Effects of head posture on the rotational torque movement of mandible in patients with temporomandibular disorders

치의학과/박사[한글] 측두하악장애환자들이 일상에서 취할 수 있는 여러형태의 두경부자세에 따른 하악의 torque 회전운동량의 변화를 측정하여 하악기능장애의 임상적 진단 및 치료과정의 판단에 필요한 하악운동상태의 정확한 분석과 평가를 위해 본 연구를 시행하였다. 연구대상으로는 측두하악장애 증상이 없는 대조군 30명과 1997년 11월부터1999년 9월까지 연세대학교 치과대학병원에 내원한 편측성 측두하악장애 환자 90명을 대상으로 하였으며 임상 및 방사선 검사결과에 따라 각각 정복성 관절원판 변위환자 30명, 비정복성 관절원판 변위 환자 30명, 퇴행성 관절질환 환자 30명으로 분류하였다. 관찰된 두경부자세는 직립자세, 상방자세, 하방자세 및 두부전방자세 등 4가지로 각각에서 하악의 개폐구 운동, 좌우 측방운동, 전방운동시 하악 torque 회전운동량을 측정하였다. 하악 torque 회전운동량은 Bio-EGN(Bioreserch Inc, Wl,USA)의 Rotate 프로그램을 이용하여 전두면상 회전각도, 수평면상 회전각도를 관찰했고 측정시마다 동일한 두경부자세를 견지하기 위해 경부운동범위 측정기구인 CROM(Performance attainment Inc, St. Paul, USA)을 사용해 조정하였으며 상, 하방 자세시의 경사도는 30도로 하였으며 두부전방자세의 거리는 4cm로 하였다. 수집된 자료를 통계처리해서 다음의 결론을 얻었다. 1. 대조군에서 최대개구운동시 상방두부자세에서의 하악 torque 회전운동량이 하방두부자세 및 두부전방자세에서의 하악 torque 회전운동량보다 컸으며, 정복성 관절원판 변위군에서 측방운동시 직립두부자세에 비해 하방두부자세 및 두부전방자세에서의 하악 torqu e 회전운동량이 컸다(p<0.05). 2. 비정복성 관절원판 변위군에서 최대개구운동 및 측방운동시 또한 퇴행성 관절질환군에서는 최대개구운동, 측방운동 및 전방운동시 두부전방자세에서의 하악 torque 회전운동량이 다른 두경부자세에 비해서 컸다(p<0.05). 3. 직립두부자세에서 최대개구운동시 대조군의 전두면상 회전운동각도가 세 환자군의 전두면상 회전운동각도보다 컸으며, 정복성 관절원판 변위군의 전두면상 회전운동각도가 비정복성 관절원판 변위군의 전두면상 회전운동각도보다 컸고, 비정복성 관절원판 변위군의 수평면상 회전운동각도가 정복성 관절원판 변위군 및 퇴행성 관절질환군의 수평면상 회전운동각도보다 컸다(p<0.75). 4. 이환측으로의 측방운동시 비정복성 관절원판 변위군의 하악 torque 회전운동량이대조군 및 정복성 관절원판 변위군의 하악 torque 회전운동량보다 컸으며, 비이환측으로의 측방운동시 비정복성 관절원판 변위군의 전두면상 회전운동각도가 대조군의 전두면상 회전운동각도보다 작았으며, 비정복성 관절원판 변위군의 수평면상회전운동각도가 정복성 관절원판 변위군의 수평면상 회전운동각도보다 컸다(p<0.05). 5. 전방운동시 대조군의 전두면상 회전운동각도가 정복성 및 비정복성 관절원판 변위군의 전두면상 회전운동각도보다 작았으며 수평면상 회전운동각도는 비정복성관절원판 변위군 및 퇴행성 관절질환군의 수평면상 회전운동각도보다 작았고, 비정복성 관절원판 변위군의 수평면상 회전운동각도는 정복성 관절원판 변위군 및퇴행성 관절질환군의 수평면상 회전운동각도보다 컸다(p<0.05). 6. 비정복성 관절원판 변위군 및 퇴행성 관절질환군에서 이환측으로 측방운동시의하악 torque 회전운동량7l 비이환측으로 측방운동시의 하악 torque 회전운동량보다 컸다(p<0.05). 이와같은 소견을 종합해 볼 때 두경부자세에 따라 하악운동시의 하악 terque 회전운동량은 변화하며, 측두하악관절내장증 및 퇴행성 판절질환자는 다른 두경부자세보다 두부전방자세에서 하악 torque 회전운동량이 큰 것을 알 수 있었다. 또한 측두하악장애와 두경 부자세 간에는 여러 측면에서 관련성을 관찰할 수 있으므로 두경부자세를 을바르게 하는 것이 중요하며 특히 기능장애를 보이는 측두하악장애환자들에서는 그 중요성이 더 크다고 볼 수 있다. 그러므로 측두하악장애환자를 다루는 임상가의 입장에서는 측두하악장애환자들이 취하는 두부전방자세가 하악의 비대칭적기능을 심화시킬 수 있음을 알고 이러한 불량한 자세를 진찰을 통해 발견하고 교정하는 것이 치료목표가 될 수 있다. [영문] The purpose of this study was to evaluate the effect of specific head positions on the mandibular rotational torque movements in maximum mouth opening, protrusion and lateral excursion. Thirty dental students without anysign or symptom of temporomandibular disorders(TMDs) were included as acontrol group and 90 patients with TMDs were selected and examined by routine diagnostic procedure for TMDs including radiographs and were classified into 3 subgroups disc displacement with reduction, disc displacement without reduction, and degenerative joint disease. Mandibular rotational torque movements were observed in four head postures; upright head posture(NHP), upward head posture(U7), downward head posture(DHP), and forward head posture(FHP). For UHP, the head was inclined 30 degrees upward; for DHP, the head was inclined 30 degrees downward; for FHP, the head was positioned 4cm forward. These positions were adjusted with the use of cervical range-of-motion instrumentation(CROM, Performance Attainment Inc, St. Paul, U.S.A.).Mandibular rotational torque movements were monitored with the Rotate program of BioPAK system (Bioresearch Inc, Wl, U.S.A.). The rotational torque movements in frontal and horizontal plane during mandibular