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The Research about the Classification System Improvement and Cord Development of Korean Classification of Disease on Oriental Internal Medicine (한국표준질병사인분류중 한방내과영역의 분류체계 개선 및 진단명 구성에 관한 연구)

  • Lee, Won-Chul
    • The Journal of Internal Korean Medicine
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    • v.31 no.1
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    • pp.1-10
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    • 2010
  • Objectives : It is necessary that the international classification of diseases (ICD) be examined in order to comprise the third revision of the Korean Classification of Disease on Oriental Medicine (KCD-OM) and disease classification in the oriental internal medicine field. It is essential that the selection, classification and definition of disease and pattern names of oriental concepts in internal medicine be clear. Since 2008, the fifth revision of the Korean Classification of Disease (KCD-5) has been used in Korea. It was required to use the reference classification from the Oriental medicine area based on the ICD-10. Methods : In this review, the necessity for, meaning of and content of the third revision are briefly described. The ICD system was reviewed and KCD-OM was reconstructed. How diagnosis in the oriental internal medicine area had changed is discussed. Review and Results : In 1973, the disease classification of oriental medicine was established the basis on the contents of Dongeuibogam. It was irrespective of the ICD. As to the classification system in the Oriental internal medicine field, systemic disease was comprised of wind, cold, warm, wet, dryness, heat, spirit, ki, blood, phlegm and retained fluid, consumptive disease, etc. Diseases of internal medicine comprised a system according to the five viscera and the six internal organs and followed the classification system of Dongeuibogam. The first and second revisions were of the classification system based on the curriculum in 1979 and 1995. In 1979, in the first revision, geriatric disease and idiopathic types of disease were deleted, and skin disease was included among surgery diseases. This classification was expanded to 792 small classification items and 1,535 detailed classification items to the dozen disease classes. In 1995, in the second revision, it was adjusted to 644 small classes and 1,784 detailed classification items in the dozen disease classes. KCD-OM3 did KCD from this basis. It added and comprised the oriental medical doctor's concept names of diseases considering the special conditions in Korea. KCD-OM3 examined the KCD-OMsecond revised edition (1994). It improved the duplex classification, improper classifications, etc. It is difficult for us to separate the disease names and pattern names in oriental medicine. We added to the U code and made one classification system. By considering the special conditions in Korea, 169 codes (83 disease name codes, 86 pattern name codes) became the pre-existence classification and links among 306 U codes of KCD-OM3. 137 codes were newly added in the third revision. U code added 3 domains. These are composed of the disease name (U20-U33, 97 codes), the disease pattern name (U50-U79, 191 codes) and the constitution pattern name of each disease (U95-U98, 18 codes). Conclusion : The introduction of KCD-OM3 conforms to the diagnostic system by which oriental medical doctors examine classes used with the basic structure of the reference classification of WHO and raises the clinical study and academic activity of the Korean oriental medicine and makes the production of all kinds of nation statistical indices possible. The introduction of KCD-OM3 promotes the diagnostic system by which doctors of Oriental medicine examine classes using the association with KCD-5. It will raise the smoothness and efficiency of oriental medical treatment payments in the health insurance, automobile insurance, industrial accident compensation insurance, etc. In addition, internationally, the eleventh revision work of the ICD has been initiated. It needs to consider incorporating into the International Classification of Diseases some of every country's traditional medicine.

A Study of Image Quality Improvement Through Changes in Posture and Kernel Value in Neck CT Scanning (경부 CT검사 시 Kernel 값과 검사자세 변화를 통한 화질개선에 관한 연구)

