Recent Prevalence of and Factors Associated With Chronic Obstructive Pulmonary Disease in a Rapidly Aging Society: Korea National Health and Nutrition Examination Survey 2015–2019

Background@#The prevalence of chronic obstructive pulmonary disease (COPD) increases with age, and aging is an important risk factor for COPD development. In the era of global aging, demographic information about the prevalence of and factors associated with COPD are important to establish COPD care plans. However, limited information is available in rapidly aging societies, including Korea. @*Methods@#We conducted a cross-sectional observational study using Korea National Health and Nutrition Examination Survey data from 2015–2019. We included 15,613 participants and analyzed trends of and factors associated with COPD. @*Results@#During the study period, the overall prevalence of COPD was 12.9%. Over five years, the yearly prevalence of COPD was fairly constant, ranging from 11.5% to 13.6%. Among individuals aged ≥ 70 years, nearly one-third met COPD diagnostic criteria. In the multivariable analysis, age 70 years or older was the most strong factor associated with COPD (adjusted odds ratio [aOR], 17.86; 95% confidence interval [CI], 14.16–22.52; compared with age 40–49), followed by asthma (aOR, 3.39; 95% CI, 2.44–4.71), male sex (aOR, 2.64; 95% CI, 2.18–3.19), and current smokers (aOR, 2.60; 95% CI, 2.08–3.25). Additionally, exsmokers, low income, decreased forced expiratory volume in 1 second %pred, and a history of pulmonary tuberculosis were associated with COPD. On the other hand, body mass index (BMI) ≥ 25 kg/m 2 (aOR, 0.62; 95% CI, 0.54–0.71; compared with BMI 18.5–24.9 kg/m 2 ) had an inverse association with COPD. @*Conclusion@#Recent trends in the prevalence of COPD in South Korea are relatively stable.Approximately one-third of participants aged 70 years and older had COPD. Aging was the most important factor associated with COPD.

Risk of Rapid Lung Function Decline in Young Adults With Chronic Obstructive Pulmonary Disease: A Community-Based Prospective Cohort Study

It is unclear whether young adults with chronic obstructive pulmonary disease (COPD) are at an increased risk of rapid lung function decline. A total of 2,934 Korean adults aged 40–49 years who had consecutive lung function measurements were included. COPD was defined as pre-bronchodilator forced expiratory volume in 1 second (FEV 1 )/forced vital capacity < lower limit of normal. The risk of rapid decline in FEV 1 , defined as ≥ 60 mL/year, was assessed using multivariable logistic regression analysis. In the multivariable model, a significantly higher risk of rapid decline in FEV 1 was observed for the COPD group compared with the non-COPD group (adjusted odds ratio, 1.89; 95% confidence interval, 1.18–2.95), which was especially significant in subjects with FEV 1 less than the median value (< 110%pred) (P interaction = 0.017) and inactive physical activity (P interaction = 0.039). In conclusion, the risk of rapid FEV 1 decline was higher in young adults with COPD than in those without COPD, especially in those with FEV 1 less than the median value and inactive physical activity.

The Higher Incidence of COVID-19 in Patients With Non-Tuberculous Mycobacterial Pulmonary Disease: A Single Center Experience in Korea

The aim of our study was to investigate the incidence of and risk factors for coronavirus disease 2019 (COVID-19) in patients with non-tuberculous mycobacterial-pulmonary disease (NTM-PD). A total of 3,866 patients with NTM-PD were retrospectively identified from a single center. Compared to the general population of Korea, patients with NTM-PD had a substantially increased age-standardized incidence of COVID-19 from January 2020 to February 2021 (2.1% vs. 0.2%). The odds of being infected with COVID-19 was particularly higher in patients who received treatment for NTM-PD than in those who did not receive treatment for NTM-PD (adjusted odd ratio = 1.99, 95% confidence interval = 1.09–3.64, P = 0.026). Patients with NTM-PD might be regarded as a high-risk group for COVID-19 and may need a more proactive preventive strategy for COVID-19 and other pandemics in the future.

Characteristics and Prognosis of Hospitalized Patients at High Risk of Deterioration Identified by the Rapid Response System: a Multicenter Cohort Study

We aimed to investigate the characteristics and prognosis of high risk hospitalized patients identified by the rapid response system (RRS). A multicentered retrospective cohort study was conducted from June 2019 to December 2020. The National Early Warning Score (NEWS) was used for RRS activation. The outcome was unexpected intensive care unit (ICU) admission within 24 hours after RRS activation. The 11,459 patients with RRS activations were included. We found distinct clinical characteristics in patients who underwent ICU admission. All NEWS parameters were associated with the risk of unexpected ICU admission except body temperature. Body mass index, pulmonary disease, and cancer are related to the decreased risk of unexpected ICU admission. In conclusion, there were differences in clinical characteristics among high risk patients, and those differences were associated with unexpected ICU admissions. Clinicians should consider factors relating to unexpected ICU admission in the management of high risk patients identified by RRS.

