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Background: The Korean Interstitial Lung Disease Study Group created two nationwide, multicentre consecutive registries on idiopathic pulmonary fibrosis (IPF). Comparing these registries, this study aimed to evaluate the long-term change in clinical features, diagnostic modalities, and prognostic factors of IPF in the real world. Methods: We enrolled patients from the first registry (2008 group, January 2002-September 2008) and the second registry (2018 group, January 2012-August 2018). Survival curves were estimated using the Kaplan-Meier method. To evaluate the risk factor for the mortality in each registry, Cox regression models were used. Results: The 2008 and the 2018 groups comprised 1839 and 1345 patients, respectively. The 2018 group was younger (P=0.025), had fewer symptoms (P<0.001), had less honeycombing (P<0.001), and was less frequently diagnosed with surgical biopsy (P<0.001). Further, in the 2018 group, steroid use and conservative care declined, while the N-acetylcysteine use increased. Pirfenidone and nintedanib were only used in the 2018 group. 2018 group showed better survival. There was no significant difference in survival between the 2008 group and the 2018 subgroup group who did not use anti-fibrotic agent (P=0.197). In the evaluation of the risk factor for mortality in each registry, significant factors were higher gender-age-physiologic (GAP) score, and history of cancer in the 2008 group, while they were higher GAP score, history of hepatitis, history of cancer, honeycombing on HRCT, and steroid use in the 2018 group. Pirfenidone use (P<0.001) was related with lower mortality in the 2018 group. Conclusions: Actual clinical practice in the diagnosis and treatment of IPF patients have changed in adherence with guidelines, novel medications, and social circumstances, and the survival of IPF patients have improved. Proper guidelines for the diagnosis and management of IPF based on accumulated data and observations are crucial and must be combined with newer treatment.
Background: Preventive measures need to be implemented to lower the incidence of osteoporotic fractures. Osteoporotic fractures increase morbidity and mortality as well as impose a socioeconomic burden; however, current research is limited to the administration rates of osteoporosis drugs for Korean postmenopausal females. Methods: This study represents a nationwide, observational, and cross-sectional survey that investigates the administration rates of osteoporosis drugs based upon a bone mineral density (BMD) test performed on Korean postmenopausal patients who visited outpatient orthopedic clinics. BMD test results were examined in postmenopausal female patients (50 to 80 years of age); subsequently, the patients were classified into an osteoporosis group, osteopenia group, and normal group. The administration rates of osteoporosis drugs and bisphosphonates were then analyzed. The osteoporosis group was subdivided into a T-score less than −3.0 group and a T-score between −3.0 and −2.5 group that were separately analyzed. Results: Based on the lumbar spine BMD, the rate of administration of osteoporosis drugs in the osteoporosis group was 42.1%, which was significantly higher compared to the osteopenia group or normal group. A significantly low bone mineral density was observed in patients who were administered bisphosphonates. Based on the lumbar spine BMD, the administration rate of osteoporosis drugs in the group with a T-score between −3.0 and −2.5 (34.2%) was significantly lower than the group with a T-score less that −3.0 (46.2%). The bisphosphonate administration rate was also significantly low; however, the administration rate for osteoporosis drugs was significantly lower than that of the osteopenia group. Conclusions: Only about 40% of Korean postmenopausal female patients with osteoporosis were administered osteoporosis drugs. The administration rate in patients with a T-score between −3.0 and −2.5 was particularly low and active treatment to prevent osteoporotic fractures is required in this group.
