• Endocrinology and Metabolism
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• 제33권4호
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• pp.459-465
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• 2018

Background: Differentiated thyroid carcinoma (DTC) shows a very good prognosis, but older patients have a higher recurrence rate and those show poor prognosis than younger patients. The aim of this study was to determine the clinical outcomes of thyroid cancer patients who experienced recurrence in old age according to the treatment strategy used. Methods: This retrospective observational cohort study was conducted at Asan Medical Center, Seoul, Korea. Among DTC patients with no evidence of disease after initial treatment, we enrolled 86 patients who experienced recurrence at an age >65 years from 1994 to 2012. Sixty-nine patients had local recurrence and 17 patients showed distant metastasis. Results: The mean age of patients at recurrence was 72 years. Patients were followed up for a median of 4.1 years after recurrence. Sixty-three of the 69 patients with local recurrence received additional treatment, while the other six received conservative care. The cancer-specific mortality rate was 15.5% in the local recurrence group. Airway problems were the main cause of death in patients who did not receive further treatment for local recurrence. Among the 17 patients with distant metastasis, 10 underwent specific treatment for metastasis and seven received only supportive management. Seven of those 17 patients died, and the cancer-specific mortality rate was 35% in the distant metastasis group. Conclusion: The overall cancer-specific mortality rate was 20% in DTC patients in whom recurrence was first detected at an age >65 years. Mortality due to uncontrolled local disease occurred frequently in patients who did not receive definitive management for recurrence.

• Journal of Gastric Cancer
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• 제20권4호
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• pp.442-453
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• 2020

Purpose: Expanded indications for endoscopic submucosal dissection (ESD) in early gastric cancer (EGC) remain controversial due to the potential risk of undertreatment after adequate lymph node dissection (LND). Regional LND (RLND) is a novel technique used for limited lymphadenectomy to avoid gastrectomy. This study established the safety and effectiveness of RNLD as an additional treatment option after ESD for expanded indications. Materials and Methods: A total of 69 patients who met the expanded indications for ESD were prospectively enrolled from 2014 to 2017. The tumors were localized using intraoperative esophagogastroduodenoscopy (EGD) before RLND. All patients underwent RLND first, followed by conventional radical gastrectomy with LND. The locations of the preoperative and intraoperative EGD were compared. Pathologic findings of the primary lesion and the RLND status were analyzed. Results: The concordance rates of tumor location between the preoperative and intraoperative EGD were 79.7%, 76.8%, and 63.8% according to the longitudinal, circumferential, and regional locations, respectively. Of the 4 patients (5.7%) with metastatic LNs, 3 were pathologically classified as beyond the expanded indication for ESD and 1 had a single LN metastasis in the regional lymph node. Conclusions: RLND is a safe additional option for the treatment of EGC in patients meeting expanded indications after ESD.

• 한국사회정책
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• 제24권2호
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• pp.61-86
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• 2017

다차원적 사회적 고립은 신체적 정신적 건강의 위험요인으로 지적되어 왔다. 사회적 고립과 건강과의 관계에 대한 핵심 논의는 크게 두 가지로 정리할 수 있다. 첫째는 객관적 주관적 사회적 고립이 신체적 정신적 건강에 영향을 미치는 다양한 경로들의 역동성과 관련한 논쟁이 존재하고, 두 번째는 사회적 고립과 건강과의 관계에서 연령집단이 과연 선형적인 관계인가 또는 비선형적인 관계를 나타내는가와 관련한 논쟁이 존재한다. 본 연구에서는 공분산을 설정한 상호작용모형을 활용하여 선행연구들에서 논의하고 있는 객관적 주관적 사회적 고립이 신체적 정신적 건강에 영향을 미치는 다양한 경로를 주효과 분석을 통해 검증하고, 아울러 이질적인 연령집단에 따른 관계를 상호작용효과를 중심으로 검증하였다. 분석자료는 다차원적인 사회적 고립 개념의 특성을 충실히 반영한 KSHAP 1차년도 자료를 활용하였다. 경로모형 분석결과를 정리하자면 다음과 같다. 첫째, 객관적 사회적 고립 수준이 높아질수록 신체적 정신적 건강에 부정적 영향을 미치는 주효과가 유의한 반면, 주관적 사회적 고립은 정신적 건강에 부정적인 영향을 미치는 주효과만이 유의하게 나타났다. 둘째, 사회적 고립과 이질적인 연령집단과의 상호작용효과는 신체적 건강에 대해서 유의하게 나타났다. 구체적으로 객관적 사회적 고립의 수준이 높아질수록 장년층에 비해 전기노인의 경우 신체적 건강의 기울기는 부적으로 보다 낮아지는 것으로 나타났으며, 주관적 사회적 고립의 수준이 높아질수록 장년층에 비해 후기노인의 신체적 건강의 기울기는 부적으로 낮아지는 것으로 나타났다. 즉 연령집단에 따라 다차원적 사회적 고립과 신체적 건강과의 관계의 양상은 다르게 나타났다. 본 연구결과에 기초하여 신체적 정신적 건강의 위험요인에 해당하는 객관적 사회적 고립과 주관적 사회적 고립의 수준을 낮추기 위한 정책적 시사점에 대해 논의하였다.

