Twenty-Five Year Trend Change in the Etiology of Pediatric Invasive Bacterial Infections in Korea, 1996–2020

Background@#The coronavirus disease-2019 (COVID-19) pandemic has contributed to the change in the epidemiology of many infectious diseases. This study aimed to establish the pre-pandemic epidemiology of pediatric invasive bacterial infection (IBI). @*Methods@#A retrospective multicenter-based surveillance for pediatric IBIs has been maintained from 1996 to 2020 in Korea. IBIs caused by eight bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus, Streptococcus agalactiae, Streptococcus pyogenes, Listeria monocytogenes, and Salmonella species) in immunocompetent children > 3 months of age were collected at 29 centers. The annual trend in the proportion of IBIs by each pathogen was analyzed. @*Results@#A total of 2,195 episodes were identified during the 25-year period between 1996 and 2020. S. pneumoniae (42.4%), S. aureus (22.1%), and Salmonella species (21.0%) were common in children 3 to 59 months of age. In children ≥ 5 years of age, S. aureus (58.1%), followed by Salmonella species (14.8%) and S. pneumoniae (12.2%) were common. Excluding the year 2020, there was a trend toward a decrease in the relative proportions of S. pneumoniae (rs = −0.430, P = 0.036), H. influenzae (rs = −0.922, P 3 months of age. These findings can be used as the baseline data to navigate the trend in the epidemiology of pediatric IBI in the post COVID-19 era.

Citation Activity of Journal of Korean Medical Science in 2011–2020:Reflection on the Most and Least Cited Items

Background@#The Journal of Korean Medical Science (JKMS) is a weekly periodical published by the Korean Academy of Medical Sciences. JKMS invites global researchers to submit articles covering various areas in general medicine. The present article’s aim was to analyze citations of JKMS articles in 2011–2020 for updating editorial policies. @*Methods@#Citation records of JKMS articles were tracked in Web of Science (WoS), Clarivate ®from August 2021 to June 2022. @*Results@#In 2011–2020, JKMS published 2,880 articles, including 2,757 (96.0%) ever cited. All reviews (57/57) and 96% of original research reports (2,184 out of 2,264) received at least one citation. Brief communications, opinions, and images were least cited items. Of 36 subject categories covered by JKMS, only biomedical engineering was significantly less advantageous citation-wise. Five articles published in 2012–2017 attracted more than 100 citations. Most other articles were cited less than 50 times. Article categories of nationwide epidemiology, disease or patient registries, clinical trials, and infectious diseases were distinguished as well cited. Of 378 articles published in 2020, 10 were cited at least 100 times; all these ten items were related to severe acute respiratory syndrome coronavirus 2 and coronavirus disease 2019. In the past 5 years, studies on health care laws, management, and some specific topics in clinical specialties were not cited. The citation trends in WoS, Crossref, and Scopus were similar while PubMed Central records were roughly twice less. @*Conclusion@#Most of JKMS articles are cited during 5 years post publication, with 1.4% noncitation rate. The obtained results suggest that inviting review articles in clinical sciences, research reports on hot medical topics, and nationwide database analyses may attract more author interest and related citations.

Vibraimage Characteristics of Offenders with Schizophrenia Spectrum Disorder / 생물치료정신의학