  • Kim, Hyeon-Ju;Chung, Woo-Jun;Cho, Jae-Hwan
    • Journal of the Korean Society of Radiology
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    • v.5 no.2
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    • pp.59-66
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    • 2011
  • There is a difficulty because of classifying the anatomical structure in the neck CT scan by the beam hardening artifact no more than disease and it including the 6, 7 number cervical spine and intervertebral disk. In case of enforcing the neck CT scan cause of the inner diameter of beam artifact tried to be inquired by the image evaluation according to the change of the image evaluation according to the direction of the shoulder joint applying the variation method of a posture and location and Kernel value and it was most appropriate, the lion tax and Kernel value try to be searched for through an experiment. Somatom Sensation 16 (Siemens, Enlarge, Germany) equipment was used in a patient 30 people coming to the hospital for the neck CT scan. A workstation used the AW 4.4 version (GE, USA). According to a direction and location of the shoulder joint, the patient posture gave a change to the direction of the shoulder joint as the group S it gave a change as three postures and placed the both arms comfortably and helps a group N and augmented unipolar left in the wealthy merchant and group P it memorized the both hands and ordered the eversion and drops below to the utmost and enforced a scan. By using a reconstructing method as the second opinion, it gave and reconstructed the Kernel value a change based on scan data with B 10 (very smooth), B 20 (smooth), B 30 (medium smooth), B 40 (medium), B 50 (medium sharp), B 60 (sharp), and B 70 (very sharp). By using image data which gave the change of the examination posture and change of the Kernel value and are obtained, we analyzed through the noise value measurement and image evaluation of. The outside wire eversion orders the both hands and the examination posture is cost in the neck CT scan with the group P it drops below to the utmost. And in case of when reconstructing with B 40 (medium) or B 50 (medium sharp) being most analyzed into the inappropriate posture and Kernel value and applying the Kernel value to a clinical, it is considered to be very useful.

PTV Margins for Prostate Treatments with an Endorectal Balloon (전립선 암의 방사선치료 시 직장 내 풍선삽입에 따른 계획표적부피마진)

  • Kim, Hee-Jung;Chung, Jin-Beom;Ha, Sung-Whan;Kim, Jae-Sun;Ye, Sung-Joon
    • Radiation Oncology Journal
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    • v.28 no.3
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    • pp.166-176
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    • 2010
  • Purpose: To determine the appropriate prostate planning target volume (PTV) margins for 3-dimensitional (3D) conformal radiotherapy (CRT) and intensity-modulated radiation therapy (IMRT) patients treated with an endorectal balloon (ERB) under our institutional treatment condition. Materials and Methods: Patients were treated in the supine position. An ERB was inserted into the rectum with 70 cc air prior to planning a CT scan and then each treatment fraction. Electronic portal images (EPIs) and digital reconstructed radiographs (DRR) of planning CT images were used to evaluate inter-fractional patient's setup and ERB errors. To register both image sets, we developed an in-house program written in visual $C^{++}$. A new method to determine prostate PTV margins with an ERB was developed by using the common method. Results: The mean value of patient setup errors was within 1 mm in all directions. The ERB inter-fractional errors in the superior-inferior (SI) and anterior-posterior (AP) directions were larger than in the left-right (LR) direction. The calculated 1D symmetric PTV margins were 3.0 mm, 8.2 mm, and 8.5 mm for 3D CRT and 4.1 mm, 7.9 mm, and 10.3 mm for IMRT in LR, SI, and AP, respectively according to the new method including ERB random errors. Conclusion: The ERB random error contributes to the deformation of the prostate, which affects the original treatment planning. Thus, a new PTV margin method includes dose blurring effects of ERB. The correction of ERB systematic error is a prerequisite since the new method only accounts for ERB random error.

Surgical Treatment of Metastatic Tumor in Proximal Femur with Recycling Autograft Prosthetic Composite after Wide Excision (근위 대퇴골 전이성 종양의 수술적 치료로서 광범위 절제술 후 재활용 자가골을 이용한 복합 고관절 성형술)