border movement were recorded with two parameters; frontal rotational torque angle and horizontal rotational torque angle. The data obtained was analyzed by the SAS/Stat Program. The obtained results were as follows: 1. The control group showed significantly larger mandibular rotational angles in UHP than those in DHP and FHP during maximum mouth opening in both frontal and horizontal planes. Disc displacement with reduction group showed significantly larger mandibular rotational angles in DHP and FHP than those in NHP during lateral excursion to the affected and non-affected sides in both frontal and horizontal planes(p<0.05). 2. Disc displacement without reduction group showed significantly larger mandibular rotational angles in FHP than those in any other head postures during maximum mouth opening as well as lateral excursion to the affected and non-affected sides in both frontal and horizontal planes. Degenerative joint disease group showed significantly larger mandibular rotational angles in FHP than those in any other head postures during maximum mouth opening, protrusion and lateral excursion in both frontal and horizontal planes(p<0.05) 3. In NHP, mandibular rotational angle of the control group was significantly larger than that of any other patient subgroups. Mandibular rotational angle of disc displacement with reduction group was significantly larger than that of disc displacement without reduction group during maximum mouth opening in the frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of disc displacement with reduction group or degenerative joint disease group during maximum mouth opening in the horizontal plane(p<0.05). 4. In NHP, mandibular rotational angles of disc displacement without reduction group were significantly larger than those of the control group or disc displacement with reduction group during lateral excursion to the affected side in both frontal and horizontal planes. Mandibular rotational angle of disc displacement without reduction group was significantly smaller than that of the control group during lateral excursion to the non-affected side in frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of disc displacement with reduction group during lateral excursion to the non-affected side in the horizontal plane(p<0.05). 5. In NHP, mandibular rotational angle of the control group was significantly smaller than that of disc displacement with reduction group or disc displacement without reduction group during protrusion in the frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of the disc displacement with reduction group or degenerative joint disease group during protrusion in the horizontal plane. Mandibular rotational angle of the control group was significantly smaller than that of disc displacement without reduction group or degenerative joint disease group during protrusion in the horizontal plane(p<0.05). 6. In NHP, disc displacement without reduction group and degenerative joint disease group showed significantly ]armer mandibular rotational angles during lateral excursion to the af(acted side than during lateral excursion to the non-affected side in both frontal and horizontal planes(p<0.05).The findings indicate that changes in head posture can influence mandibular rotational torque movements. The more advanced state is a progressive stage of TMDs, the more influenced by FHP are mandibular rotational torque movements of the patients with TMDs.ope