Objectives@#：The purpose of this study was to identify characteristic Vibraimage parameters in schizophrenia spectrum and other psychotic disorders. @*Methods@#：This study retrospectively analyzed subjects who were referred to the National Forensic Hospital in Gongju city for psychiatric evaluation between April 2019 and October 2019. After divided into two groups; Schizophrenia Spectrum Disorders group and non-organic non-psychotic disorders group, Vibraimage parameters and MMPI-2 items were compared between the two groups. In addition, we investigated the relations between Vibraimage parameters and MMPI-2 items characteristic of schizophrenia spectrum and other psychotic disorders by using the Correlation analysis. @*Results@#：Compared to non-organic non-psychotic disorders group, Schizophrenia Spectrum Disorders group scored low at Aggression (t=-2.752, p=0.007), Tension (t=-2.106, p=0.039), and Suspects (t=-2.617, p=0.011); high at Neuroticism (t=4,215, p<0.001) in the Vibraimage, and the group scored comparatively high at Sc (Schizophrenia) (t=-2.099, p=0.039) and low at Hy (Hysteria) (t=-2.228, p=0.029) in the MMPI-2. The Sc (Schizophrenia) item in the MMPI-2 showed a negative correlation with Suspect parameter (r=0.242 p=0.035) and positive correlation with Neuroticism parameter (r=0.267, p=0.02) in the Vibraimage. @*Conclusion@#：Our findings suggest that Suspect and Neuroticism parameters of the Vibraimage were characteristic in schizophrenia spectrum and other psychotic disorders, and showed potential as diagnostic tools, especially in psychiatric evaluations.

The Influence of Femoral Internal Rotation on Patellar Tracking in Total Knee Arthroplasty Using Gap Technique

Background@#Femoral internal rotation in total knee arthroplasty (TKA) is well known as one of the main causes of patellar maltracking. Although femoral internal rotation in TKA is considered unacceptable due to the risk of patellar maltracking, it is sometimes required for ligament balancing. We evaluated the influence of femoral internal rotation on patellar tracking in TKA performed using the gap technique. @*Methods@#From April 2008 to May 2018, 1,612 cases of TKA were done. Among them, 245 cases of TKA for osteoarthritis were followed up for at least 1 year and included in this study. We compared patellar tracking in two groups; group I consisted of 99 cases whose femoral rotation was less than 0° and group II consisted of 146 cases whose femoral rotation was 3°–5° external rotation. Preoperative femoral rotation was measured with the condylar twist angle (CTA) by using computed tomography. The patella was replaced in all cases. Patellar tracking was evaluated with patellar tilt angle (lateral tilt [+] and medial tilt [–]) in the merchant radiograph. Statistical analysis was done using Mann-Whitney U-test. Clinical assessment was performed using the Knee Society clinical rating system. @*Results@#The preoperative CTA was 5.3° ± 1.6° in group I and 5.4° ± 1.6° in group II, showing no statistically significant difference between groups (p = 0.455). Intraoperative femoral rotation was –0.5° ± 0.8° in group I and 3.9° ± 0.8° in group II when the gap technique was used (p < 0.001). The postoperative patellar tilt angle was –0.4° ± 3.6° in group I and 0.1° ± 4.1° in group II with no statistically significant difference (p = 0.251). @*Conclusions@#Compared with femoral external rotation, femoral internal rotation with ligament balance in TKA was not more associated with patellar maltracking. Therefore, patellar tracking might be related with ligament balance in flexion regardless of the anatomic femoral rotational alignment.

Vibraimage Characteristics of Offenders with Schizophrenia Spectrum Disorder / 생물치료정신의학

Objectives@#：The purpose of this study was to identify characteristic Vibraimage parameters in schizophrenia spectrum and other psychotic disorders. @*Methods@#：This study retrospectively analyzed subjects who were referred to the National Forensic Hospital in Gongju city for psychiatric evaluation between April 2019 and October 2019. After divided into two groups; Schizophrenia Spectrum Disorders group and non-organic non-psychotic disorders group, Vibraimage parameters and MMPI-2 items were compared between the two groups. In addition, we investigated the relations between Vibraimage parameters and MMPI-2 items characteristic of schizophrenia spectrum and other psychotic disorders by using the Correlation analysis. @*Results@#：Compared to non-organic non-psychotic disorders group, Schizophrenia Spectrum Disorders group scored low at Aggression (t=-2.752, p=0.007), Tension (t=-2.106, p=0.039), and Suspects (t=-2.617, p=0.011); high at Neuroticism (t=4,215, p<0.001) in the Vibraimage, and the group scored comparatively high at Sc (Schizophrenia) (t=-2.099, p=0.039) and low at Hy (Hysteria) (t=-2.228, p=0.029) in the MMPI-2. The Sc (Schizophrenia) item in the MMPI-2 showed a negative correlation with Suspect parameter (r=0.242 p=0.035) and positive correlation with Neuroticism parameter (r=0.267, p=0.02) in the Vibraimage. @*Conclusion@#：Our findings suggest that Suspect and Neuroticism parameters of the Vibraimage were characteristic in schizophrenia spectrum and other psychotic disorders, and showed potential as diagnostic tools, especially in psychiatric evaluations.