Characteristics and Prognosis of Hospitalized Patients at High Risk of Deterioration Identified by the Rapid Response System: a Multicenter Cohort Study

We aimed to investigate the characteristics and prognosis of high risk hospitalized patients identified by the rapid response system (RRS). A multicentered retrospective cohort study was conducted from June 2019 to December 2020. The National Early Warning Score (NEWS) was used for RRS activation. The outcome was unexpected intensive care unit (ICU) admission within 24 hours after RRS activation. The 11,459 patients with RRS activations were included. We found distinct clinical characteristics in patients who underwent ICU admission. All NEWS parameters were associated with the risk of unexpected ICU admission except body temperature. Body mass index, pulmonary disease, and cancer are related to the decreased risk of unexpected ICU admission. In conclusion, there were differences in clinical characteristics among high risk patients, and those differences were associated with unexpected ICU admissions. Clinicians should consider factors relating to unexpected ICU admission in the management of high risk patients identified by RRS.

Effect of Dialysis on Aryl Hydrocarbon Receptor Transactivating Activity in Patients with Chronic Kidney Disease

Endoscopic Treatment of Mirizzi Syndrome in a Patient with Low Lying Cystic Duct and Remnant Cystic Duct Stone / 대한췌담도학회지

Mirizzi syndrome is a rare complication, resulting in bile duct obstruction and jaundice that usually arise from impacted gallstone in the cystic duct or neck of the gallbladder. It is vitally important to confirm underlying cystic duct anomaly in Mirizzi syndrome since it can produce surgical difficulty and higher complications. Generally, Mirizzi syndrome is treated surgically while endoscopic treatment is limited. Herein, we present Mirizzi syndrome with low lying cystic duct and remnant cyst duct calculi treated successfully by biliary stent and administration of choleretic agent, following by balloon dilatation on cystic duct and balloon extraction of the stone.

Endoscopic Treatment of Mirizzi Syndrome in a Patient with Low Lying Cystic Duct and Remnant Cystic Duct Stone / 대한췌담도학회지

Mirizzi syndrome is a rare complication, resulting in bile duct obstruction and jaundice that usually arise from impacted gallstone in the cystic duct or neck of the gallbladder. It is vitally important to confirm underlying cystic duct anomaly in Mirizzi syndrome since it can produce surgical difficulty and higher complications. Generally, Mirizzi syndrome is treated surgically while endoscopic treatment is limited. Herein, we present Mirizzi syndrome with low lying cystic duct and remnant cyst duct calculi treated successfully by biliary stent and administration of choleretic agent, following by balloon dilatation on cystic duct and balloon extraction of the stone.

Association between Muscle Loss and Urinary Incontinence in Elderly Korean Women / 가정의학회지

BACKGROUND: Incontinence and muscle loss are important senior health issues. Nevertheless, there are no available domestic or international studies on the association between urinary incontinence and muscle loss. The aim of this study was to investigate the association between muscle loss and urinary incontinence in elderly Korean woman. METHODS: Korean women (1,313) > or =65 years of age whose complete body composition data were collected using dual X-ray absorptiometry were analyzed from the Fourth Korean National Health and Nutritional Examination Surveys. Class I and II losses of the appendicular, truncal, and total muscle mass were defined using adjustments for weight and height. Each participant's incontinence status was collected using constructed questionnaires. Multiple logistic regression was performed to examine the association between muscle loss and incontinence. RESULTS: On the basis of physician-diagnosed incontinence, weight- and height-adjusted muscle loss showed no association with urinary incontinence (weight-adjusted muscle loss: class I adjusted odds ratio [aOR], 0.77; 95% confidence interval [CI], 0.34 to 1.73; class II aOR, 1.37; 95% CI, 0.59 to 3.18; height-adjusted muscle loss: class I aOR, 0.51; 95% CI, 0.18 to 1.51; class II aOR, 1.86; 95% CI, 0.22 to 15.79). Similar results were observed for truncal muscle and total muscle mass as well as self-reported urinary incontinence. CONCLUSION: Our study found no association between urinary incontinence and appendicular, truncal, and total muscle loss in elderly Korean women.

