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요추 추간판 탈출증 환자의 의·한의 협진 의료이용 현황 분석: 건강보험심사평가원 환자표본 데이터를 이용하여
고준혁 ( Jun-Hyuk Ko ),유지웅 ( Ji-Woong Yu ),서상우 ( Sang-Woo Seo ),서준원 ( Joon-Won Seo ),강준혁 ( Jun-Hyuk Kang ),김태오 ( Tae-Oh Kim ),조휘성 ( Whi-Sung Cho ),서연호 ( Yeon-Ho Seo ),안종현 ( Jong-Hyun Ahn ),이우주 ( Woo-Joo 한방재활의학과학회 2021 한방재활의학과학회지 Vol.31 No.4
Objectives Lumbar herniated intervertebral disc (L-HIVD) is common disease in which Western-Korean collaborative treatment is performed in Korea. This study aimed to analyze Western-Korean collaborative treatment utilization of Korean patients with L-HIVD using Health Insurance Review & Assessment Service’s Patients Sample Data. Methods This study used the Health Insurance Review & Assessment Service-National Patient Sample (HIRA-NPS) in 2018. Claim data of L-HIVD patients were extracted. The claim data were rebuilt with the operational concept of ‘episode of care’ and divided into Korean medicine episode group (KM), Western medicine episode group (WM) and collaborative treatment episode group (CT). General characteristics, medical expenses and healthcare utilization were analyzed. In addition, the difference of average visit day and average medical expenses between non-collaborative group (KM plus WM) and CT were analyzed by the propensity score matching method. Results A Total of 64,333 patients and 365,745 claims were extracted. The number of episodes of WM, KM and CT was 69,383 (92.97%), 3,903 (5.23%), and 1,341 (1.80%) respectively. The frequency of collaborative treatment episode was higher in women and the age of 50s. The most frequently described treatment in CT was acupuncture therapy. As a result of the propensity score matching, the number of visit days and medical expenses in the collaborative treatment group was higher than in the non-collaborative group. Conclusions The analysis of healthcare utilization of Korean-Western collaborative treatment may be used as basic data for establishing medical policies and systematic collaborative treatment model in the future. (J Korean Med Rehabil 2021;31(4):105-116)
An epidemiological study of alopecia in 4,012 Korean patients: 10-year single center follow up
( Joon Hyuk Suh ),( Yeon A No ),( Eun Jung Ko ),( Seong Jun Seo ),( Chang Kwun Hong ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2
Background: There have been many clinical studies on individual alopecic disorders, but long-term reports of overall alopecia patients are rare. Objectives: The aim of this study is to investigate the clinical and epidemiologic aspects of diseases occurring in alopecia in 4,012 patients over 10 years. Methods: From January 2006 to December 2015, clinical records of 4,012 alopecic patients who visited Chung-Ang University Hospital were analyzed for diagnosis, age, sex, and annual distribution. Results: During the last 10 years, clinically diagnosed alopecia patients comprised 5.32% of the total number of dermatology patients, showing composition of androgenic alopecia (68.1%), alopecia areata (18.0%), telogen effluvium (7.4%), and trichotillomania (1.5%). The overall ratio of male to female patients was 1.3:1. In particular, androgenic alopecia showed male predominance (M:F=2:1) with increasing proportion of female patients compared to 4:1 ratio described in 2006, while alopecia areata showed similar distribution (M:F=1:1.1). There was a trend of lowering in the age of onset of alopecia in both genders, and more than 36.6% of patients visited the clinic within one year of onset. Family history was present in 41.5% of androgenic alopecia patients and 12.9% of alopecia areata. Conclusion: In this study, we could provide the essential findings from clinical data of various alopecia patients over recent 10 years.