The Influence of Femoral Internal Rotation on Patellar Tracking in Total Knee Arthroplasty Using Gap Technique

Background@#Femoral internal rotation in total knee arthroplasty (TKA) is well known as one of the main causes of patellar maltracking. Although femoral internal rotation in TKA is considered unacceptable due to the risk of patellar maltracking, it is sometimes required for ligament balancing. We evaluated the influence of femoral internal rotation on patellar tracking in TKA performed using the gap technique. @*Methods@#From April 2008 to May 2018, 1,612 cases of TKA were done. Among them, 245 cases of TKA for osteoarthritis were followed up for at least 1 year and included in this study. We compared patellar tracking in two groups; group I consisted of 99 cases whose femoral rotation was less than 0° and group II consisted of 146 cases whose femoral rotation was 3°–5° external rotation. Preoperative femoral rotation was measured with the condylar twist angle (CTA) by using computed tomography. The patella was replaced in all cases. Patellar tracking was evaluated with patellar tilt angle (lateral tilt [+] and medial tilt [–]) in the merchant radiograph. Statistical analysis was done using Mann-Whitney U-test. Clinical assessment was performed using the Knee Society clinical rating system. @*Results@#The preoperative CTA was 5.3° ± 1.6° in group I and 5.4° ± 1.6° in group II, showing no statistically significant difference between groups (p = 0.455). Intraoperative femoral rotation was –0.5° ± 0.8° in group I and 3.9° ± 0.8° in group II when the gap technique was used (p < 0.001). The postoperative patellar tilt angle was –0.4° ± 3.6° in group I and 0.1° ± 4.1° in group II with no statistically significant difference (p = 0.251). @*Conclusions@#Compared with femoral external rotation, femoral internal rotation with ligament balance in TKA was not more associated with patellar maltracking. Therefore, patellar tracking might be related with ligament balance in flexion regardless of the anatomic femoral rotational alignment.

Clinical Results of Medial Unicompartmental Knee Arthroplasty in Elderly Patients Older than 70 Years of Age / 대한정형외과학회잡지

Purpose@#To evaluate the long-term clinical results and survivorship of unicompartmental knee arthroplasty (UKA) in elderly patients older than 70 years by analyzing cases that have been implanted for >10 years ago. @*Materials and Methods@#The long-term follow-up results were evaluated in 39 patients (46 cases) who underwent medial UKA from March 2002 to February 2004. The mean age of the patients at the time of surgery was 74.0 years, and the preoperative diagnosis was degenerative arthritis of the knee in all cases. @*Results@#Of the 46 cases, reoperation occurred due to the complications in four cases. In 22 cases without 14 cases of death and six cases of follow-up loss, follow-up more than 10 years was possible. The mean Knee Society knee and function scores improved significantly from 53.0 and 52.5 points pre-operatively to 89.4 and 80.9 points at the last follow-up, respectively (p<0.001). The mean range of motion of the knee recovered to 132.5°, and the mean tibiofemoral angle changed to 5.9° of valgus at the last follow-up. Complications following the UKA occurred in four cases; the most prevalent complication was mobile bearing dislocation (n=2). One case of failure occurred due to aseptic loosening and degenerative arthritis of the lateral compartment, respectively. The cumulative survival rate of the implants was 95.0% at 10 years and 85.7% at 15 years. Of the 40 cases, excluding six cases of follow-up loss, 36 cases (90.0%) could be used without reoperation until death or at the last follow-up after surgery. @*Conclusion@#These results showed the outstanding functions of the knee and satisfactory long-term survivorship after UKA. Therefore, UKA could be a useful method for the treatment of osteoarthritis of the knee in elderly patients older than 70 years of age.

