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Phytoncide, a forest healing indicator, is known to help suppress depression, anxiety, and stress of human. Furthermore, it has positive effects on blood pressures, pulses, and mood fluctuations. Previous studies mostly focused on phytoncide emission trends and its concentration prediction in forest. Moreover, a direct comparison of phytoncide concentrations between existing studies is often challenging owing to the use of differingunits, target analytes, analysis conditions, as well as unreported concentrations per type of the compound. Therefore, this study evaluated the overall performance of adsorption sampling and thermal desorption coupled with gas chromatography to evaluatethe phytoncide concentration in a forest atmosphere. To this end, the analysis quality management and analysis accuracy were evaluated for on-site samples in two different laboratories. The phytoncide analysis results obtained from each laboratory can serve as reference data for the adsorption capture-thermal desorption method applied to biogenic volatile organic compounds.

Ankle fractures are relatively common orthopaedic injuries; however, irreducible ankle fractures with or without dislocations are a rare, unstable type of injury that require surgical treatment. The structures impeding the accurate reduction of ankle fractures may be soft tissues, such as the deltoid ligament, extensor retinaculum, tendons, or bony fragments between the fracture sites. A 47-year-old male patient with irreducible medial malleolus and distal fibula fracture was referred for treatment. Intraoperatively, it was discovered that failed reduction was due to the interposition of the posterior tibial tendon in the syndesmosis. The posterior tibial tendon was pushed posteriorly through the tibiofibular interosseous interval and relocated to its anatomical position. Reduction and fixation were only achieved after relocation of the tendon. In conclusion, when anatomical reduction is not easily achieved, interposition of the posterior tibial tendon in the syndesmosis should be considered.

Background: Probiotics are live microorganisms that confer health benefits on the host. Many animal studies have shown that among the probiotics, lactobacilli exert favorable effects on bone metabolism. Herein, we report the results of a randomized controlled trial performed to investigate the effect of Lactobacillus fermentum (L. fermentum) SRK414 on bone health in postmenopausal women.Methods: The bone turnover markers (BTMs) and bone mineral density (BMD) in participants in the study group (N=27; mean age, 58.4±3.4 years) and control group (N=26; mean age, 59.5±3.4 years) were compared during a 6-month trial. BTMs were measured at pretrial, 3 months post-trial, and 6 months post-trial, while BMD was measured at pre-trial and 6 months post-trial. Changes in the gut microorganisms were also evaluated.Results: Femur neck BMD showed a significant increase at 6 months post-trial in the study group (P=0.030) but not in the control group. The control group showed a decrease in osteocalcin (OC) levels (P=0.028), whereas the levels in the study group were maintained during the trial period. The change in L. fermentum concentration was significantly correlated with that in OC levels (r=0.386, P=0.047) in the study group at 3 months post-trial.Conclusions: Probiotic (L. fermentum SRK414) supplementation was found to maintain OC levels and increase femur neck BMD during a 6-month trial in postmenopausal women. Further studies with a larger number of participants and a longer study period are required to increase the utility of probiotics as an alternative to osteoporosis medication.

Tibial torsion lacks a single and reliable method for its measurement. While physical examination, computed tomography (CT), and EOS imaging are used complementarily, three-dimensional (3D) CT is the most widely used method for intuitive documentation and visualization. However, concern regarding the associated radiation hazard limits its use in the evaluation of pediatric patients. Moreover, EOS machines are too expensive and too large to be placed in every clinic requiring the measurement of tibial torsion. Therefore, a new method for 3D reconstruction is needed. In the present study, we tested the validity and reliability of a novel reconstruction tool for the lower leg.A statistical shape model and Laplacian constraint were adopted for the development of a new reconstruction tool for measuring tibial torsion. Tibial torsion measurements based on a 3D reconstruction application and CT images for 36 patients were evaluated for intraobserver and interobserver reliability. Tibial torsion measurements for 75 patients were compared for validation.A 3D reconstruction system for the lower leg was developed as a mobile application and was installed in a portable device for easy access in the clinical setting. In terms of interobserver reliability, the intraclass correlation coefficient among 3 clinicians was 0.896 (95% confidence interval [CI], 0.828 to 0.941). The correlation coefficient between tibial torsion measured with use of 3D CT and that measured with the mobile application was 0.865 (p0.001).The mobile application showed excellent reliability and validity for measuring tibial torsion. Concurrent utilization with mobile application for the femur allows visualization of the rotational profile of the leg without the need for CT or EOS.Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Background: To compare refractive prediction errors between phacotrabeculectomy and phacoemulsification. Methods: Refractive prediction error was defined as the difference of spherical equivalent between the predicted value using the Barrett Universal II formula and the actual value obtained at postoperative one month. Forty-eight (48) eyes that had undergone uncomplicated phacotrabeculectomy (19 eyes, open-angle glaucoma; 29 eyes, angle-closure glaucoma) were matched with 48 eyes that had undergone uncomplicated phacoemulsification by age, average keratometry value and axial length, and their prediction errors were compared. The factors associated with prediction error were analyzed by multivariable regression analyses. Results: The absolute prediction error was larger in the phacotrabeculectomy group than in the phacoemulsification group (0.51 ± 0.37 Diopters vs. 0.38 ± 0.22, P=0.033). Larger absolute prediction error was associated with both longer axial length (P=0.010) and higher intraocular pressure difference (P=0.012). A logistic regression analysis showed that hyperopic shift (prediction error>0) was associated with shallower preoperative anterior chamber depth (P=0.024)and larger intraocular pressure difference (P=0.031). In the phacotrabeculectomy group, the prediction error was inversely correlated with axial length: long eyes showed myopic shift and short eyes hyperopic shift (P=0.002). Conclusions: Intraocular lens (IOL) power calculation might be less accurate in phacotrabeculectomy than in phacoemulsification due to large axial length and anterior chamber depth changes with intraocular pressure lowering. Surgeons therefore should be aware of the possibility of worse refractive outcomes when planning phacotrabeculectomy especially in eyes with high preoperative intraocular pressure, shallow anterior chamber depth, and/or extreme axial length.

