• Journal of Korean Neurosurgical Society
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• v.65 no.4
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• pp.549-557
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• 2022

Objective : This study analyzed the risk factors in patients who developed distal junctional kyphosis (DJK) after posterior cervical fusion. Methods : We retrospectively analyzed the clinical and radiographic outcomes of 64 patients, aged ≥18 years (51 and 13 male and female patients, respectively), who underwent single-staged multilevel (3-6 levels) posterior cervical fusion surgery due to multiple cervical spondylotic myelopathy. The surgeries were performed by a single spinal surgeon between January 2012 and December 2017. Demographic data, clinical outcomes, and radiological results were collected. We divided the patients into a DJK group and a non-DJK group according to the presence of DJK and investigated the risk factors by comparing the differences between the two groups. Results : Of the 64 patients, 13 developed DJK. No significant differences in clinical results were observed between the two groups before and immediately after the surgery. At the final follow-up, a higher visual analog score for neck pain was observed in the DJK group compared to the non-DJK group (p<0.01). The DJK group had a significantly lower T1 slope and a significantly higher C2-7 sagittal vertical axis (SVA) before surgery compared to the non-DJK group (p=0.03 and p<0.01, respectively). Immediately after surgery, the difference between the two groups decreased and no significant difference was observed. However, at the last follow-up, a significantly higher C2-7 SVA was observed in the DJK group (p<0.01). At the last follow up, there is no discrepancy in T1S-CL. In multiple logistic regression analysis, preoperative higher C2-7 SVA and preoperative lower T1 slope were identified as independent risk factors (p=0.03 and p<0.01, respectively). As a result, it was confirmed that DJK occurred along the process of returning to preoperative values. Conclusion : DJK can be considered to be caused by cervical misalignment due to excessive change in the surgical site in patients with low T1 slope and high C2-7 SVA before surgery. This also affects the clinical outcome after surgery. It is recommended to refrain from excessive segmental lordosis changes during multilevel cervical post fusion surgery, especially in patients with a small preoperative T1 slope and a large SVA value.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.34 no.2
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• pp.38-52
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• 2021

Objectives : The purpose of this study is to analyze the use of insured herbal extracts and Korean medicinal treatments, which are mainly used to treat allergic rhinitis in Korean medicine. Methods : Among all HIRA(Health Insurance Review and Assessment Service) claims data in 2016, we included all statements that included J30(vasomotor and allergic rhinitis) or a subcategory of J30(J30.0, J30.1, J30.2, J30.3, or J30.4) as the main disease, using the Korean Standard Classification of Diseases(KCD-7). This study analyzed the most frequently used insured herbal extracts and Korean medicinal treatments for allergic rhinitis in Korean medicine. We performed a frequency analysis on subgroups based on treatment type(inpatient or outpatient), sex, age, insurance type, and medical institution type. Results : The result shows the 10 most frequently used insured herbal extracts and Korean medicinal treatments for allergic rhinitis. The total number of insured herbal extracts prescriptions was 82,533, and the most commonly prescribed insured herbal extracts was socheongryong-tang(35,131 prescriptions), followed by hyeonggaeyeongyo-tang(18,157 prescriptions), samsoeum(6,257 prescriptions), and galgeun-tang(4,465 prescriptions). The total number of Korean medicinal treatments prescriptions was 1,878,541, of which the most common Korean medicinal treatments was acupuncture(922,977 prescriptions), followed by moxibustion(372,120 prescriptions), cupping(242,094 prescriptions), and segmental acupuncture(161,553 prescriptions). Conclusions : It is expected that the results of this study can be used as a basis for establishing the priorities of evidence-based clinical research topics in the field of Korean medicine and making health care policy decisions to strengthen coverage in the future.

