• 한국엔터테인먼트산업학회논문지
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• 제13권5호
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• pp.239-246
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• 2019

본 연구는 여대생의 라이프 케어 증진을 위한 둥근 어깨 자세의 작은가슴근, 어깨 가동성, 목 관절 가동 범위 의 상관관계를 알아보았다. 둥근 어깨 자세를 가진 성인 여성 80명을 대상자로 선정하였다. 대상자가 누운 자세에서 어깨의 높이를 측정하여 둥근 어깨 자세를 측정하였고, 작은가슴근의 길이, 어깨 가동성, 목 관절가동범위를 측정하여 상관분석을 한 결과는 다음과 같다. 오른쪽 둥근 어깨와 목 폄의 상관계수는 -.23(p<0.05)이었다. 오른쪽 작은가슴근 지수와 목 왼쪽 가쪽 굽힘의 상관계수는 -.25(p<0.05)이었고, 오른쪽 작은가슴근 지수와 목 굽힘 상관계수는 -.25(p<0.5)이었다. 왼쪽 어깨 가동성과 목 왼쪽 가쪽 굽힘의 상관계수는 -.23(p<0.05)이었고, 왼쪽 어깨 가동성과 목 오른쪽 돌림의 상관계수는 -.23(p<0.5)이었으며, 왼쪽 어깨 가동성과 목 왼쪽 돌림의 상관계수는 -.25(p<0.05)로 통계학적으로 유의한 음의 상관관계가 있었다(p<0.05). 이상의 결과로 오른쪽의 둥근 어깨가 심할수록 목폄이 감소하였고, 오른쪽 작은가슴근이 단축될수록 목 왼쪽 가쪽 굽힘과 목 굽힘이 감소하였으며, 왼쪽 어깨 가동성이 증가할수록 목 왼쪽 가쪽 굽힘은 감소하였고, 오른쪽 돌림과 왼쪽 돌림이 감소하였음을 알 수 있었다.

• 한국노년학
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• 제29권3호
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• pp.987-1000
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• 2009

시설입소 인지기능저하 노인은 전반적으로 활동이 부족하며 노화로 인해 근력, 유연성, 평형성 및 협응력 등이 약화되어 일상생활의 불편감 뿐 아니라 사고의 가능성이 증가되어 체계적인 활동 프로그램의 필요성이 절실하다. 본 연구는 탄력밴드를 이용한 탄력저항성운동 프로그램을 시행하여 유연성과 근력에 미치는 효과를 검증하고자 시행되었다. 본 연구는 대조군 전후 실험설계로 연구 대상자는 J시 소재의 노인시설에 거주하는 65세 이상 인지기능저하 노인 34명을 대상으로 하였다. 탄력저항성운동 프로그램 기간은 4주간으로 첫 주 3일간은 사전 조사를 수행하였으며 이후 3주간 오전에 1시간씩 일주일에 5일, 총 15일간 진행하였다. 사후 측정은 운동 프로그램이 종료 후 2일간 이루어졌다. 프로그램 시작 전·후 대상자의 일반적 특성, 일상생활동작, 인지기능, 유연성(견관절 운동범위, 상지관절 주변조직의 신장능력), 근력(악력, 어깨근력)을 측정하였다. 탄력저항성운동 프로그램 시행 후 견관절 운동범위 중 우측 굴곡, 우측 신전, 우측 외회전 범위가 실험군에서 유의하게 증가하였으며 어깨근력의 경우 좌측 굴곡 근력, 좌측 신전 근력, 좌·우측 외전 근력이 대조군에 비해 통계적으로 유의하게 증가한 것으로 나타났다. 반면에 악력과 상지관절 주변조직의 신장능력은 실험군과 대조군에서 유의한 차이가 없었다. 이상의 결과로 탄력저항성운동 프로그램은 시설 입소 노인의 유연성과 근력에 비교적 효과적인 것으로 나타났으나 프로그램의 일반화를 위해 대상자의 신체능력에 맞는 강도와 기간에 변화를 주는 연구와 효과시기, 효과의 소멸시기 등에 관한 연구가 지속되어야 하며 보다 더 정련된 프로토콜을 만들어야 함을 제언하는 바이다.

