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Tranexamic Acid Reduces Postoperative Blood Loss in Reverse Total Shoulder Arthroplasty (역행성 견관절 전치환술에서 트라넥삼산의 출혈 및 수혈 감소 효과)

  • Park, Kee Young;Kim, In Bo;Kim, Eun Yeol;Lee, Kwang Suk
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.5
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    • pp.391-397
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    • 2021
  • Purpose: Tranexamic acid (TXA) can reduce perioperative blood loss and the frequency of blood transfusions in lower extremity surgery. On the other hand, the effects of TXA on reverse total shoulder arthroplasty (rTSA) remain undetermined. This study evaluated the efficacy of TXA on perioperative blood loss, transfusion requirements, and the change in the hemotologic index. Materials and Methods: This study evaluated patients who underwent rTSA from September 2009 to July 2020. The patients were classified into two groups. The TXA group were administered TXA intravenously and topical TXA during surgery. The non-TXA group was not administered TXA. The quantity of hemovac drainage, which represented the postoperative blood loss, transfusion requirements, and postoperative change in hemoglobin and hematocrit level, were recorded. Results: The TXA and non-TXA groups consisted of 93 and 84 patients, respectively. The preoperative demographics showed no significant differences in age (72.0±7.0 vs. 71.5±5.8, p=0.656), sex (male:female, 28:65 vs. 23:61, p=0.689) and the prevalence of hypertension and diabetes (hypertension:diabetes:both, 36:3:13 vs. 32:3:8, p=0.806) between the two groups. There were significant differences in the requirements of transfusion (0 vs. 9, p=0.001), hemovac drainage at the 1st (98.8±61.2 ml vs. 162.7±98.8 ml, p<0.001), the 2nd postoperative day (73.8±48.4 ml vs. 91.5±54.5 ml, p=0.024), hemoglobin level at the 1st (11.7±1.2 g/dl vs. 11.2±1.4 g/dl, p=0.048), 3rd (10.9±1.2 g/dl vs. 10.2±1.2 g/dl, p<0.001), and 6th (11.2±1.3 g/dl vs. 10.7±1.3 g/dl, p=0.020) postoperative day, and the hematocrit level at the 1st (35.0%±3.6% vs. 32.5%±3.8%, p=0.001), 3rd (32.3%±5.0% vs. 29.8%±3.6%, p<0.001), and 6th (33.5%±3.8% vs. 31.5%±3.7%, p<0.001) postoperative day between the two groups. Conclusion: Intravenous and topical intra-articular TXA can reduce the transfusion requirement and blood loss in rTSA.

Dual Plate Fixation for Periprosthetic Femur Fracture after Total Knee Arthroplasty (슬관절 전치환술 후 발생한 대퇴골 삽입물 주위 골절의 이중 금속판 고정술)

  • Kim, Dong Hwi;Cha, Dong Hyuk;Ko, Kang Yeol
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.1
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    • pp.26-33
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    • 2021
  • Purpose: This study evaluated the results of dual plate fixation for periprosthetic femur fracture after total knee arthroplasty (TKA). Materials and Methods: From October 2007 to February 2013, 23 cases of periprosthetic femur fracture after TKA were treated at the author's hospital. There were 13 cases of fixation using a medial and lateral dual plate when the stability of the fracture site could not be achieved by one side fixation with a follow-up of more than one year. The cases included no loosening of the femoral component in fractures that were categorized as Lewis-Rorabeck classification II and supracondylar comminuted fractures and elongation of the fracture line to the lateral epicondyle of the femur or stem in the medullary canal. The mean age was 72 years (65-82 years), and 11 cases were female. Three cases had a stem due to revision. The mean bone marrow density was -3.2 (-1.7 to -4.4), and the mean period from primary TKA to periprosthetic fractures was 28 months (1-108 months). The mean follow-up period was 23 months (12-65 months). The medial fracture site was first exposed via the subvastus approach. Second, the supplementary plate was fixed on the lateral side of the fracture using a minimally invasive plate osteosynthesis technique. The average union time, complications, and Hospital for Special Surgery Knee Score (HSS) at the last follow-up were evaluated. Results: The mean union time was 17.4 weeks (7-40 weeks). Two cases showed delayed bone union and nonunion occurred in one case, in whom bone union was achieved three months later after re-fixation using a dual plate with an autogenous bone graft. The mean varusvalgus angulation was 1.67 degrees (-1.2-4.9 degrees), and the mean anterior-posterior angulation was 2.86 degrees (0-4.9 degrees) at the last follow-up. The mean knee range of motion was 90 degrees, and the HSS score was 85 points (70-95 points) at the last follow-up. Conclusion: Dual plate fixation for periprosthetic femur fractures that had not achieved stability by one side plate fixation after TKA showed a good clinical result that allowed early rehabilitation.