• Journal of the Korean Society of Radiology
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• v.16 no.7
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• pp.879-887
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• 2022

In this study, we tried to confirm whether the mechanical sequential elevation method of the body pressure measuring bed actually induces segmental motion for each part of the spine. To this end, a lateral X-ray examination was performed, and it was confirmed that the sequential pressure device induces a step-wise segmentation of the spine by mechanically lifting each part of the spine vertically. Then, pain, walking ability, and depression scale were measured and analyzed in subjects who were aware of back pain. VAS(p<0.05) and ODI(p<0.05) for 10 days tended to decrease in average after bed use. In the gait ability test(p<0.05), as the number of times of bed use increased, the moving time in the test decreased and the moving distance increased. In addition, GSDDF(p<0.05) decreased after bed use. As a result, it was confirmed that the spinal segmentation caused by the heat and acupressure provided by the bed affected gait and depression as well as pain relief.

• Journal of Korean Neurosurgical Society
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• v.65 no.5
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• pp.719-729
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• 2022

Objective : The ossification of the ligamentum flavum (OLF) is one of the major causes of thoracic myelopathy. Surgical decompression with or without instrumented fusion is the mainstay of treatment. However, few studies have reported on the added effect of instrumented fusion. The objective of this study was to compare clinical and radiological outcomes between surgical decompression without instrumented fusion (D-group) and that with instrumented fusion (F-group). Methods : A retrospective review was performed on 28 patients (D-group, n=17; F-group, n=11) with thoracic myelopathy due to OLF. The clinical parameters compared included scores of the Japanese Orthopedic Association (JOA), the Visual analogue scale of the back and leg (VAS-B and VAS-L), and the Korean version of the Oswestry disability index (K-ODI). Radiological parameters included the sagittal vertical axis (SVA), the pelvic tilt (PT), the sacral slope (SS), the thoracic kyphosis angle (TKA), the segmental kyphosis angle (SKA) at the operated level, and the lumbar lordosis angle (LLA; a negative value implying lordosis). These parameters were measured preoperatively, 1 year postoperatively, and 2 years postoperatively, and were compared with a linear mixed model. Results : After surgery, all clinical parameters were significantly improved in both groups, while VAS-L was more improved in the F-group than in the D-group (-3.4±2.5 vs. -1.3±2.2, p=0.008). Radiological outcomes were significantly different in terms of changes in TKA, SKA, and LLA. Changes in TKA, SKA, and LLA were 2.3°±4.7°, -0.1°±1.4°, and -1.3°±5.6° in the F-group, which were significantly lower than 6.8°±6.1°, 3.0°±2.8°, and 2.2°±5.3° in the D-group, respectively (p=0.013, p<0.0001, and p=0.037). Symptomatic recurrence of OLF occurred in one patient of the D-group at postoperative 24 months. Conclusion : Clinical improvement was achieved after decompression surgery for OLF regardless of whether instrumented fusion was added. However, adding instrumented fusion resulted in better outcomes in terms of lessening the progression of local and regional kyphosis and improving leg pain. Decompression with instrumented fusion may be a better surgical option for thoracic OLF.

• The Journal of the Korea Contents Association
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• v.22 no.2
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• pp.326-336
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• 2022

This study aims to examine Korean learners' production of American English vowel focused on feature analysis. Specifically, the present study adopts feature analysis so that vowel production is analyzed in terms of vowel features as well as overall segmental accuracy. To this end, 22 Korean college students participated in a production test which contained 11 English vowels /i, ɪ, eɪ, ɛ, æ, ɑ, oʊ, ɔ, ʊ, u, ʌ/. The results revealed that the degree of difficulty varied depending on features; the Korean participants showed higher accuracy for front/back features than for tongue height features and tense/lax features. In particular, the participants had more difficulty producing back vowels and non-high vowels than front vowels and high vowels with respect to tongue height features and lip rounding features. Among the individual vowels, /eɪ/ showed the highest accuracy in feature analysis. On the other hand, /ɑ, ɔ, ʌ/ showed low accuracy with respect to height features and lip rounding features, and high vowels /i, ʊ, u/ showed low accuracy with respect to tense/lax features. As for the correlation between the vowel features, tongue height features and lip rounding features are significantly correlated. Also, tongue height features and tense/lax features showed a strong correlation. Finally, pedagogical implications for teaching English vowels were further discussed based on the findings of the current study.

