• Tuberculosis and Respiratory Diseases
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• 제80권2호
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• pp.169-178
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• 2017

Background: The purpose of this study was to assess the effect of our new video-assisted asthma education program on patients' knowledge regarding asthma and asthma control. Methods: Adult asthmatics who were diagnosed by primary care physicians and followed for at least 1 year were educated via smart devices and pamphlets. The education sessions were carried out three times at 2-week intervals. Each education period lasted at most 5 minutes. The effectiveness was then evaluated using questionnaires and an asthma control test (ACT). Results: The study enrolled 144 patients (mean age, $56.7{\pm}16.7years$). Half of the patients had not been taught how to use their inhalers. After participating in the education program, the participants' understanding of asthma improved significantly across all six items of a questionnaire assessing their general knowledge of asthma. The proportion of patients who made errors while manipulating their inhalers was reduced to less than 10%. The ACT score increased from $16.6{\pm}4.6$ to $20.0{\pm}3.9$ (p<0.001). The number of asthmatics whose ACT score was at least 20 increased from 45 (33.3%) to 93 (65.3%) (p<0.001). The magnitude of improvement in the ACT score did not differ between patients who received an education session at least three times within 1 year and those who had not. The majority of patients agreed to the need for an education program (95.8%) and showed a willingness to pay an additional cost for the education (81.9%). Conclusion: This study indicated that our newly developed education program would become an effective component of asthma management in primary care clinics.

• Radiation Oncology Journal
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• 제33권3호
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• pp.188-197
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• 2015

Purpose: To investigate the patterns of care for patients with nasopharyngeal carcinoma (NPC) in South Korea. Materials and Methods: A multi-institutional retrospective study was performed (Korean Radiation Oncology Group [KROG] 11-06) on a total of 1,445 patients from 15 institutions. Results: Of the 1,445 patients, more than half were stages III (39.9%) and IV (35.8%). In addition to patterns of care, we also investigated trends over time with the periods 1988-1993, 1994-2002, and 2003-2011. The frequencies of magnetic resonance imaging and positron emission tomography-computed tomography were markedly increased in the third period compared to previous 2 periods. Concurrent chemoradiation (CCRT) was performed on 894 patients (61.9%), neoadjuvant chemotherapy on 468 patients (32.4%), and adjuvant chemotherapy on 366 patients (25.3%). Of stage II-IV patients, CCRT performed on 78.8% in 2003-2011 compared to 15.0% in 1988-1993. For patients treated with CCRT, cisplatin was the most commonly used agent in 81.3% of patients. Over the periods of time, commonly used radiotherapy (RT) techniques were changed from 2-dimensional RT (1988-1993, 92.5%) to 3-dimensional RT (2003-2011, 35.5%) or intensity-modulated RT (IMRT; 2003-2011, 56.5%). Median RT doses given to primary tumors, high-risk lymphatics, and low-risk lymphatics were 70.0 Gy, 58.1 Gy, and 48.0 Gy, respectively. Adoption of IMRT increased the dose per fraction and escalated total radiation dose. Conclusion: Assessment of the patterns of care for NPC patients in South Korea demonstrated that management for NPC including diagnostic imaging, treatment regimen, RT techniques and dose schedule, advanced in accordance with the international guidelines.

• Neonatal Medicine
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• 제18권2호
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• pp.248-256
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• 2011

목적: 부당 경량아와 자궁 내 성장 지연을 혼동하여 사용하고 있다. 실제 부당 경량아 중 약 70% 정도는 기질적으로 작게 태어난 경우로 자궁 내 성장 지연으로 인한 부당 경량아에 비해 주산기 합병증의 위험이 거의 없다. 그러나 자궁 내 성장 지연으로 인한 부당 경량아를 구별할 수 있는 뚜렷한 방법은 아직 없다. 저자들은 자궁 내 성장 지연의 위험 인자 중 모체의 고혈압, 당뇨병에 초점을 맞춰 고혈압 및 당뇨병 산모의 부당 경량아와 자궁내 성장 지연의 위험 요인을 발견할 수 없었던 부당 경량아를 대상으로 모체의 질환에 따른 임상적 특징과 혈액학적 특징을 비교해 보고 부당 경량아의 출생 시 자궁 내 성장 지연의 정도 및 예후를 예측하는 데 도움이 되고자 본 연구를 계획하였다. 방법: 2007년 1월부터 2010년 7월까지 가톨릭대학교 서울성모병원과 여의도 성모병원에서 출생한 부당 경량아 중 모체의 고혈압, 당뇨 이외의 자궁 내 성장 지연의 위험 인자를 가진 환아를 모두 제외한 163명을 대상으로 의무 기록을 후향적으로 분석하여 임상적 소견, 혈액학적 소견을 기록하였다. 대상군을 모체의 질환에 따라, 재태 연령에 따라, 재태 연령과 모체의 질환을 함께 고려하여 세가지 방법으로 분류하여 비교하였다. 결과: 모체의 질환별로 전체 부당 경량아를 분류하였을 때 예후, 임상적 특징은 큰 차이가 없었으나 고혈압 산모에서 출생한 부당 경량아에서 백혈구와 혈소판이 유의하게 낮았으며 (P=0.004, P=0.003) 혈소판 수치는 재원 기간과 관련성이 있었다. 미숙아 부당 경량아와 만삭아 부당 경량아를 재태 연령과 출생 체중을 보정하여 비교하였을 때에도 미숙아 부당 경량아에서 백혈구와 혈소판이 유의하게 낮았다(P <0.001, P <0.001). 그러나 미숙아 부당 경량아를 모체의 질환에 따라 비교하였을 때에는 이러한 차이가 나타나지 않았다. 결론: 백혈구와 혈소판 수의 감소와 자궁 내 성장 지연의 발생과 관련이 있는 것으로 보인다. 자궁 내 성장 지연아의 이학적 소견과 이러한 혈액학적 특징을 함께 고려한다면 자궁 내 성장 지연을 진단하는 데에 도움이 될 것으로 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제70권3호
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• pp.199-205
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• 2011