  • Kim, Jae-Do;Park, Pil-Jae;Kwon, Young-Ho;Jang, Jae-Ho;Lee, Young-Gu
    • The Journal of the Korean bone and joint tumor society
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    • v.11 no.1
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    • pp.71-81
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    • 2005
  • Purpose: Due to local recurrence of tumor, metal failure usually develops in patients who underwent internal fixation or hip joint arthroplasty after curettage in the case of metastatic tumor of proximal femur. The aim of this study is to find out the appropriateness of reconstruction using recycling autograft after wide excision in the case of metastatic bone tumor by performing recycling autograft and hip joint arthroplasty after wide excision, and through presence or absence of local recurrence, functions of lower limbs and occurrence of complications. Materials and Methods: Five patients, in 6 cases, who had undergone reconstruction using recycling autograft prosthetic composite after wide excision in the metastatic tumor from May 2000 to May 2003 were included in this study. The average age of the patients was 60.8 years of age with male to female ratio of 3:2. Average duration of lives following surgery was 23.3 month (7-57 months). Primary lesion included 2 cases of lung cancer, and 1 each of stomach cancer, renal cancer and multiple myeloma. After wide excision, the hip joint was reconstructed with recycling autograft prosthetic composite ; 4 cases of extracorporeal irradiation and 2 cases of pasteurization. Musculoskeletal Tumor Society (MSTS) score(1993) for 6-month period after surgery, as well as presence of complication and local recurrence during the rest of their lives, were studied. Results: Average Musculoskeletal Tumor Society (MSTS) score over the 6-month period after surgery was 63.3% and 1 case of dislocation of hip joint, as a complication following surgery, was discovered. Local recurrence during the lives of the patients was not observed. Conclusion: In the case of metastatic tumor of proximal femur, in which the life span following surgery is expected to be more than 6 months, undergoing reconstruction using recycling autograft after wide excision, in comparison to internal fixation or hip joint arthroplasty after curettage, is deemed to have better results in prevention of local recurrence, and preservation of the functions of all limbs during the life span of the patient.

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Comparison Radiation Dose of Z-Axis Automatic Tube Current Modulation Technique with Fixed Tube Current Multi-Detector Row CT Scanning of Lower Extremity Venography (하지 정맥조영술 MDCT에서 고정 관전류 기법과 Z-축 자동 관전류 변동 제어에 의한 선량 비교)

  • Yoo, Beong-Gyu;Lee, Jong-Seok;Jang, Keun-Jo;Jeon, Sang-Hwan;Kim, Yong-Soo;Kweon, Dae-Cheol
    • Journal of Radiation Protection and Research
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    • v.32 no.3
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    • pp.123-133
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    • 2007
  • Z-axis automatic tube current modulation technique automatically adjusts tube current based on size of body region scanned. The purpose of the current study was to compare noise, and radiation dose of multi-detector row CT (MDCT) of lower extremity performed with Z-axis modulation technique of automatic tube current modulation with manual selection fixed tube current. Fifty consecutive underwent MDCT venography of lower extremity with use of a MDCT scanner fixed tube current and Z-axis automatic tube current modulation technique (10, 11 and 12 HU noise index, $70{\sim}450\;mA$). Scanning parameters included 120 kVp, 0.5 second gantry rotation time, 1.35:1 beam pitch, and 1 mm reconstructed section thickness. For each subject, images obtained with Z-axis modulation were compared with previous images obtained with fixed tube current (200, 250, 300 mA) and with other parameters identical. Images were compared for noise at five levels: iliac, femoral, popliteal, tibial, and peroneal vein of lower extremity. Tube current and gantry rotation time used for acquisitions at these levels were recorded. All CT examinations of study and control groups were diagnostically acceptable, though objective noise was significantly more with Z-axis automatic tube current modulation. Compared with fixed tube current, 2-axis modulation resulted in reduction of CTDIvol (range, $-6.5%{\sim}-35.6%$) and DLP (range, $-0.2%{\sim}-20.2%$). Compared with manually selected fixed tube current, 2-axis automatic tube current modulation resulted in reduced radiation dose at MDCT of lower extremity venography.

A Study on the Effects of the Institutional Pressure on the Process of Implementation and Appropriation of System: M-EMRS in Hospital Organization (시스템의 도입과 전유 과정에 영향을 미치는 제도적 압력에 관한 연구: 병원조직의 모바일 전자의무기록 시스템을 대상으로)