유방암 검출 향상을 위한 디지털 유방 토모신세시스의 영상 획득 파라미터에 관한 연구

Dept. of Radiological Science/박사Conventional mammography provides the projection of two-dimensional (2D) images from three-dimensional (3D) anatomical structures. This leads to a high false positive rate and an excess of mammography recalls and biopsies, with non-trivial morbidity risks because overlapping structures produce shadows and artifacts. Digital breast tomosynthesis (DBT) is a new 3D technique of imaging that can be expected to solve this problem by reducing or eliminating tissue overlap. DBT system has all the advantages of conventional mammography because DBT is based upon modifications to existing conventional mammography system and can perform both 2D mammography and 3D tomosynthesis with the same unit. However, DBT system is fundamentally limited by the limited angular range and incomplete set of projections and its constraints can cause non-isotropic resolution and propensity to artifacts. Thus, this dissertation has focused on improvement of new DBT technology. The purpose of this study is to investigate the effect of acquisition exposure parameters and geometry parameters, and to characterize their relationships for the newly developed DBT system. To study optimal values for exposure parameters, the analysis was based on the simulated micro-calcifications on homogeneous phantoms, and the figure of merit (FOM) was retrieved from the contrast-to-noise ratio (CNR) and average glandular dose (AGD). In addition, the optimal acquisition parameters for this system were compared with those of conventional mammography. To investigate the effects of acquisition geometry parameters, the CNR for in-focus plane quality and the artifact spread function (ASF) for resolution in the z-direction were used for optimizing the angular range and number of projection view (PV). And the effects of the various PVs and angular dose (AD) distributions on the quality of reconstructed images obtained using a constant total dose is evaluated using these factors. A prototype DBT system which has a CsI(Tl) scintillator/CMOS flat panel digital detector and x-ray generator of tungsten/rhodium (W/Rh) anode/filter combinations was used for the acquisition of DBT scans.The optimal kVp increased more than 2 kV with increasing glandularity for thicker (≥50 mm) breast. The optimal kVp for DBT was found to be 4 kV-7 kV higher than that calculated for conventional mammography with breast phantoms thicker than 50 mm. In the study of acquisition parameters, a wide angular range improved the reconstructed image quality in the z-direction, while the image quality of microcalcifications in the in-focus plane did not improve with increasing noise due to the greater effective breast thickness. And Increasing the central PV density or angular dose improved reconstructed image quality, an excessive PV density at center increased noise in peripheral views to the detriment of image quality. Therefore, a strategic trade-off among physical imaging properties may be necessary to optimize diagnostic accuracy in a DBT system. The results and the findings of this dissertation are expected to be utilized as a basic theory in analytical protocol that may improve image quality in DBT.restrictio