Review of the Reasons in Cases Requiring Varus/Valgus Constrained Prosthesis in Primary Total Knee Arthroplasty (일차 슬관절 전치환술 시내·외반 구속형 치환물이 필요했던 사례들의 원인 분석)

  • Kong, Dong Yi;Park, Sang Hoon;Choi, Choong Hyeok
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.3
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    • pp.253-260
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    • 2021
  • Purpose: The least constrained prosthesis is generally recommended in primary total knee arthroplasty (TKA). Nevertheless, a varus/valgus constrained (VVC) prosthesis should be implanted when a semi-constrained prosthesis is not good for adequate stability, especially in the coronal plane. In domestic situations, however, the VVC prosthesis could not always be prepared for every primary TKA case. Therefore, it is sometimes impractical to use a VVC prosthesis for unsual unstable situations. This study provides information for preparing VVC prostheses in the preoperative planning of primary TKA through an analysis of primary VVC TKA cases. Materials and Methods: This study reviewed 1,797 primary TKAs, performed between May 2003 and February 2016. The reasons for requiring VVC prosthesis and the preoperative conditions in 29 TKAs that underwent primary TKA with a VVC prosthesis were analyzed retrospectively. Results: In primary TKA, 29 cases (1.6%) in 27 patients (6 male and 21 female) used VVC prosthesis. Two patients underwent a VVC prosthesis on both knees. The mean age of the patients was 63.4 years old (34-79 years). The mean flexion contracture was 16.2° (-20°-90°), and the mean angle of great flexion was 111.7° (35°-145°). The situations requiring a VVC prosthesis were severe valgus deformity in 10 knees, knee stiffness requiring extensive soft tissue release in 10 knees, previously injured collateral ligaments in five knees, and distal femoral bone defect due to avascular necrosis in four knees. The mean tibiofemoral angle was 25.7° (21°-43°) in 10 cases with a valgus deformity. The mean flexion contracture was 37.5° (20°-90°), and the mean range of motion was 48.5° (10°-70°) in 10 cases with knee stiffness. Conclusion: The preparation of VVC prosthesis is recommended, even for primary TKA in cases of severe valgus deformity (tibiofemoral angle>20°), stiff knee (the range of motion: less than 70° with more than 20° flexion contracture), and the cases with a previous collateral ligament injury. This information will help in the preparation of adequate TKA prostheses for unusual unstable situations.

Correlation of the Deformation of the Kyphotic Angle with the Fat Infiltration Rate of Multifidus and Erector Spinae in Patients with Acute Osteoporotic Fractures of the Lumbar Spine (급성 골다공증성 요추 골절 환자에서 척추 기립근 및 다열근의 지방침투율과 후만각 변형의 연관 관계)