Is the Cross-sectional Area after Unilateral Open Door Laminoplasty Wider than that after Midline Splitting Laminoplasty ? : Mathematical Approach

OBJECTIVE: The aim of this study was to compare geometrically cross-sectional areas of two different laminoplasty techniques in same opening size. Some investigators have studied the expanded areas of the two different techniques using imaging study. Although it is unclear that postoperative spinal canal is correlated with the surgical outcome we just focused on mathematical and geometrical correlation of the expandable area with surgical opening size in different laminoplasty techniques. METHODS: To predict the expandable area by a midline splitting technique and a unilateral open door technique, we placed an imaginary isosceles triangle in the spinal canal and drew graphs for the equation of the expandable areas in same opening size using the Pythagorean theorem and mathematical program. To substitute the constant figures of mathematical formula we estimated the normal cervical spine CT scans of 50 Korean adults. RESULTS: We subtracted the imaginary triangle from the spinal canal and were left with the remaining area of the spinal canal that was not changed before and after surgery. In same opening size the expandable area by the midline splitting technique was same but slightly wider than the unilateral open door technique, irrespective of the triangular shape. For a normal isosceles triangle the results were the same. CONCLUSION: Using mathematical proof, the expandable area after the midline splitting technique was same but slightly larger than that after the unilateral open door technique, irrespective of the size of the lamina opening.

Recurrence Rate after Herniotomy only versus Discectomy in Lumbar Disc Herniation

OBJECTIVE: Lumbar disc herniation (LDH) recurrence necessitating reoperation can pose problems following spinal surgery, with an overall reported incidence of approximately (3-13%). The purpose of this study is to identify the rate of recurrent disc herniation, to discuss the radiologic indications for herniotomy and to analyze clinical outcomes compared with conventional discectomy. METHODS: This study is a retrospective case control study. The authors retrospectively reviewed 114 patients who underwent herniotomy & conventional discectomy by a single surgeon for single-level LDH between June 2009 and May 2012. Herniotomy group was 57 patients and conventional discectomy group was 57 patients that were selected from 631 patients using stratified randomization. Evaluation for LDH recurrence included detailed medical chart and radiologic review and telephone interview. Postoperative VAS and the Korean version of ODI were examined one week after surgery. Clinical outcome was investigated according to Odom's criteria from three months to three years. RESULTS: Of the 114 patients for whom the authors were able to definitively assess symptomatic recurrence status, four patients (7%) experienced LDH recurrence following single-level herniotomy and three patients (5.2%) conventional discectomy. There were no differences in the VAS and Korean version of ODI between herniotomy group and conventional discectomy group. The herniotomy group had better results than the conventional discectomy group in clinical outcome from three months to three years, but the difference was not significant. CONCLUSION: There were no significant differences in clinical outcome between herniotomy and conventional discectomy. Recurrence rates following herniotomy for LDH compare favorably with those in patients who have undergone conventional discectomy, lending further support for its effectiveness in treating herniotomy.

Trends of the New Outpatients in a University-based Family Practice / 가정의학회지

BACKGROUND: Analysis of outpatient visits to primary care offers essential data for residency training by understanding 'reasons for encounter (RFE).' This study was designed to recognize the effect of population aging on demographic characteristics and RFEs. METHODS: We included all patients who had visited family practice clinic in Kyung Hee University Hospital in Seoul during each first 5 working days of September, October, and November in 2001 and 2008. New patients included those who hadn't visited within the last 6 months or more. Information on each patient's age, sex, and reason for encounter was obtained from the electronic medical record. The RFEs were compared using International Classification of Primary Care (ICPC)-2-E. RESULTS: Mean age of overall outpatients was 50.5 and 52.4 years in 2001 and 2008 respectively. The number of new outpatient visits increased from 215 (21.3%) to 326 (29.7%) between 2001 and 2008 (P < 0.001) along with the number of patients aged 65 or more from 7.4% to 12.0% (P = 0.08). Mean age of established patients was 52.5 and 56.9 years (P < 0.001), and the patients aged 65 or more was 14.1% and 35.8% (P < 0.001) in 2001 and 2008 respectively. Analysis by ICPC-2-E revealed a decrease in chapter A in 2008 (P = 0.03) and an increase in chapter F, L, and X (P = 0.01, 0.003, <0.001). Component 1 had increased (P = 0.01), and component 2 had decreased (P = 0.04) in proportion. CONCLUSION: Changes in population composition have brought a shift of the distribution of age in outpatients, more significantly in follow-up patients. Comparison by ICPC-2-E showed changes in RFEs of new patients between 2001 and 2008.