• 한국임상약학회지
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• 제31권1호
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• pp.44-52
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• 2021

Background: Post-transplant immunosuppression with calcineurin inhibitors (CNIs) is associated with kidney function impairment while mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, can be used for its renal-sparing effects. In this study, we compared the efficacy and safety of everolimus with low dose tacrolimus (EVR+Low TAC) and conventional dose tacrolimus (TAC) in liver transplantation recipients. Methods: Medical records of recipients who received liver transplantation at Seoul National University Bundang Hospital from January 1st 2009 to December 31st 2018 were retrospectively reviewed. Cohort entry date was defined as the day everolimus was initiated and tacrolimus dosage was reduced. All patients were followed up for 1 year. Indicator of efficacy was the incidence of rejection and safety was evaluated by incidence of drug adverse events including renal function. Results: Among 118 patients, there were 40 patients (33.9%) in EVR+Low TAC group. Incidence of rejection, including both biopsy proven acute rejection and clinical rejection, was similar in two groups [7.5% (n=3) vs. 6.4% (n=5), p=1.000]. Renal dysfunction was less frequent in EVR+Low TAC [17.5% (n=7) vs. 35.9% (n=28), p=0.038]. However, incidence rates of dyslipidemia, oral ulcer were more frequent in EVR+Low TAC [45.0% (n=18) vs. 21.8% (n=17), p=0.009; 15.0% (n=6) vs. 1.3% (n=1), p=0.006]. Conclusions: In terms of prevention of rejection, EVR+Low TAC was as effective as TAC and had renal-sparing effect but was associated with increased risk of dyslipidemia and oral ulcer. This study demonstrates that EVR+Low TAC could be an alternative to liver transplant recipients with nephrotoxicity after administration of conventional dose tacrolimus.

• Journal of Korean Neurosurgical Society
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• 제65권2호
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• pp.287-296
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• 2022

Objective : Although radiotherapy (RT) is recommended for multiple myeloma (MM) involving spine, the treatment of choice between reconstructive surgery with RT and RT alone for pathologic vertebral fractures (PVFs) associated with structural instability or neurologic compromises remains controversial. The purpose of this study was to evaluate the clinical efficacies of reconstructive surgery with adjuvant RT for treatment of MM with PVFs by comparing with matched cohorts treated with RT alone. Methods : Twenty-eight patients underwent reconstructive surgery followed by RT between 2008 and 2015 in a single institution, for management of PVFs associated with structural instability of the spine and/or neurologic compromises (group I). Twenty-eight patients were treated with RT alone (group II) after propensity score matching in a 1-to-1 format based on instability of the spine, as well as age and performance. Clinical outcomes including the overall survival rates, duration of independent ambulation, neurological status, and numeric rating scale (NRS) for back pain were compared. Results : Clinical and radiological features before treatment were similar in both groups. The median survival period was similar between the two groups. However, the mean duration of independent ambulation was significantly longer in group I (88.8 months; 95% confidence interval [CI], 66.0-111.5) than in group II (39.4 months; 95% CI, 25.2-53.6) (log rank test; p=0.022). Deterioration of Frankel grade (21.4% vs. 60.7%, p=0.024) and NRS for back pain (2.7±2.2 vs. 5.0±2.7, p=0.000) at the last follow-up were higher in the group II. Treatment-related complications were similar in both groups. Conclusion : In patients with unstable PVFs due to MM, reconstructive surgery may yield superior clinical outcomes compared with RT alone in maintaining independent ambulation and neurological status, as well as pain control despite similar median survival and complications.