  • Jun, Deuk Soo;Baik, Jong-Min;Baek, Seung Hyun
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.3
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    • pp.208-214
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    • 2021
  • Purpose: Verifying a reliable predictor of the progression of vertebral deformity in patients with acute osteoporotic fractures of the lumbar spine may be useful. A qualitative analysis of the muscle near the spine was performed using magnetic resonance imaging (MRI), and its correlation with a spinal deformity was determined under the hypothesis that the causes of the kyphotic deformity are associated with muscle reduction in the multifidus and erector spinae. Materials and Methods: The study was performed in a retrospective manner using the electronic medical records of patients who presented to the author's institution between January 2007 and March 2018, and were diagnosed with an acute lumbar fracture. The fat infiltration rates of the multifidus and erector spinae were measured using MRI taken at the time of injury, and the mean value was defined as the total fat infiltration rate (TFI). Based on lateral radiographs of the lumbar spine at the one-year follow-up, the loss of height of the vertebral body, the kyphotic angle and the wedge angle were measured. The statistical significance was confirmed by calculating the Pearson correlation coefficient. Results: One hundred twenty-nine patients, of which 30 were male and 99 were female, were examined. The mean age was 71.28 years. The mean T-score was -3.53±0.79 g/cm2, and the mean fat infiltration was 15.20%±11.99%. TFI was positively correlated with age (R=0.373, p<0.001), compression rate (R=0.369, p<0.001), and Cobb's angle (R=0.386, p<0.001) after a one year follow-up, but negatively correlated with the BMD score (R=-0.252, p=0.004). As the fracture progressed to the lower lumbar level, the compression rate (R=-0191, p=0.030) and wedge angle (R=-0.428, p<0.001) at the time of injury tended to decrease. Conclusion: In patients with osteoporotic vertebral fractures, the fat infiltration rate may be an important predictor of conservative treatment. The prognosis of patients with a high-fat infiltration rate should be explained during patient education, and the patients must be monitored closely through short-term outpatient follow-up.

Ventilation at Supra-Optimal Temperature Leading High Relative Humidity Controls Powdery Mildew, Silverleaf Whitefly, Mite and Inhibits the Flowering of Korean Melon in a Greenhouse Cultivation (참외 시설 재배 시 고온에서의 환기 처리에 의한 상대습도 상승과 흰가루병, 담배가루이, 응애 방제 및 개화 억제)

  • Seo, Tae Cheol;Kim, Jin Hyun;Kim, Seung Yu;Cho, Myeong Whan;Choi, Man Kwon;Ryu, Hee Ryong;Shin, Hyun Ho;Lee, Choung Keun
    • Journal of Bio-Environment Control
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    • v.31 no.1
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    • pp.43-51
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    • 2022
  • This study was conducted to investigate the effect of ventilation at high temperature on the control of powdery mildew, silverleaf whitefly two-spotted spider mite occurred at Korean melon cultivation greenhouse, and on leaf rolling and flowering of the plant in summer season. 'Alchanggul' grafted onto 'Hidden Power' rootstock was planted on soil bed with the distance of 40 cm. Three ventilation temperatures of 45℃, 40℃, and 35℃ as set points were compared. Ventilation treatment was done by control of side window operation from 18th June to 13th July when silverleaf whitefly, mite, and powdery mildew were occurred in all greenhouses. The temperature inside greenhouse was increased up to the set temperature point on sunny days and maintained for about 9 hours with high relative humidity at 45℃ condition. The differences of day maximum air temperature and day minimum RH were the highest at 45℃ treatment. After 11 days of treatments, the damage by powdery mildew and two-spotted spider mite was almost recovered at 45℃ treatment but not at 40 and 35℃. The population of silverleaf whitefly and two-spotted spider mite were significantly decreased at 45℃ treatment at 14 days after treatment, while powdery mildew symptom was not significantly decreased. Leaf rolling was observed at high temperature but not severe at 45℃ treatment. After 26 days of treatments, female flowers did not bloom at all at 45℃ treatment, and the number of male flowers was 1.2 among 15 nodes of newly grown shoots. As the result, it indicates that ventilation at the high temperature of 45℃ for about 2 to 3 weeks can be an applicable method to control above mentioned pests and disease, and to recover the vegetative growth of Korean melon by reducing flowering of the plant.

