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Clinical Features, Diagnosis, Management, and Outcomes of Idiopathic Pulmonary Fibrosis in Korea: Analysis of the Korea IPF Cohort (KICO) Registry

  • Jegal, Yangjin;Park, Jong Sun;Kim, Song Yee;Yoo, Hongseok;Jeong, Sung Hwan;Song, Jin Woo;Lee, Jae Ha;Lee, Hong Lyeol;Choi, Sun Mi;Kim, Young Whan;Kim, Yong Hyun;Choi, Hye Sook;Lee, Jongmin;Uh, Soo-Taek;Kim, Tae-Hyung;Kim, Sang-Heon;Lee, Won-Yeon;Kim, Yee Hyung;Lee, Hyun-kyung;Lee, Eun Joo;Heo, Eun Young;Yang, Sei Hoon;Kang, Hyung Koo;Chung, Man Pyo;Korea ILD Study Group,
    • Tuberculosis and Respiratory Diseases
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    • v.85 no.2
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    • pp.185-194
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    • 2022
  • Background: The Korea Interstitial Lung Disease Study Group has made a new nationwide idiopathic pulmonary fibrosis (IPF) registry because the routine clinical practice has changed due to new guidelines and newly developed antifibrotic agents in the recent decade. The aim of this study was to describe recent clinical characteristics of Korean IPF patients. Methods: Both newly diagnosed and following IPF patients diagnosed after the previous registry in 2008 were enrolled. Survival analysis was only conducted for patients diagnosed with IPF after 2016 because antifibrotic agents started to be covered by medical insurance of Korea in October 2015. Results: A total of 2,139 patients were analyzed. Their mean age at diagnosis was 67.4±9.3 years. Of these patients, 76.1% were males, 71.0% were ever-smokers, 14.4% were asymptomatic at the time of diagnosis, and 56.9% were at gender-age-physiology stage I. Occupational toxic material exposure was reported in 534 patients. The mean forced vital capacity was 74.6% and the diffusing capacity for carbon monoxide was 63.6%. Treatment with pirfenidone was increased over time: 62.4% of IPF patients were treated with pirfenidone initially. And 79.2% of patients were treated with antifiboritics for more than three months during the course of the disease since 2016. Old age, acute exacerbation, treatment without antifibrotics, and exposure to wood and stone dust were associated with higher mortality. Conclusion: In the recent Korean IPF registry, the percentage of IPF patients treated with antifibrotics was increased compared to that in the previous IPF registry. Old age, acute exacerbation, treatment without antifibrotics, and exposure to wood and stone dust were associated with higher mortality.

The Effects of Recognition of Retirement Responsibility on Financial Retirement Preparedness: Focusing on Moderating Effects of Income-level (노후준비에 대한 책임인식이 경제적 노후준비에 미치는 영향: 소득수준의 조절효과를 중심으로)

  • Kim, Jeungkun;Park, Eunju
    • 한국노년학
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    • v.40 no.4
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    • pp.639-657
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    • 2020
  • The purpose of this study is to analyze the effect of individual differences in recognition of retirement responsibility on financial preparedness for retirement and to examine moderating effect of income-level on the relationships between the two variables, using the 7th Korean Retirement and Income Study(KReIS). Two research methods, descriptive analysis and hierarchical multiple logistic regression(HMLR) analysis, have been conducted. The total number of sample was 3,869 subjects with an average age of 58.9 years and 55.3% males. The results show that only 35.8% of the respondents make financial plans for retirement, and 64.2% did not. Main findings are as follows. First, 65% of respondents take a responsibility for financial preparedness for retirement, compared to 37% in European countries. Second, people with responsibility for their own retirement are more likely to have a financial preparation for retirement than people who think others(family, society, government) have to take a responsibility for retirement instead of them. Third, there is a significant moderating effect of income-level on relationships between recognition of retirement responsibility and financial preparedness for retirement. As income level decreases, the moderating effect reduces the positive effect of recognition of retirement responsibility on financial preparedness for retirement and vice versa. Fourth, as income level increases and educational level is higher, the tendency to prepare financially for retirement is also increasing. Low-income and low-educated people are less likely to have a financial preparation for retirement than their counterparts. The findings suggest that it is necessary to design an effective incentive scheme for financial preparedness for retirement for low-income and low-educated people and to develop various policies and services to encourage them to prepare financially for retirement.