Background: The use of sedative drugs may be an important therapeutic intervention during noninvasive ventilation (NIV) in intensive care units (ICUs). The purpose of this study was to assess the current application of analgosedation in NIV and its impact on clinical outcomes in Korean ICUs. Methods: Twenty Korean ICUs participated in the study, and data was collected on NIV use during the period between June 2017 and February 2018. Demographic data from all adult patients, NIV clinical parameters, and hospital mortality were included. Results: A total of 155 patients treated with NIV in the ICUs were included, of whom 26 received pain and sedation therapy (sedation group) and 129 did not (control group). The primary cause of ICU admission was due to acute exacerbation of obstructed lung disease (45.7%) in the control group and pneumonia treatment (53.8%) in the sedation group. In addition, causes of NIV application included acute hypercapnic respiratory failure in the control group (62.8%) and post-extubation respiratory failure in the sedation group (57.7%). Arterial partial pressure of carbon dioxide (PaCO2) levels before and after 2 hours of NIV treatment were significantly decreased in both groups: from 61.9±23.8 mm Hg to 54.9±17.6 mm Hg in the control group (P<0.001) and from 54.9±15.1 mm Hg to 51.1±15.1 mm Hg in the sedation group (P=0.048). No significant differences were observed in the success rate of NIV weaning, complications, length of ICU stay, ICU survival rate, or hospital survival rate between the groups. Conclusions: In NIV patients, analgosedation therapy may have no harmful effects on complications, NIV weaning success, and mortality compared to the control group. Therefore, sedation during NIV may not be unsafe and can be used in patients for pain control when indicated.
( Joo Han Song ), ( Korean Interstitial Lung Diseases Research Group ), ( Kyung Soo Chung ), ( Song Yee Kim ), ( Eun Young Kim ), ( Ji Ye Jung ), ( Young Ae Kang ), ( Young Sam Kim ), ( Se Kyu Kim ), ( Joon Ch) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by abnormal accumulation of lipoproteinaceous material within the alveoli. This study aims to compare clinical and laboratory features and therapeutic approach of PAP over the years. Methods: A total of 78 patients with PAP from 13 university hospitals registered in Korean Interstitial Lung Disease Research Group were included in this study. The patients were divided into two groups, based on the year of diagnosis: group A withpatients diagnosed from 1993 to 2007 (n= 41) and group B diagnosed from 2008 to 2013 (n = 37). We compared group A and B using the data on demographics, smoking status, diagnostic methods, symptom at presentation, pulmonary function tests, and occupation and exposed dusts. Results: The median age at diagnosis was 41 years (range, 15-81) in group A and 48 years (range, 15-68) in group B (p=0.349). Male to female ratio was similar. In recent years, less number of patients received BAL and/or TBLB (90.2% vs 75.7%; p=0.085), while surgical lung biopsy (SLB) was performed in similar numbers (43.9% vs 45.9%; p=0.856). Although not significant, the incidence of PAP in never smoker was increased after 2008. A history of dust exposure was seen in 43.6% (39.0% vs. 48.6%; p=0.392). Thirty-five (44.9%) patients underwent whole lung lavage (WLL), which was used less in recent years (58.5% vs. 29.7%; p=0.011). Oxygenation (PaO2: n=23, p=0.016; DLco: n=13, p=0.089) markedly improved after WLL. Anti-GM CSF antibody treatment was used for 1 patient in group A (2.4%) and 3 patients in group B (8.1%; p=0.341). Overall survival was 96% (n=75). Conclusions: PAP is increasing in Korea. Dust exposure seems an important predisposingfactor. WLL is a safe procedure and yields dramatic improvements in oxygenation in PAP.