The gait kinematics of an individual is affected by various factors, including age, anthropometry, gender, and disease. Detecting anomalous gait features aids in the diagnosis and treatment of gait-related diseases. The objective of this study was to develop a machine learning method for automatically classifying five anomalous gait features, i.e., toe-out, genu varum, pes planus, hindfoot valgus, and forward head posture features, from three-dimensional data on gait kinematics. Gait data and gait feature labels of 488 subjects were acquired. The orientations of the human body segments during a gait cycle were mapped to a low-dimensional latent gait vector using a variational autoencoder. A two-layer neural network was trained to classify five gait features using logistic regression and calculate an anomalous gait feature vector (AGFV). The proposed network showed balanced accuracies of 82.8% for a toe-out, 85.9% for hindfoot valgus, 80.2% for pes planus, 73.2% for genu varum, and 92.9% for forward head posture when the AGFV was rounded to the nearest zero or 1. Multiple anomalous gait features were detectable using the proposed method, which has a practical advantage over current gait indices, including the gait deviation index with a single value. The overall results confirmed the feasibility of using the proposed method for screening subjects with anomalous gait features using three-dimensional motion capture data.

Objectives This study aimed to investigate the association of self-reported weight change and physical activity with the level of knee pain and health-related quality of life in East Asian women with knee osteoarthritis using population-based data. Methods A total of 564 women (mean age, 68.2 years, standard deviation, 8.9 years) aged 50 years or older with knee osteoarthritis (Kellgren-Lawrence (K-L) grade ≥ 2) were included in the data analyses from the fifth Korea National Health and Nutrition Examination Survey. Data regarding the radiographic grade, self-reported weight change during the past year, physical activity, level of knee pain, and health-related quality of life (EuroQOL five-dimension (EQ-5D) index) were collected. Multiple regression analysis was performed to identify factors significantly associated with the level of knee pain and health-related quality of life in subgroups according to the body mass index (BMI) range (≤ 22.5, between 22.6 and 27.5, and > 27.5 kg/m2). Results In the whole group, the level of knee pain was significantly associated with K-L grade ( P < 0.001), and EQ-5D was negatively associated with age ( P < 0.001), the level of knee pain ( P < 0.001), and weekly hours of vigorous-intensity activity ( P = 0.026). In the subgroup analysis, weight gain showed significant association with the level of knee pain only in women with 22.5 kg/m2 < BMI ≤ 27.5 kg/m2 ( P = 0.006). Weight gain showed significant association with EQ-5D in women with BMI ≤ 22.5 kg/m2 ( P = 0.047) whereas weekly hours of moderate-intensity activity was negatively associated with EQ-5D in women with BMI > 27.5 kg/m2. Conclusions The association of weight change and physical activity with knee pain and health-related quality of life might be different according to BMI ranges. Well-designed interventions to improve both knee pain and health-related quality of life need to be investigated in future studies that would strictly control physical activity, diet, and weight changes.

Many elderly people use hip protectors to prevent hip fractures from sideways falls. These hip protectors absorb or shunt away the energy applied to the greater trochanter. Herein, shear-thickening polymer (STP)-based hip protectors composed of STP and polyurethane foam are studied. The purpose of this study was to identify the main factor that reduces the impact force directly applied to the femoral neck region and to determine the optimal thickness of STP in hip protectors. Seven hip protectors of different thicknesses were prepared, and two sets of free-fall mechanical tests with a low impact energy of 25.1 J and moderate impact energy of 44.1 J were conducted for each hip protector. When the thickness of STP exceeded 8 mm, the resultant peak force tended to plateau under both impact conditions, and the force attenuation capacity decreased even under low impact energy conditions. Thus, a hip protector with a 6 mm or 8 mm STP and 5 mm foam was recommended. The STP was the key factor affecting force attenuation capacity, not the polyurethane foam. However, the foam also played an important role in helping the STP function and improving compliance for users.

