• Journal of the Korean Orthopaedic Association
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• v.56 no.4
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• pp.317-325
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• 2021

Purpose: This study compared the functional and radiologic outcomes of intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) for tibia fractures in distal tibial spiral fractures combined with posterior malleolar fractures, as well as the functional and radiologic outcomes with and without fixation for posterior malleolar fractures. Materials and Methods: From January 2010 to December 2018 the radiological and clinical outcomes of 30 skeletally mature patients with tibial spiral fractures (AO Foundation/Orthopaedic Trauma Association classification 42-A1, B1, C1) combined with posterior malleolar fractures were analyzed. Sixteen patients were treated with IMN, and 14 patients were treated with MIPO. Depending on the surgical methods, the radiologic and clinical outcomes were compared by evaluating the bone union time, postoperative alignment, postoperative displacement of the posterior malleolar fragment, and American Orthopaedic Foot and Ankle Society (AOFAS) score. Moreover, the functional and clinical outcomes with and without fixation for posterior malleolar fractures were compared. Results: The mean bone union time was 21.8 weeks in the IMN group and 23.1 weeks in the MIPO group (p=0.500). At the final follow up, the mean alignment was coronal angulation of 1.8°, sagittal angulation of 1.6° in the IMN group and coronal angulation of 1.2° and sagittal angulation of 1.7° in the MIPO group (conoral angulation: p=0.131, sagittal angulation: p=0.850). The postoperative and final radiologic evaluation showed no displacement of the posterior malleolar fragment and excellent joint congruity in all cases. At the final follow-up, the mean AOFAS score was 88.0 on average in the IMN group and 87.6 on average in the MIPO group (p=0.905). The ankle range of motion and AOFAS score were similar in the fixation group and no fixation group for posterior malleolar fractures. Conclusion: Both IMN and MIPO for tibial spiral fractures combined with posterior malleolar fractures result in satisfactory radiological and clinical outcomes.

• Journal of the Korean Orthopaedic Association
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• v.56 no.3
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• pp.234-244
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• 2021

Purpose: To date, studies of firearm and explosive injuries in the Korean military have been limited compared to its importance. To overcome this, this study examined the characteristics of musculoskeletal damages in soldiers who have suffered firearm and explosive injuries over the past four years. Materials and Methods: From January 2015 to July 2019, military forces who had suffered musculoskeletal injuries from firearms or explosive substances were included. The medical records and radiographs were reviewed retrospectively, and telephone surveys about Short Musculoskeletal Functional Assessment (SMFA) for this group were conducted. To compare the functional outcomes, statistical analysis was performed using a t-test for the types of weapons, and ANOVA for others. Results: Of the 61 patients treated for firearms and explosives injuries, 30 patients (49.2%) were included after undergoing orthopedic treatment due to musculoskeletal injury. The average age at injury was 26.4 years old (21-52 years old). The number of officers and soldiers was similar. Eleven were injured by gunshot and 19 by an explosive device. Sixteen were treated in the Armed Forces Capital Hospital and 10 at private hospitals. More than half of the 16 patients (53.3%) with a fracture had multiple fractures. The most common injury site was the hand (33.3%), followed by the lower leg (30.0%). There were 14 patients (46.7%) with Gustilo-Anderson classification 3B or higher who required a soft tissue reconstruction. Fifteen patients agreed to join the SMFA survey for the functional outcomes. Between officers and soldiers, officers had better scores in the Bother Index compared to soldiers (p=0.0045). Patients treated in the Armed Forces Capital Hospital had better scores in both the Dysfunction and Bother Index compared to private hospitals (p=0.0008, p=0.0149). Conclusion: This is the first study to analyze of weapons injuries in the Korean military. As a result of the study, the orthopedic burden was high in the treating patients with military weapon injuries. In addition, it is necessary to build a military trauma registry, including firearm and explosive injuries, for trauma treatment evaluation and development of military trauma system.

