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      • KCI등재

        Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterioronly Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review

        Terence Tan,Tom J. Donohoe,Milly Shu-Jing Huang,Joost Rutges,Travis Marion,Joseph Mathew,Mark Fitzgerald,Jin Tee 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.3

        The aim of this systematic review was to evaluate the surgical, radiological, and functional outcomes of posterior-only versus combined anterior-posterior approaches in patients with traumatic thoracolumbar burst fractures. The ideal approach (anterior-only, posterior-only, or combined anterior-posterior) for the surgical management of thoracolumbar burst fracture remains controversial, with each approach having its advantages and disadvantages. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed (registration no., CRD42018115120). The authors reviewed comparative studies evaluating posterior-only approach compared with combined anterior-posterior approaches with respect to clinical, surgical, radiographic, and functional outcome measures. Five retrospective cohort studies were included. Postoperative neurological deterioration was not reported in either group. Operative time, estimated blood loss, and postoperative length of stay were increased among patients in the combined anterior-posterior group in one study and equivalent between groups in another study. No significant difference was observed between the two approaches with regards to long-term postoperative Cobb angle (mean difference, −0.2; 95% confidence interval, −5.2 to 4.8; <i>p</i> =0.936). Moreover, no significant difference in functional patient outcomes was observed in the 36item Short-Form Health Survey, Visual Analog Scale, and return-to-work rates between the two groups. The available evidence does not indicate improved clinical, radiologic (including kyphotic deformity), and functional outcomes in the combined anterior-posterior and posterior-only approaches in the management of traumatic thoracolumbar burst fractures. Further studies are required to ascertain if a subset of patients will benefit from a combined anterior-posterior approach.

      • KCI등재

        Predictors of erectile dysfunction after transperineal template prostate biopsy

        Jo-Lynn Tan,Nathan Papa,Uri Hanegbi,Ross Snow,Jeremy Grummet,Sarah Mann,Adam Cuthbertson,Mark Frydenberg,Daniel Moon 대한비뇨의학회 2021 Investigative and Clinical Urology Vol.62 No.2

        Purpose: To investigate the incidence and possible contributing factors of erectile dysfunction (ED) after transperineal template prostate biopsy (TTPB). Materials and Methods: Males undergoing TTPB were prospectively administered a Sexual Health Inventory for Men (SHIM) questionnaire before biopsy and one month after. SHIM questionnaires were repeated at 3- and 9-months for males not receiving interventional treatment. Sexually inactive males were excluded. Interval change in SHIM categories based upon baseline characteristics were evaluated. Multivariable logistic regression models were used to evaluate predictors of change in SHIM score category. Results: A total of 576 males were included in our sample. Of these, 450 (78%) males underwent their first biopsy. A decline in SHIM category within the immediate 4-weeks post-biopsy was reported by 167 males (31% of total eligible sample). Age was the strongest predictor of decline in SHIM category, the predicted probability of a decline in SHIM at age 50 was 10% (95% confidence interval [CI], 1%–19%), 32% at age 60 (95% CI, 25%–40%) and 36% at age 70 (95% CI, 29%–44%). For new onset ED, the predicted probability of ED within 4-weeks post-TTPB were 6.7% at age 50 (95% CI, 0%–15%), 26% at age 60 (95% CI, 17%–34%) and 31% at age 70 (95% CI, 21%–40%). Conclusions: Older age at biopsy is an independent predictor of immediate ED after TTPB in sexually active males. This association was observed in the subgroup with no pre-existing ED. These findings provide useful information when counselling males undergoing TTPB.

      • KCI등재

        Strategies of Knowledge Pricing and the Impact on Firms’ New Product Development Performance

        ( Chuanrong Wu ),( Ning Tan ),( Zhi Lu ),( Xiaoming Yang ),( Mark E. Mcmurtrey ) 한국인터넷정보학회 2021 KSII Transactions on Internet and Information Syst Vol.15 No.8

        The economics of big data knowledge, especially cloud computing and statistical data of consumer preferences, has attracted increasing academic and industry practitioners' attention. Firms nowadays require purchasing not only external private patent knowledge from other firms, but also proprietary big data knowledge to support their new product development. Extant research investigates pricing strategies of external private patent knowledge and proprietary big data knowledge separately. Yet, a comprehensive investigation of pricing strategies of these two types of knowledge is in pressing need. This research constructs an overarching pricing model of external private patent knowledge and proprietary big data knowledge through the lens of firm profitability as a knowledge transaction recipient. The proposed model can help those firms who purchase external knowledge choose the optimal knowledge structure and pricing strategies of two types of knowledge, and provide theoretical and methodological guidance for knowledge transaction recipient firms to negotiate with knowledge providers.