Social welfare services for respiratory-disabled persons in Korea are offered based on the respiratory impairment grade, which is determined by 3 clinical parameters; dyspnea, forced expiratory volume in 1 second ($FEV_1$), and arterial oxygen tension. This grading system has several limitations in the objective assessment of respiratory impairment. We reviewed several guidelines for the evaluation of respiratory impairment and relevant articles. Then, we discussed a new grading system with respiratory physicians. Both researchers and respiratory physicians agreed that pulmonary function tests are essential in assessing the severity of respiratory impairment, forced vital capacity (FVC), $FEV_1$ and single breath diffusing capacity ($DL_{co}$) are the primarily recommended tests. In addition, we agreed that arterial blood gas analysis should be reserved for selected patients. In conclusion, we propose a new respiratory impairment grading system utilizing a combination FVC, $FEV_1$ and $DL_{co}$ scores, with more social discussion included.

• Tuberculosis and Respiratory Diseases
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• 제70권4호
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• pp.293-300
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• 2011

Chronic obstructive pulmonary disease (COPD) is a substantially under-diagnosed disorder, and the diagnosis is usually delayed until the disease is advanced. However, the benefit of early diagnosis is not yet clear, and there are no guidelines in Korea for doing early diagnosis. This review highlights several issues regarding early diagnosis of COPD. On the basis of several lines of evidence, early diagnosis seems quite necessary and beneficial to patients. Early diagnosis can be approached by several methods, but it should be confirmed by quality-controlled spirometry. Compared with its potential benefit, the adverse effects of spirometry or pharmacotherapy appear relatively small. Although it is difficult to evaluate the benefit of early diagnosis by well-designed trials, several lines of evidence suggest that we should try to diagnose and manage patients with COPD at early stages of the disease.

• Journal of Korean Medical Science
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• 제33권49호
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• pp.323.1-323.12
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• 2018

Background: Vitamin K antagonist (VKA) to prevent thromboembolism in non-valvular atrial fibrillation (NVAF) patients has limitations such as drug interaction. This study investigated the clinical characteristics of Korean patients treated with VKA for stroke prevention and assessed quality of VKA therapy and treatment satisfaction. Methods: We conducted a multicenter, prospective, non-interventional study. Patients with $CHADS_2{\geq}1$ and treated with VKA (started within the last 3 months) were enrolled from April 2013 to March 2014. Demographic and clinical features including risk factors of stroke and VKA treatment information was collected at baseline. Treatment patterns and international normalized ratio (INR) level were evaluated during follow-up. Time in therapeutic range (TTR) > 60% indicated well-controlled INR. Treatment satisfaction on the VKA use was measured by Treatment Satisfaction Questionnaire for Medication (TSQM) after 3 months of follow-up. Results: A total of 877 patients (age, 67; male, 60%) were enrolled and followed up for one year. More than half of patients (56%) had $CHADS_2{\geq}2$ and 83.6% had $CHA_2DS_2-VASc{\geq}2$. A total of 852 patients had one or more INR measurement during their follow-up period. Among those patients, 25.5% discontinued VKA treatment during follow-up. Of all patients, 626 patients (73%) had poor-controlled INR (TTR < 60%) measure. Patients' treatment satisfaction measured with TSQM was 55.6 in global satisfaction domain. Conclusion: INR was poorly controlled in Korean NVAF patients treated with VKA. VKA users also showed low treatment satisfaction.