• Journal of the Korean Institute of Traditional Landscape Architecture
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• v.39 no.1
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• pp.10-19
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• 2021

This study investigated the actual state and transformation of the major garden ornaments in Changdeokgung Palace(昌德宮) in the modern and contemporary period, focusing on Nakseonjae(樂善齋), Juhamnu(宙合樓), Jondeokjeong(尊德亭), and Daebodanji (大報壇址). This study can be used as useful data for establishing the restoration and maintenance plan of the garden ornaments in Changdeokgung Palace, and the main results of the study can be summarized as follows. First, according to a photo taken by the Czech Vráz, in 1901, a total of six garden ornaments, including a stone pond and odd-shaped stones, were located in the backyard of Nakseonjae. Since liberation, arbitrary relocation of garden ornaments has frequently occurred, and in the process, two odd-shaped stones, originally located on the first floor of the terraced flower bed, have been transferred to the backyard of Gyeonghungak(景薰閣). Second, unlike the late Joseon Dynasty when 「Donggwoldo(東闕圖)」 was produced, odd-shaped stones were arranged symmetrically in the backyard of Juhamnu in the early 1900s. It was a traditional style garden ornament with similar appearance, size, and design. However, all the odd-shaped stones in the backyard of Juhaumnu were relocated to other places in the 1970s and 1980s. One is located at the rear of Aeryeonjeong(愛蓮亭) through the entrance of Bingcheon(氷泉) and the vicinity of Geumcheongyo(錦川橋), and the other remains in front of the Yeongyeongdang Jangnakmun(演慶堂 長樂門). Third, among the garden ornaments located in the area of Jondeokjeong in the past, one odd-shaped stone is now relocated around the stone bridge near the pavilion and the Yeonghwadang(暎花堂) with its components separated. The bondstone near Yeonghwadang was relocated in 1990 for the purpose of installing an imitation of Angbuilgu(仰釜日晷). Another odd-shaped stone has been relocated to the front door of the Secret Garden(後苑), and now it is difficult to grasp the location. Fourth, the two bondstones remaining in the Daebodanji were actually building materials that were used as the foundation stone for the entrance pillars of the Yi Royal Office Building(李王職廳舍) during the Japanese colonial period. After liberation, the Yi Royal Office Building was reorganized into Imperial Estate Administration Office(皇室財産事務總局), and when the office building was burned down in 1960, the stone statues and foundation stones placed on the stylobate were relocated to the Daebodanji. The bondstone at Daebodanji is a representative example of construction materiasl being mistaken for gaeden ornaments.

• Journal of the Korean earth science society
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• v.43 no.1
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• pp.128-139
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• 2022

This study aimed to investigate the tectonic setting of the volcanic edifice at Mt. Baekdu by analyzing petrochemical characteristics of Holocene felsic volcanic rocks distributed in the Baekdusan stratovolcano edifice and summit of the Cheonji caldera rim, as well as Pleistocene mafic rocks of the Gaema lava plateau and Changbaishan shield volcano edifice. During the early eruption phases, mafic eruption materials, with composition ranging from alkali basalt to trachybasalt, or from subalkaline (tholeiitic) basalt to basaltic andesite formed the Gaema lava plateau and Changbaishan shield volcanic edifice, whereas the Baekdusan stratovolcano edifice and Holocene tephra deposits near the summit of the Cheonji caldera comprises trachytic and rhyolitic compositions. Analysis results revealed bimodal compositions with a lack of 54-62 SiO₂, between the felsic and mafic volcanic rocks. This suggested that magmatic processes occurred at the locations of extensional tectonic settings in the crust. Mafic volcanic rocks were plotted in the field of within-plate volcanic zones or between within-plate alkaline and tholeiite zones on the tectonic discrimination diagram, and it was in good agreement with the results of the TAS diagram. Felsic volcanic rocks were plotted in the field of within-plate granite tectonic settings on discrimination diagrams of granitic rocks. None of the results were plotted in the field of arc islands or continental margin arcs. The primitive mantle-normalized spider diagram did not show negative (-) anomalies of Nb and Ti, which are distinctive characteristics of subduction-related volcanic rocks, but exhibited similar patterns of ocean island basalt. Trace element compositions showed no evidence of, magmatic processes related to subduction zones, indicating that the magmatic processes forming the Baekdusan volcanic field occurred in an intraplate environment. The distribution of shallow earthquakes in this region supports the results. The volcanic rocks of the Baekdusan volcanic field are interpreted as the result of intraplate volcanism originating from the upwelling of mantle material during the Cenozoic era.