1982년에서 2006년까지 동북아시아 지역에서 식생의 시공간적 변동과 기후변수와의 관계

In order to examine surface changes over East Asia, in response to the climate change, mean NDVI data for the growing seasons (April–October) from 1982 to 2006 were used to examine the spatiotemporal variations in the vegetation. Results indicate that there was a prominent change in the trend of NDVI around the mid‐1990s: a pronounced positive trend over most of the Northeast Asian domain before the mid‐1990s (1982–1996), consistent with findings from other studies and a reverse (or weakened) trend after the mid‐1990s (1997–2006). The reverse trend is evident over the higher‐latitude regions north of 50°N and the eastern Mongolian border area. Distinct declines in the local vegetation greenness after the mid‐1990s were shown more clearly in seasonal variations of NDVI anomalies. During the springtime (April-May), most area except some northeast parts of Mongolia experienced severe reductions of NDVI after the mid-1990s, which was dominant especially in the higher latitudes of 50°N. Vegetation in the cultivated areas of North China had increased in summertime (June-August), while vegetation in the higher latitudes of 50°N showed a decline trend after the mid-1990s.Decreasing of summertime NDVI was obvious particularly in the south of Mongolia and Inner-Mongolia near the Gobi border. During the autumn (September-October), vegetation reduction after the mid-1990s was great in the northeast Mongolia and east parts of Lake Baikal, while vegetation continuously increased over the other areas. Possible causes in the vegetation changes were examined with other climate variables. It was suggested that the dominant warming trend during growing season until the mid‐1990s led to the increased NDVI in most North East Asia, especially over the high‐latitude regions. However, after the mid‐1990s, the reverse NDVI trend found primarily in the east of Lake Baikal and the arid and semiarid regions south of 50°N seems to be closely linked to local precipitation changes occurred abruptly in the mid‐1990s despite the continued temperature rise. Based on the assumption that surface vegetation changes should lead to the radiation energy budget, possible influences of vegetation changes on surface albedo and longwave radiation were examined. It was indicated that change in surface albedo in the clear-sky condition seems to be not directly related to the variation of vegetation but closely associated with changes in soil moisture. On the other hand, clear-sky outgoing longwave radiation at surface showed continuous increasing trend over the whole area with maximum in Mongolia for the whole period, because of increased temperature associated with anthropogenic warming. Overall, influences of surface vegetation changes on the radiation budget over the twenty-year analysis period appeared to be less significant.1. Introduction 1_x000D_ 2. Climate Change 6_x000D_ 2.1 Global warming 6_x000D_ 2.2 Temperature change 7_x000D_ 2.3 Precipitation change 13_x000D_ 2.4 Vegetation change 17_x000D_ 2.5 Land surface radiation change 20_x000D_ 3. Data and Methods 23_x000D_ 3.1 NDVI data 23_x000D_ 3.2 Temperature and precipitation data 25_x000D_ 3.3 Soil moisture Data 26_x000D_ 3.4 Surface Radiation Budget(SRB) Data 27_x000D_ 3.5 Methodologies 28_x000D_ 4. Variations in Vegetation Activity and Climate Variables 32_x000D_ 4.1 Trend change in mean growing season NDVI 32_x000D_ 4.1.1 Spatial pattern of NDVI trend 32_x000D_ 4.1.2 Trends in spatially averaged NDVI 36_x000D_ 4.2 Spatio-temporal variations of NDVI and climate variables 39_x000D_ 4.2.1 EOF analysis of NDVI 39_x000D_ 4.2.2 EOF analysis of precipitation and temperature 43_x000D_ 4.3 Trend Changes of NDVI Around 1997 49_x000D_ 4.4 Seasonal variation in NDVI and climate variables 51_x000D_ 4.4.1 Trends in spatially averaged seasonal NDVI, temperature and precipitation 51_x000D_ 4.4.2 Trend changes in seasonal NDVI 62_x000D_ 5. NDVI changes related to the climate variables 67_x000D_ 5.1 Spatial correlation between NDVI and climate variables 67_x000D_ 5.2 NDVI changes related to precipitation and temperature 72_x000D_ 5.2.1 Growing season 72_x000D_ 5.2.2 Spring 79_x000D_ 5.2.3 Summer 86_x000D_ 5.2.4 Autumn 93_x000D_ 6. Vegetation changes related to soil moisture 103_x000D_ 6.1 Variation of soil moisture 104_x000D_ 6.2 NDVI variations in association with soil moisture 108_x000D_ 7. Variations in clear-sky surface radiation budget 112_x000D_ 7.1 Variations in the clear sky surface albedo 113_x000D_ 7.2 Variations in outgoing longwave radiation at surface in the clear sky 120_x000D_ 7.3 Relationship between surface radiation budgets, NDVI, soil moisture and climate variable 124_x000D_ 7.3.1 Changes in surface albedo related to vegetation 124_x000D_ 7.3.2 Changes in surface albedo related to soil moisture 128_x000D_ 7.3.3 Surface OLR changes related to temperature 134_x000D_ 8. Summary and discussions 136_x000D_ References 144Docto