Jung-Joon Cha,Jong-Youn Kim,Hyoeun Kim,Young-Guk Ko,Donghoon Choi,이재환,Chang-Hwan Yoon,In-Ho Chae,Cheol Woong Yu,Seung Whan Lee,Sang-Rok Lee,Seung Hyuk Choi,Yoon Seok Koh,Pil-Ki Min 대한심장학회 2022 Korean Circulation Journal Vol.52 No.6
Background and Objectives: Endovascular therapy (EVT) first strategy has been widely adopted for the treatment of chronic limb threatening ischemia (CLTI) patients in real-world practice. This study aimed to investigate long-term outcomes of CLTI patients who underwent EVT and identify prognostic factors. Methods: From the retrospective cohorts of a Korean multicenter endovascular therapy registry, 1,036 patients with CLTI (792 men, 68.8 ± 9.5 years) were included. The primary endpoint was amputation-free survival (AFS) defined as the absence of major amputation or death. Secondary endpoints were major adverse limb events (MALE; a composite of major amputation, minor amputation, and reintervention). Results: Five-year AFS and freedom from MALE were 69.8% and 61%, respectively. After multivariate analysis, age (hazard ratio [HR], 1.476; p<0.001), end-stage renal disease (ESRD; HR, 2.340; p<0.001), Rutherford category (RC) 6 (HR, 1.456; p=0.036), and suboptimal EVT (HR, 1.798; p=0.005) were identified as predictors of major amputation or death, whereas smoking (HR, 0.594; p=0.007) was protective. Low body mass index (HR, 1.505; p=0.046), ESRD (HR, 1.648; p=0.001), femoropopliteal lesion (HR, 1.877; p=0.004), RC-6 (HR, 1.471; p=0.008), and suboptimal EVT (HR, 1.847; p=0.001) were predictors of MALE. The highest hazard rates were observed during the first 6 months for both major amputation or death and MALE. After that, the hazard rate decreased and rose again after 3–4 years. Conclusions: In CLTI patients, long-term outcomes of EVT were acceptable. ESRD, RC-6, and suboptimal EVT were common predictors for poor clinical outcomes.
고위험군 및 전이성 유방암 환자에서 말초혈액 자가 조혈모세포 이식술을 동반한 고용량 항암치료
박준성,정철권,고광현,조도연,김현수,최진혁,남동기,임호영,김효철 대한조혈모세포이식학회 1999 대한조혈모세포이식학회지 Vol.4 No.2
연구배경: 제4기 유방암 환자의 2년 생존율이 15-20%정도로 알려지고 있으며, 최근 20년간 사망률을 줄이기 위한 노력들이 시도되었으나 전이성 유방암 환자나 액와 림프절 10개 이상의 전이를 보이는 고위험군이 경우 근치적 수술 및 수술후의 고식적 항암 화학요법으로 장기 생존율을 놓이지 못하는 실정이다. 이에 저자 등은 최근 10년간 고용량 항암 화학요법에 대한 주목할만한 연구들이 진행되고 있는바, 고 위험군 및 초치료 후 전이성 유방암으로 재발된 환자에게 말초 및 혈액 자가 조혈모세포 이식술을 동반한 고용량 항암 화학요법에 따른 전체 생존율(Oerall survival rate: OS) 과 병기 유지 생존율 (Progression Free survival rate: PFS)을 경험하여그 경향을 보고하는 바이다. 방법: 1995년 5월부터 1998년 11월까지 고 위험군 및 초치료 후 전이성 유방암으로 재발되어 아주대학교병원에서 고용량 항암화학요법 및 말초혈액 자가조혈모세포 이식술을 시행받은 27명의 여자환자를 대상으로 고 위험군(high risk for relapse), 단순 재발군(sensitive relapse), 불응성 재발군(refractory relapse)으로 나누어 치료효과를 비교하였다. 결과: 액와 림프절 10개 이상의 전이를 보인 고위험군이 6명, 재발한 후 고식적 항암 화학 요법에 반응을 보인 단순 재발군이 11명, 반응을 보이지 않은 불응성 재발군이 11명이였고, 불응성 재발군 중 3명은 고용량 항암 화학요법 이후에도 병소가 남아있어서 한 차례 더 고용량 항암 화학 요법을 시행받았다. 중앙추적기간은 16개월(1-36개월), 중앙연령은 44세(30-58세)이었고, 말초혈액 조혈모세포 이식을 위하여 G-CSF 투여후 추출된 단핵세포 (MNC) 수는 평균 3.70×10^(8)/kg, CD34^(+) 세포는 평균 8.18×10^(8)/kg이었다. 골수 생착(말초혈액 절대 호중구 수치 >500/㎕)은 모든 환자에서 이루어졌으며, 골수 이식 후 평균 11.1일(중앙값 9일)에 이루어졌다. 치료관련 사망률(Treatment Related Mortality)은 5예로 그 중 1예는 정맥 폐쇄 질환(Ven-Occlusive Disorder), 4예는 패혈증(sepsis)으로 사망하였다. 대상포진 6예에서 발생하였고, 미만성 폐포 손상(Diffuse Alveolar Damage)이 3예 발생하였다. 