Children with cerebral palsy (CP) often have changes in proximal femoral geometry. Neck-shaft angle (NSA), Hilgenreiner epiphyseal angle (HEA) and head-shaft angle (HSA) are used to measure these changes. The impact of femoral rotation on HEA/HSA and of ab/adduction on HEA/HSA/NSA is not well known. This study aimed to determine and compare the effect of rotation, ab/adduction and flexion/extension on HEA/HSA/NSA. Radiographic measurements from 384 patients with Gross Motor Function Classification System (GMFCS) levels I-V were utilized. NSA/HSA for affected hips were used with femoral anteversion averages to create three-dimensional models of 694 hips in children with CP. Each hip was rotated, ab/adducted and flexed/extended to simulate malpositioning. HEA/HSA/NSA of each model were measured in each joint position, and differences from correct positioning were determined. Mean HEA error at 20° of internal/external rotations were -0.60°/3.17°, respectively, with the NSA error of -6.56°/9.94° and the HSA error of -3.69°/1.21°. Each degree of ab/adduction added 1° of the HEA error, with no NSA/HSA error. NSA was most sensitive to flexion. Error for all measures increased with increasing GMFCS level. HEA/HSA were minimally impacted by rotation. NSA error was much higher than HEA/HSA in internal rotation and flexion whereas HEA was sensitive to changes in ab/adduction. Given abduction is more easily detectable on imaging than rotation, HEA may be less affected by positioning errors that are common with children with CP than NSA. HSA was least affected by position changes. HEA/HSA could be robust, complementary measures of hip deformities in children with CP.

Radiographic factors estimate the state of the static knee joint, and it is questionable how well these parameters reflect the dynamic knee condition. The external knee adduction moment (KAM) during gait is known to be a kinetic variable contributing to osteoarthritis progression. This study aims to investigate the effects of static radiographic parameters on the dynamic KAM during gait.Overall, 123 patients (mean age, 65.7 years; standard deviation, 8.1 years; 34 men and 89 women) were included. Seven radiographic parameters including the mechanical tibiofemoral angle (mTFA), Kellgren-Lawrence grade, and ankle joint line orientation (AJLO) were measured on radiographs, and the maximum KAM and KAM-time integral in the stance phase were obtained using three-dimensional gait analysis. The correlation and multiple regression analyses were performed for identifying significant radiographic measurements associated with the KAM.Most of the radiographic measurements correlated with the maximum KAM and KAM-time integral. As a result of multiple regression analysis, the mTFA (p 0.001) and AJLO (p = 0.003) were identified as significant factors associated with the KAM-time integral (RThe mTFA and AJLO were significantly associated with the KAM. However, to be used as a surgical indication for corrective osteotomy, a longitudinal study is needed to validate whether the mTFA and AJLO values directly cause osteoarthritis progression as we have suggested.III.

This paper describes a conceptual design of hierarchical composite hydrogels. The hydrogel materials comprise MoS2 flakes and interpenetrating polymer networks, and further exhibit controlled release and tunable strength that are caused by the synergistic combination of select components. In terms of design, MoS2 flakes initiate radical polymerization of chosen monomers and simultaneously provide physical cross-linking points, both of which afford a primary composite network. Then, the sequential formation of additional networks results in functional, hierarchical, composite hydrogels. Therefore, we were able to demonstrate double-network hydrogels as a stimuli-responsive vector for programmed release of cargo molecules in response to heat or light or to form triple-network hydrogels showing tunable mechanical strength owing to intermolecular interaction between charged monomers and MoS2 flakes. The design concept would be expanded by incorporating other chalcogenides or functional monomers, which advance the properties and functionalities of materials and broadens the versatility of nanocomposite hydrogels.

OBJECTIVE We aimed to investigate the progression of patella alta (PA) in patients with cerebral palsy (CP) using the Koshino-Sugimoto (KS) index and assess associated risk factors. METHOD Participants in our retrospective study met the following inclusion criteria: patients with CP who visited our institute from May 2003 to December 2019, were ≤18 years of age, were followed up for >2 years and had at least two lateral knee radiographs. KS indices of both knee radiographs were measured for each patient. A linear mixed model was implemented. RESULTS Our participants included 222 CP patients. KS index values were measured via 652 knee radiographs. Reference values of the KS index for those between 4 and 18 years of age were determined according to Gross Motor Function Classification System (GMFCS) levels. In all GMFCS levels, the KS index decreased with patients' ages (P < 0.0001). In groups where the KS index increased, GMFCS levels IV (P = 0.0045) and V (P = 0.0040) were statistically significant. CONCLUSIONS Change in the KS index values indicates that PA improves as patients age within all GMFCS levels. However, in patients with GMFCS levels of IV and V, progressive PA is expected.

The purpose of the study was to investigate whether the position of the central retinal vascular trunk (CRVT), as a surrogate for lamina cribrosa (LC) offset, is associated with the dominant hemisphere of visual field defect in primary angle-closure glaucoma (PACG) eyes.Central retinal vascular trunk deviation was measured from Bruch's membrane opening (BMO) centre, which was delineated by OCT imaging, using the horizontal midline as a reference. The dominant hemisphere developing visual field defect was defined as three connected abnormal points (having a p-value 5% probability of being normal) appearing in only one hemisphere or each point of the hemisphere having a statistically worse value compared with its mirrored point in the opposite hemisphere on pattern deviation plots.One hundred five (80%) of 132 eyes with PACG had dominant hemisphere of visual field defect initially: 70 eyes (67%) in the superior and 35 eyes (33%) in the inferior hemisphere. The CRVT was located superiorly in the dominant superior visual field defect group (p 0.001). A logistic regression analysis revealed that superior deviation of the CRVT was the only factor associated with dominant superior visual field defect (p 0.001). Externally oblique border (EOB) presence was associated with larger BMO (p = 0.005) and angular deviation of CRVT (p = 0.002).Central retinal vascular trunk deviation was associated with the dominant hemisphere of visual field defect in PACG eyes. This finding implies that the LC position relative to the BMO centre (LC/BMO offset) may incur structural vulnerability in the optic nerve head of PACG eyes.