• Journal of Trauma and Injury
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• v.36 no.4
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• pp.362-368
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• 2023

Purpose: Clinical reports on treatment outcomes of sternal fractures are lacking. This study details the clinical features, treatment approaches, and outcomes related to traumatic sternal fractures over a 10-year period at a single institution. Methods: A retrospective cohort study was conducted of patients admitted to a regional trauma center between January 2012 and December 2021. Among 7,918 patients with chest injuries, 266 were diagnosed with traumatic sternal fractures. Patient data were collected, including demographics, injury mechanisms, severity, associated injuries, sternal fracture characteristics, hospital stay duration, mortality, respiratory complications, and surgical details. Surgical indications encompassed emergency cases involving intrathoracic injuries, unstable fractures, severe dislocations, flail chest, malunion, and persistent high-grade pain. Results: Of 266 patients with traumatic sternal fractures, 260 were included; 98 underwent surgical treatment for sternal fractures, while 162 were managed conservatively. Surgical indications ranged from intrathoracic organ or blood vessel injuries necessitating thoracotomy to unstable fractures with severe dislocations. Factors influencing surgical treatment included flail motion and rib fracture. The median length of intensive care unit stay was 5.4 days (interquartile range [IQR], 1.5-18.0 days) for the nonsurgery group and 8.6 days (IQR, 3.3-23.6 days) for the surgery group. The median length of hospital stay was 20.9 days (IQR, 9.3-48.3 days) for the nonsurgery group and 27.5 days (IQR, 17.0 to 58.0 days) for the surgery group. The between-group differences were not statistically significant. Surgical interventions were successful, with stable bone union and minimal complications. Flail motion in the presence of rib fracture was a crucial consideration for surgical intervention. Conclusions: Surgical treatment recommendations for sternal fractures vary based on flail chest presence, displacement degree, and rib fracture. Surgery is recommended for patients with offset-type sternal fractures with rib and segmental sternal fractures. Surgical intervention led to stable bone union and minimal complications.

• Journal of Korean Neurosurgical Society
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• v.66 no.6
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• pp.716-725
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• 2023

Objective : Anterior cervical spine surgery (ACSS) is a common surgical procedure used to treat cervical spinal degenerative diseases. One of the complications associated with ACSS is prevertebral soft tissue swelling (PSTS), which can result in airway obstruction, dysphagia, and other adverse outcomes. This study aims to investigate the correlation between various cervical sagittal parameters and PSTS following single-level ACSS, as well as to identify independent risk factors for PSTS. Methods : A retrospective study conducted at a single institution. The study population included all patients who underwent single-level ACSS between January 2014 and December 2022. Patients with a history of cervical spine surgery or trauma were excluded from the study. The presence and severity of PSTS was assessed by reviewing pre- and postoperative imaging studies. The potential risk factors for PSTS that were examined include patient age, sex, body mass index, tobacco use, comorbidities, serum albumin levels, operative time, implant type, implanted level, and various cervical spine sagittal parameters. Multivariate linear regression analysis was performed to identify the independent risk factors for PSTS. Results : A total of 62 consecutive patients who underwent single-level ACSS over a 8-year period at a single institution were enrolled in this study. Only preoperative segmental angle showed positive correlation with PSTS among various cervical spine sagittal parameters (r=0.36, p=0.005). Artificial disc replacement showed a negative correlation with PSTS (β=-0.38, p=0.002), whereas the use of demineralized bone matrix (DBM) had a positive impact on PSTS (β=0.33, p=0.009). We found that male sex, lower preoperative serum albumin, and implantation of upper cervical level (above C5) were independent predictors for PSTS after single-level ACSS (β=1.21; 95% confidence interval [CI], 0.27 to 2.15; p=0.012; β=-1.63; 95% CI, -2.91 to -0.34; p=0.014; β=1.44; 95% CI, 0.38 to 2.49; p=0.008, respectively). Conclusion : Our study identified male sex, lower preoperative serum albumin levels, and upper cervical level involvement as independent risk factors for PSTS after single-level ACSS. These findings can help clinicians monitor high-risk patients and take preventive measures to reduce complications. Further research with larger sample sizes and prospective designs is needed to validate these findings.