Comparison of the Injury Mechanism, Pattern and Initial Management Approach for Orthopedic Injuries According to the Injury Severity in Moderate-to-Severe Injured Patients (중등도 이상의 손상 환자에서 손상 중증도에 따른 정형외과적 손상에 대한 수상기전, 손상유형, 초기 치료적 접근의 비교)

  • Lee, Eui-Sup;Sohn, Hoon-Sang;Kim, Younghwan;Shon, Min Soo
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.5
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    • pp.383-396
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    • 2020
  • Purpose: This study compared the injury mechanism, site, type, initial management approach of orthopedic injury, and outcomes according to the injury severity in moderate-to-severe injured patients. Materials and Methods: During 57-month, excluding the period when the authors' emergency/trauma center was not operating, from 2014 to 2019, a retrospective study was conducted on 778 patients with orthopedic injuries among patients with an Injury Severity Score (ISS)>9 scored. The patients were classified into moderate-injured group (group-1, 679) and severe-injured group (group-2, 99) according to the injury severity based on the ISS and physiologic parameters. The injury mechanism and non-orthopedic injury were evaluated. Orthopedic injuries were assessed according to the injury pattern and the number of anatomical regions and bone sites involved. The management approach for the orthopedic injuries in two groups was compared. Outcomes (hospital stay, systemic complications, and in-hospital mortality) were evaluated, and the risk factors for mortality were analyzed. Results: In group-2, the incidence of younger males, high-energy mechanisms, and accompanying injuries was significantly higher than in group-1. The number of anatomical regions and bone sites involved increased in group-2. The involvement of the pelvis, spine, and upper extremity was significantly higher in group-2, whereas group-1 was involved mainly by the lower extremities. Depending on the patient's condition, definitive or staged management for orthopedic injuries may be used. Group-1 was treated mainly with definite fixation after the physiological stabilization process, and group-2 was treated with staged management using temporary external fixation. The hospital stay was significantly longer in group-2. The overall systematic complications and in-hospital mortality was approximately 4.9% and 4.5%. A higher injury severity was associated with higher in-hospital mortality (2.9%, 15.2%; p<0.0001). Increasing age and high ISS are independent risk factors for mortality. Conclusion: A higher severity of injury was associated with a higher incidence of high-energy mechanism, younger, male, accompanying injuries, and the frequency and severity of orthopedic injuries. Severe polytrauma patients were treated mainly with a staged approach, such as external fixation. The hospital stay, systematic complications, and in-hospital mortality were significantly higher in severe-injured patients. Age and ISS are strong predictors of in-hospital mortality in polytrauma.

Outcome of Conservative Treatment of the Zone I, II 5th Metatarsal Base Fracture under Early Weight-Bearing (제5 중족골 제1, 2 구역 골절의 조기 체중부하의 비수술적 치료 결과)

  • Gwak, Heui-Chul;Park, Dae-Hyun;Kim, Jung-Han;Lee, Chang-Rack;Kwon, Yong-Uk;Kim, Dong-Seok
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.2
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    • pp.150-156
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    • 2021
  • Purpose: To determine how the location, displacement, intra-articular involvement, comminution of a 5th metatarsal base fracture affect results of early weight-bearing treatment. Materials and Methods: From January 2013 to July 2017, 34 cases of 34 patients diagnosed with a fracture of the zone I and II 5th metatarsal base were enrolled. The mean follow-up period was 13 months (6-15 months). One patient was excluded as a refracture during the follow-up period, and 33 patients underwent conservative treatment. Anteroposterior, lateral, and simple oblique radiography and computed tomography of the foot were performed to evaluate the location and displacement of the fracture, the degree of joint involvement, and comminution. In all 33 patients, a short leg cast or boot brace was selected immediately after the injury, tolerable weight bearing was allowed. If the pain disappeared, full weight bearing was performed after wearing a plain shoe or postoperative shoe. As a clinical result, the American Orthopedic Foot and Ankle Society (AOFAS) score was evaluated at the final follow-up. During outpatient follow-up, a simple radiograph of the foot was taken to confirm the time of radiological bone union and return to work. Results: Nine males and 24 females, with an average age of 48.7 years, were enrolled in the study. Twenty-four patients had zone I fractures, and nine patients had zone II fractures. Twenty-two out of 33 patients had a fracture displacement of 2 mm or more. Nine and five patients had joint involvement and comminution, respectively. There was a statistically significant return to work from zone I to zone II. The AOFAS score was excellent at the final follow-up and there was no significant difference. When classifying and comparing the degree of fracture displacement, joint involvement, and comminution, there were no significant differences in the radiological union time and return to work. In all cases, satisfactory results were obtained at the final follow-up. Conclusion: Satisfactory clinical results can be obtained by allowing early weight-bearing regardless of the fracture location, displacement, joint involvement, or comminution in zone I and II 5th metatarsal base fractures.