Background In a randomized controlled trial, we compared the bone mineral densities (BMDs) and blood markers of bone turnover during short-term treatment of osteoporotic women with bisphosphonate alendronate or bazedoxifene, a selective estrogen receptor modulator. Methods Ten and eleven patients were randomized to the alendronate and bazedoxifene groups, respectively. BMDs were measured before and after 6 months of treatment. Blood tests were used to measure the levels of osteocalcin (OC), C-terminal telopeptide of type I collagen (CTX), vitamin D3, and parathyroid hormone pretreatment and after 3 and 6 months of treatment. The variables were compared statistically. Results The alendronate group showed decreases in blood levels of both OC and CTX during the study period (P

A sustainable biobased thermoset exhibiting shape-memory behavior and modular recycling capabilities has been developed herein. The prepared thermoset consists of naringenin and biocompatible polymer components. Naringenin, which has three phenolic moieties, has been converted to a multifunctional monomer containing glycidyl groups and readily formed a thermosetting network via epoxide ring opening reaction with a poly(ethylene glycol) diacid under solvent-free conditions. The resulting material is malleable yet as strong as articular cartilage and selectively absorbs water when compared with n-dodecane oil. Moreover, the thermoset can be physically reused. After being crumpled, stretched, or coiled, the initial shape of the material is restored in response to heat or water. Furthermore, the material is amenable to chemical recycling in a bulk state via transesterification, and its components can be recovered on a molecular level after degradation under benign conditions, as was confirmed using a model co...

For the long-term dynamic simulation of a fluidized bed reactor (FBR), a two-way coupled computational fluid dynamics (CFD)-direct quadrature method of moments (DQMOM) approach is proposed. In this approach, CFD is first used only for hydrodynamic information without simulating any other chemical reactions or physical phenomena. Subsequently, the derived information is applied to the DQMOM calculation in MATLAB. From the calculation, a particle size distribution is obtained and subsequently adopted in a new CFD model to reflect the flow change caused by a change in the particle size distribution. Through several iterative calculations, long-term dynamic simulations are performed. To evaluate the efficacy of the proposed approach, the results from the suggested approach are compared for 60 s with those of the CFD-quadrature method of moments (QMOM) approach, which calculates hydrodynamics and physical phenomena simultaneously in CFD. The proposed approach successfully simulated the FBR for 6 h. The results confirmed that the proposed method can simulate complex flow patterns, which cannot be obtained in conventional CFD models. Another advantage of the approach is that it can be applied to various industrial multiphase reactors without any tuning parameters.

Aims Hip displacement, common in patients with cerebral palsy (CP), causes pain and hinders adequate care. Hip reconstructive surgery (HRS) is performed to treat hip displacement; however, only a few studies have quantitatively assessed femoral head sphericity after HRS. The aim of this study was to quantitatively assess improvement in hip sphericity after HRS in patients with CP. Methods We retrospectively analyzed hip radiographs of patients who had undergone HRS because of CP-associated hip displacement. The pre- and postoperative migration percentage (MP), femoral neck-shaft angle (NSA), and sphericity, as determined by the Mose hip ratio (MHR), age at surgery, Gross Motor Function Classification System level, surgical history including Dega pelvic osteotomy, and triradiate cartilage status were studied. Regression analyses using linear mixed model were performed to identify factors affecting hip sphericity improvement. Results A total of 108 patients were enrolled. The mean preoperative MP was 58.3% (SD 31.7%), which improved to 9.1% (SD 15.6%) at the last follow-up. NSA and MHR improved from 156.5° (SD 11.5°) and 82.3% (SD 8.6%) to 126.0° (SD 18.5°) and 89.1% (SD 9.0%), respectively. Factors affecting the postoperative MHR were preoperative MP (p = 0.005), immediate postoperative MP (p = 0.032), and history of Dega osteotomy (p = 0.046). Conclusion We found that hip sphericity improves with HRS. Preoperative MP, reduction quality, and acetabular coverage influence femoral head remodelling. We recommend that surgeons should consider intervention early before hip displacement progresses and that during HRS, definite reduction and coverage of the femoral head should be obtained. Cite this article: Bone Joint J 2021;103-B(1):198–203.

Patients’ perspectives on the conventional synthetic cast vs a newly developed open cast for ankle sprains

Previous research has suggested that cognitive functions such as execution, attention, memory, and perception differ when body position changes. However, the influence of body position on these cog...