박혜인,Kim,Juhee,조아진,Kim,Do,Hyoung,이영기,Ryu,Hyunjin,김현숙,Oh,Kook-Hwan,오윤규,Hwang,Young-Hwan,Lee,Kyu-Beck,Kim,Soo,Wan,Kim,Yeong,Hoon,Lee,Joongyub,안규리,KNOW-CKD,Investigators,Group 대한의학회 2020 Journal of Korean medical science Vol.35 No.22
Background: Intrarenal renin-angiotensin system (RAS) is known to play the major role in the development of hypertension and renal progression in autosomal dominant polycystic kidney disease (ADPKD). Urinary angiotensinogen to creatinine ratio (AGT/Cr) was suggested as a novel biomarker to reflect intrarenal RAS activity. This study was performed to evaluate urinary AGT/Cr as a predictive biomarker for renal function decline in addition to imaging classification in a prospective ADPKD cohort. Methods: From 2011 to 2016, a total of 364 ADPKD patients were enrolled in the prospective cohort called the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). Among them, a total of 207 subjects in chronic kidney disease stage 1–4 with baseline urinary AGT and total kidney volume and subsequent renal function follow-up data over more than 1 year were included in the analysis. Patients were defined as slow progressors (SP) if they are classified as 1A or 1B by imaging classification whereas rapid progressors (RP) if they are classified as 1C–1E. Patients were divided according to AGT/Cr quartiles and annual estimated glomerular filtration rate (eGFR) slope was compared among highest quartile (hAGT group) and the rest of quartiles (lAGT group). Patients were divided into 4 groups to evaluate the predictive value of urinary AGT/Cr in addition to imaging classification: SP/lAGT, SP/hAGT, RP/lAGT, and RP/hAGT. The Cox regression model was used to evaluate the hazard ratio (HR) between groups. Results: The mean age was 45.9 years and 88.9% had hypertension. Baseline eGFR was 79.0 ± 28.4 mL/min/1.73 m2 and median height-adjusted total kidney volume was 788.2 (471.2;1,205.2) mL/m. The patients in the hAGT group showed lower eGFR (72.4 ± 24.8 vs. 81.1 ± 29.2 mL/min/1.73 m2 , P = 0.039), lower plasma hemoglobin (13.0 ± 1.4 vs. 13.7 ± 1.6 g/dL, P = 0.007), higher urinary protein to creatinine ratio (0.14 [0.09, 0.38] vs. 0.07 [0.04, 0.12] g/g, P = 0.007) compared to the lAGT group. The hAGT group was an independent risk factor for faster eGFR decline after adjusting for gender, RP, baseline eGFR, and other known risk factors. During median follow-up duration of 4.6 years, a total of 29 renal events (14.0%) occurred. The SP/hAGT group showed significantly higher risk of developing renal outcome compared to SP/lAGT group (HR, 13.4; 95% confidence interval, 1.282–139.324; P = 0.03). Conclusion: Urinary AGT/Cr can be a useful predictive marker in the patients with relatively small ADPKD. Various biomarkers should be considered to define RP when implementing novel treatment in the patients with ADPKD.
Background/Aims : We used flexible starting doses and early titration of atorvastatin to determine the rate of achievement of a low-density lipoprotein cholesterol (LDL-C) target for hyperlipidemic patients with type 2 diabetes mellitus. Methods : This study was a multicenter, open-label, prospective trial of atorvastatin therapy in hyperlipidemic patients with type 2 diabetes. The patients were divided into three groups according to initial LDL-C levels (130-149, 150-159 and≥160 mg/dL), and 10, 20, and 40 mg of atorvastatin was administered to each group, respectively. If LDL-C did not reach the 100 mg/dL target level at four weeks after initiation of treatment, the doses were increased by one step. Endothelial function tests and plasminogen activator inhibitor (PAI)-1 levels were measured in 41 patients. Results : Groups of 62, 18, and 69 patients were started on 10, 20, and 40 mg of atorvastatin, respectively, and 91% of the patients achieved the LDL-C target after four weeks of treatment. The overall percentage of patients achieving the LDL-C target after eight weeks of treatment was 89.3%: 87.5% in the 10 mg group, 86.4% in the 20 mg group, 93.9% in the 40 mg group, and 66.7% in the 80 mg group. A statistically significant reduction was observed in the mean percentage change in flow-mediated endothelium-dependent dilatation after eight weeks of treatment (p<0.0001). Conclusions : Flexible initial dosing and early aggressive titration of atorvastatin according to LDL-C levels is an efficient and safe strategy for achieving the target level and for improving endothelial dysfunction in hyperlipidemic patients with type 2 diabetes.