Distribution Status of Invasive Alien Species (Procambarus clarkii (Girard, 1852)) Using Biomonitoring with Environmental DNA in South Korea (생물모니터링 및 환경유전자(eDNA)를 이용한 침입외래종 미국가재(Procambarus clarkii)의 한국분포 현황)

  • Jung, Sang Woo;Lee, Jae-Ha;Kawai, Tadashi;Kim, Phil-Jae;Kim, SuHwan
    • Korean Journal of Environment and Ecology
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    • v.36 no.4
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    • pp.368-380
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    • 2022
  • Biomonitoring of an invasive alien crayfish species, Procambarus clarkii (Girard, 1852), was performed from February to October 2021, along with environmental DNA analysis, at five locations including Wanju-gun, Hampyeong-gun, Naju-si, Gurye-gun, and Cheongju-si. For the investigation, an umbrella-shaped trap for adults and a hand net for young crayfish were used, and 8 to 10L of freshwater was collected for eDNA analysis. The current status and past distributional records of crayfish in Korea were analyzed along with benthic macroinvertebrates at each survey site. As a result of the investigation, a total of 122 individuals were identified, and Hampyeong-gun recorded the largest number of populations with 59 individuals (48.36%) and the highest environmental DNA (eDNA). The frequency of appearance of P. clarkii was highest in May. The ratio of females to males was 21:5, and the body size was 72.2±21.1mm for female, 80.5±15.6mm for male, and 25.3±9.8mm for young crayfish. P. clarkii introduced into Korea is mainly spreading in the southwest region and it has not been observed in Seoul where there had been a record of appearance in the past. No external symbiosis (Branchiobdellida) of P. clarkii has been identified, and P. clarkii that has appeared in Korea was presumed to be imported from Japan. There are more than eight kinds of exotic crayfish distributed in Korea, and among them, the marbled crayfish (P. virginalis) was identified as a harmful species to the ecosystem of Korea by the Ministry of Environment in 2021. The identified species of benthic macroinvertebrates inhabiting the survey area where P. clarkii has appeared were 69 belonging to 39 families, 15 orders, five classes, and three phyla. Among them, Odonata were the most abundant (16 spp.; 24.62%), followed by Coleoptera (11 spp.; 16.92%) and Hemiptera (11 spp.; 16.92%). In the survey area, one Korean endemic species (Rhoenanthus coreanus), one species (Helophorus auriculatus) classified as Near Threatened (NT) on the Korean Red List, and six species of Crustaceans appeared. In the functional feeding group, the predators appeared predominantly while in habitat oriented group, the climbers appeared to be abundant. It was confirmed that P. clarkii in the survey area prefers an area rich in aquatic vegetation with waterside vegetation, and has high resistance to turbid water quality. The omnivore invader P. clarkii is expected to maintain a competitive relationship with carnivorous benthic macroinvertebrates that are predominant in the same species, and is expected to continue to generate ecosystem disturbance along the food chains.

A Comparative Study on the Growth Performance of Korean Indigenous Chicken Pure Line by Sex and Twelve Strains (토종닭 순계 12계통과 성별에 따른 성장능력 비교 연구)

  • Kim, Kigon;Park, Byoungho;Jeon, Iksoo;Choo, Hyojun;Ham, Jinjoo;Park, Keon;Cha, Jaebeom
    • Korean Journal of Poultry Science
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    • v.48 no.4
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    • pp.193-206
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    • 2021
  • This study aimed to identify the growth performance of Korean indigenous chicken pure-line by sex and twelve strains conserved in Poultry Research Institute, National Institute of Animal Science, Rural Development Administration. The effect of sex and strain on body weight was significantly different in every period, with males being heavier in all periods than females. In the case of biweekly weight gain, the tendency to increase rapidly from birth to six weeks old, and to decrease in the period from twelve to fourteen weeks old was common across all sex and strains. Depending on sex and strain, there were significant differences in age and the number of peaks. Regardless of sex and strain, the determination coefficient and adjusted determination coefficient showed high goodness of fit (99.1~99.9%) to growth functions. However, for each model, the goodness-of-fit had variations by sex and strains. von Betalanffy function had the best fit to growth curves in all the female strains except strain D. On the other hand, Gompertz function had the best fit for all the male strains except strain C. Logistic function showed the lowest goodness-of-fit in all sex and strains. Mature weights were in the order of von bertalanffy, Gompertz, and Logistic models, while growth ratio and maturing rate followed the order of logistic, gompertz, and von bertalanffy functions. This information could be useful for Korean indigenous chicken management and designing crossbreeding tests and breeding programs.