BACKGROUND Idiopathic pes planovalgus is one of the most common foot deformities in children and adolescents. However, there is a discrepancy between subjective symptoms and radiographic severity in idiopathic planovalgus deformity, and very few studies have investigated this aspect. Further, the assessment of subjective symptoms in patients with pes planovalgus requires a quantitative scoring system for making meaningful comparisons, such as the Oxford Ankle Foot Questionnaire for Children (OxAFQ-c) and that for parents (OxAFQ-p). Therefore, the purpose of this study was to evaluate the factors affecting the symptoms of idiopathic planovalgus using the OxAFQ. METHODS All patients who were ≤18 years of age, had visited our clinic for the evaluation of pes planovalgus deformity, and had completed the OxAFQ were included in this study. The anteroposterior talo-first metatarsal, lateral talo-first metatarsal, and hallux valgus angles were measured on weight-bearing radiographs. The data were analyzed using a multiple regression model, with age, sex, and radiographic indices as explanatory variables. RESULTS Overall, 123 patients were enrolled in this study, and 246 standing foot radiographs were evaluated along with scores in each domain of the OxAFQ. The factors affecting physical domain scores in the OxAFQ-c were female sex (p = 0.047) and the anteroposterior talo-first metatarsal angle (p = 0.033). Age of ≥10 years was a significant factor (p < 0.05) affecting all domains in both the OxAFQ-c and OxAFQ-p other than the physical domain score. CONCLUSIONS Although pes planovalgus deformity is 3-dimensional, the forefoot abduction component of the deformity should be carefully assessed as it is closely related to subjective symptoms. Further, in female patients with a more severe anteroposterior talo-first metatarsal angle, an aggravation of symptoms with aging should be expected when managing pes planovalgus deformity. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Purpose To evaluate and compare the morphologic characteristics of buried optic disc drusen (ODD) and optic disc edema (ODE) by using en face optical coherence tomography (OCT) and OCT angiography (OCTA). Design Retrospective, cross-sectional study. Methods We reviewed the medical records of 61 patients (92 eyes) with buried ODD, 45 patients (62 eyes) with ODE, and 42 normal-appearing fellow eyes examined at 1 referral center between November 1, 2017 and April 30, 2019. Characteristic en face OCT and OCTA findings of buried ODD compared to those of ODE and normal optic discs were investigated. Results On en face OCT, all buried ODD were visualized as hyperreflective kidney-shaped masses well demarcated from the optic nerve axons, whereas ODE was visualized as ill-defined boundaries confluent with the retinal nerve fibers. On OCTA, 25.0% of the eyes with buried ODD showed a C-shaped vessel density decrease in the nasal radial peripapillary capillary layer, while 40.3% of the eyes with ODE had nonspecific focal vessel density decrease around the optic nerve head. Larger ODD were significantly associated with a vessel density decrease on OCTA (P = .009). The disc diameter positively correlated with the ODD area (r = 0.245; P = .018) and negatively correlated with the ODD height (r = −0.237; P = .023). Conclusions En face OCT showed the characteristic features of buried ODD compared to those of ODE or normal optic discs. The demarcation of buried ODD from the optic nerve axons on en face OCT and the poor vascular perfusion of buried ODD on OCTA suggest that buried ODD are materials deposited around the optic disc rather than the herniated optic nerve axon fibers.

Background Some patients with cerebral palsy (CP) exhibit excessive knee flexion at initial contact followed by knee hyperextension (KE) in mid-stance. Research question This study investigated the change in sagittal kinematics after distal hamstring lengthening (DHL) and triceps surae lengthening procedures in CP patients with KE, and compared it to those without KE. In addition, the risk factors for the worsening of postoperative KE were analyzed. Methods Consecutive 312 patients (596 limbs) with CP who underwent DHL and triceps surae lengthening were included. All patients underwent preoperative and 1-year postoperative three-dimensional gait analysis. Patients’ limbs were divided into the KE and knee flexion (KF) groups, according to preoperative minimum knee flexion in stance. KE was defined as minimum knee flexion in stance less than 0°. Results The KE and KF groups included 130 and 466 limbs, respectively. Knee and ankle sagittal kinematics significantly improved after surgery in both groups. Minimum knee flexion in stance significantly increased from -6.6˚ to 0.5˚ in the KE group, but decreased from 14.6˚ to 7.8˚ in the KF group. Among the KE group, minimum knee flexion in stance improved in 103 limbs (79.2 %), but worsened in 27 limbs (20.8 %). Degree of preoperative KE was the only factor significantly associated with postoperative worsening of KE (p=0.002). The cutoff value for the worsening of KE was -5.8˚ of preoperative minimum knee flexion in stance. Significance This study demonstrated that the sagittal kinematics of the knee and ankle joints improved after DHL and triceps surae lengthening procedures in CP patients with and without KE. Preoperative degree of KE was a risk factor for the worsening of KE after surgery. Therefore, careful selection for indication of DHL is required to prevent postoperative KE due to overlengthening of the hamstrings, particularly in patients with severe preoperative KE.