• Journal of the Korean Orthopaedic Association
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• v.56 no.2
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• pp.142-149
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• 2021

Purpose: This study examined the effectiveness of tranexamic acid in reducing postoperative blood loss in total knee arthroplasty by comparing the methods of administration between an intravenous group, topical group, and non-tranexamic acid group. Materials and Methods: This was a retrospective case series study of patients who underwent primary total knee arthroplasty from March 2017 to February 2019 performed by a single surgeon. The study population was divided into three groups according to the method of tranexamic acid administration (Group I: intravenous group, Group II: topical group, Group III: non-tranexamic acid group). To evaluate the effectiveness of tranexamic acids, the total amount of postoperative blood loss, postoperative hemoglobin loss, and volume of red blood cell transfusion in the three groups were compared. Results: The total amount of postoperative blood loss was lower in the tranexamic acid administered group than in the non-tranexamic acid group (1,366±866 ml). Among the administration methods, the intravenous group (987±449 ml) was significantly lower than the topical group (1,136±339 ml) (p=0.004). Postoperative hemoglobin loss was lower in the tranexamic acid group than the non-tranexamic acid group. Among the administration methods, the intravenous group was lower than the topical group. The transfusion rate was higher in the non-tranexamic acid group (5.7%) than the tranexamic administered group. The transfusion rate of the intravenous group was 1.4%, and no patient required a transfusion postoperatively in the topical group. The number of postoperative thromboembolic events, as a complication of tranexamic acid, was similar in the three groups. Conclusion: Tranexamic acid was effective in reducing postoperative blood loss after primary total knee arthroplasty compared to the non-tranexamic acid administered group. No significant difference in the complications induced by tranexamic acid was observed among the three groups.

• Journal of the Korea Organic Resources Recycling Association
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• v.31 no.1
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• pp.47-56
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• 2023

This study describes the successful synthesize strategy for the silica nanoparticles utilizing various water sources, including tap, industrial, and stream waters without using deionized water. Also, as-synthesized silica nanoparticles are employed as dispersive materials for the electro-responsive smart fluid application. Specifically, homogeneous silica nanoparticles with sizes of 500-700nm are successfully prepared in large scale at once (ca. 12.0 g) with the described experimental method and showing similar structural and chemical characteristics with silica nanoparticles synthesized using the deionized water. The size of silica nanoparticles are varied according to the ion conductivity differences of tap, industrial, stream water, and deionized water. The size of silica nanoparticles decresed with the increased ion conductivity, indicating the ion suppression of growth of silica nanoparticles. Moreover, as-synthesized silica nanoparticles from various water sources of electro-responsive characteristic are investigated by the smart fluid application. The smart fluids containing silica nanoparticles synthesized by tap, industrial, and stream water exhibited higher shear stress compared to the deionized water, owing to the more rigid fibril-like structures formed by the smaller silica nanoparticles. Conclusively, uniform silica nanoparticles from various water sources without any purification are able to successfully prepared without usage of deionized water and resulting silica nanoparticles manifested higher electro-responsive performance.

