• Archives of Plastic Surgery
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• 제51권1호
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• pp.52-61
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• 2024

Background Although prepectoral implant-based breast reconstruction has recently gained popularity, dual-plane reconstruction is still a better option for patients with poor-quality mastectomy skin flaps. However, shoulder morbidity is aggravated by subpectoral reconstruction, especially in irradiated patients. This study aimed to demonstrate shoulder exercise improvement in subpectoral reconstruction by delayed prepectoral conversion with an acellular dermal matrix (ADM) inlay graft technique at the time of expander-to-implant exchange after irradiation. Methods Patients with breast cancer treated for expander-to-implant exchange after subpectoral expander insertion and subsequent radiotherapy between January 2021 and June 2022 were enrolled. An ADM inlay graft was inserted between the pectoralis major muscle and the previously inserted ADM. The ADM was sutured partially overlapping the pectoralis muscle from the medial side with the transition part, to the muscle border at the lateral side. Perioperative shoulder joint active range-of-motion (ROM) for forward flexion, abduction, and external rotation was also evaluated. Results A total of 35 patients were enrolled in the study. Active shoulder ROM significantly improved from 163 degrees preoperatively to 176 degrees postoperatively in forward flexion, 153 to 175 degrees in abduction, and 69 to 84 degrees in external rotation. There was no difference in patient satisfaction regarding the final outcome between the conventional prepectoral reconstruction group and the study group. Conclusion Shoulder exercises in irradiated patients who underwent subpectoral reconstruction were improved by delayed prepectoral conversion using an ADM inlay graft. It is recommended that subpectoral reconstruction not be ruled out due to concerns regarding muscle contracture and shoulder morbidity in radiation-planned patients with poor mastectomy skin flaps.

• 한국철도학회논문집
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• 제15권6호
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• pp.543-549
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• 2012

본 연구는 차세대 분산형 고속전철 시제차량(HEMU-430X)의 후미진동저감에 관한것이다. VAMPIRE 해석을 통한 주행거동 관찰에서 HEMU-430X는 전두부 유선형 형상유지를 위하여 설치된 한방향 요댐퍼 때문에 후미차량에서 횡방향 진동이 예상되었으며, 430km/h에서 기준치를 초과하는 경우가 있었다. 이 후미진동을 감소시키기 위하여 차륜답면 형상변경, 횡댐퍼 댐핑계수조정, 요댐퍼 계수조정 등 다양한 방법을 시도하였으나 후미진동이 없어지지 않았다. 최종적으로 요댐퍼를 양방향으로 바꾸었을 때 횡방향 진동이 사라졌다. 실제 시운전에서는 150km/h로 주행하였을 때 횡방향 후미진동이 나타났으며, 요댐퍼를 양방향으로 바꾸어 300km/h 주행 시에도 후미진동이 나타나지 않았다. 추후 430km/h까지 최고속도시험을 수행할 예정인데 높은 속도에서 후미진동이 다시 발생한다면 본 연구에서 제시한 차륜답면 형상변화, 횡댐퍼 계수 조정 등의 방법을 이용해서 진동을 저감시킬 수 있을 것이다.

• 한국운동역학회지
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• 제17권2호
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• pp.31-40
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• 2007

Proper weight shifting is essential for a successful shot in golf swing and this could be described by means of the ground forces between the feet and ground. It is assumed that the ground forces would different according to the club used because the length and swing weight of each club is different. But, in present, it is not clear what changes are made by the change of clubs and this affect the swing motion. Therefore this study focused on the investigation of the changes of the ground forces and ground reaction forces (GRF) by the change of club length. The subjects were three professional male golfers. Four swings (driver, iron 3, iron 5, and iron 7) for each subject were taken by two high speed video cameras and two AMTI force platforms were used to measure the GRF simultaneously. Kwon GRF 2.0 and Mathcad 13 software were used to post processing the data. Changes of the three major component of GRF (Vertical, lateral, anterior-posterior force) at 10 predefined events were analyzed including the maximum. Major findings of this study were as follows. 1. Vertical forces; - There were no significant changes until the top of backswing. - Maximum was occurred at the club horizontal position in the downswing for both feet. The shorter club produced more maximum forces than longer ones in the left foot, but reverse were true for the right foot. - Maximum forces at impact shows the same patterns. 2. Lateral forces; Maximum was occurred at the club horizontal position for both feet, but there were no lateral forces because the direction of two forces was different. Maximum force pattern by different clubs was same as the vertical component. 3. Anterior-posterior forces; - This component made a counter-clock wise moment about a vertical axis located between two foot until the club vertical position was reached during the backswing, and reverse moment were produced when the club reached horizontal at the downswing. - Also this component made a forward moment about a horizontal axis located in the CG during the fore half of the downswing, and a reverse moment until the club reached vertical at the follow through phase. Maximum was occurred at the club vertical in the downswing for both feet. The longer club produced more maximum forces than shorter ones for both feet.