본 논문의 목적은 기생이 어떤 유교적 가치관을 지녔었는지를 알아보고 이를 통해 기생의 가치를 논해보는데 있다. 그리고 이를 설명함에 있어 기생의 시조를 활용하고자 한다. 전해지는 수는 적지만 기생은 조선시대 시조 작자 층의 한 축을 담당했고, 시조는 우리말로 쓴 국문문학이었기 때문에 정서와 사상을 가장 잘 담아냈다고 볼 수 있다. 그렇기에 시조에 나타난 기생들의 삶의 환경 그리고 거기서 얻은 경험을 통해 표현한 기생들의 가치관과 진정성을 살폈다. 8천에 속하는 천민인 기생들이 유교적인 가치관을 가지게 된 것은 당 시대의 사조이거니와 그 시대의 지식인층과 교류를 하기 위해서는 필수적인 요소라고 하겠다. 하지만 사대부 남성들이나 여성들의 유교적 인식과 차이를 두는 점은 경전을 비롯한 교리에 충실하지는 않았다고 본다. 오히려 현실에서 얻는 경험에 바탕을 두는 유교적 인식을 보여준다. 기생들이 이를 찾을 수 있는 경험은 사람과 사람의 만남에서 얻어진다. 그래서 인간의 내재된 본질을 말하는 사덕이나 오상보다는 유교에서 기본적인 인간관계를 나타내는 오륜 중에서 벗에게 요구되는 오륜의 가치인 믿음에서 찾을 수 있으며 이에 대한 사대부 남성들의 배신과 위선에 맞서는 모습을 보여준다. 더불어 국가의 위난이나 왕조의 교체 등 특수상황에 나타난 기생들의 희생정신의 가치를 충으로 보고 이를 사대부들의 변심과 엮어 풀어낸 기생들의 유교적인 가치관은 열녀적 태도로 이어지기도 했다. 사대부여성과 동일한 수준의 모습을 드러내며 위선적이고 거짓된 언사를 일삼는 남성들과는 다른 길을 가겠다는 뜻을 행동으로 나타낸다. 사대부들과 자신들은 다르다는 것을 주체적인 태도를 통해 보여주며 자신의 수준에 맞지 않는 남성이나 옳지 않다고 생각하는 일을 거부하는 모습을 통해 자신들의 가치를 스스로 찾아가는 주체적인 기생들의 모습을 밝혔다. 기생들은 자유와 억압, 양반의 머리 천민의 몸으로 표현되는 모순적인 삶 속에서 받는 상처와 외로움, 무시와 배신 등을 자신 스스로 타개해 나가고자 했으며 강요되지 않은 유교적 가치관을 주체적으로 수용하고 실천함으로써 그 가치를 증명했고, 문화의 한 축을 담당하는 존재로 자리매김 할 수 있었다.

This paper describes the multifunctional effect of molybdenum disulfide (MoS2) that enables the rapid and accessible preparation of nanocomposite hydrogels via a bottom-up design. The MoS2 nanoplat...

Background This study evaluate the radiographic changes in the mid-tarsal joint, including the calcaneocuboid and talonavicular (TN) joints after calcaneal lengthening for planovalgus deformity in children. Methods This study included 38 patients (68 feet) who underwent calcaneal lengthening for planovalgus deformity. Radiographic osteoarthritic changes at the CC or TN joint were defined as modified Kellgren–Lawrence grade of ≥1. Results Among the 68 feet, 31 feet (45.6%) showed radiographic osteoarthritic changes at the CC joint and 20 (29.4%) showed changes at the TN joint. Risk of radiographic osteoarthritic changes at the CC joint was associated with increased age at surgery (OR = 1.2, p = 0.038). Risk of radiographic osteoarthritic changes at the TN joint was associated with increased age at surgery (OR = 2.2; p = 0.002), preoperative AP talus-1st metatarsal angle (OR = 1.1; p = 0.044), and degree of CC subluxation (OR = 2.1; p = 0.007). Conclusions Surgeons should consider the risk factors in the surgical correction of planovalgus deformity to prevent mid-tarsal arthritis.

Intraosseous alignment of the tarsal bone has not been investigated in relation to various foot deformities. This study aimed to investigate three-dimensional computed tomography (3D CT) talar morphology in children with idiopathic and neuromuscular pes planovalgus. Eleven children [nine boys, two girls; mean (SD) age: 10.5 (2.8) years] with idiopathic pes planovalgus and 15 children [three boys, 12 girls; mean (SD) age: 10.8 (3.4) years] with neuromuscular pes planovalgus were included. All patients underwent 3D CT and weight-bearing anteroposterior, lateral, and axial radiography. Demographic data and talar 3D CT and radiographic measurements were compared between both groups. The correlation between the measurements was also analyzed. The neuromuscular group showed significantly more severe deformity than the idiopathic group in the radiographic and 3D sagittal talus measurements. The 3D coronal talus measurement showed a significant negative correlation with the axial hindfoot alignment in the idiopathic group while the 3D transverse talus measurement was significantly correlated with the lateral talocalcaneal angle in the neuromuscular group. 3D intraosseous alignment of the talus is correlated with pes planus deformity. Longitudinal and biomechanical studies including a control group are necessary to elucidate the role of 3D talar morphology on a dynamic imbalance in pes planovalgus.