전체 28명 환자의 전체 생존율(OS)은 56.5%, 고 위험군은 100%, 단순 재발군은 58.8%, 불응성 재발군은 36.4%이었으며, 고위험군의 무병 생존율(DFS)은 55.5%, 평균값(mean DFS duration)은 26개월이었고, 단순 재발군의 병기 유지 생존율(PFS)은 25.2%, 중앙값(median PFS duration)은 20개월이었으며 , 불응성 재발군의 병기 유지 생존율25%, 중앙값은 8개월이다. 결론: 이상의 결과를 고려해 볼 때, 고 위험군과 단순재발군의 경우는 비교적 높은 전체생존율을 보이는 반면, 불응성 재발군의 경우, 고용량 항암화학요법으로 병의 진행을 8개월 정도밖에는 막지 못함을 알수 있었다. 대상포진은 수두바이러스 면역 글로블린으로써 성공적으로 예방할수 있었다. 고용량 항암 화학 요법이 진행성 유방에서 어느 정도 효과적인가를 객관적으로 확인하기 위해서는 보다 많은 증례 수 및 추적기간의 누적, 추적검사의 정확성이 필요하고, 적응증의 선별에 의한 비교연구가 시행되어야 하겠고, 아마도 그에 따라서 통계학적으로 의미 있는 결과를 도출할 수 있을 것으로 기대된다. It is widely accepted that node-positive breast cancer patients should receive adjuvant chemotherapy of hormonal therapy following definitive surgery. While significant change have been made in the care of breast cancer patients over the last 20 years, particularly with regard to surgical management and adjuvant therapy, long term prognosis remains poor for patients with 10 or more involved axillary nodes (high risk for relapse group) and is dismal for patients with stage Ⅳ disease following conventional dose chemotherapy. We investigated the outcomes of 28 patients with breast cancer undergoing chemo-mobilization of peripheral blood stem cells (PBSC) and high dose chemotherapy (HDCT) with PBSC transplantation. 28 patients with a median age of 44 years (range 30-58 years) were entered to out study, three of them received HDCT twice because of residual disease after first HDCT. We divided, the patients into three groups consisting of (1) six patients with 10 or more node positive as a high risk group, (2) 11 relapsed patients who responded to conventional chemotherapy as a sensitive relapsed group, (3) 11 relapsed patients who did not respond to conventional chemotherapy as a refractory relapsed group. Mean follow-up duration was 16.5 months (range 1-36 months), Pre-mobilization chemotherapy included FEC regimen (5-FU 600 mg/m² , Epirubicin 60 mg/m² , Cyclophosphamide 600 mg/m²×3 or 6 cycles) in 15 patients, Paclitaxel with Carboplatin regimen (Taxol 160 mg/m², Carboplatin 300 mg/m²× 3 cycles) in 4 patients, anthracycline containing regimen in eight patients. We collected autologous stem cells from CSF primed peripheral blood after conventional chemotherapy. Mean mononuclear cell (MNC) count was 3.4±1.1×10^(8)/kg, CD34^(+) was 7.6±5.0×10^(6)/kg, CFU-GM was 1.8±2.1×10^(5)/kg. All of the patients engrafted at mean date of 11.1 days after transplantation (median 9 days). As the high dose chemotherapy, 22 patients received CBP regimen (Cyclophosphamide 6g/m², BCNU 400mg/m² Cisplatin 165 mg/m²), three patients ICE regimen (Ifosphamide 8g/m², Carboplatin 1.2 g/m², Etoposide 600 mg/m²), six patients ML regimen (Mitoxantrone 75 mg/m², Melphalan 180 mg/m²) Treatment-related mortality (TRM) was developed in five patients (one due to VOD, four due to sepsis). Diffuse alveolar damage was developed in three patients, and Herpes Zoster infection was developed in six patients. Overall survival (OS) rate of all patients was 56.5%(high risk group 100%, sensitive relapsed group 58.9%, refractory relapsed group 36.4%). Disease free survival (DFS) rate of high risk group was 55.5% with 26 months of mean DFS duration. Progression free survival (PFS) rate of sensitive relapsed group was 25.2% with 20 months of median PFS duration. PFS rate of refractory relapsed group was 25% with 8 months of median PFS duration.