• 대한족부족관절학회지
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• 제24권2호
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• pp.87-93
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• 2020

Purpose: This study evaluated the clinical results of surgical treatment with minimally invasive plate osteosynthesis for treating displaced intra-articular fractures of the calcaneus in comparison with conventional lateral extensile approach plate osteosynthesis. Materials and Methods: Of 79 cases of Sanders type II or III calcaneus fractures, 15 cases treated with the minimally invasive calcaneal plate (group M) and 64 cases treated with lateral extensile approach calcaneal plate (group E) were identified. After successful propensity score matching considering age, sex, diabetes mellitus history, and Sanders type (1:3 ratio), 15 cases (group M) and 45 cases (group E) were matched and the demographic, radiologic, and clinical outcomes were compared between the two groups. Results: The median time of surgery from injury was 2.0 days in group M and 6.0 days in group E (p=0.014). At the six months follow-up, group M showed results comparable with those of group E in radiographic outcomes. In the clinical outcomes, group M showed better postoperative American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores than did group E (p=0.001, p=0.008). A greater range of subtalar motion was achieved at the six months follow-up in group M (inversion 20.0° vs. 10.0°, p=0.002; eversion 10.0° vs. 5.0°, p=0.025). Although there were no significant differences in complications between the two groups (1 [6.7%] vs. 7 [15.6%], group M vs. group E; p=0.661), there was only one sural nerve injury and no wound dehiscence and deep infection in group M. Conclusion: Minimally invasive plate osteosynthesis showed superior clinical outcomes compared with that of the conventional lateral extensile approach plate osteosynthesis in Sanders type II or III calcaneus fractures. We suggest applying minimally invasive plate osteosynthesis in Sanders type II or III calcaneus fractures.

• Clinics in Shoulder and Elbow
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• 제10권1호
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• pp.50-58
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• 2007

목적: 주관절의 후외측 동통과 탄발음을 유발할 수 있는 주관절의 활막추벽 9예에 대한 관절경적 경험과 해부학적 특징을 보고하고자 하였다. 대상 및 방법: 1999년 5월부터 2004년 1월까지 주관절 관절경을 받은 43명의 환자 중 활막추벽으로 진단되었거나 제거 받은 12개월 이상 추시가 가능했던 8명의 환자 9예를 대상으로 조사하였다. 양측 성을 보인 1명 2예를 포함한 남자가 8예 여자가 1예이었고 평균 연령은 29세 이었다. 모든 환자는 수술 전까지 최소 6개월의 보존적 치료를 받았으며 술 전 활막 추벽이라고 진단했던 경우가 6예, 외상과 염으로 진단했거나 진단이 처음부터 불분명하여 수술 중에 발견했던 경우가 3예이었다. 수술 직 후 관절경 소견으로 추벽의 형태를 분류하였고 최종 추시시점에서 통증 및 탄발음 소실 여부와 함께 Visual Analogue Scale (VAS)의 변화와 환자의 만족도를 조사였다. 결과: 관절경 소견상 전 예에서 외측 활막 추벽과 함께 전 외측에서 국한된 국소적 활막염의 소견이 관찰되었으며 7예에서 요골 두의 연골 연화증 또는 미란 소견을 보였다. 그러나 소두변화는 1예에서만 보였다. 2예를 제외한 7예에서 수술 직후부터 통증과 탄발음이 소실 또는 완화되었으며(VAS<1) 최종 추시 상에의 통증지수는 평균 6.8 에서 0.9로 감소하였다. 그 중 미약한 탄발음이 지속되었던 1예는 불완전한 제거로 판단하여 재수술을 시행하였다. 결론: 주관절의 활막 추벽은 주관절의 잠김 또는 외측 동통을 일으키는 주 진단범주에 포함시켜야할 것이며 특히 오랫동안 지속된 저항성 외 상과염이라면 활막 추벽을 고려해 봐야 할 것이다. 관절경을 통한 추벽의 제거는 매우 안전하고 효과적이었으며 단기 추시에서 매우 우수한 결과를 보였다.

