• 대한이식학회지
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• 제31권4호
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• pp.182-192
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• 2017

Background: In recent years, introduction of novel immunosuppressive agents and its proper implementation for clinical practice have contributed to improving clinical outcomes of kidney transplantation (KT). Here, we report clinical outcomes of KTs and related risk factors. Methods: From July 1998 to June 2016, 354 KTs (182 from living and 172 from deceased donors) have been performed at Ulsan University Hospital. We retrospectively reviewed the clinical characteristics and outcomes of KT recipients, then estimated graft and patient survival rate were estimated and analyzed risk factors using Cox-regression. Results: The median follow-up period was 53 months (range; 3 to 220 months). The mean ages of recipients and donors were 45.0 years (SD, 12.5) and 44.7 years (SD, 13.6) years, respectively. During follow-up, 18 grafts were lost and 5- and 10-year death-censored graft survival was 96.7% and 91.5%, respectively. Biopsy-proven acute rejection (BPAR) occurred in 71 patients (55 cases of acute cellular rejection and 16 of antibody-mediated rejection). Cox-regression analysis showed that BPAR was a risk factor related to graft loss (hazard ratio [HR], 14.38; 95% confidence interval [CI], 3.79 to 54.53; P<0.001). In addition, 15 patients died, and the 5- and 10-year patient survival was 97.2% and 91.9%, respectively. Age ≥60 years (HR, 6.03; 95% CI, 1.12 to 32.61; P=0.037) and diabetes (HR, 6.18; 95% CI, 1.35 to 28.22; P=0.019) were significantly related to patient survival. Conclusions: We experienced excellent clinical outcomes of KT in terms of graft failure and patient survival despite the relatively high proportion of deceased donors. Long-term and short-term clinical outcomes have improved in the last two decades.

• Asian Pacific Journal of Cancer Prevention
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• 제17권9호
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• pp.4381-4389
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• 2016

Background: Surgery is the corner stone for the management of rectal cancer. The purpose of this study was to demonstrate the optimal time of surgical resection after the completion of neoadjuvant chemo-radiotherapy (CRT) in treatment of locally advanced rectal cancer. Materials and Methods: This study compared 2 groups of patients with locally advanced rectal cancer, treated with neoadjuvant CRT followed by surgical resection either 6-8 weeks or 9-14 weeks after the completion of chemo-radiotherapy. The impact of delaying surgery was tested in comparison to early surgical resection after completion of chemo-radiotherapy. Results: The total significant response rate that could result in functional preservation was estimated to be 3.85% in group I and 15.4% in group II. Some 9.62% of our patients had residual malignant cells at one cm surgical margin. All those patients with positive margins at one cm were in group I (19.23%). There was less operative time in group II, but the difference between both groups was statistically insignificant (P=0.845). The difference between both groups regarding operative blood loss and intra operative blood transfusion was significantly less in group II (P=0.044). There was no statistically significant difference between both groups regarding the intra operative complications (P=0.609). The current study showed significantly less post-operative hospital stay period, and less post-operative wound infection in group II (P=0.012 and 0.017). The current study showed more tumor regression and necrosis in group II with a highly significant main effect of time F=61.7 (P<0.001). Pathological TN stage indicated better pathological tumor response in group II (P=0.04). The current study showed recurrence free survival for all cases at 18 months of 84.2%. In group I, survival rate at the same duration was 73.8%, however none of group II cases had local recurrence (censored) (P=0.031). Disease free survival (DFS) during the same duration (18 months) was 69.4 % for patients in group I and 82.3% for group II (P=0.429). Conclusions: Surgical resection delay up to 9-14 weeks after chemo-radiation was associated with better outcome and better recurrence free survival.