(A) comparative study on the temporomandibular joint sounds before and after occlusal splint therapy using electrovibrato

치의학과/석사[한글] 연구 대상자는 두개하악장애 치료를 위해 연세대학교 치과병원 구강내과에 내원한 환자 22명(평균 나이 24.3±7.6세)이었으며 대상자들에게 병력조사와 임상검사 및 방사선 촬영을 시행하여 세군으로 나누었으며(정복성 관절원판 변위군, 비정복성 관절원판 변위군, 퇴행성 관절질환군)치료전 악관절음을 Sonopak을 이용하여 측정하였으며 평균 2.7±0.8개월의 교합안정 장치를 포함한 보존적 치료 후 Sonopak으로 악관절음을 재측정하였다. Sonopak상 진동 관련항목으로는 진동 총에너지, 고주파 진동에너지, 저주파에 대한 고주파 비율, 최대진폭, 최대 주파수, 중간 주파수이었으며 환자가 주관적으로 느끼고 있는 악관절음의 크기는 가시적 상사 척도를 이용하여 표시하게 하였으며 연구 결과는 다음과 같다. 1. 초진시 세가지 환자군에서 정복성 관절원판 변위군의 최대 진폭이 다른 두군보다 유의하게 크게 관찰되었으며 퇴행성 관절질환군의 중간 주파수가 세군중에서 가장 높게 나타났으며 저주파에 대한 고주파의 비율과 최대 주파수는 다른 두 군보다 높은 경향을 보였다. 비정복성 관절원판 변위군에서 고주파 진동에너지가 다른 두 군보다 유의성 있게 낮게 나타났으며 진동 총에너지는 낮은 경향을 보였다. 2. 교합안정장치를 포함한 보존적 치료후 퇴행성 관절 질환군이 진동 총에너지에서 유의성 있게 감소했고 정복성 관절원판 변위군의 고주파 진동에너지가 유의성 있게 감소했으며 그 외 진동 관련 항목도 감소 경향을 보였다. 3. 악관절음 치료지수(VAS Ti)는 급성 (증상 보유기간 6개월 미만)보다 만성(증상 보유기간 6개월 이상)에서 약간 높은 경향을 보였다. 구강 악습관(이갈이, 이악물기, 편측저작) 소유자는 비소유자보다 악관절음 치료지수가 약간 높은 경향을 보였다. 외상 경험자는 무경험자보다 악관절음 치료지수가 약간 높은 경향을 보였다. 이상의 결과를 종합해 볼 때 교합안정장치를 비롯한 보존적 치료가 두개하악장애의 악관절음 치료에 어느 정도 효과가 있었으며, Sonopak은 두개하악장애환자의 진단 및 치료평가에서 비교적 조작이 간편하고 정확한 정보를 얻을 수 있는 유용한 방법으로, 향후 보 다 다양하고 장기간의 관절음에 관한 연구 등이 필요하리라 사료된다. [영문] This study was performed to compare the TMJ sounds by means of vibration-related items by Sonopak such as integral, high integral, above 300/(0-300)ratio, peak amplitude, peak frequency and median frequency before and after occlusal splint therapy as well as counselling, phyaical modalities. For this study 22 patients with craniomandibular disorders (CMDs) were selected and examined by routine diagnostic procedure for CMDs including Transcranial and Panoramic radiographs and were classified into 3 CMDs subgroups : disc displacement with reduction disc displacement without reduction, and degenerative joint disease. Visual analogue scale (VAS) about joint sound was recorded during treatment period and VAS treatment index (VAS Ti) was calculated Trom the VAS data and treatment duration. The author evaluated and compared treatment results by several parameters such as symptom duration, parafunctional habits, trauma, and diagnostic classification. The obtained results were as follows : 1. Before the treatment, the highest value of peak amplitude was observed in disc displacement with reduction group and value of median frequency was highest in degenerative joint disease group. In addition the highest values of peak frequency and ratio were observed in degenerative joint disease group, though they were not significant. Furthermore the lowest value of high integral was observed in disc displacement without reduction group and though it was not significant, value of integral was lowest in that group. 2. Among 3CMDS subgroups disc displacement with reduction group showed the significantly decreased value of high integral and degenerative joint disease group had the significantly decreased value of integral after conservative treatment including occlusal splint therapy. Conclusively conservative treatment including occlusal splint therapy may be effective in the treatment of CMDs including TMJ sound. 3. Fair prognosis for conservative treatment was observed in acute group under 6 months than chronic group, 6 months over in symptom duration but there was no statistical difference. The result for conservative treatment was observed slightly poor in subjects with bruxism, clenching, unilateral chewing habit and trauma history but there were no statistical differences.restrictio