• 한국철도학회논문집
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• 제20권2호
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• pp.165-172
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• 2017

도심을 지나는 철도 궤도는 급격한 곡선 구간이 존재하며, 철도차량이 곡선부를 주행하며 발생시키는 높은 주파수의 스킬소음은 곡선부 인근에 소음 민원을 야기하고, 해당 구간 궤도의 마모를 과도하게 발생시킨다. 본 논문에서는 대표적 비선형, 과도 특성인 스킬소음의 현상을 정확하게 파악하기 위해서 실차를 대상으로 곡선부 스킬 소음실험을 수행하였다. 특정 대차내 4 차륜을 대상으로 스킬소음의 음압의 크기, 주파수 특성, 주행 속도 변화에 따른 영향, 차륜의 진동응답특성과 스킬소음의 연관관계를 파악하였다. 동시에 차륜과 레일의 접촉 위치의 변화를 촬영한 영상을 분석하여 스킬소음 발생시 차륜의 레일에 대한 상대적 움직임에 대한 현상을 살펴보았다. 철도 차량 곡선 주행시 스킬소음은 내측 전륜에서 가장 크게 발생하며, 이는 차륜의 횡방향 진동 응답 특성과 관련이 있다고 생각된다. 이 발생 스킬소음의 크기는 차량 속도 증가와는 직접적인 관련이 없음을 알 수 있었다.

• 한국운동역학회지
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• 제31권1호
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• pp.1-15
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• 2021

Objective: The aim of this study was to investigate 1) the difference in static lower extremity alignment (SLEA) according to a history of lateral ankle sprain (LAS), 2) to identify SLEA factors affecting LAS, and 3) to present the cut-off value and 4) the usefulness and limitations of the SLEA measurement. Method: This case-control study recruited 88 men (age: 27.78±4.69 yrs) and 39 women (age: 24.62±4.20 yrs) subjects with and without LAS. SLEA measurement protocol included Q angle, tibiofemoral angle, genu recurvatum, rear foot (RF) angle, tibal varum and torsion, navicular drop, ankle dorsiflexion range of motion (DF ROM). Independent t-test, logistic regression and receiver operating characteristic (ROC) curve were used for statistical analysis. Results: Men with a history of LAS had significantly smaller Q angles both in standing and in supine position, while women with a history of LAS had significantly greater DF ROM in non-weight bearing (NWB; p < 0.05). Logistic regression model suggests tibial varum (OR = 0.779, p = 0.021) and WB DF ROM (OR = 1.067, p = 0.045) were associated with LAS in men. In case of women, there were no significant SLEA factors for LAS, however, ROC curve analysis revealed standing RF angle (AUC = 0.647, p = 0.028) and NWB DF ROM (AUC = 0.648, p = 0.026) could be affecting factors for LAS. Conclusion: There are differences in SLEA according to the history of LAS, furthermore, the identified items were different by sex. In case of men, tibial varum and WB DF ROM affect LAS occurrence. Standing RF angle and NWB DF ROM of women could be a predictor for LAS. However, since the sensitivity and specificity in most of the SLEA measurements are low, kinematic in dynamic tasks should be considered together for a more accurate evaluation of LAS risk.