Developmental Characteristics of Zophobas atratus (Coleoptera: Tenebrionidae) at Varing Temperatures (온도에 따른 아메리카왕거저리(Zophobas atratus)의 발육 특성)

  • Kwak, Kyu-Won;Kim, Sun Young;Lee, Kyeong Yong;Yoon, Hyung Joo
    • Korean journal of applied entomology
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    • v.61 no.2
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    • pp.357-368
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    • 2022
  • We investigated the developmental characteristics of super mealworm (Coleoptera: Tenebrionidae) at four different temperatures (25℃, 27℃, 30℃, and 33℃). The rearing conditions were 9L/15D, 65% RH, and 1,330 to 1,800 lux with wheat bran. The length of developmental period of 1 to 18 instars at each temperature showed that 30℃ was the shortest at 120.0±5.8 days, compared to that at 27℃ (132.6±10.7 days), 33℃ (136.5±9.2 days), and 25℃ (156.7±7.5 days). The larval developmental period was statistically significantly longer at 25℃, 27℃, and 30℃ compared to the length at 33℃. However, the death rate of larvae at 33℃ was 2.7-3.3 times higher than the rate at other temperatures. Body weight was heaviest at 30℃ followed by 27℃, 33℃, and 25℃. The patterns of head capsule, body capsule, and body length were similar to that of body weight. Regression analyses of developmental period, larval body weight, and length according to temperature revealed 29-30℃ as the most suitable temperature. The prepupa rate was 43.1% in 17 instars, 30.3% in 18 instars, 15.4% in 16 instars, 7.1% in 19 instars, 2.2% in 15 instars, and 1.9% in 20 instars, accounting for 88.8% in 16-18 instars. Prepupal period was longer at lower temperatures. For the average prepupal period of 15-18 instars, prepupa time was 18.8±1.9 days at 27℃, 18.8±2.3 days at 30℃, 23.0±2.4 days at 33℃, and 23.1±2.9 days at 25℃. The average pupal period of females and males was 11.1±2.2 and 11.6±2.4 days, respectively. The data indicate that the most suitable rearing temperature of super mealworm was 30℃.

Prevalence of Tarsal Coalition in the Korean Population: A Single Institution-Based Study (한국인의 족근골 유합의 유병률: 병원 내원 환자에 대한 연구)

  • Kim, Tae Yong;Yoon, So Hee;Ko, Jung Hoon;Lee, Tae Ho;Yi, Seung Rim
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.4
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    • pp.324-330
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    • 2020
  • Purpose: Korean studies on the prevalence of a tarsal coalition are quite rare, and there are very few reports on the prevalence of multiple tarsal coalitions among adults in the foreign literature. Therefore, this study examined the characteristics and prevalence of tarsal coalition in the Korean population based on imaging tests. Materials and Methods: The prevalence of tarsal coalition and its anatomical location and histological classification were reviewed retrospectively among 4,711 patients (4,454 males and 257 females) with an ankle sprain or ankle fracture who underwent foot and ankle computed tomography and magnetic resonance imaging between March 2009 and February 2019 at the authors' institution. Results: Over a period of 10 years, 78 patients (1.7%) had a tarsal coalition, among whom 53 patients (67.9%) had an isolated tarsal coalition and 25 patients (32.1%) had multiple tarsal coalitions. Regarding the anatomical location, a talocalcaneal coalition was the most common type in both isolated (31 patients, 37 cases [62.7%]) and multiple (22 patients, 23 cases [45.1%]) tarsal coalitions. In the isolated coalition group, the second-most common type was calcaneonavicular coalition (10 patients, 16.9%), followed by naviculocuneiform (nine patients, 15.3%) and cuboidonavicular coalitions (three patients, 5.1%). In the multiple coalition group, the second-most common coalition type was calcaneonavicular coalition (14 patients, 14 cases [27.5%]), followed by talonavicular coalition (six patients, six cases [11.8%]). From a total of 60 cases of talocalcaneal coalition, 24 cases (40.0%) were in the posterior facet, 18 cases (30.0%) in the middle facet, and four cases (6.7%) in the anterior facet. Regarding the histological classification, cartilaginous coalition was the most common in both single (32 patients, 35 cases [59.3%]) and multiple (20 patients, 37 cases [72.5%]) coalition groups. Conclusion: The present study found that talocalcaneal coalition was the most common type of tarsal coalition. In contrast to previous reports that a talocalcaneal coalition generally occurs in the middle facet, it was usually observed in the posterior facet in the present study. In addition, although multiple tarsal coalitions have been reported to be quite rare, this study confirmed that they are not rare and can occur in a range of patterns.