Acoustic characteristics of speech-language pathologists related to their subjective vocal fatigue (언어재활사의 주관적 음성피로도와 관련된 음향적 특성)

  • Jeon, Hyewon;Kim, Jiyoun;Seong, Cheoljae
    • Phonetics and Speech Sciences
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    • v.14 no.3
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    • pp.87-101
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    • 2022
  • In addition to administering a questionnaire (J-survey), which questions individuals on subjective vocal fatigue, voice samples were collected before and after speech-language pathology sessions from 50 female speech-language pathologists in their 20s and 30s in the Daejeon and Chungnam areas. We identified significant differences in Korean Vocal Fatigue Index scores between the fatigue and non-fatigue groups, with the most prominent differences in sections one and two. Regarding acoustic phonetic characteristics, both groups showed a pattern in which low-frequency band energy was relatively low, and high-frequency band energy was increased after the treatment sessions. This trend was well reflected in the low-to-high ratio of vowels, slope LTAS, energy in the third formant, and energy in the 4,000-8,000 Hz range. A difference between the groups was observed only in the vowel energy of the low-frequency band (0-4,000 Hz) before treatment, with the non-fatigue group having a higher value than the fatigue group. This characteristic could be interpreted as a result of voice abuse and higher muscle tonus caused by long-term voice work. The perturbation parameter and shimmer local was lowered in the non-fatigue group after treatment, and the noise-to-harmonics ratio (NHR) was lowered in both groups following treatment. The decrease in NHR and the fall of shimmer local could be attributed to vocal cord hypertension, but it could be concluded that the effective voice use of speech-language pathologists also contributed to this effect, especially in the non-fatigue group. In the case of the non-fatigue group, the rhamonics-to-noise ratio increased significantly after treatment, indicating that the harmonic structure was more stable after treatment.

Distribution Status of Invasive Alien Species (Procambarus clarkii (Girard, 1852)) Using Biomonitoring with Environmental DNA in South Korea (생물모니터링 및 환경유전자(eDNA)를 이용한 침입외래종 미국가재(Procambarus clarkii)의 한국분포 현황)

  • Jung, Sang Woo;Lee, Jae-Ha;Kawai, Tadashi;Kim, Phil-Jae;Kim, SuHwan
    • Korean Journal of Environment and Ecology
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    • v.36 no.4
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    • pp.368-380
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    • 2022
  • Biomonitoring of an invasive alien crayfish species, Procambarus clarkii (Girard, 1852), was performed from February to October 2021, along with environmental DNA analysis, at five locations including Wanju-gun, Hampyeong-gun, Naju-si, Gurye-gun, and Cheongju-si. For the investigation, an umbrella-shaped trap for adults and a hand net for young crayfish were used, and 8 to 10L of freshwater was collected for eDNA analysis. The current status and past distributional records of crayfish in Korea were analyzed along with benthic macroinvertebrates at each survey site. As a result of the investigation, a total of 122 individuals were identified, and Hampyeong-gun recorded the largest number of populations with 59 individuals (48.36%) and the highest environmental DNA (eDNA). The frequency of appearance of P. clarkii was highest in May. The ratio of females to males was 21:5, and the body size was 72.2±21.1mm for female, 80.5±15.6mm for male, and 25.3±9.8mm for young crayfish. P. clarkii introduced into Korea is mainly spreading in the southwest region and it has not been observed in Seoul where there had been a record of appearance in the past. No external symbiosis (Branchiobdellida) of P. clarkii has been identified, and P. clarkii that has appeared in Korea was presumed to be imported from Japan. There are more than eight kinds of exotic crayfish distributed in Korea, and among them, the marbled crayfish (P. virginalis) was identified as a harmful species to the ecosystem of Korea by the Ministry of Environment in 2021. The identified species of benthic macroinvertebrates inhabiting the survey area where P. clarkii has appeared were 69 belonging to 39 families, 15 orders, five classes, and three phyla. Among them, Odonata were the most abundant (16 spp.; 24.62%), followed by Coleoptera (11 spp.; 16.92%) and Hemiptera (11 spp.; 16.92%). In the survey area, one Korean endemic species (Rhoenanthus coreanus), one species (Helophorus auriculatus) classified as Near Threatened (NT) on the Korean Red List, and six species of Crustaceans appeared. In the functional feeding group, the predators appeared predominantly while in habitat oriented group, the climbers appeared to be abundant. It was confirmed that P. clarkii in the survey area prefers an area rich in aquatic vegetation with waterside vegetation, and has high resistance to turbid water quality. The omnivore invader P. clarkii is expected to maintain a competitive relationship with carnivorous benthic macroinvertebrates that are predominant in the same species, and is expected to continue to generate ecosystem disturbance along the food chains.