  • Lee, Zoon-Ky;Shin, Ho-Kyoung;Choi, Hee-Jae
    • Asia pacific journal of information systems
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    • v.19 no.2
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    • pp.95-116
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    • 2009
  • Increasingly the institutional theory has been an important theoretical view of decision making process and IT adoption in many academic researches. This study used the institutional theory as a lens through which we can understand the factors that enable the effective appropriation of advanced information technology. It posits that mimetic, coercive, and normative pressures existing in an institutionalized environment could influence the participation of top managers or decision makers and the involvement of users toward an effective use of IT in their tasks. Since the introduction of IT, organizational members have been using IT in their daily tasks, creating and recreating rules and resources according to their own methods and needs. That is to say, the adaptation process of the IT and outcomes are different among organizations. The previous studies on a diverse use of IT refer to the appropriation of technology from the social technology view. Users appropriate IT through not only technology itself, but also in terms of how they use it or how they make the social practice in their use of it. In this study, the concepts of institutional pressure, appropriation, participation of decision makers, and involvement of users toward the appropriation are explored in the context of the appropriation of the mobile electronic medical record system (M-EMRS) in particularly a hospital setting. Based on the conceptual definition of institutional pressure, participation and involvement, operational measures are reconstructed. Furthermore, the concept of appropriation is measured in the aspect of three sub-constructs-consensus on appropriation, faithful appropriation, and attitude of use. Grounded in the relevant theories to appropriation of IT, we developed a research framework in which the effects of institutional pressure, participation and involvement on the appropriation of IT are analyzed. Within this theoretical framework, we formulated several hypotheses. We developed a second order institutional pressure and appropriation construct. After establishing its validity and reliability, we tested the hypotheses with empirical data from 101 users in 3 hospitals which had adopted and used the M-EMRS. We examined the mediating effect of the participation of decision makers and the involvement of users on the appropriation and empirically validated their relationships. The results show that the mimetic, coercive, and normative institutional pressure has an effect on the participation of decision makers and the involvement of users in the appropriation of IT while the participation of decision makers and the involvement of users have an effect on the appropriation of IT. The results also suggest that the institutional pressure and the participation of decision makers influence the involvement of users toward an appropriation of IT. Our results emphasize the mediating effect of the institutional pressure on the appropriation of IT. Namely, the higher degree of the participation of decision makers and the involvement of users, the more effective appropriation users will represent. These results provide strong support for institutional-based variables as predictors of appropriation. These findings also indicate that organizations should focus on the role of participation of decision makers and the involvement of users for the purpose of effective appropriation, and these are the practical implications of our study. The theoretical contribution of this study is lies in the integrated model of the effect of institutional pressure on the appropriation of IT. The results are consistent with the institutional theory and support previous studies on adaptive structuration theory.

A Low-Dose High-Resolution SPECT System with CdTe for Small-Animal Imaging Applications: A GATE Simulation Study (GATE 시뮬레이션을 통한 고해상도 저선량용 소동물 영상화를 위한 CdTe 검출기 기반의 SPECT 기기 연구)

  • Park, Su-Jin;Yu, A Ram;Kim, Yeseul;Lee, Young-Jin;Kim, Hee-Joung
    • Progress in Medical Physics
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    • v.24 no.3
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    • pp.162-170
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    • 2013
  • Dedicated single-photon emission computed tomography (SPECT) systems based on pixelated semiconductors are being developed for studying small animal models of human disease. To clarify the possibility of using a SPECT system with CdTe for a high resolution low-dose small animal imaging, we compared the quality of reconstructed images from pixelated CdTe detector to those from a small SPECT system with NaI(Tl). The CdTe detector was $44.8{\times}44.8$ mm and the pixels were $0.35{\times}0.35{\times}5$ mm. The intrinsic resolution of the detector was 0.35 mm, which is equal to the pixel size. GATE simulations were performed to assess the image quality of both SPECT systems. The spatial resolutions and sensitivities for both systems were evaluated using a 10 MBq $^{99m}Tc$ point source. The quantitative comparison with different injected dose was performed using a voxelized MOBY phantom, and the absorbed doses for each organ were evaluated. The spatial resolution of the SPECT with NaI(Tl) was about 1.54 mm FWHM, while that of the SPECT with a CdTe detector was about 1.32 mm FWHM at 30 mm. The sensitivity of NaI(Tl) based SPECT was 83 cps/MBq, while that of the CdTe detector based SPECT was 116 cps/MBq at 30 mm. The image statistics were evaluated by calculating the CNR of the image from both systems. When the injected activity for the striatum in the mouse brain was 160 Bq/voxel, the CNR of CdTe based SPECT was 2.30 while that of NaI(Tl) based SPECT was 1.85. The CNR of SPECT with CdTe was overall higher than that of the NaI(Tl) based SPECT. In addition, the absorbed dose was higher from SPECT with CdTe than those from NaI(Tl) based SPECT to acquire the same quantitative values. Our simulation results indicated that the SPECT with CdTe detector showed overall high performance compared to the SPECT with NaI(Tl). Even though the validation study is needed, the SPECT system with CdTe detector appeared to be feasible for high resolution low-dose small animal imaging.