      • KCI등재

        Spinal Navigation during Orthopedic Residency Training: A Double-Edged Sword?

        Arun-Kumar Kaliya-Perumal,Tamara Soh,Mark Tan,Colum Patrick Nolan,Chun Sing Yu,Jacob Yoong-Leong Oh 대한정형외과학회 2019 Clinics in Orthopedic Surgery Vol.11 No.2

        Background: Orthopedic residents in our institute have the opportunity to participate in navigation-assisted spine surgery during their residency training. This paves the way for a new dimension of learning spine surgery, which the previous generation was not exposed to. To study this in detail, we conducted a cross-sectional descriptive survey among our residents to analyse their perception, understanding, and competency regarding pedicle screw application using spinal navigation. Methods: We selected orthopedic residents (n = 20) who had completed 3 years of training that included at least one rotation (4–6 months) in our spine division. They were asked to respond to a four-part questionnaire that included general and Likert scale-based questions. The first two parts dealt with various parameters regarding spinal navigation and free-hand technique for applying pedicle screws. The third part dealt with residents’ opinion regarding the advantages and disadvantages of spinal navigation. The final part was an objective analysis of residents’ ability to identify the pedicle screw entry points in selected segments. Results: We found that our residents were better trained to apply pedicle screws using spinal navigation. The mean Likert scale score for perception regarding their competency to apply pedicle screws using spinal navigation was 3.65 ± 0.81, compared to only 2.8 ± 0.77 when using the free-hand technique. All residents agreed that spinal navigation is an excellent teaching tool with higher accuracy and greater utility in anatomically critical cases. However, 35% of the residents were not able to identify the entry points correctly in the given segments. Conclusions: All selected residents were perceived to be competent to apply pedicle screws using spinal navigation. However, some of them were not able to identify the entry points correctly, probably due to overreliance on spinal navigation. Therefore, we encourage residents to concentrate on surface anatomy and tactile feedback rather than completely relying on the navigation display monitor during every screw placement. In addition, incorporating cadaveric and saw bone workshops as a part of teaching program can enhance better understanding of surgical anatomy.

      • KCI등재

        Long-term outcomes of surgery for oesophageal achalasia

        Zi Qin Ng,Brendan Murphy,Simon Edmunds,Mark Whitby,Jih Huei Tan,Stephen Archer 소화기인터벤션의학회 2022 Gastrointestinal Intervention Vol.11 No.1

        Background: Long-term patient-reported outcomes following surgery for achalasia are lacking in the literature. The aim of this study was to evaluate both short- and long-term outcomes of the surgical management of achalasia. Methods: A retrospective analysis was performed of all surgically managed achalasia cases from January 2004 to December 2017. Data collection included demographics, previous interventions, type of surgery performed, and postoperative outcomes. Long-term data collected by questionnaire included residual regurgitation, dysphagia, chest pain, heartburn, need for subsequent intervention, and overall satisfaction. Patients were divided into primary group (group P) and secondary group (group S) based on whether they had undergone a previous intervention. Results: Ninety-one patients (male : female = 43 : 49; group P : S = 66 : 25) underwent surgery for achalasia. The median follow-up was 107 months (32–172 months). Twenty-five patients (27.5%) had previous interventions. Eighty-nine (97.8%) underwent Heller cardiomyotomy; the procedure was laparoscopic in 86 cases (97%) and open in three patients (3.3%). Two patients underwent stapled cardiomyotomy. The postoperative complication rate was 4.4%, and no complications were serious. There was no significant difference in length of stay between the groups. Short-term followup showed that most residual symptoms were mild. During long-term follow-up, the residual symptoms were mainly mild and did not differ between the groups. Furthermore, 72.9% of patients were satisfied or very satisfied with their symptoms post-surgery. Conclusion: The peri-operative morbidity for the surgical management of achalasia is low and re-intervention is uncommon. Heartburn was not a major long-term sequela of myotomy. Though patients still experienced mild symptoms in the longer term, most were satisfied with their outcome.