• Asia Marketing Journal
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• 제11권1호
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• pp.39-72
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• 2009

최근 들어 마케팅지출의 수익책임성이 쟁점으로 떠오르고 있다. 재무제표에서 마케팅비가 차지하는 비중이 높아지고 있기 때문일 것이다. 본 연구는 이러한 쟁점을 연구하는 기초 작업으로서 마케팅지출과 마케팅성과를 분류하는 체계를 마련하는데 목적이 있다. 이를 위해 마케팅지출과 마케팅성과의 관계를 다섯 가지 가설로 검증하였으며 검증결과에 근거하여 다음과 같은 분류체계를 제안한다. 첫째는 투자성업무비가 마케팅성과에 미치는 영향이 비교적 많이 검증되었다. 따라서 마케팅지출을 투자성업무비로 정의하는 것이 타당함을 제안한다. 재무제표상의 계정과목으로 시장조사비, 경상개발비, 광고선전비, 판촉비, 해외시장개척비 등이 여기에 속한다. 둘째는 마케팅지출은 여러 시기에 걸쳐서 마케팅성과에 영향을 미치는 것을 확인할 수 있었다. 따라서 마케팅지출은 투자라고 할 수 있다. 장기간에 걸쳐서 효과가 나타나는 것을 일반적으로 투자라고 하기 때문이다. 셋째는 마케팅지출은 매출액에서 차지하는 비율도 중요하지만 업계의 비율과 비교한 초과개념이 중요하다. 끝으로 마케팅성과는 과정모델보다는 균형모델로 분류하는 것이 타당하다. 그 이유는 마케팅성과인 고객성과, 시장성과, 재무성과 간의 영향을 확인하기 어렵기 때문이다. 향후 연구에서는 연구의 목적에 맞추어 과정모델과 균형모델을 선택할 것을 제안한다.

• Korean Journal of Radiology
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• 제21권10호
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• pp.1187-1195
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• 2020

Objective: This study aimed to determine the sonographic features suggestive of extrathyroidal extension (ETE) of thyroid cancers. Materials and Methods: We retrospectively reviewed the sonographic images of 1656 consecutive patients who had undergone thyroidectomy in 2017. The diagnostic performance of sonographic features suggestive of ETE was evaluated using operation and histopathologic reports. Sonographic features for gross ETE to the strap muscle and minor ETE were assessed for thyroid cancer abutting the anterolateral thyroid capsule. Sonographic features for tracheal invasion were assessed according to whether the angle between the tumor and the trachea was an acute, right, or obtuse angle. Sonographic features for recurrent laryngeal nerve (RLN) invasion were assessed based on the association between the tumor and tracheoesophageal groove (TEG) as preserved normal tissue, abutting or protruding into the TEG. Results: ETE was observed in 783 patients (47.3%), including 123 patients with gross ETE (7.4% [strap muscle, n = 97; RLN, n = 24; and trachea, n = 14]) and 660 patients with minor ETE (39.9%). Regarding the diagnosis of gross and minor ETE to the strap muscle, sonographic features of replacement of the strap muscle and capsular disruption showed the highest positive predictive value (75.9% and 58.5%, respectively). Thyroid cancer forming an obtuse angle with the trachea had the highest sensitivity for the diagnosis of tracheal invasion (85.7%), and thyroid cancer protrusion into the TEG showed the highest sensitivity for the diagnosis of RLN (83.3%). Conclusion: Sonography is considered beneficial in the diagnosis of ETE to the strap muscle, trachea, and RLN. Assessment of ETE is important for the accurate staging of thyroid cancer, which in turn determines the extent of surgery or whether active surveillance is appropriate or not.