Assessment of the Position of the Mandibular Foramen and Mandibular Lingula in Children and Adolescents using CBCT (소아 청소년에서 하악공 및 하악소설의 위치에 대한 CBCT 분석)

  • Lee, Jihye;Choi, Namki;Kim, Byunggee;Kim, Seonmi
    • Journal of the korean academy of Pediatric Dentistry
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    • v.48 no.1
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    • pp.64-76
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    • 2021
  • The purpose of this study is to evaluate the position of the mandibular foramen and location and morphological characteristics of the mandibular lingula using Cone-Beam Computed Tomography (CBCT). Mandibular CBCT images of children aged 6 - 16 years were collected. A total of 180 patients were divided into 3 groups, 6 - 7, 10 - 11 and 15 - 16 years, with 30 male and female patients per group. Either side of the ramus was analyzed. The shortest distances from the anterior, posterior, superior and inferior border of the ramus to the mandibular lingula were measured. The shortest distance between the mandibular lingula and the mandibular foramen was also measured. The vertical distance from the mandibular lingula and the mandibular foramen to the occlusal plane was measured. The shapes of the mandibular lingula was classified into 4 types according to the criteria. The distances of the mandibular lingula from the anteroposterior and vertical reference points of the ramus increased in all directions with age. The distance between the mandibular lingula and the mandibular foramen also increased with age. The location of the mandibular lingula and the mandibular foramen in relation to the occlusal plane moved upwards with age. The most common shape of the mandibular lingula was triangular, followed by nodular, truncated and assimilated, and there was no difference in the shape according to age. It is recommended that the horizontal insertion point of the anesthesia from the anterior border of the ramus increased to 17 mm, 18 mm, and 19 mm according to the age groups. It is also suggested that the vertical insertion point increased by 2 - 3 mm, 5 - 6 mm and 9 - 10 mm above the occlusal plane according to the age groups.

On the (Un-)Possibility of a Labor Film in the Early Period of Democratization -A Study of Guro Arirang (민주화 초기 노동자 영화의 (불)가능성 -<구로아리랑> 연구)