The effect of 4-hexylresorinol administration on NAD+ level and SIRT activity in Saos-2 cells / 대한악안면성형재건외과학회지

Background@#4-hexylresorcinol (4HR) has been shown to have anti-oxidant activity similar to that of resveratrol. As resveratrol increases sirtuin (SIRT) activity, 4HR might behave similarly to resveratrol.Method: In this study, the expression levels of SIRT1, SIRT3, and SIRT6 were evaluated after 4HR administration (1–100 μM). As NAD+ is a substrate for SIRTs, its levels with SIRT activity were also studied. @*Results@#In the results, SIRT3 (100 μM at 24 h) and SIRT6 (1–100 μM at 24 h and 10 μM at 8 h) were shown to have significantly higher expression levels compared to untreated control (p < 0.05). Pan-SIRT activity and the NAD+ level was significantly increased compared to that of the untreated control (p < 0.05; 10 and 100 μM at 24 h). @*Conclusion@#4HR administration increased SIRT activity and the NAD+ level in Saos-2 cells.

Diagnostic Value of SusceptibilityWeighted MRI in Differentiating Cerebellopontine Angle Schwannoma from Meningioma

Background@#Differentiation of cerebellopontine angle (CPA) schwannoma from meningioma is often a difficult process to identify.Purpose: To identify imaging features for distinguishing CPA schwannoma from meningioma and to investigate the usefulness of susceptibility-weighted imaging (SWI) in differentiating them. @*Materials and Methods@#Between March 2010 and January 2015, this study pathologically confirmed 11 meningiomas and 20 schwannomas involving CPA with preoperative SWI were retrospectively reviewed. Generally, the following MRI features were evaluated: 1) maximal diameter on axial image, 2) angle between tumor border and adjacent petrous bone, 3) presence of intratumoral dark signal intensity on SWI, 4) tumor consistency, 5) blood-fluid level, 6) involvement of internal auditory canal (IAC), 7) dural tail, and 8) involvement of adjacent intracranial space. On CT, 1) presence of dilatation of IAC, 2) intratumoral calcification, and 3) adjacent hyperostosis were evaluated. All features were compared using Chi-squared tests and Fisher’s exact tests. The univariate and multivariate logistic regression analysis were performed to identify imaging features that differentiate both tumors. @*Results@#The results noted that schwannomas more frequently demonstrated dark spots on SWI (P = 0.025), cystic consistency (P = 0.034), and globular angle (P = 0.008); schwannomas showed more dilatation of internal auditory meatus and lack of calcification (P = 0.008 and P = 0.02, respectively). However, it was shown that dural tail was more common in meningiomas (P < 0.007). In general, dark spots on SWI and dural tail remained significant in multivariate analysis (P = 0.037 and P = 0.012, respectively). In this case, the combination of two features showed a sensitivity and specificity of 80% and 100% respectively, with an area under the receiver operating characteristic curve of 0.9. @*Conclusion@#In conclusion, dark spots on SWI were found to be helpful in differentiating CPA schwannoma from meningioma. It is noted that combining dural tail with dark spots on SWI yielded strong diagnostic value in differentiating both tumors.