Background: The os subfibulare is usually asymptomatic and found incidentally on radiographs. However, sometimes it may cause subfibular pain and may be associated with chronic lateral ankle instability (CLAI). We hypothesized that os subfibulare could interrupt the talofibular space causing impingement, resulting in chronic pain and functional instability around the lateral malleolus. The purposes of this study were to analyze morphologic characteristics of os subfibulare, and to evaluate the clinical significance of the os subfibulare in patients with CLAI. Methods: Between November 2011 and April 2015, 70 patients who had both computed tomography (CT) and magnetic resonance imaging (MRI) among 252 patients who visited our hospital with the symptom of lateral ankle instability were included in this study. The location of the ossicle was classified into 3 zones in reference to the attachment site of the lateral ankle ligaments. The impingement was classified into 2 groups according to the presence of talofibular encroachment. Digital radiographs were used to measure the ossicle width and shape determined by the length and width on an magnetic resonance (MR) image. Results: The most common shape of ossicles was oval, and the most common location of ossicles was at the anterior talofibular ligament (ATFL) attachment site. Sixty-one percent of patients showed talofibular impingement on coronal MR images. In 48 cases, the dimension of fibula plus os subfibulare was larger than that of the contralateral normal fibula. The larger size and talofibular impingement of the ossicle were associated with greater need for operative treatment in patients with ankle instability. Conclusion: The morphologic analysis of the os subfibulare revealed that there might be impingement of the talofibular space by the ossicle in some patients. We suggest that morphologic characteristics of the os subfibulare should be considered when selecting treatment options in patients with CLAI and os subfibulare. Level of Evidence: Level III, retrospective comparative series.

Plantar fasciitis is a common cause of heel pain affecting 10% of the general population. This study aimed to investigate the specific symptoms in patients with plantar fasciitis using the Foot and Ankle Outcome Score (FAOS) questionnaire and their relationship with demographic and radiographic factors.We retrospectively analyzed 73 consecutive patients (mean age, 53.8 ± 10.0 years; 20 men and 53 women) with plantar fasciitis who had visited our foot and ankle clinic and undergone weight-bearing foot X-ray examinations. Their demographic data, anteroposterior and lateral talo-first metatarsal angles, intermetatarsal and hallux valgus angles, and responses to the FAOS questionnaire were recorded.The quality-of-life subscale showed the lowest score of all FAOS subscales. Age was significantly correlated with quality of life (Demographic factors were associated with specific symptoms in patients with plantar fasciitis. Calcaneal spur size was the only radiographic parameter correlated with symptoms. These findings help communicate with patients, set appropriate treatment goals, and evaluate treatment effectiveness.

AimsTo investigate the longitudinal changes of peripapillary retinal nerve fibre layer (RNFL) and choroidal thickness during myopic axial elongation.MethodsPeripapillary RNFL and choroidal thickness were prospectively evaluated by spectral-domain optical coherence tomography (SD-OCT) in 46 eyes of 23 myopic children over the course of 4 years. Using serial OCT images acquired based on a fixed scan circle in the glaucoma progression analysis mode, general and sectoral RNFL thicknesses were acquired at the same position and the angular location of the peak was measured. The peripapillary choroidal thickness likewise was measured at eight positions in serial OCT images.ResultsThe mean age at the baseline was 9.6±1.7 years. The mean axial length increased from 24.80±1.28 mm to 25.64±1.35 mm. The global peripapillary RNFL thickness was 98.54±12.06 µm at baseline. The global and sectoral RNFL thicknesses did not change during the 4 years. The angular location of RNFL peaks was also stable and was located in the superotemporal (64.18±10.85°) and inferotemporal (293.98±11.62°) sectors. The global peripapillary choroidal thickness was 145.40±28.67 µm at the baseline. The global and sectoral choroidal thicknesses did not change during the 4 years.ConclusionsThe peripapillary RNFL and choroidal thicknesses as well as the locations of the RNFL peaks had been preserved, during the 4-year follow-up on myopic children, when traced and measured from the same location.

Gait, the style of human walking, has been studied as a behavioral characteristic of an individual. Several studies have utilized gait to identify individuals with the aid of machine learning and computer vision techniques. However, there is a lack of studies on the nature of gait, such as the identification power or the uniqueness. This study aims to quantify the uniqueness of gait in a cohort. Three-dimensional full-body joint kinematics were obtained during normal walking trials from 488 subjects using a motion capture system. The joint angles of the gait cycle were converted into gait vectors. Four gait vectors were obtained from each subject, and all the gait vectors were pooled together. Two gait vectors were randomly selected from the pool and tested if they could be accurately classified if they were from the same person or not. The gait from the cohort was classified with an accuracy of 99.71% using the support vector machine with a radial basis function kernel as a classifier. Gait of a person is as unique as his/her facial motion and finger impedance, but not as unique as fingerprints.

To compare the inter-strain differences of three rodent glaucoma models as induced by magnetic bead injection, hydrogel injection, and circumlimbal suture.In Brown Norway (BN) and Sprague Dawley (SD) rat strains, intraocular pressure (IOP) was elevated by injection of magnetic beads or hydrogel to obstruct the aqueous humor outflow or by external compression of circumlimbal suture. Maximum and average IOP values were compared according to both procedure and rat strain over 1 month postoperatively. Retinal ganglion cell (RGC) density loss was evaluated using confocal microscopic images of the flat-mounted retina obtained at postoperative days 14 and 30.The maximum IOPs were higher in the hydrogel injection or circumlimbal injection models than in the magnetic bead injection model (P0.001), whereas average IOP showed no difference between the two strains (both P ≥ 0.05). A generalized estimating equation regression model showed that the IOP increase was maintained better in the BN rats than in the SD rats (P0.001). Such inter-strain difference was smaller in the circumlimbal suture model. A significant decrease in RGC density was observed in all of the models for the BN rats and in the circumlimbal suture model for the SD rats at postoperative day 30.BN rats were advantageous for the magnetic bead or hydrogel injection model, but either rat strain could be used for the circumlimbal suture model. Strains should be considered cautiously when establishing rodent glaucoma models with different IOP profiles.This comparison offers the best strain for each rodent glaucoma model for assessment of glaucoma-relevant therapeutics.