• Journal of the Korean Geotechnical Society
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• v.26 no.7
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• pp.117-133
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• 2010

A hybrid system of soil-nailing and compression anchor is proposed in this paper; the system is composed of an anchor bar (installed at the tip) with two PC strands and a steel bar. After drilling a hole, installing proposed hybrid systems, and filling the hole with grouting material, prestress is applied to the anchor bar to restrict the deformation at the head and/or to prevent shallow slope failures. However, since the elongation rate of PC strand is much larger than that of steel bar, yield at the steel bar will occur much earlier than at the PC strand. It means that the yield load of the hybrid system will be overestimated if we simply add yield loads of the two - anchor bar and PC strands. It might be needed to try to match the yielding time of the two materials by applying the prestress to the anchor bar. It means that the main purpose of applying prestress to the anchor bar should be two-fold: to restrict the deformation at the nail head; and more importantly, to maximize the design load of the hybrid system by utilizing load transfer mechanism that transfers the prestress applied at the tip to the head through anchor bar. In order to study the load transfer mechanism in a systematic way, in-situ pullout tests were performed with the following conditions: soil-nailing only; hybrid system with the variation of prestress stresses from 0 kN to 196 kN. It was found that the prestress applied to the anchor system will induce the compressive stress to the steel bar; it will result in decrease in the slope of load-displacement curve of the steel bar. Then, the elongation at which the steel bar will reach yield stress might become similar to that of PC strands. By taking advantage of prestress to match elongations at yield, the pullout design load of the hybrid system can be increased up to twice that of the soil-nailing system.

• The Journal of Korean Society for Radiation Therapy
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• v.34
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• pp.83-92
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• 2022

Purpose: To evaluate usefulness of Tomotherapy and Halcyon VMAT treatment in radiation therapy for bi-breast cancer Materials and Methods: For 10 patients with bi-breast cancer, volumetric modulated arc therapy(VMAT) treatment plan was established using helical Tomotherapy(Accuray. USA) with field width of 5.0-cm and pitch of 0.287, and Halcyon(Varian Medical System, Palo Alto, CA, Version 3.0 USA) of 6arc and 8arc. Prescribed dose was 42.4 Gy/16, and V _40.3Gy of Planning Target Volume(PTV) was 90%. The quality of plan was evaluated by comparing the dose to tumor and normal organs, and the efficiency was evaluated by comparing total MU and beam on time. Results: About three treatment plans(Tomotherapy, Halcyon 6Arc VMAT, Halcyon 8Arc VMAT) , the mean homogeneity index(H.I) of PTV were 1.07, 1.10, 1.11, and the mean conformity index(C.I) of PTV were 1.21, 1.16, 1.17, respectively. The average value of the dose assessment item for a normal organ is V _5Gy(%) of both lung was 36.3, 31.2, 29.7, and V _15Gy(%) were 18.6, 15.5, 14.6, respectively. The mean heart dose(Gy) were 4.17, 2.69, 2.51. Total MU were (7498.6, 2494.2, 2471.5), and beam on time(sec) were 462.5, 195.4, 198.0. Conclusion: Halcyon VMAT showed similar quality of treatment plan compared to helical Tomotherapy, while also protecting normal organs. In addition, the efficiency of radiotherapy increased due to a decrease in Beam On Time and MU.

• The Journal of Korean Society for Radiation Therapy
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• v.34
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• pp.7-12
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• 2022