      • Accuracy of Thoracolumbar Pedicle Screw Insertion Based on Routine Use of Intraoperative Imaging and Navigation

        Sundaram Pirateb Paramasivam Meenakshi,Oh Jacob Yoong-Leong,Tan Mark,Nolan Colum Patrick,Yu Chun Sing,Ling Ji Min 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.4

        Study DesignRetrospective review.PurposeTo determine the accuracy of thoracolumbar pedicle screw insertion with the routine use of three-dimensional (3D) intraoperative imaging and navigation over a large series of screws in an Asian population.Overview of LiteratureThe use of 3D intraoperative imaging and navigation in spinal surgery is aimed at improving the accuracy of pedicle screw insertion. This study analyzed 2,240 pedicle screws inserted with the routine use of intraoperative navigation. It is one of very few studies done on an Asian population with a large series of screws.MethodsPatients who had undergone thoracolumbar pedicle screws insertion using intraoperative imaging and navigation between 2009 and 2017 were retrospectively analyzed. Computed tomography (CT) images acquired after the insertion of pedicle screws were analyzed for breach of the pedicle wall. The pedicle screw breaches were graded according to the Gertzbein classification. The breach rate and revision rate were subsequently calculated.ResultsA total of 2,240 thoracolumbar pedicle screws inserted under the guidance of intraoperative navigation were analyzed, and the accuracy of the insertion was 97.41%. The overall breach rate was 2.59%, the major breach rate was 0.94%, and the intraoperative screw revision rate was 0.7%. There was no incidence of return to the operating theater for revision of screws.ConclusionsThe routine use of 3D navigation and intraoperative CT imaging resulted in consistently accurate pedicle screw placement. This improved the safety of spinal instrumentation and helped in avoiding revision surgery for malpositioned screws.

      • KCI등재

        Factors Influencing Early Disc Height Loss Following Lateral Lumbar Interbody Fusion

        Kaliya-Perumal Arun-Kumar,Soh Tamara Lee Ting,Tan Mark,Oh Jacob Yoong-Leong 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.5

        Study Design: Retrospective radiological analysis.Purpose: To analyze the factors influencing early disc height loss following lateral lumbar interbody fusion (LLIF).Overview of Literature: Postoperative disc height loss can occur naturally as a result of mechanical loading. This phenomenon is enabled by the yielding of the polyaxial screw heads and settling of the cage to the endplates. When coupled with cage subsidence, there can be significant reduction in the foraminal space which ultimately compromises the indirect decompression achieved by LLIF.Methods: Seventy-two cage levels in 37 patients aged 62±10.2 years who underwent single or multilevel LLIF for degenerative spinal conditions were selected. Their preoperative and postoperative follow-up radiographs were used to measure the anterior disc height (ADH), posterior disc height (PDH), mean disc height (MDH), disc space angle (DSA), and segmental angle. Correlations between the loss of disc height and several factors, including age, construct length, preoperative lordosis, postoperative lordosis, disc height, cage dimensions, and cage position, were analyzed.Results: We found that the lateral interbody cages significantly increased ADH, PDH, MDH, and DSA after surgery (p <0.0001). However, there was a loss of disc height over time. All postoperative disc height parameters, especially the amount of increase in MDH (r =0.413, p <0.0001) after surgery, showed a significant positive association with early disc height loss. The levels demonstrating a significant (≥25%) height loss were those that exhibited a substantial height increase (128.3%, 4.6±3.0 to 10.5±5.6 mm) postoperatively. However, the levels that showed less than 25% height loss were those that exhibited, on average, only a 57.4% height increase post-operatively.Conclusions: The greater the postoperative increase in disc height, the greater the disc height loss throughout early follow-up. Therefore, achieving an optimal disc height rather than overcorrection is an important surgical strategy to adopt when performing LLIF.

      • KCI등재

        Soluble Expression and Purification of Bioactive Interleukin 33 in E. coli

        Bich Hang Do,박상수,Grace G. Kwon,NGUYEN MINH TAN,강효정,송정아,유지원,Anh Ngoc Nguyen,장재평,장미희,이선주,소성준,심성락,진종화,이경진,Mark J Osborn,최한 한국생물공학회 2017 Biotechnology and Bioprocess Engineering Vol.22 No.3

        Interleukin-33 (IL-33) is one of the important alarmins of the immune system and possesses dual functions as an anti- or pro-inflammatory molecule. The production of this cytokine in E. coli is hampered by the insoluble expression in the cytoplasm, resulting in inclusion body formation. In this study, the expression of IL-33 was optimized by fusing the N-terminus of IL-33 with several solubilizing tags that act as chaperones for proper protein folding: maltose binding protein (MBP), b´a´ domain of protein disulfide isomerase (PDIb´a´) and glutathione Stransferase (GST). The expression of the fusion proteins was stimulated by 0.5 mM IPTG at different temperatures, 37, 30, 25, and 18oC. As a result, IL-33 was expressed highly and in soluble form in the cytoplasm of E. coli when fused with MBP or PDIb´a´ tags in the presence of 0.5 mM IPTG at 25 or 30oC. We describe a simple purification procedure of IL-33 from the PDIb´a´-IL-33 construct using immobilized metal affinity chromatography (IMACs) with supplementary of tobacco etch virus (TEV) protease for tag removal. The high bioactivity of purified IL-33 on the proliferation and activation of macrophages was confirmed by MTT and nitrite releasing assays using RAW 264.7 These data show an improved method for producing high grade and yield IL-33.