• Journal of the Society of Disaster Information
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• v.20 no.2
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• pp.329-338
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• 2024

Purpose: This study verified the safety of the improved box-type girder behavior by comparing and evaluating the bending behavior results of a full-scale specimen based on the analytical behavior of the splice element PSC U-shaped girder with integrated tensioning systems. Method: Based on the results of the service and strength limit state design using the bridge design standard(limit state design method), the applied load of a 40m full-scale specimen was calculated and a static loading experiment using the four-point loading method was performed. Result: When the design load, crack load, and ultimate load were applied, the specimen deflection occurred at 97.1%, 98.5%, and 79.0% of the analytical deflection value. When the design load, crack load, and ultimate load were applied, the crack gauge was measured at 0.009~0.035mm, 0.014~0.050mm, and 6.383~5.522mm at each connection. Conclusion: The specimen behaved linear-elastically until the crack load was applied, and after cracks occurred, it showed strainhardening up to the ultimate load, and it was confirmed that the resistance of bending behavior was clearly displayed against the applied load. The cracks in the dry joints were less than 25% of grade B based on the evaluation of facility condition standard. The final residual deformation after removing the ultimate load was 0.114mm, confirming the stable behavior of the segment connection.

• The Journal of the Acoustical Society of Korea
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• v.28 no.2
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• pp.155-163
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• 2009

In text-to-speech systems, the conversion of text into prosodic parameters is necessarily composed of three steps. These are the placement of prosodic boundaries. the determination of segmental durations, and the specification of fundamental frequency contours. Prosodic boundaries. as the most important and basic parameter. affect the estimation of durations and fundamental frequency. Break prediction is an important step in text-to-speech systems as break indices (BIs) have a great influence on how to correctly represent prosodic phrase boundaries, However. an accurate prediction is difficult since BIs are often chosen according to the meaning of a sentence or the reading style of the speaker. In Japanese, the prediction of an accentual phrase boundary (APB) and major phrase boundary (MPB) is particularly difficult. Thus, this paper presents a method to complement the prediction errors of an APB and MPB. First, we define a subtle BI in which it is difficult to decide between an APB and MPB clearly as a variable break (VB), and an explicit BI as a fixed break (FB). The VB is chosen using the classification and regression tree, and multiple prosodic targets in relation to the pith and duration are then generated. Finally. unit-selection is conducted using multiple prosodic targets. In the MOS test result. the original speech scored a 4,99. while proposed method scored a 4.25 and conventional method scored a 4.01. The experimental results show that the proposed method improves the naturalness of synthesized speech.

• The Journal of the Acoustical Society of Korea
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• v.28 no.1
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• pp.77-83
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• 2009

This paper proposes a new noise-biased compensation of minimum statistics(MS) method using a nonlinear function and a priori speech absence probability(SAP) for speech enhancement in non-stationary noisy environments. The minimum statistics(MS) method is well known technique for noise power estimation in non-stationary noisy environments. It tends to bias the noise estimate below that of true noise level. The proposed method is combined with an adaptive parameter based on a sigmoid function and a priori speech absence probability (SAP) for biased compensation. Specifically. we apply the adaptive parameter according to the a posteriori SNR. In addition, when the a priori SAP equals unity, the adaptive biased compensation factor separately increases ${\delta}_{max}$ each frequency bin, and vice versa. We evaluate the estimation of noise power capability in highly non-stationary and various noise environments, the improvement in the segmental signal-to-noise ratio (SNR), and the Itakura-Saito Distortion Measure (ISDM) integrated into a spectral subtraction (SS). The results shows that our proposed method is superior to the conventional MS approach.