The Clinical and Radiological Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Single Level Fusion

STUDY DESIGN: This is a retrospective study that was done according to clinical and radiological evaluation. PURPOSE: We analyzed the clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody single level fusion. OVERVIEW OF LITERATURE: Minimally invasive transforaminal lumbar interbody fusion is effective surgical method for treating degenerative lumbar disease. METHODS: The study was conducted on 56 patients who were available for longer than 2 years (range, 24 to 45 months) follow-up after undergoing minimally invasive transforminal lumbar interbody single level fusion. Clinical evaluation was performed by the analysis of the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) and the Kirkaldy-Willis score. For the radiological evaluation, the disc space height, the segmental lumbar lordotic angle and the whole lumbar lordotic angle were analyzed. At the final follow-up after operation, the fusion rate was analyzed according to Bridwell's anterior fusion grade. RESULTS: For the evaluation of clinical outcomes, the VAS score was reduced from an average of 6.7 prior to surgery to an average of 1.8 at the final follow-up. The ODI was decreased from an average of 36.5 prior to surgery to an average of 12.8 at the final follow-up. In regard to the clinical outcomes evaluated by the Kirkaldy-Willis score, better than good results were obtained in 52 cases (92.9%). For the radiological evaluation, the disc space height (p = 0.002), and the whole lumbar lordotic angle (p = 0.001) were increased at the final follow-up. At the final follow-up, regarding the interbody fusion, radiological union was obtained in 54 cases (95.4%). CONCLUSIONS: We think that if surgeons become familiar with the surgical techniques, this is a useful method for minimally invasive spinal surgery.

Dysphagia Caused by Ossificaion of the Cervical Anterior Longitudial Ligament : Report of Two Cases

We report two cases with progressive dysphagia and foreign body sensation resulted from severe cervical ossification of the anterior longitudinal ligament (OALL). A 63-years-old male presented progressive dysphagia and foreign body sensation with neck pain. Cervical computed tomography (CT) and magnetic resonance images (MRI) revealed diffuseOALL from C2 to C7 with esophageal compression by most severe OALL of C5, C6, C7 and spondylotic stenosis of C5- 6, C6-7. OALL removal of C5, 6, 7 and discectomy with interbody fusion via anterior approach was performed. The other 56-years-old female presented progressive dysphagia with foreign body sensation. Cervical CT and MRI revealed severe OALL of C4, 5, 6, 7 with esophageal compression and surgical removal was performed. In both patients, dysphagia and foreign body sensation was immediately relieved after operation and the distance between trachea and each cervical body was increased than preoperative distance in cervical lateral view.

Full Thickness Macular Holes Associated with Terson Syndrome

PURPOSE: To report a case of a full-thickness macular hole caused by Terson syndrome. CASE SUMMARY: A 49-year-old man presented to our clinic with decreased visual acuity in the right eye after a subarachnoid hemorrhage due to spontaneous rupture a middle cerebral artery aneurysm. On the first examination, the corrected visual acuity was hand movement in the right eye and 1.0 in the left eye. There was massive vitreous hemorrhage in the right eye. In the left eye, there was no abnormal ocular finding. He was diagnosed with vitreous hemorrhage due to Terson syndrome and waited for the spontaneous absorption of the vitreous hemorrhage. Six months later, the vitreous hemorrhage was considerably absorbed, but a macular hole was observed. OCT scans showed a full-thickness macular hole with an epiretinal membrane.

Aneurysmal Bone Cyst Arising from Iliac Bone Mimicking Liposarcoma

Aneurysmal bone cysts (ABCs) are benign, non-neoplastic, expansile lesions. We present a case of a male patient aged 46 presented with 4-month history of left hip and low back pain and left hip swelling. Lumbosacral magnetic resonance imaging (MRI) and computed tomography (CT) demonstrated a large multi-loculated hemorrhagic lumbosacral and retroperitoneal mass with spinal dysraphism and tethered cord. Curettage and Biopsy were performed with partially resected cystic wall which was histological confirmed with aneurismal bone cyst. Large cystic mass of the vertebrae, sacrum, and pelvic bone must be considered with ABCs.