History and Concept of Manual Therapy / 대한정형외과학회잡지

Manual therapy has undergone parallel development throughout many parts of the world dating back to ancient times for at least 2,500 years. The earliest historical reference to the practice of manual therapy in Greece, dates back to 400 B.C. Over the centuries, manual medicines have fallen in and out of favor with the medical profession. To truly understand the principle, it is important to know that manual therapy was initially the mainstay of the three leading alternative health care systems, osteopathy, chiropractic, and most notably physical therapy. These were all founded in the latter part of the 19th century in response to the shortcomings in allopathic medicine. Although it has been around for a long time and has been used all over the world, there are a few reports on manual therapy treatment, and most papers provided a low level of evidence. Despite the controversies over manual therapy, its use appears to be increasing gradually. This article reviews the history of manual therapy from ancient times to the present including Korean history, discusses the current state of knowledge on manual therapy, and informs physicians who manage musculoskeletal pain.

Erratum: Addition of a Co-Author: Etiology of Invasive Bacterial Infections in Immunocompetent Children in Korea (2006–2010): a Retrospective Multicenter Study

The authors regret that one co-author (Kyung-Hyo Kim) was missing in the article.

An Atypical Case of Middle East Respiratory Syndrome in a Returning Traveler to Korea from Kuwait, 2018

We report a case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in a 61-year-old businessman returning from Kuwait. The patient arrived there on August 16, 2018, developed watery diarrhea on August 28 (day 0), and came back to Korea on September 7 (day 10) as his condition worsened. Upon arrival, he complained of diarrhea and weakness, but denied any respiratory symptoms, and he directly went to visit an emergency room. Chest radiography revealed interstitial infiltrates in the lungs, and he was immediately transferred to an isolation unit. Quantitative real-time PCR analysis of sputum samples taken on day 11 returned positive for MERS-CoV. No secondary MERS-CoV infection was identified among people who had close contact with him. This case underscores the importance of a high index of suspicion of MERS-CoV infection in any febrile patients who present after a trip to the Middle East.

Identifying Adverse Events Using International Classification of Diseases, Tenth Revision Y Codes in Korea: A Cross-sectional Study / 예방의학회지

OBJECTIVES: The use of administrative data is an affordable alternative to conducting a difficult large-scale medical-record review to estimate the scale of adverse events. We identified adverse events from 2002 to 2013 on the national level in Korea, using International Classification of Diseases, tenth revision (ICD-10) Y codes. METHODS: We used data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC). We relied on medical treatment databases to extract information on ICD-10 Y codes from each participant in the NHIS-NSC. We classified adverse events in the ICD-10 Y codes into 6 types: those related to drugs, transfusions, and fluids; those related to vaccines and immunoglobulin; those related to surgery and procedures; those related to infections; those related to devices; and others. RESULTS: Over 12 years, a total of 20 817 adverse events were identified using ICD-10 Y codes, and the estimated total adverse event rate was 0.20%. Between 2002 and 2013, the total number of such events increased by 131.3%, from 1366 in 2002 to 3159 in 2013. The total rate increased by 103.9%, from 0.17% in 2002 to 0.35% in 2013. Events related to drugs, transfusions, and fluids were the most common (19 446, 93.4%), followed by those related to surgery and procedures (1209, 5.8%) and those related to vaccines and immunoglobulin (72, 0.3%). CONCLUSIONS: Based on a comparison with the results of other studies, the total adverse event rate in this study was significantly underestimated. Improving coding practices for ICD-10 Y codes is necessary to precisely monitor the scale of adverse events in Korea.

Factors affecting objective and subjective masticatory ability assessment of Korean elderly people / 대한구강보건학회지