Shinje,Moon,Yong,Kyun,Roh,Jong,Lull,Yoon,Ki,Un,Jang,Hun,Jong,Jung,Hyung,Joon,Yoo,Hak,Chul,Jang,Geriatric,Syndromes,Study,Group,of,Korea,Geriatrics,Society 대한노인병학회 2019 Annals of geriatric medicine and research Vol.23 No.4
Background: This study explored the prevalence and clinical characteristics of geriatric syndromes among Korean older adults with diabetes mellitus (DM). Methods: We used data from the 2017 National Survey of Older Koreans to analyze the classic geriatric syndromes of polypharmacy, urinary incontinence, falls, cognitive impairment, and functional impairment according to the presence of DM. Results: Among 10,299 participants aged 65 years or older, 2,395 had DM. The prevalence of polypharmacy was 64.1% in the DM group and 31.6% in the non-DM group (p<0.001). One or more falls per year occurred in 18.7% of participants with DM compared with 14.9% of those without DM (p<0.001). The prevalence of urinary incontinence was significantly higher in the DM group (3.8%) than in the non-DM group (2.5%) (p=0.001). The prevalence of cognitive impairment was 17.7% in the DM group versus 14.9% in the non-DM group (p=0.001). Functional impairment occurred in 32.2% of participants in the DM group compared with 26.8% of participants in the non-DM group (p<0.001). Finally, the number of geriatric syndromes was significantly associated with cardiovascular disease (CVD) and chronic kidney disease (CKD) in patients with DM. Conclusion: The results of this study showed a higher prevalence of geriatric syndromes among older Korean adults with DM. In addition, the coexistence of multiple geriatric syndromes was associated with CVD and CKD among patients with DM. These findings support the current guidelines for older adults with DM that recommend assessment for geriatric syndromes.
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연구목적 및 방법 : 대표적인 비정형 항정신병약물인 리스페리돈과 올란자핀은 소위 '비정형성'을 갖는다는 측면에선 공통적이지만, 두 약물들간에는 특성 차이를 가질 것으로 예상된다. 그러나 두 약물을 직접 비교한 연구는 거의 없는 상태이다. 이에 국제 공동 연구인 RODOS(Risoeridone and Olanzapine Drug Outcomes study in Schizophrenia)의 일환으로 국내 24개 병원의 정신분열병 및 분열형정동장애 입원환자의 의무기록 재검토를 통해 리스페리돈과 올란자핀의 효과인 안전성을 후향적으로 비교하였다. 결 과 : 올란자핀 사용군이 리스페리돈 사용군에 비하여 이환 기간이 보다 길었고, 최초 입원 환자 비율과 최초 항정신병약물 치료 환자 비율도 보다 낮았다. 이런 변수들의 차이를 공변인으로 교정하였음에도 불구하고 리스페리돈 사용군에서 치료 반응을 보인 환자 비율이 보다 높았으며 치료 효과를 나타내는 시점의 중간 값도 보다 빨랐다. 추체외로 증상의 발생률에선 두 약물간에 차이가 없었으나, 항콜린제 병용 비율은 리스페리돈 사용군에서 유의하게 높았으며, 부작용으로 인한 약물 사용 중단 탈락 비율도 리스페리돈 사용군이 올란자핀 사용군에 비해 유의하게 높았다. 기타 부작용은 두 약물간에 차이가 없었으나, 체중 증가는 올란자핀 사용군에서 유의하게 많았다. 결 론 : 본 연구는 후향적 연구로 두 약물을 처방한 환자 특성의 동등성을 확보하지 못하는 등 여러 가지 문제점과 제한점들을 지니고 있기 때문에 최종적인 결론을 내릴 수는 없었다. 그러나 본 연구는 국내 비정형 항정신병약물의 실제 사용 현황을 보여 주며, 이 약물들간의 단순한 우월성 비교 보다는 장, 단점을 파악하고 약물 사용 시 지침을 제시한다는 점에서 그 의의가 있겠다. Objectives : Risperidone and Olanzapine, two representative atypical antipsychotics, both have so called 'atypicality' in common ; however, some discreoancies are exoected. Considering this, studies have been surprisingly rare that had directly compared the two drugs head-to-head. We compared the efficacy and tolerability of Risperidone and Olanzapine by retrospective chart review of the patients diagnosed as Schizphrenia and Schizoaffective disorder. This study was a part of international collaborative study, RODOS(Risperidone and Olanzapine Drug Outcomes study in Schizophrenia), and the total of 24 hospitals in Korea had participated in this study. Results : Among the baseline characteristics, the duration of illness was longer in olanzapine group. Also the proportion of first admitted patients, and of first medicated patients were both lower in Olanzapine group. Though these baseline differences have been controlled as covariates, the proportion of responsive patients was higher, and the median value of this time to effect was shorter in Risperidone group. There was no sifnificant difference in the rate of extrapyramidal