      • KCI등재

        Early Postoperative Loss of Disc Height Following Transforaminal and Lateral Lumbar Interbody Fusion: A Radiographic Analysis

        Kaliya-Perumal Arun-Kumar,Soh Tamara Lee Ting,Tan Mark,Oh Jacob Yoong-Leong 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.4

        Study Design: Retrospective comparative radiological study. Purpose: To analyze the difference in early disc height loss following transforaminal and lateral lumbar interbody fusion (TLIF and LLIF). Overview of Literature: Minimal disc height loss facilitated by the polyaxial screw heads can occur naturally due to mechanical loading following lumbar fusion procedures. This loss does not usually cause any significant foraminal narrowing. However, when there is concomitant cage subsidence, symptomatic foraminal compromise could occur, especially when posterior decompression is not performed. It is not known whether the type of procedure, TLIF or LLIF, could influence this phenomenon. Methods: Retrospectively, patients who underwent TLIF and LLIF for various degenerative conditions were shortlisted. Each of their fused levels with the cage in situ was analyzed independently, and the preoperative, postoperative, and follow-up disc height measurements were compared between the groups. In addition, the total disc height loss since surgery was calculated at final follow-up and was compared between the groups. Results: Forty-six patients (age, 64.1±8.9 years) with 70 cage levels, 35 in each group, were selected. Age, sex, construct length, preoperative disc height, cage height, and immediate postoperative disc height were similar between the groups. By 3 months, disc height of the TLIF group was significantly less and continued to decrease over time, unlike in the LLIF group. By 1 year, the TLIF group demonstrated greater disc height loss (2.30±1.3 mm) than the LLIF group (0.89±1.1 mm). However, none of the patients in either group had any symptomatic complications throughout follow-up. Conclusions: Although our study highlights the biomechanical advantage of LLIF over TLIF in maintaining disc height, none of the patients in our cohort had symptomatic complications or implant-related failures. Hence, TLIF, as it incorporates posterior decompression, remains a safe and reliable technique despite the potential for greater disc height loss.

      • KCI등재

        The effect of diabetes and prediabetes on the prevalence, complications and mortality in nonalcoholic fatty liver disease

        Cheng Han Ng,Kai En Chan,Yip Han Chin,Rebecca Wenling Zeng,Pei Chen Tsai,Wen Hui Lim,Darren Jun Hao Tan,Chin Meng Khoo,Lay Hoon Goh,Zheng Jye Ling,Anand Kulkarni,Lung-Yi Loey Mak,Daniel Q Huang,Mark C 대한간학회 2022 Clinical and Molecular Hepatology(대한간학회지) Vol.28 No.3

        Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is closely associated with diabetes. The cumulative impact of both diseases synergistically increases risk of adverse events. However, present population analysis is predominantly conducted with reference to non-NAFLD individuals and has not yet examined the impact of prediabetes. Hence, we sought to conduct a retrospective analysis on the impact of diabetic status in NAFLD patients, referencing non-diabetic NAFLD individuals. Methods: Data from the National Health and Nutrition Examination Survey 1999–2018 was used. Hepatic steatosis was defined with United States Fatty Liver Index (US-FLI) and FLI at a cut-off of 30 and 60 respectively, in absence of substantial alcohol use. A multivariate generalized linear model was used for risk ratios of binary outcomes while survival analysis was conducted with Cox regression and Fine Gray model for competing risk. Results: Of 32,234 patients, 28.92% were identified to have NAFLD. 36.04%, 38.32% and 25.63% were non-diabetic, prediabetic and diabetic respectively. Diabetic NAFLD significantly increased risk of cardiovascular disease (CVD), stroke, chronic kidney disease, all-cause and CVD mortality compared to non-diabetic NAFLD. However, prediabetic NAFLD only significantly increased the risk of CVD and did not result in a higher risk of mortality. Conclusions: Given the increased risk of adverse outcomes, this study highlights the importance of regular diabetes screening in NAFLD and adoption of prompt lifestyle modifications to reduce disease progression. Facing high cardiovascular burden, prediabetic and diabetic NAFLD individuals can benefit from early cardiovascular referrals to reduce risk of CVD events and mortality.

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