• Nutrition Research and Practice
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• 제15권sup1호
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• pp.32-40
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• 2021

BACKGROUND/OBJECTIVES: Considering the high number of deaths from coronavirus disease 2019 (COVID-19) in Latin American countries, together with multiple factors that increase the prevalence of vitamin D deficiency, we aimed to determine 25-hydroxyvitamin D (25[OH]D) levels and its association with mortality in patients with critical COVID-19. SUBJECTS/METHODS: This was a prospective observational study including adult patients with critical COVID-19. Data, including clinical characteristics and 25(OH)D levels measured at the time of intensive care unit admission, were collected. All patients were followed until hospital discharge or in-hospital death. The patients were divided into those surviving and deceased patient groups, and univariate and multivariate logistic regression analyses were performed to determine independent predictors of in hospital mortality. RESULTS: The entire cohort comprised 94 patients with critical COVID-19 (males, 59.6%; median age, 61.5 years). The median 25(OH)D level was 12.7 ng/mL, and 15 (16%) and 79 (84%) patients had vitamin D insufficiency and vitamin D deficiency, respectively. The median serum 25(OH)D level was significantly lower in deceased patients compared with surviving (12.1 vs. 18.7 ng/mL, P < 0.001). Vitamin D deficiency was present in 100% of the deceased patients. Multivariate logistic regression analysis revealed that age, body mass index, other risk factors, and 25(OH)D level were independent predictors of mortality. CONCLUSIONS: Vitamin D deficiency was present in 84% of critical COVID-19 patients. Serum 25(OH)D was independently associated with mortality in critical patients with COVID-19.

• 한국콘텐츠학회논문지
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• 제22권9호
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• pp.561-569
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• 2022

우리나라 신장암 발생을 소득 수준에 따라 확인하고 병기별로 분석하여 소득 수준에 따른 지연된 진단 정도의 차이를 확인하기 위하여 2015년부터 2017년까지 중앙암등록자료 및 국민건강보험공단, 건강보험심사평가원 데이터베이스를 연계하여 국가 단위 신장암 코호트를 구축하여 병기별, 소득수준별 신장암 발생률을 산출하였다. 연구 기간 중 우리나라 신장암 발생률은 모든 소득 분위에서 증가하나 의료보장인구에서만 감소하는 양상을 보였다. 신장암 발생률은 인구 10만 명 당 7.35 명이었고 이 중 83.54%가 국한 및 국소 신장암으로 소득 상위 20%에서 인구 10만 명 당 21.46명의 높은 발생률을 보였다. 그 중 국한 및 국소 신장암이 18.37명으로 소득 수준이 높을수록 국한 및 국소 신장암 발생률이 높은 것으로 확인된 반면 소득 수준이 낮을수록 원격 전이된 상태로 신장암을 진단받을 위험이 높음(소득 하위 20% adj.OR 1.807, 95% CI 1.411-2.222)을 확인하였고 의료보장인구에서는 병기 미상으로 진단받을 위험비가 1.926(95% CI 1.317, 2.816)으로 관찰되었다. 소득 수준이 높을수록 조기에 암을 진단하는 빈도가 높지만 소득 수준이 낮을수록 전이 신장암으로 진단받거나 병기 미상으로 진단받을 위험이 높아 소득 수준에 따른 건강 불평등이 관찰되었다.