Effect of Protein Supplementation, O2 Concentration and Co-Culture on the Development of Embryos Produced by Nuclear Transfer Using Cultured Cumulus Cells in Hanwoo (Korean Cattle)

  • Im, G.S.;Yang, B.S.;Park, S.J.;Im, S.K.;Yang, B.C.;Yi, Y.J.;Park, C.S.
    • Asian-Australasian Journal of Animal Sciences
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    • v.14 no.9
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    • pp.1260-1266
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    • 2001
  • The effect of protein supplementation, $O_2$ concentration and co-culture on the development of embryos produced by nuclear transfer using cultured cumulus cell was investigated. Recipient oocytes and cumulus cells were obtained from the ovaries of the slaughtered Hanwoo cows. Donor cumulus cells were cultured in Dulbecco's modified Eagle medium containing 10% fetal bovine serum at 5% $CO_2$ in air at $38.5^{\circ}C$. The 1 to 6 passages of cumulus cells were isolated and used as donor cells. The in vitro matured oocytes were enucleated and then the isolated donor cells were introduced. One $15{\mu}s$ pulse of 180 volts was applied to induce the fusion between karyoplast and cytoplast. The fused embryos were activated with $10{\mu}M$ calcium ionophore for 5 min and 2 mM 6-dimethylaminopurine for 3 h. To examine the effect of protein supplementation, nuclear transfer (NT) embryos were cultured in one of the following 4 treatments : 1) CR1aa + 3 mg/ml BSA for 7 days ; 2) CR1aa + 10% FBS for 7 days ; 3) CR1aa + 1.5 mg/ml BSA + 5% FBS for 7 days ; and 4) CR1aa + 3 mg/ml BSA for first 3 days and then CR1aa + 1.5 mg/ml BSA + 5% FBS for 4 days. Culture took place at 5% $CO_2$, 5% $O_2$ and 90% $N_2$ at $38.5^{\circ}C$. Although there were no significant differences in cleavage rate among different protein supplements, the rates of blastocyst formation were significantly different. When NT embryos were cultured in the medium supplemented with only BSA, they could develop to only morula not to blastocyst. However, when FBS was supplemented, NT embryos developed to blastocyst stage. In order to investigate the effect of $O_2$ concentration and co-culture, NT embryos were cultured in CR1aa + 1.5 mg/ml BSA + 5% FBS with or without cumulus cell co-culture at an atmosphere of 5% $CO_2$ in air (20% $O_2$) or 5% $CO_2$, 5% $O_2$, 90% $N_2$ (5% $O_2$) at $38.5^{\circ}C$ for 7 days. The percentage of blastocyst development was significantly higher when the NT embryos were cultured at an atmosphere of 5% $O_2$ than that of 20% $O_2$ (p<0.05). However, there was no significant difference between with and without cumulus cell co-culture at an atmosphere of 5% $O_2$ or 20% $O_2$. Fifty embryos were transferred to 25 recipients and 5 recipients were pregnant at 100 days. From 5 pregnant cows, only one cow was delivered of female twin. In conclusion, the embryos reconstructed by enucleation of metaphase II oocytes and introduction of the cycling and quiescent cumulus donor cells in Hanwoo had developmental potential to term after embryo transfer to recipient cows.