• Korean Journal of Radiology
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• 제23권10호
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• pp.976-985
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• 2022

Objective: To compare the clinical and radiological features of various etiologies of chronic diffuse lacrimal gland enlargement. Materials and Methods: We retrospectively reviewed 91 consecutive patients who underwent surgical biopsy for chronic diffuse lacrimal gland enlargement and were diagnosed with non-specific dacryoadenitis (DA) (n = 42), immunoglobulin G4-related dacryoadenitis (IgG4-RD) (n = 33), and lymphoma (n = 16). Data on patient demographics, clinical presentation, and CT imaging findings (n = 73) and MRI (n = 43) were collected. The following radiologic features of lacrimal gland enlargement were evaluated: size, unilaterality, wedge sign, angle with the orbital wall, heterogeneity, signal intensity, degree of enhancement, patterns of dynamic contrast-enhanced, and apparent diffusion coefficient value. Radiological features outside the lacrimal glands, such as extra-lacrimal orbital involvement and extra-orbital head and neck involvement, were also evaluated. The clinical and radiological findings were compared among the three diseases. Results: Compared to the DA and IgG4-RD groups, the lymphoma group was significantly older (mean 59.9 vs. 46.0 and 49.4 years, respectively; p = 0.001) and had a higher frequency of unilateral involvement (62.5% vs. 31.0% and 15.2%, respectively; p = 0.004). Compared to the IgG4-RD and lymphoma groups, the DA group had significantly smaller lacrimal glands (2.3 vs. 2.8 and 3.3 cm, respectively; p < 0.001) and a lower proportion of cases with a wedge sign (54.8% vs. 84.8% and 87.5%, respectively; p = 0.005). The IgG4-RD group showed more frequent involvement of the extra-orbital head and neck structures, including the infraorbital nerve (36.4%), paranasal sinus (72.7%), and salivary gland (58.6%) compared to the DA and lymphoma groups (4.8%-28.6%) (all p < 0.005). Conclusion: Patient age, unilaterality, lacrimal gland size, wedge sign, and extra-orbital head and neck involvement differed significantly different between lymphoma, DA, and IgG4-RD. Our results will be useful for the differential diagnosis and proper management of chronic lacrimal gland enlargement.

• Korean Journal of Radiology
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• 제23권10호
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• pp.1019-1027
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• 2022

Objective: Thyroidectomy bed lesions frequently show suspicious ultrasound (US) features after thyroid surgery. Fine-needle aspiration (FNA) may not provide definitive pathological information about the lesions. Although core-needle biopsy (CNB) has excellent diagnostic performance in characterizing suspicious thyroid nodules, no published studies have evaluated the performance of CNB specifically for thyroidectomy bed lesions. Therefore, we aimed to evaluate the diagnostic performance and safety of CNB for characterizing thyroidectomy bed lesions. Materials and Methods: A total of 124 thyroidectomy bed lesions in 113 patients (79 female and 34 male; age, 23-85 years) who underwent US-guided CNB between December 2008 and December 2020 were included. We reviewed the US imaging features of the target lesions and the histories of previous biopsies. The pathologic results, diagnostic performance for malignancy, and complications of CNB were analyzed. Results: All samples (100%) obtained by CNB were adequate for pathological analysis. Pathological analysis revealed inconclusive results in two lesions (1.6%). According to the reference standard, 50 lesions were ultimately malignant (40.3%), and 72 were benign (58.1%), excluding the two inconclusive lesions. The performance of CNB for diagnosing malignant thyroidectomy bed lesions in the 122 lesions had a sensitivity of 98.0% (49/50), a specificity of 100% (72/72), positive predictive value of 100% (49/49), and negative predictive value of 98.6% (72/73). Eleven lesions were referred for CNB after prior inconclusive FNA results in thyroidectomy bed lesions, for all of which CNB yielded correct conclusive pathologic diagnoses. According to the pathological analysis of CNB, there were various benign lesions (58.9%, 73/124) besides recurrence, including benign postoperative lesions other than suture granuloma (32.3%, 40/124), suture granuloma (15.3%, 19/124), remnant thyroid tissue (5.6%, 7/124), parathyroid lesions (4%, 5/124), and abscesses (1.6%, 2/124). No major or minor complications were associated with the CNB procedure. Conclusion: US-guided CNB is accurate and safe for characterizing thyroidectomy bed lesions.