Wedge-Shaped Resection for Massive Xanthomatosis of Achilles Tendon (양측 아킬레스건에 발생한 거대 황색종의 쐐기형 절제술을 이용한 수술적 치료)

  • Kim, Sungmin;Ahn, Yeong Seub;Jung, Dong-Min;Jung, Sung Taek
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.2
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    • pp.157-163
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    • 2021
  • Purpose: Xanthomatosis of the Achilles tendons is rare. In some patients, however, the lesions in the Achilles tendon need to be removed, which may be painful and disfiguring. While studies of successful surgical outcomes for the total resection and reconstruction of the Achilles tendon have been reported, reconstruction surgery has a technical challenge, and extended surgical exposures are required. This study analyzed five cases of bilateral xanthoma of the Achilles tendon, which was treated surgically using a wedge-shaped tendon-sparing approach to eliminate the need for tendon reconstruction. Materials and Methods: From July 2010 to May 2018, five patients with xanthomatosis in both Achilles tendons underwent wedge-shaped tendon preserving surgery. The average age was 49 years (range, 40-55 years), and the follow-up period was 21.4 months (range, 12-31 months). The patients consisted of three males and two females. Complications related to surgery were recorded. The outcome measures included the range of motion of the ankle joint, American Orthopaedic Foot and ankle Society (AOFAS) ankle/hindfoot score, and visual analogue scale (VAS) for overall satisfaction at the last follow-up. The availability of a single-limb heel raise and returning time to work were also measured. Results: Wound dehiscence that did not require secondary surgery was noted in one patient. At the last follow-up, the range of motion of the ankle joint was normal in all patients. The mean AOFAS ankle/hindfoot score was 91 (range, 85-96) and the VAS for the overall satisfaction ranged from 8 to 10. The average time between surgery and return to work was 27.6 days (range, 17-58 days) and all patients could perform a single-limb heel raise test. Conclusion: The tendon-sparing technique, which can preserve the anatomical functioning of the Achilles tendon, could be an excellent surgical approach because it has very promising functional and cosmetic surgical outcomes in patients with Achilles tendon xanthomatosis.

Results of Surgical Treatment of Patella Dislocation (슬개골 탈구의 수술적 치료 결과)

  • Kim, Hui Taek;Cho, Yoon Jae
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.2
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    • pp.134-141
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    • 2021
  • Purpose: Patellar dislocations have a range of causes. This study examined the results of treatment aimed at balancing soft tissues around the patella. Materials and Methods: Thirty-two patellar dislocations in 28 patients (21 females and seven males) were examined. The mean patient age at the time of surgery was 11.5 years, and the mean follow-up period was 4.6 years. Dislocations were 19 chronic, six habitual, six congenital, and one acute. Soft tissue balancing surgery included lateral capsular release, medial capsular plication, and inferolateral transfer of the vastus medialis obliquus. Medial transfer of the patellar tendon, partial strip of the rectus femoris and patella tendon, and distal femoral osteotomy were also performed selectively. The preoperative Q angle, femoral anteversion angle, tibial external rotation angle, tibial tubercle-trochlear groove distance (TT-TG distance), mechanical femoral-tibial angle, and femoral trochlear dysplasia according to Dejour were measured, and the pre- and postoperative Lysholm-Tegner scores were used to analyze the clinical results. Results: The mean preoperative Q angle, TT-TG distance, femoral anteversion angle, tibial external rotation angle, mechanical femoraltibia angle, and Lysholm-Tegner score were 9.3°, 15.5 mm, 25.6°, 30.4°, 3.0°, and 75.8, respectively. Eleven patients had systemic ligament laxity with a Beighton score of five or more. Twenty-two patients had femoral trochlear dysplasia: four type A (3 patients), 16 type B (15 patients), one type C (1 patient), and four type D (3 patients). Of the 32 cases, 28 were corrected successfully by the first operation. Of four cases of postoperative subluxation, three were corrected by the second operation, and one of them was corrected after a third operation. The last patient is currently being followed-up. The mean Lysholm-Tegner score improved to 85.6 after the operation. Conclusion: Correcting all the causes of patella dislocation simultaneously is difficult. Nevertheless, satisfactory outcomes were obtained with soft tissue balancing surgery around the patella and a corrective osteotomy for an abnormal mechanical axis of the femur-tibia and torsion.