  • Oh, Ja-Eun
    • Journal of Popular Narrative
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    • v.26 no.4
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    • pp.9-41
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    • 2020
  • Park Jong-won's debut film "Guro Arirang," based on a short story of the same title by Lee Moon-yeol, is the first commercial film to deal with labor struggles from a worker's point of view in the wake of the 1987 democratic movement, and a pioneering work in terms of representing female workers the Korean cinema has traditionally turned away from. In this film Park Jong-won tried to win the sympathy of the middle class for labor movement in spite of the red scare which still stood firm in the Korean society at that time. To convey its progressive message in a form acceptable to the middle class public, the film portrays labor issues in the light of universal humanity and ethics, not in terms of class hostility or struggle. Park Jong-won calls this point of view "common sense of normal people" and emphasizes its universality and objectivity. This study critically examines the cinematic strategies to deal with labor issues in a form acceptable to the public in a conventional and commercial film and the ideological implications of the "common sense of normal people" reflected in such strategies. The first chapter of the study reveals that the film destroys the irony of the original story and reduces the complex constellation of the characters to the conflict between pure good and evil, creating a melodramatic composition in which the good falls victim to evil. The tragedies suffered by the workers in the film are of course intended to arouse the audience's strong sympathy and solidarity with them. The second chapter shows that the film's various scenes and episodes converge on the them of compassion and grief, and are mostly based on cultural and real experiences and events that caused great public sensations at that time. Especially in the last decisive scene of the movie, the memory of the June 1987 uprising is strongly recalled. So "Guro Arirang" can be seen as a patchwork of proven cases of compassion and grief. The third chapter examines the implications of the scene where the workers turn back demands for wages and put the issues of human treatment and trust to the forefront at the crucial moment of their struggle. It appeals to universal moral values and sentiments that everyone has to acknowledge and removes the political dimension from the workers' campaign. While the film tends to become a pure story of humanity marginalizing irreconcilable conflicts of class interest, the workers fall to the position of passive victims who can be deeply sympathetic on the one hand, and on the other, are idealized as leaders with noble attitude keeping themselves aloof from the hard reality. As a result, the movie loses its realistic ground and weakens its narrative probability. The scenes reminiscent of the 1987 uprising which evoke the solidarity between working and middle class fail to integrate harmoniously into the whole story of the film and remain only as fragmentary parts of the patchwork of compassion and grief.

Comparison of the Video Dramas Based on Yoon Sim-duk, Kim Woo-jin and Reconsidering the Movie Praise of Death(1991) (윤심덕과 김우진 소재 영상물 비교 및 영화 <사의 찬미>(1991) 재론)

  • Chung, Woo-Suk
    • Journal of Popular Narrative
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    • v.26 no.4
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    • pp.43-76
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    • 2020
  • After comparing three video dramas based on Yoon Sim-duk and Kim Woo-jin, this paper intensively explores the movie Praise of Death(1991), which has the most meaningful traits in embodying the characters, focusing on the relationship with the previous works of the director or an actress. The movie Yoon Sim-duk(1969) focuses on meiodramatic narrative around the issue like love triangle or a relationship between out-of-wedlock woman and the wife of one man. The TV drama Praise of Death(2018) is pursuing ideal youth genre between attractive two lovers adorning even the suffering of the Japanese occupation with customary visual image. In comparison, the movie Praise of Death(1991) focuses on visual beauty, while overlaps the agony of two characters as pioneering artists with frustrated love narrative. In the process, this film reveals two-sided characteristics, especially the heroine, compared to the other two. She shows a rift between the passivity for the salvation of man and the activity of choosing even the fall of her own life. In order to examine this trait, we have to explore the other works which affect the movie Praise of Death. This came from the tendency director Kim Ho-sun and actress Jang Mi-hee had built in 1970s films. It also relates in the movies Jang Mi-hee had worked with director bae Chang-ho in the 1980s. The tendency to show a pursuit of classical cultures in the field of popular movies, and to overlap the problems of desire, including sexuality, with mental and intellectual issues, continues from the previous films to the movie Praise of Death for shaping a main female character. This study results in examining the movie Praise of Death in two contexts. One is the context of three video dramas having same materials, Yoon Sim-duk and Kim Woo-jin. And other is the context of the works that director Kim Ho-sun and actress Jang Mi-hee have continued together, or the works that Jang Mi-hee have continued with director Bae Chang-ho. Until now, Yoon Sim-duk and Kim Woo-jin has been used as a material for cultural contents in the various genres over and over again. Under this circumstance, by looking at this movie, one of representative case dealing with Yoon and Kim, in the complex context, it can reaffirm the effect and difficulty in fictionalisation of them as a subject matter.