• Korean Journal of Radiology
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• 제21권6호
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• pp.736-745
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• 2020

Objective: To identify the initial chest computed tomography (CT) findings and clinical characteristics associated with the course of coronavirus disease 2019 (COVID-19) pneumonia. Materials and Methods: Baseline CT scans and clinical and laboratory data of 72 patients admitted with COVID-19 pneumonia (39 men, 46.2 ± 15.9 years) were retrospectively analyzed. Baseline CT findings including lobar distribution, presence of ground glass opacities, consolidation, linear opacities, and lung severity score were evaluated. The outcome event was recovery with hospital discharge. The time from symptom onset to discharge or the end of follow-up (for those remained hospitalized) was recorded. Data were censored in events such as death or discharge without recovery. Multivariable Cox proportional hazard regression was used to explore the association between initial CT, clinical or laboratory findings, and discharge with recovery, whereby hazard ratio (HR) values < 1 indicated a lower rate of discharge at four weeks and longer time until discharge. Results: Thirty-two patients recovered and were discharged during the study period with a median length of admission of 16 days (range, 9 to 25 days), while the rest remained hospitalized at the end of this study (median, 17.5 days; range, 4 to 27 days). None died during the study period. After controlling for age, onset time, lesion characteristics, number of lung lobes affected, and bilateral involvement, the lung severity score on baseline CT (> 4 vs. ≤ 4 [reference]: adjusted HR = 0.41 [95% confidence interval, CI = 0.18-0.92], p = 0.031) and initial lymphocyte count (reduced vs. normal or elevated [reference]: adjusted HR = 0.14 [95% CI = 0.03-0.60], p = 0.008) were two significant independent factors that influenced recovery and discharge. Conclusion: Lung severity score > 4 and reduced lymphocyte count at initial evaluation were independently associated with a significantly lower rate of recovery and discharge and extended hospitalization in patients admitted for COVID-19 pneumonia.

• 환경영향평가
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• 제28권2호
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• pp.101-112
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• 2019

서울 및 수도권 지역의 미세먼지 문제는 지역 주민의 건강, 생태계 및 산업활동에 다양한 영향을 미치며 최근 가장 심각한 환경문제의 하나로 대두되고 있다. 정부와 개인은 미세먼지 문제에 대응하기 위해 다양한 비용을 지불하고 있다. 따라서, 본 연구는 동지역에 거주하고 있는 사회문화적 특성이 다른 두 집단(서울 및 수도권 지역의 외국인학교와 일반학교)의 학부모들을 대상으로 미세먼지 문제 해결을 위한 두 집단 간의 지불의사액이 어떻게 다른지를 추정하고자 한다. 응답자들의 지불의사액을 도출하기 위해 단일양분선택형(single-bounded dichotomous choice) 질문기법을 이용한 조건부가치추정법(contingent valuation model: CVM)을 사용하였다. 토빗과 프로빗모형을 이용한 지불의사액 추정 결과, 서울 및 수도권지역에 거주하는 전체 학부모들은 지역 내 미세먼지 문제 개선을 위한 청정 전기(green electricity) 사용료를 가구당 월평균 3,993원 가량 더 지불할 의사가 있는 것으로 추정되었다. 두 집단 간의 지불의사액 비교 시 비내국인 그룹(international group)은 월 3,325원, 내국인 그룹(domestic group)은 월 4,449원으로 다소 큰 차이를 보였는데, 이는 각 집단이 속한 사회문화적 배경의 차이에 따라 사회경제적 지위, 개인적 경험, 정부정책에 대한 신뢰 및 가치관 등이 개인의 지불의사를 결정하는데 다르게 작용한 것으로 보인다. 본 연구의 결과, 현재 수도권지역의 미세먼지 문제 해결을 위해서는 무엇보다 시민들이 미세먼지 문제를 청정 에너지 사용과 연결 지어 생각할 수 있도록 환경의식을 고취하는 것이 필요하며, 특히 사회문화적 배경이 다른 계층에 대한 정부 오염 저감 정책의 신뢰도 향상에 초점을 맞출 필요가 있다.