• Earthquakes and Structures
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• 제24권6호
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• pp.455-475
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• 2023

The present study investigates the non-linear soil-pile interaction using three-dimensional (3D) non-linear finite element models. The numerical models were validated by using the results of extensive pile load and shaking table tests. The pile performance in liquefiable and non-liquefiable soil has been studied by analyzing the liquefaction ratio, pile lateral displacement (LD), pile bending moment (BM), and frictional resistance (FR) results. The pile models have been developed for the different ground conditions. The study reveals that the results obtained during the pile load test and shaking cycles have good agreement with the predicted pile and soil response. The soil density, peak ground acceleration (PGA), slenderness ratio (L/D), and soil condition (i.e., dry and saturated) are considered during modeling. Four ground motions are used for the non-linear time history analyses. Consequently, design charts are proposed depended on the analysis results to be used for design practice. Eleven models have been used to validate the capability of these charts to capture the soil-pile response under different seismic intensities. The results of the present study demonstrate that L/D ratio slightly affects the lateral displacement when compared with other parameters. Also, it has been observed that the increasing in PGA and decreasing L/D decreases the excess pore water pressure ratio; i.e., increasing PGA from 0.1 g to 0.82 g of loose sand model, decrease the liquefaction ratio by about 50%, and increasing L/D from 15 to 75 of the similar models (under Kobe earthquake), increase this ratio by about 30%. This study reveals that the lateral displacement increases nonlinearly under both dry and saturated conditions as the PGA increases. Similarly, it is observed that the BM increases under both dry and saturated states as the L/D ratio increases. Regarding the acceleration histories, the pile BM was reduced by reducing the acceleration intensity. Hence, the pile BM decreased to about 31% when the applied ground motion switched from Kobe (PGA=0.82 g) to Ali Algharbi (PGA=0.10 g). This study reveals that the soil conditions affect the relationship pattern between the FR and the PGA. Also, this research could be helpful in understanding the threat of earthquakes in different ground characteristics.

• 대한방사선치료학회지
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• 제26권1호
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• pp.69-76
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• 2014

목 적 : 외부 압박을 통해 전립선암 환자의 복강 내 압력을 안정화시켜 움직임을 감소하여 치료 간(interfraction)과 치료 중(intrafraction)에 변화를 측정하여 평가하고자 시행하였다. 대상 및 방법 : 10명의 전립선환자들은 전체 치료과정동안 MVCT 스캔을 통해 치료 전과 후에 걸쳐 환자 당 60개의 영상을 획득하였고 획득한 좌우방향(X), 상하방향(Y), 전후방향(Z), 회전방향(Roll)에 대한 Shift 값들을 이용하여 복부 압박 시 치료 간 치료준비 변화와 치료 중 표적 움직임의 상호 연관성을 분석하였다. 결 과 : 치료 간의 움직임 변화는 평균 좌우방향(X)에서 $0.65{\pm}2.32mm$, 상하방향(Y)에서 $1.41{\pm}4.83mm$, 전후방향(Z)에서 $0.73{\pm}0.52mm$, 회전방향(Roll)에서 $0.96{\pm}0.21^{\circ}$로 나타났다. 치료 중 움직임 변화는 평균 좌우방향(X)에서 $0.15{\pm}0.44mm$, 상하방향(Y)에서 $0.13{\pm}0.44mm$, 전후방향(Z)에서 $0.24{\pm}0.64mm$, 회전방향(Roll)에서 $0.1{\pm}0.9^{\circ}$로 나타났다. 결 론 : 전처치과정과 외부에서 복부압박을 통한 전복부의 움직임을 제한한다면 치료동안에 내부 장기와 환자의 움직임을 감소시켜 보다 적은 여유(margin)로 계획용 표적체적(PTV)을 생성할 수 있어서 정상조직의 부작용 증가 없이 더욱 이상적인 선량 체적을 얻을 수 있을 것으로 사료된다.

• 한국항해항만학회지
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• 제27권3호
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• pp.247-252
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• 2003

This paper is mainly concerned with the assessment of safe navigation between ships moving each other in restricted waterways. The numerical simulation of manoeuvring motion was conducted parametrically to propose an appropriate safe speed and distance, which is required to avoid sea accident under the different conditions, such as ship-velocity ratios, ship-length ratios, separation and stagger between ships. As for the calculation parameters, the ratios of velocity difference between two ships were considered as 0.6, 1.2, 1.5 and the ones of ship-length difference were regarded were regarded as 0.5, 1.0, 1.18. From the inspection of this investigation, it indicates the following result. Firstly, the separation between ships is more needed for the small vessel, compared to the large vessel. Secondly, the lateral distance between ships is necessarily required for the velocity ration of 1.2, compared to the cases of 0.6 and 1.5. The manoeuvring characteristics based on this investigation will be very useful for keeping the safety of navigation from the practical point of ships design and traffic control in confined water.