• Ecology and Resilient Infrastructure
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• 제8권2호
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• pp.120-132
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• 2021

서울시 생태경관보전지역은 자연환경보전법과 자연환경보전조례에 근거하고 있다. 2018년 제13차 람사르협약 당사국총회에서 '습지 생태계서비스 간편평가 도구'가 채택되었으며, 람사르습지 도시 인증제 항목에 습지 생태계서비스 평가 항목이 포함됨에 따라 이를 평가할 자료가 필요하다. 본 연구는 서울시 생태경관 보전지역 중 생태적 보전 가치가 높은 습지 5곳을 선정하여 InVEST 모델로 탄소저장량과 경제성 평가를 하고자 하였다. 연구결과는 탄천습지 3,674.62 Mg, 한강 밤섬 1,511.57 Mg, 고덕동 습지 5,007.21 Mg, 암사동 습지 7,108.47 Mg, 여의도 샛강 습지 290.27Mg으로 도출되었다. 이 중 탄천습지는 2013년의 탄천습지의 탄소저장량은 4,804.99 Mg로 탄소저장량 1,130.37 Mg 감소하여 실효탄소요금 평균값인 $16.06(US)를 적용하였을 경우, $15,910.58(US) 손실된 것으로 환산되었고, 기후변화에 따른 생산성과 생태계에 미치는 영향을 포함한 탄소의 사회적 비용 평균값인 $204(US)를 적용하였을 경우, $202,101.97(US) 손실로 도출되었다. 본 연구는 서울시 주요 습지지역을 선정하여 도심 속 습지가 주고 있는 자연자원의 가치를 평가하고자 하였다. 서울시 주요 습지의 생태적 가치 평가를 통하여 생태경관보전지역 보호 및 관리 방안의 기초자료로 활용이 가능할 것으로 판단된다. 또한, 습지 가치 평가에 대한 중요 의제로 간주되고 있음에 따라 향후 람사르 습지도시 인증제 항목에서 생태계서비스 평가 방안 제시가 가능하다고 사료된다. 람사르 습지를 인식하여 중요한 습지의 발굴 유도에 활용이 가능하며, 도심지역 내 습지 보전의 중요성에 대한 인식 증진과 람사르 습지의 국제적 교류에 도움을 줄 수 있다고 판단된다.

• Tuberculosis and Respiratory Diseases
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• 제85권1호
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• pp.37-46
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• 2022

Background: Although respiratory tract infection is one of the most important factors triggering acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), limited data are available to suggest an epidemiologic pattern of microbiology in South Korea. Methods: A multicenter observational study was conducted between January 2015 and December 2018 across 28 hospitals in South Korea. Adult patients with moderate-to-severe acute exacerbations of COPD were eligible to participate in the present study. The participants underwent all conventional tests to identify etiology of microbial pathogenesis. The primary outcome was the percentage of different microbiological pathogens causing AE-COPD. A comparative microbiological analysis of the patients with overlapping asthma-COPD (ACO) and pure COPD was performed. Results: We included 1,186 patients with AE-COPD. Patients with pure COPD constituted 87.9% and those with ACO accounted for 12.1%. Nearly half of the patients used an inhaled corticosteroid-containing regimen and one-fifth used systemic corticosteroids. Respiratory pathogens were found in 55.3% of all such patients. Bacteria and viruses were detected in 33% and 33.2%, respectively. Bacterial and viral coinfections were found in 10.9%. The most frequently detected bacteria were Pseudomonas aeruginosa (9.8%), and the most frequently detected virus was influenza A (10.4%). Multiple bacterial infections were more likely to appear in ACO than in pure COPD (8.3% vs. 3.6%, p=0.016). Conclusion: Distinct microbiological patterns were identified in patients with moderate-to-severe AE-COPD in South Korea. These findings may improve evidence-based management of patients with AE-COPD and represent the basis for further studies investigating infectious pathogens in patients with COPD.

• Journal of Gastric Cancer
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• 제23권2호
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• pp.315-327
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• 2023

Purpose: Oxaliplatin, a component of the capecitabine plus oxaliplatin (XELOX) regimen, has a more favorable toxicity profile than cisplatin in patients with advanced gastric cancer (GC). However, oxaliplatin can induce sensory neuropathy and cumulative, dose-related toxicities. Thus, the capecitabine maintenance regimen may achieve the maximum treatment effect while reducing the cumulative neurotoxicity of oxaliplatin. This study aimed to compare the survival of patients with advanced GC between capecitabine maintenance and observation after 1st line XELOX chemotherapy. Materials and Methods: Sixty-three patients treated with six cycles of XELOX for advanced GC in six hospitals of the Catholic University of Korea were randomized 1:1 to receive capecitabine maintenance or observation. The primary endpoint was progression-free survival (PFS), analyzed using a two-sided log-rank test stratified at a 5% significance level. Results: Between 2015 and 2020, 32 and 31 patients were randomized into the maintenance and observation groups, respectively. After randomization, the median number of capecitabine maintenance cycles was 6. The PFS was significantly higher in the maintenance group than the observation group (6.3 vs. 4.1 months, P=0.010). Overall survival was not significantly different between the 2 groups (18.2 vs. 16.5 months, P=0.624). Toxicities, such as hand-foot syndrome, were reported in some maintenance group patients. Maintenance treatment was a significant factor associated with PFS in multivariate analysis (hazard ratio, 0.472; 95% confidence interval, 0.250-0.890; P=0.020). Conclusions: After 6 cycles of XELOX chemotherapy, capecitabine maintenance significantly prolonged PFS compared with observation, and toxicity was manageable. Maintenance treatment was a significant prognostic factor associated with PFS.

• Korean Journal of Radiology
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• 제22권12호
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• pp.2094-2123
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• 2021

Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1-2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.