Scrambler therapy is a noninvasive electroanalgesia technique designed to remodulate the pain system. Despite growing evidence of its efficacy in patients with neuropathic pain, little is known about the clinical factors associated with treatment outcome. We conducted a prospective, open-label, single-arm trial to assess the efficacy and safety of scrambler therapy in patients with chronic neuropathic pain of various etiologies. A post-hoc analysis was performed to investigate whether cluster analysis of the Neuropathic Pain Symptom Inventory (NPSI) profiles could identify a subgroup of patients regarding neuropathic pain phenotype and treatment outcome. Scrambler therapy resulted in a significant decrease in the pain numerical rating scale (NRS) score over 2 weeks of treatment (least squares mean of percentage change from baseline, − 15%; 95% CI − 28% to − 2.4%; p

Although many radiographic measurements of the foot and ankle have been used, reference values for normal functional groups are rarely reported. These can change according to sex and age; therefore, this study aimed to: (1) determine reference values for radiographic foot and ankle angles in an asymptomatic healthy Korean population, and (2) compare differences in the measurements according to sex and age. A total of 200 healthy volunteers were recruited, including 100 young adults (50 males, 50 females) aged 20 to 35 years, and 100 older adults (50 males, 50 females) aged 60 to 69 years. Weightbearing ankle anteroposterior views, talar tilt, and tibiotalar angles were measured. On the weightbearing foot anteroposterior views, the hallux valgus, hallux interphalangeal, and talo-first metatarsal angles were measured. On the weightbearing lateral foot views, the calcaneal pitch, lateral talo-calcaneal, lateral talo-first metatarsal, and lateral calcaneo-first metatarsal angles were measured. Values were stratified by sex and age, and statistically compared. The hallux valgus, calcaneal pitch, and lateral calcaneo-first metatarsal angles were affected by both sex and age; the hallux interphalangeal angle was affected by age and the lateral talo-first metatarsal angle by sex. We presented reference values for foot and ankle radiographic measurements in a healthy Korean population; several radiographic indices varied significantly by sex or age, which were grossly similar to previous studies based on white race. The study data can serve as a basis for evaluation of foot and ankle disorders.

This study demonstrates the preparation of dual cross-linked hydrogels capable of selective, spontaneous de-cross-linking behavior triggered by head-to-tail depolymerization. A primary covalent structure of the materials was established on a thermoresponsive network containing pendant functional moieties that could induce noncovalent interaction when combined with a macro-cross-linker. The incorporation of the macro-cross-linker not only reinforced the entire structure while providing secondary physical cross-linking but also caused the resulting materials to show autonomous responses via depolymerization. As a result, transformation of the material was achieved without structural collapse, as the noncovalent network in the materials was rapidly, selectively, and completely removed through the depolymerization reaction of the polymer cross-linker when initiated by a trace (

Many anatomical factors, such as bone geometry and muscle condition, interact to affect human movements. This work aims to build a comprehensive musculoskeletal model and its control system that reproduces realistic human movements driven by muscle contraction dynamics. The variations in the anatomic model generate a spectrum of human movements ranging from typical to highly stylistic movements. To do so, we discuss scalable and reliable simulation of anatomical features, robust control of under-actuated dynamical systems based on deep reinforcement learning, and modeling of pose-dependent joint limits. The key technical contribution is a scalable, two-level imitation learning algorithm that can deal with a comprehensive full-body musculoskeletal model with 346 muscles. We demonstrate the predictive simulation of dynamic motor skills under anatomical conditions including bone deformity, muscle weakness, contracture, and the use of a prosthesis. We also simulate various pathological gaits and predictively visualize how orthopedic surgeries improve post-operative gaits.

This study aimed to estimate the annual change in radiographic indices for juvenile hallux valgus (JHV) and to analyze the factors that influence deformity progression.Patients aged15 years who had JHV and were followed up for at least 1 year were included. Hallux valgus angle (HVA), hallux interphalangeal angle, intermetatarsal angle, metatarsus adductus angle, distal metatarsal articular angle, anteroposterior talo-first metatarsal angle, and lateral talo-first metatarsal angle were evaluated. The progression rate of HVA was adjusted by multiple factors by using a linear mixed model.A total of 133 feet were included. The HVA and distal metatarsal articular angle both increased by 0.8° per year (p0.001 and p=0.003, respectively). HVA increased by 1.5° per year (p0.001) at under the age of 10, and the HVA progression in the older patients was not statistically significant.JHV deformity could progress with aging. Most deformity progression could occur before the age of 10 years.