Three Dimensional Study on the Postoperative Stability after Advancement of Maxilla Using Le Fort I Osteotomy (Le Fort I 골절단술을 이용한 상악골 전진 후 안정성에 관한 3차원적 연구)

  • Oh, Chul-Jung;Hur, Jung-Woo;Chung, Kwang;Cho, Min-Sung;Jung, Seunggon;Park, Hong-Ju;Oh, Hee-Kyun;Ryu, Sun-Youl;Kook, Min-Suk
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.35 no.2
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    • pp.82-87
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    • 2013
  • Purpose: This study evaluated postoperative maxillary stabilities in patients with skeletal Class III malocclusion who were taken both maxillary advancement surgery and mandibular retrusive surgery, using Le Fort I osteotomy, through three-dimensional computed tomography. Methods: We selected 14 patients who were taken postoperative three-dimensional computerized tomography at the time before surgery, immediately after surgery, six months after surgery among the patients undergone both maxillary advancement surgery using Le Fort I osteotomy and mandibular retrusive surgery using bilateral sagittal split ramus osteotomy. We measured and compared the vertical distance of A-point and posterior nasal spine (PNS), the horizontal distance of A-point and PNS in transverse plane and coronal plane of the three-dimensional reconstructed images, respectively. Results: In transverse plane, the distance difference between immediately after surgery ($S_1$) and immediately before surgery ($S_0$) of A-point was $-0.04{\pm}1.80$ mm, $S_2$ and $S_0$ was $-0.15{\pm}1.69$ mm, and between $S_1$ and $S_2$ was $0.11{\pm}0.58$ mm. There were no significant differences between these data (P>0.05). In transverse plane, the distance between $S_1-S_0$ of PNS was $-3.87{\pm}2.37$ mm, $S_2-S_0$ of PNS was $-3.79{\pm}2.39$ mm, and $S_1-S_2$ of PNS was $-0.08{\pm}0.18$ mm. There were significant differences between these data (P<0.05). In coronal plane, the distance between $S_1-S_0$ of A-point was $3.99{\pm}0.86$ mm, $S_2-S_0$ was $3.57{\pm}1.09$ mm, and $S_1-S_2$ was $0.42{\pm}0.42$ mm. There were significant differences between these data (P<0.05). In coronal plane, the distance between $S_1-S_0$ of PNS was $3.82{\pm}0.96$ mm, $S_2-S_0$ was $3.43{\pm}0.91$ mm, and $S_1S_2$ was $0.39{\pm}0.49$ mm. There were significant differences between these data (P<0.05). In transverse plane, it was estimated that PNS has no statistical postoperative stability in the same direction. In coronal plane, it was estimated that both A-point and PNS had no statistical postoperative stability (P<0.05). Conclusion: Clinically, the operation plan needs to take into account of the maxillary relapse.

An Interpretation of the Insa-dong Landscape from a Social Construction Viewpoint (인사동 경관의 사회 구성론적 해석)

  • Kim, Yun-Geum;Kim, Hai-Gyoung;Choi, Key-Soo
    • Journal of the Korean Institute of Landscape Architecture
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    • v.36 no.6
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    • pp.91-101
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    • 2009
  • In this study, the landscape of Insa-dong was interpreted from the viewpoint of a social construction of landscape, which regards the dynamic process of landscape change as more important than landscape visibility. This viewpoint also regards landscape as the result of its interaction with certain actors. From a review of previous studies on the same subject, it was found that the physical environment, institutions, and images are essential factors influencing landscape change. Insa-dong, which was Kwanindaing and Daesadong during the Joseon Dynasty, acquired symbolic meaning as a traditional area during the Japanese colonial period because of its many antique shops and Korean-style buildings. In 1970, the establishment of modern galleries in the district added to its image as a haven of the traditional Korean culture. Insa-dong thus eventually came to be referred to as "the street of traditional culture" by the people of Korea. Thanks to global festivals like the Asian Games, the Olympics, and the World Cup, Insa-dong's reputation as a cultural tourist destination has become stronger as these festivals created a need for a place in Korea where the country's traditional culture can be showcased to foreign tourists. After the mid-1990s, the merchants of Insa-dong began to cash in on the district's image as a showcase of traditional Korean culture due to the economic depression that emerged then. The people of Insa-dong and those outside it, however, came to feel that this trend damaged the district's image. Therefore, the people of Insa-dong and the district's local government started a movement to restore the aesthetic value and symbolic meaning of the district's landscape. This effort induced institutional change. Insa-dong used to be a natural haven of traditional Korean culture. Its landscape has recently been reconstructed so that this image could be restored. This process was made possible by the active interaction of diverse people: merchants, users, administrators, and NGOs.