Purpose: When it is difficult to secure the skin dose when treating Irregularly Shaped Skin Surface such as the nose where it is difficult to apply a bolus, increase the skin dose with a treatment plan that combines the IMRT (Intensity Modulated Radiation Therapy) delivery technique and FFF (Flattening Filter Free), It was tried to find out whether or not through the phantom experiment. Materials & Methods: Based on the 6MV-FF (Flattening Filter) and VMAT (Volumetric-Modulated Arc Therapy) treatment plans, which are the most commonly used treatment plans for head and neck cancer, A comparison group was created by combining VMAT and IMRT, FF and FFF, and the presence or absence of 5 mm bolus application. A virtual target was created on the Rando Phantom's nose, and a virtual bolus of 5 mm was applied assuming full contact on the Rando Phantom's nose. Five measurement points were determined based on the phantom's nose, and the absorbed dose was measured by irradiating each treatment plan 3 times per treatment plan according to the treatment technique and whether or not the bolus was applied. Result: The difference in skin dose in FF vs FFF increased in the case of FFF in VMAT bolus off, and there was no difference in case of IMRT bolus off. In VMAT bolus 5 mm and IMRT bolus 5 mm, it was confirmed that the skin dose was rather decreased in FFF. The difference in skin dose between VMAT and IMRT increased only in the case of FFF bolus off, and there was no statistical difference in the rest. For the difference in skin dose between bolus off vs bolus 5 mm, it was confirmed that the skin dose increased at bolus 5 mm, except for the case of using IMRT FFF. The treatment plan combining IMRT and FFF did not find any statistically significant difference as a result of analyzing the measured values of the treatment plan skin dose applied with a 5 mm bolus using the commonly used VMAT and FF. Therefore, it is thought that by using IMRT_FFF, it is possible to deliver a skin dose similar to that of applying a 5 mm bolus to VMAT_FF, which can be useful for patients who need a high skin dose but have difficulty applying a bolus. Conclusion: For patients who find it difficult to apply bolus, an increase in skin dose can be expected with a treatment plan that properly combines IMRT and FFF compared to VMAT and FF.

• The Journal of Korean Society for Radiation Therapy
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• v.34
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• pp.13-20
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• 2022

Purpose : IMRT using Tomotherapy during nasopharyngeal cancer radiation therapy irradiate an accurate dose to tumor tissues and is effective to reduce a dose rapidly in normal tissues. However, this has high MU and long Beam On Time. This study aims to analyze differences in tumors, normal tissues and low-dose distributions and the efficiency of Split VMAT after applying Helical IMRT (Tomotherapy), VMAT (Linac : 2Arc) and Split VMAT (Linac : 4Arc) plans. Materials and Methods : This study targeted ten nasopharyngeal cancer patients of this hospital and compared three treatment plans (Helical IMRT, VMAT, Split VMAT). For Helical IMRT planning, Precision^® (Version 1.1.1.1, Accuray, USA) was used, and for VMAT and Split VMAT planning, Pinnacle^3® (Version 9.10, Philips, USA) was used. The total dose applied was 38.4 Gy / 32 Gy (Daily Dose 2.4 Gy (GTV + 0.3 cm) / 2 Gy (CTV + 0.3 cm) 16Fx), and for GTV + 0.3 cm (P_GTV), 95% of V_38.4Gy was prescribed. VMAT with an angle of 360° 2Arc was applied, and for Split VMAT, the field was divided into the right, the left, the top and the bottom and an angle of 360° 4Arc, 6MV was set. For evaluating the quality of the treatment plans, differences in tumors, normal tissues and low-dose area were compared, and Beam On Time was measured to analyze the efficiency. Results : When calculating the mean values of evaluation items of the three treatment plans (Helical IMRT, VMAT, Split VMAT) for the patients, the H.I (Homogeneity Index) of P_GTV was 1.04, 1.11 and 1.1 respectively, and the C.I (Confomity Index) of P_CTV was 1.03, 0.99 and 1.00 respectively. The mean dose of RT Parotid Gland (Gy) was 14.54, 17.06 and 14.76 respectively, the mean dose of LT Parotid Gland (Gy) was 14.32, 17.32 and 15.09 respectively, the maximum dose of P_Cord (Spinal Cord + 0.3 cm) (Gy) was 20.57, 22.59 and 21.06 respectively, and the maximum dose of Brain Stem (Gy) was 22.35, 23.99 and 21.68 respectively. The 50% isodose curve (cc) was 1332, 1132.5 and 1065.2 respectively. Beam On Time (sec) was 373.7, 130.7 and 254.4 respectively. Conclusion : Displaying a similar treatment plan quality to Helical IMRT, which is used a lot for head and neck treatment, Split VMAT reduced the low-dose area and Beam On Time and produced a better result than VMAT. Therefore, it is considered that Split VMAT is effective not only for nasopharyngeal cancer but also for other head and neck cancers.