles, ranged from 0.02 to 40 MHz, and dominated by contribution from bound pool, which is bound to macromolecule regardless of binding ratios. In addition, as more Gd-chelate bound to macromolecule, sharp increase of relaxivity at higher field occurs. The NMRD profiles for different values of ${\tau}_S$ show the enormous increase of low field profile whereas relaxivity at high field is not affected by ${\tau}_S$. On the other hand, the change in ${\tau}$V does not affect low field profile but strongly in fluences on both inflection fie이 and the maximum relaxivity value. The results shows a fluences on both inflection field and the maximum relaxivity value. The results shows a parabolic dependence of relaxivity on ${\tau}_M$. Conclusion : Binding of Gd-chelate to a macromolecule causes slower rotational tumbling of Gd-chelate and would result in relaxation enhancement, especially in clinical imaging field. However, binding to macromolecule can change water enchange rate (${\tau}_M$) and electronic relaxation ($T_le$) vis structural deformation of electron environment and the access of bulk water to hydration site of metal-chelate. The clinical utilities of Gd-chelate bound to macromolecule are the less dose requirement, the tissue specificity, and the better perfusion and intravascular agents.

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Immunological Monitoring of Urinary Aflatoxins and Estimation of Liver Cancer Incidence in Koreans

  • Choi, Mun-Jung;You, Young-Chan;Kim, Hyung-Sik;Lee, Byung-Mu
    • BMB Reports
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    • v.29 no.2
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    • pp.105-110
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    • 1996
  • Polyclonal antiserum R101 against aflatoxin $B_1$ ($AFB_1$) was raised in New Zealand white rabbits after injection of bovine serum albumin-$AFB_1$ conjugate. Competitive ELISA (enzyme linked immuno-sorbent assay) demonstrated that antiserum R101 has the highest binding for $AFB_1$ (50% inhibition at 170 fmol) and aflatoxicol II (50% inhibition at 112 fmol). It also reacts with other aflatoxins such as $AFB_2$, $AFG_1$, $AFG_2$, and aflatoxin metabolites ($AFM_1$, $AFM_2$, $AFP_1$, and $AFQ_1$), but it does not cross-react with $AFG_2a$. Using this antiserum, aflatoxins were quantitated in 100 urine samples of undergraduate students at the College of Pharmacy, Sung Kyun Kwan University, Republic of Korea. By ELISA, $AFB_1$ and its metabolites were detected in human urine samples (N=100, male=89, female=11, ages=20~31 yrs) with a range of 1.4~200.6 ng/kg/day (mean$\pm$SD=$18.11{\pm}33.01\;ng\;AFB_1/kg/day$ in males, $3.82{\pm}2.65\;ng/kg/day$ in females). Assuming that urinary excretion is about 7.6% of $AFB_1$ intake (Groopman et al., 1992), we estimated that Koreans were daily exposed to a total dietary $AFB_1$ of $240.20{\pm}438.67\;ng/kg/day$ in males and $50.35{\pm}29.88\;ng/kg/day$ in females, respectively. When the human monitoring data was applied to a linear regression model of Y=21.67X-10.04 {Y=liver cancer incidence per 100,000, X=Log $AFB_1$ intake (ng/kg/day), r=0.99} developed from previously reported epidemiological data, calculated liver cancer incidences attributed to $AFB_1$ exposure were 41.56/100,000 in males and 26.84/100,000 in females. The incidences were similarly correlated with liver cancer mortality rates of 43.43/100,000 in males and 11.23/100,000 in females in Korea. These results suggest that aflatoxin exposure may be an important risk factor for the high incidence of liver cancer in Korea.

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