OBJECTIVES: The purpose of the study was to investigate factors affecting the assessment of objective and subjective masticatory ability in the elderly, and to evaluate masticatory ability assessment more accurately. METHODS: A total of 112 participants were recruited after oral examination in senior citizen welfare facilities. The participants' masticatory ability was evaluated objectively (Mixing ability index; MAI), and subjectively (Key food intake ability; KFIA). Participants' general characteristics and oral health-related variables were also recorded. Based on masticatory ability assessment, participants were classified as either high or low. IBM SPSS Statistics Ver.23.0 was used for all analyses, including descriptive statistics, Chi-square test, Mann-Whitney U test, Spearman rank correlation, and Logistic regression analysis. RESULTS: Higher masticatory ability was positively correlated with higher scores on MAI and KFIA. Additionally, there was a significant positive correlation between MAI and KFIA. When analyzing factors affecting objective and subjective masticatory ability assessments, Functional tooth units (FTUs) were revealed as a related factor. In subjective masticatory ability assessment, oral moisture, difficulty in chewing, and the Geriatric Oral Health Assessment Index (GOHAI) were also influential factors. CONCLUSIONS: In order to accurately assess masticatory ability, it is necessary to use both objective and subjective measures. Additionally, to improve the masticatory ability in the elderly, treatment should be provided to improve overall oral health and satisfaction.

Case of Renal Microaneurysms and Multiple Renal Infarctions in a Patient with Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a chronic inflammatory, heterogeneous autoimmune disease characterized by autoantibody production and the potential involvement of almost every organ system. Although vasculitis usually confined to small vessels is a fairly common feature of SLE, ischemic vasculitis with an aneurysm is an uncommon feature. In particular, renal arterial microaneurysms and multiple renal infarctions are very rarely reported in patients with SLE. Furthermore, to the best of the authors' knowledge, there is no report on renal arterial microaneurysms associated with SLE in Korea. Here, this paper presents a case of renal microaneurysms and multiple renal infarctions in a 41-year-old woman with SLE.

Long-Term Clinical Results of Unicompartmental Knee Arthroplasty in Patients Younger than 60 Years of Age: Minimum 10-Year Follow-up

PURPOSE: To evaluate the long-term clinical results and survivorship of unicompartmental knee arthroplasty (UKA) in patients younger than 60 years of age. MATERIALS AND METHODS: One hundred and six cases of medial UKA with a minimum follow-up of 10 years were selected for this study. There were 80 patients and the preoperative diagnosis was osteoarthritis in all cases. The mean age of the patients was 54.2 years and the mean duration of follow-up was 12.1 years. Clinical assessments were performed using the Knee Society clinical rating system, and a survival analysis was performed using the Kaplan-Meier method. RESULTS: The mean knee and function scores improved from 52.8±8.4 points and 56.6±10.6 points preoperatively to 85.4±9.1 points and 84.7±10.4 points at the last follow-up, respectively (p < 0.001). The mean range of motion was recovered from 130.7° to 132.8° at the last follow-up. Complications occurred in 20 cases (16.7%) and the most prevalent complication was mobile bearing dislocation (n=9, 7.5%). The 10-year survival rate was 92.8% when conversion to total knee arthroplasty was defined as failure, whereas 89.3% when failure was defined as all revision surgeries. CONCLUSIONS: The long-term clinical results of UKA were satisfactory in patients under 60 years of age. Therefore, UKA could be a useful method for the treatment of medial compartment osteoarthritis of the knee in patients younger than 60 years of age.

Etiology of Invasive Bacterial Infections in Immunocompetent Children in Korea (2006–2010): a Retrospective Multicenter Study

BACKGROUND: Invasive bacterial infections in apparently immunocompetent children were retrospectively analyzed to figure causative bacterial organisms in Korea. METHODS: A total of 947 cases from 25 university hospitals were identified from 2006 to 2010 as a continuance of a previous 10-year period study from 1996 to 2005. RESULTS: Escherichia coli (41.3%), Streptococcus agalactiae (27.7%), and Staphylococcus aureus (27.1%) were the most common pathogens in infants < 3 months of age. S. agalactiae was the most prevalent cause of meningitis and pneumonia and E. coli was the major cause of bacteremia without localizing signs in this group. In children 3 to 59 months of age, Streptococcus pneumoniae (54.2%), S. aureus (20.5%), and Salmonella spp. (14.4%) were the most common pathogens. S. pneumoniae was the leading cause of pneumonia (86.0%), meningitis (65.0%), and bacteremia without localizing signs (49.0%) in this group. In children ≥ 5 years of age, S. aureus (62.8%) was the predominant pathogen, followed by Salmonella species (12.4%) and S. pneumoniae (11.5%). Salmonella species (43.0%) was the most common cause of bacteremia without localizing signs in this group. The relative proportion of S. aureus increased significantly over the 15-year period (1996–2010) in children ≥ 3 months of age (P < 0.001), while that of Haemophilus influenzae decreased significantly in both < 3 months of age group (P = 0.036) and ≥ 3 months of age groups (P < 0.001). CONCLUSION: S. agalactiae, E. coli, S. pneumoniae, and S. aureus are common etiologic agents of invasive bacterial infections in Korean children.