• 정신신체의학
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• 제30권2호
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• pp.145-154
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• 2022

연구목적 본 연구는 메르스 생존자에서 감염 당시 낙인에 대한 인식, 12개월 후 이들이 사용하는 대처전략, 24개월 후 우울 및 외상후 스트레스 증상에 끼치는 영향 간의 연관성을 확인하고자 하였다. 방 법 63명의 2015년 메르스 생존자를 대상으로 코호트 연구를 진행하여 12개월 및 24개월 후에 인구학적 정보, 메르스 감염의 심각도, 우울 및 외상후 스트레스 증상, 대처전략, 낙인에 대한 인식 등을 조사했다. 결 과 감염 당시 낙인의 인식은 12개월 후 부정적 대처전략(p=0.003), 24개월 후 우울(p=0.058) 및 외상후 스트레스 증상(p=0.011)과 연관성을 보였다. 12개월 후 부정적 대처전략과 24개월 후 우울(p=0.002) 및 외상후 스트레스 증상(p<0.001) 간에도 유의한 연관성이 있었다. 결 론 감염자에 대한 낙인은 생존자들의 장기적 정신 건강에 부정적 영향을 줄 수 있다. 향후 신종감염병 유행 시 낙인 문제를 개선하고 생존자들이 적응적 대처전략을 가지도록 도와야 한다.

• Journal of Chest Surgery
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• 제55권5호
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• pp.388-396
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• 2022

Background: In this study, we present recent trends in heart valve surgery in Korea through analyses of data from the Korea Heart Valve Surgery Registry (KHVSR). Methods: We enrolled 8,981 patients who were registered in the KHVSR from 2017 to 2020. Yearly trends in patients' baseline characteristics, surgical profiles, and early mortality rates were explored. The observed/expected mortality ratio (O/E ratio), calculated from the actual mortality in the KHVSR and the predicted mortality estimated using the EuroSCORE II, was also analyzed. Results: The proportion of aortic valve surgery significantly increased from 56.8% in 2017 to 60.3% in 2020. The proportion of all combined procedures and minimally invasive surgery significantly increased over the 4-year study period. The operative mortality rate was 2.9% in the entire cohort, while mitral valve repair showed the lowest mortality risk (0.9%). The mortality rates of isolated aortic valve replacement (AVR) significantly decreased from 2.1% in 2017 to 0.8% in 2020 (p=0.016). Overall, the O/E ratio was 0.784 (95% confidence interval [CI], 0.677-0.902) demonstrating significantly lower actual mortality risks than expected based on the EuroSCORE II. In particular, the O/E ratios were as low as 0.364 (95% CI, 0.208-0.591) for isolated AVR. Conclusion: The recent data from the KHVSR showed increasing trends for complex procedures and minimally invasive surgery in heart valve surgery in Korea, and demonstrated remarkably low risks of operative mortality.

• Pediatric Infection and Vaccine
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• 제28권3호
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• pp.144-148
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• 2021

목적: 사회적 거리두기와 같은 비약물적 조치는 아동기 질병 발병률 감소를 포함하여 의도하지 않은 결과를 초래하였다. 이에 대하여 한국의 국가 데이터를 사용하여 열성 경련 발병률과 사회적 거리두기의 영향을 연구하였다. 방법: 이 연구는 한국의 건강보험심사평가원의 청구 데이터를 사용하여 2010년 1월부터 2020년 9월까지 0-5세 사이의 아동에서 열성 경련 진단을 받은 모든 입원 환자가 포함되었으며, 2010-2019년 1월 1일부터 9월 30일까지, 2020년 같은 기간동안 인구 100,000명 당 발병률을 추정하기 위해 월별 사례 수를 집계하였다. 결과: 2010-2019년 열성경련의 발병률은 1월 100,000명 당 116명에서 9월 101명 이었으나, 2020년 2월 사회적 거리두기 이후 열성 경련의 발병률은 1월 100,000명당 113명에서 9월 27명으로 감소하였다. 결론: 2010-2019년에 비해 2020년 열성경련의 발병률 순 감소는 -38% 였으며, 사회적 거리두기가 열성 경련의 발병률 감소에 기여했음을 시사하는 결과를 확인하였다.