symptoms. However, the drop-out rate due to intolerance and the rate of concomitant anticholinergic usage were significantly higher in Risperidone group compared to Olanzapine group. The rate of other somatic side effects showed no between-group difference, except weight gain which was significantly more prevalent and higher in Olanzapine group. Conclusion : Though Risperidone was found to be superior in efficacy, we could not draw a final conclusion since this study was a retrospective chart review without any randomization which has a severe inherent limitation. This study should not be taken as an attempt to prove one drug's superiority over th other ; rather, an attempt tp scrutinize each drugs' weak and strong points to provide a guideline for proper drug usage accordingly.
The prognostic significance of age in renal cell carcinoma (RCC) is a subject of debate. The aim of the present multi-institutional study was to evaluate the impact of age on clinicopathological features and survival in a large cohort of patients with RCC. A total of 5,178 patients who underwent surgery for RCC at eight institutions in Korea between 1999 and 2011 were categorized into three groups according to age at diagnosis as follows: young age (< 40 years, n = 541), middle-age (≥ 40 and < 60 years, n = 2,551), and old age (≥ 60 years, n = 2,096) groups. Clinicopathological variables and survival rates were compared between the three groups. Young patients had lower stage tumors with a low Fuhrman grade, a lower rate of lymphovascular invasion than patients in the other age groups. Regarding histologic type, the young age group had a lower percentage of clear cell histology and a greater incidence of Xp11.2 translocation RCC. Kaplan-Meier estimates showed that cancer-specific survival was significantly better in the young age group than in the other groups (log rank test, P = 0.008). However, age at diagnosis was not an independent predictor of survival in multivariate analysis. In conclusion, young age at diagnosis was associated with favorable pathologic features, although it was not an independent prognostic factor for survival in patients with surgically-treated RCC. Age itself should not be regarded as a crucial determinant for the treatment of RCC.
Purpose: Asthma in the elderly (EA; ≥ 65 years of age) is increasing, adding a heavy socioeconomic burden to the healthcare system. However, little is known about risk factors associated with acute exacerbations in EA patients. The objective of this study was to investigate risk factors for acute exacerbation in EA compared to non-elderly asthma (NEA). Methods: We combined data from 3 adult asthma cohorts under a unified protocol and database. Asthmatic patients with regular follow-up during a 1-year period were selected from the cohorts to identify the risk factors predicting acute exacerbations in EA compared to NEA. Results: We selected a total of 1,086 patients from the merged cohort. During the observation period, 503 and 583 patients were assigned to the EA and NEA groups, respectively. The exacerbation rate was 31.0% in the EA and 33.2% in the NEA group. Multivariate logistic regression analysis revealed fixed airway obstruction, chronic rhinosinusitis (CRS), and male sex as independent risk factors for exacerbation in the EA group. In the NEA group, exacerbation increased along with an increase in eosinophil count. Bayesian analysis of the interactions among clinical factors revealed that forced expiratory volume in 1 second/forced vital capacity was directly related to exacerbation in the EA group, and eosinophil count was related to exacerbation in the NEA group. Conclusions: We suggest that fixed airway obstruction and CRS as the important clinical factors predicting acute exacerbations in EA, whereas in NEA, eosinophil count was the strong predictor of exacerbation.