• Korean Journal of Radiology
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• 제24권10호
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• pp.1028-1037
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• 2023

Objective: To evaluate the computed tomography (CT) features for diagnosing metastatic cervical lymph nodes (LNs) in patients with differentiated thyroid cancer (DTC) and validate the CT-based risk stratification system suggested by the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) guidelines. Materials and Methods: A total of 463 LNs from 399 patients with DTC who underwent preoperative CT staging and ultrasound-guided fine-needle aspiration were included. The following CT features for each LN were evaluated: absence of hilum, cystic changes, calcification, strong enhancement, and heterogeneous enhancement. Multivariable logistic regression analysis was performed to identify independent CT features associated with metastatic LNs, and their diagnostic performances were evaluated. LNs were classified into probably benign, indeterminate, and suspicious categories according to the K-TIRADS and the modified LN classification proposed in our study. The diagnostic performance of both classification systems was compared using the exact McNemar and Kosinski tests. Results: The absence of hilum (odds ratio [OR], 4.859; 95% confidence interval [CI], 1.593-14.823; P = 0.005), strong enhancement (OR, 28.755; 95% CI, 12.719-65.007; P < 0.001), and cystic changes (OR, 46.157; 95% CI, 5.07-420.234; P = 0.001) were independently associated with metastatic LNs. All LNs showing calcification were diagnosed as metastases. Heterogeneous enhancement did not show a significant independent association with metastatic LNs. Strong enhancement, calcification, and cystic changes showed moderate to high specificity (70.1%-100%) and positive predictive value (PPV) (91.8%-100%). The absence of the hilum showed high sensitivity (97.8%) but low specificity (34.0%). The modified LN classification, which excluded heterogeneous enhancement from the K-TIRADS, demonstrated higher specificity (70.1% vs. 62.9%, P = 0.016) and PPV (92.5% vs. 90.9%, P = 0.011) than the K-TIRADS. Conclusion: Excluding heterogeneous enhancement as a suspicious feature resulted in a higher specificity and PPV for diagnosing metastatic LNs than the K-TIRADS. Our research results may provide a basis for revising the LN classification in future guidelines.

• Korean Journal of Radiology
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• 제24권12호
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• pp.1284-1292
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• 2023

Objective: We investigated the impacts of computed tomography (CT) added to ultrasound (US) for preoperative evaluation of patients with papillary thyroid carcinoma (PTC) on staging, surgical extent, and postsurgical survival. Materials and Methods: Consecutive patients who underwent surgery for PTC between January 2015 and December 2015 were retrospectively identified. Of them, 584 had undergone preoperative additional thyroid CT imaging (CT + US group), and 859 had not (US group). Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to adjust for 14 variables and balance the two groups. Changes in nodal staging and surgical extent caused by CT were recorded. The recurrence-free survival and distant metastasis-free survival after surgery were compared between the two groups. Results: In the CT + US group, discordant nodal staging results between CT and US were observed in 94 of 584 patients (16.1%). Of them, CT accurately diagnosed nodal staging in 54 patients (57.4%), while the US provided incorrect nodal staging. Ten patients (1.7%) had a change in the extent of surgery based on CT findings. Postsurgical recurrence developed in 3.6% (31 of 859) of the CT + US group and 2.9% (17 of 584) of the US group during the median follow-up of 59 months. After adjustment using IPTW (580 vs. 861 patients), the CT + US group showed significantly higher recurrence-free survival rates than the US group (hazard ratio [HR], 0.52 [95% confidence interval {CI}, 0.29-0.96]; P = 0.037). PSM analysis (535 patients in each group) showed similar HR without statistical significance (HR, 0.60 [95% CI, 0.31-1.17]; P = 0.134). For distant metastasis-free survival, HRs after IPTW and PSM were 0.75 (95% CI, 0.17-3.36; P = 0.71) and 0.87 (95% CI, 0.20-3.80; P = 0.851), respectively. Conclusion: The addition of CT imaging for preoperative evaluation changed nodal staging and surgical extent and might improve recurrence-free survival in patients with PTC.