평가 보상기제의 차별적 효과에 관한 연구

학위논문 (석사)-- 서울대학교 대학원 : 행정학과(정책학전공), 2011.8. 금현섭.Maste

'Unification' as Pedagogical Content in Korean Culture Education - Based on the Analysis of the German Textbooks for Foreigners -

본 연구의 목적은 외국어로서 독일어(DaF) 교육의 통일 교육 사례를 통해 향후 외국어로서의 한국어 문화 교육에 있어서 분단과 통일에 관한 교육 방향을 모색해 보고자 하는 데 있으며, 이의 달성을 위해 DaF 교재의 관련 내용과 구성을 분석하고 시사점을 모색하였다. DaF 교재 분석의 결과 대상 교재는 모두 관련 내용을 중급 단계의 교재에 도입하고 있었으며, 통일과 관련한 사실적 역사 정보, 통일 전후 독일 국민의 정서적 경험 및 반응, 통일의 영향 그리고 통일에 대한 긍정적·부정적 태도 등에 대한 종합적 이해 달성을 학습 목표로 설정하고 있었다. 이것은 통일과 분단이 독일 국민들의 의사소통을 위한 문화 해석의 틀(Deutungsmuster) 형성에 중요한 요소로서 기능하기 때문이다. 한국의 경우에도 분단과 통일은 공동체 구성원들이 공유하고 있는 중요한 의사소통적 상황맥락이라는 점에서 외국인 학습자를 위한 문화교육의 주요 내용이 될 수 있다. 또, DaF 교재의 경우 학습 목표 달성을 위해 사실적 역사 정보 및 독일 국민의 개인적 경험과 느낌 등을 중심으로 통일 교육 내용을 구성하고 있었으며, 독일 통일에 대한 역사적·정치적 평가 등에 관해서는 다루지 않고 있었다. 한국어 문화 교육의 통일 교육 역시 중급 단계에 적절한 교육 내용을 반영하는 방안에 관해 검토할 필요가 있다. 또, 교재의 유형에 따라 적절한 방식으로 교육 내용을 도입하고 다뤄야 하며, 가치평가적인 내용보다는 분단과 통일을 둘러싼 국민들의 실제적 경험과 사회적 분위기에 관한 이해를 가능하게 하는 내용을 우선적으로 제시할 필요가 있는 것으로 보인다.This paper aims to discuss how to set up the contents of Korean culture education for foreigners; by considering how the topic of Wiedervereinigung und Trennung(통일과 분단) was dealt with in the German culture education for foreigners. To achieve this goal we will analyze the recently published textbooks of German culture education for foreigners, and then accordingly make some suggestions for setting up the Korean culture education contents. In the German textbooks, contents related to the unification and division issues are introduced at the intermediate level, because these issues have been a major factor in shaping Kulturelle Deutungsmuster(문화 해석의 틀). This is applicable to Korean culture education for foreigners, considering that the unification and split issues of the Korean Peninsula are fresh in the minds of Koreans, activated across Handlungskontext(행위맥락). In terms of pedagogical content, the German textbooks include not only historical information, and emotional experiences of the unification and division, but also influences of the unification, while completely excluding the political and historical evaluations. We need to consider introducing the unification and division issues at the intermediate level in Korean culture education for foreigners. Depending on the type of textbook, we need to accommodate the pedagogical content within them, especially focusing on the authentic experiences about and the social atmosphere around the unification and division issues