Central Retinal Artery Occlusion Associated with Chickenpox

PURPOSE: To report a case of central retinal artery occlusion (CRAO) associated with chickenpox. CASE SUMMARY: A 24-year-old female presenting with a history of centripetal eruption and erythema, followed by vesicle and eschar, was diagnosed with varicella and managed in a local medical clinic. Five days after the varicella eruption, she experienced decreased vision in her left eye. On initial exam visual acuity was light-sense positive in the left eye and 1.0 in the right eye; on fundus examination the patient was diagnosed with CRAO. We performed hematologic tests including thrombophilia studies, but there were no abnormal findings on routine hematologic tests, the carotid artery, or cardiovascular examinations. Antinuclear antibody, rheumatoid factor, and antiphospholipid antibody were negative. Skin biopsy and PCR results both corresponded with varicella, and the patient was diagnosed with CRAO associated with chickenpox.

Radiologic Comparison of Cervical Athroplasty with Cervical Arthrodesis

OBJECTIVE: The incidence of symptomatic adjacent segment disease appears to occur at a rate of 2% to 3% per year, following anterior cervical discectomy and fusion. Recently, cervical arthroplasty is a preferred procedure to arthrodesis. METHODS: We performed 16 arthropalsties form January 2005 to December 2006 in the Samsung medical center, using the BRYAN artificial disc and 16 anterior cervical interbody fusions. Radiographic evaluation included flexion and extension roentgenogram images of cervical spine. In the former group, the pre- and postoperative segmental sagittal range of motion(ROM) in the arthroplasty level and the adjacent level were measured. In the later group, the pre- and postoperative segmental sagittal ROM in the adjacent level to the fusion level was measured and the Cobb angles at C2-7(or 6) to ascertain overall cervical alignment was measured in both groups. RESULTS: There was minimal change in sagittal ROM of whole cervical spine in all patients in the two groups. Sagittal ROM of arthroplaty level were increased 7.581+/-4.222 to 11.512+/-5.398(p<0.05) ROM of adjacent level to arthroplasty level were no significant change pre- and postoperatively. But ROM of adjacent level to arthrodesis level were increased 7.160+/-3.609 to 11.260+/-4.832(p<0.05). CONCLUSIONS: Artificial disc could maintain ROM of pathologic level and adjacent level to fusion level should replace ROM of pathologic level but adjacent level to arthroplasty level should not replace additional ROM postoperatively. Long-term follow up studies are required to prove its efficacy and its ability to prevent adjacent segment disease.

Determine a Proper Axial Length by Ultrasonic Biometry in Opaque Hydrophilic Acrylic Intraocular Lens

PURPOSE: To investigate the accuracy of measuring ultrasonic axial lengths using A-scan (Ocuscan(R), Alcon, USA) on opaque intraocular lenses after hydrophilic lens (ACRL-160(R), Ophthalmed, USA) implantation. METHODS: We measured axial length through ultrasonic biometry prior to intraocular lens exchange. Twelve eyes of 14 patients who had intraocular lens opacity following hydrophilic acryl lens implantation were examined in a clinical study. We compared pre-cataract operative axial lengths to pre-IOL exchange axial lengths. The pre-IOL exchange axial lengths were measured in aphakic and pseudophakic modes. In the pseudophakic mode, the ultrasound velocity through an IOL was set at a rate ranging between 1,500 m/sec to 2,200 m/sec. RESULTS: The pre-IOL exchange axial lengths in the pseudophakic mode at the rate of 1,600 m/sec in lens velocity were the closest to pre-cataract operative values (p=0.88). CONCLUSIONS: When pre-cataract operative axial length is known with a hydrophilic acrylic intraocular lens, previous values may be used for IOL exchange of an opacity patient. If not, however, the closest values to pre-cataract operative axial lengths may be obtained by setting the velocity in the pseudophakic mode to a lens velocity rate of 1,600 m/sec.

Bilateral Central Retinal Vein Occlusion in Primary Antiphospholipid Syndrome

PURPOSE: To Report a case of bilateral central retinal vein occlusion (CRVO) caused by primary antiphospholipid syndrome. METHODS: A 38-year-old male is referred to the department of ophthalmology for the bilateral visual loss. RESULTS: On initial visit, both visual acuity was 0.3. Upon consider changing to fundoscopic examination, the patient was diagnosed with bilateral CRVO. We performed hematologic tests including thrombophilia examination. There were no abnormal findings on routine hematologic tests. Antinuclear antibody and rheumatoid factor were negative but anticardiolipin antibodies presented high titer, on two occasions six weeks apart. We prescribed oral aspirin and performed intravitreal bevacizumab injection under the diagnosis of bilateral CRVO in primary antiphospholipid syndrome. CONCLUSIONS: It may be necessary to check antiphospolipid antibody in cases of bilateral CRVO in young patients without medical problem.