• Korean Journal of Radiology
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• 제23권11호
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• pp.1078-1088
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• 2022

Objective: To develop and validate a model using radiomics features from apparent diffusion coefficient (ADC) map to diagnose local tumor recurrence in head and neck squamous cell carcinoma (HNSCC). Materials and Methods: This retrospective study included 285 patients (mean age ± standard deviation, 62 ± 12 years; 220 male, 77.2%), including 215 for training (n = 161) and internal validation (n = 54) and 70 others for external validation, with newly developed contrast-enhancing lesions at the primary cancer site on the surveillance MRI following definitive treatment of HNSCC between January 2014 and October 2019. Of the 215 and 70 patients, 127 and 34, respectively, had local tumor recurrence. Radiomics models using radiomics scores were created separately for T2-weighted imaging (T2WI), contrast-enhanced T1-weighted imaging (CE-T1WI), and ADC maps using non-zero coefficients from the least absolute shrinkage and selection operator in the training set. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of each radiomics score and known clinical parameter (age, sex, and clinical stage) in the internal and external validation sets. Results: Five radiomics features from T2WI, six from CE-T1WI, and nine from ADC maps were selected and used to develop the respective radiomics models. The area under ROC curve (AUROC) of ADC radiomics score was 0.76 (95% confidence interval [CI], 0.62-0.89) and 0.77 (95% CI, 0.65-0.88) in the internal and external validation sets, respectively. These were significantly higher than the AUROC values of T2WI (0.53 [95% CI, 0.40-0.67], p = 0.006), CE-T1WI (0.53 [95% CI, 0.40-0.67], p = 0.012), and clinical parameters (0.53 [95% CI, 0.39-0.67], p = 0.021) in the external validation set. Conclusion: The radiomics model using ADC maps exhibited higher diagnostic performance than those of the radiomics models using T2WI or CE-T1WI and clinical parameters in the diagnosis of local tumor recurrence in HNSCC following definitive treatment.

• Korean Journal of Radiology
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• 제23권11호
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• pp.1102-1111
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• 2022

Objective: To evaluate the ultrasonography (US) features for diagnosing metastasis in cervical lymph nodes (LNs) in patients with thyroid cancer and compare the US classification of risk of LN metastasis between European and Korean guidelines. Materials and Methods: From January 2014 to December 2018, US-guided fine-needle aspiration was performed on 836 LNs from 714 patients for the preoperative nodal staging of thyroid cancer. The US features of LNs were retrospectively reviewed for the following features: size, presence of hilum, margin, orientation, cystic change, punctate echogenic foci (PEF), large echogenic foci, eccentric cortical thickening, abnormal vascularity, and cortical hyperechogenicity. A multiple logistic regression analysis was performed to identify the independent US features for the diagnosis of metastatic LNs. The diagnostic performance of independent US features was subsequently evaluated. LNs were categorized according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and European Thyroid Association (ETA) guidelines, and the correlation between the two sets of classifications was assessed. Results: Absence of the hilum, presence of cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity were independent US features of metastatic LNs. Cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity showed high specificity (86.8%-99.6%). The absence of the hilum had the highest sensitivity yet low specificity (66.4%). When LNs were classified according to the ETA guidelines and K-TIRADS, they yielded similar categorizations of malignancy risks and were strongly correlated (Spearman coefficient, 0.9766 [95% confidence interval, 0.973-0.979]). According to the ETA guidelines, 9.8% (82/836) of LNs were classified as "not specified." Conclusion: Absence of hilum, cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity were independent US features suggestive of metastatic LNs in thyroid cancer. Both K-TIRADS and the ETA guidelines provided similar risk stratification for metastatic LNs with a high correlation; however, the ETA guidelines failed to classify 9.8% of LNs into a specific risk stratum. These results may provide a basis for revising LN classification in future guidelines.