Prolotherapy / 대한정형외과학회잡지

Prolotherapy is defined as “the rehabilitation of an incompetent structure such as ligament or tendon by induced proliferation of new cells” in the dictionary. It may include any treatment promoting the proliferation of new cells such as stem cell therapy. Traditionally, prolotherapy has been thought of as a method of strengthening a lax ligament by injecting various types of sclerosing or proliferant solutions which have commonly included hypertonic dextrose. And this therapy should involve the process of injecting solutions at the enthesis, where tendons and ligaments attach to the bone, to cause an inflammatory reaction. This inflammation initiates the regeneration and repair processes of the injured tissue in and around the joint to promote tissue proliferation and growth. Therefore, the method of prolotherapy includes the injection of small volumes of an irritant solution at painful ligament and tendon insertion sites over several treatment sessions. Because prolotherapy is a treatment modality that may provide a solution to a patient who complains of enthesopathic pain symptoms, it may be beneficial prior to long-term medication treatment or surgical intervention. Despite controversies over prolotherapy, its usage appears to be increasing gradually. This article discusses the current state of knowledge on prolotherapy and informs it to the physicians who manage the musculoskeletal pains.

Identifying Adverse Events Using International Classification of Diseases, Tenth Revision Y Codes in Korea: A Cross-sectional Study / 예방의학회지

OBJECTIVES@#The use of administrative data is an affordable alternative to conducting a difficult large-scale medical-record review to estimate the scale of adverse events. We identified adverse events from 2002 to 2013 on the national level in Korea, using International Classification of Diseases, tenth revision (ICD-10) Y codes.@*METHODS@#We used data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC). We relied on medical treatment databases to extract information on ICD-10 Y codes from each participant in the NHIS-NSC. We classified adverse events in the ICD-10 Y codes into 6 types: those related to drugs, transfusions, and fluids; those related to vaccines and immunoglobulin; those related to surgery and procedures; those related to infections; those related to devices; and others.@*RESULTS@#Over 12 years, a total of 20 817 adverse events were identified using ICD-10 Y codes, and the estimated total adverse event rate was 0.20%. Between 2002 and 2013, the total number of such events increased by 131.3%, from 1366 in 2002 to 3159 in 2013. The total rate increased by 103.9%, from 0.17% in 2002 to 0.35% in 2013. Events related to drugs, transfusions, and fluids were the most common (19 446, 93.4%), followed by those related to surgery and procedures (1209, 5.8%) and those related to vaccines and immunoglobulin (72, 0.3%).@*CONCLUSIONS@#Based on a comparison with the results of other studies, the total adverse event rate in this study was significantly underestimated. Improving coding practices for ICD-10 Y codes is necessary to precisely monitor the scale of adverse events in Korea.

Complications of Mobile-Bearing Unicompartmental Knee Arthroplasty in Korean Patients / 대한정형외과학회잡지

PURPOSE: To evaluate the causes and modes of complications after unicompartmental knee arthroplasty (UKA) in Korean patients, and to identify the adaptability of mobile-bearing UKA for Korean patients by analyzing its complications. MATERIALS AND METHODS: Between January 2002 and December 2015, a total of 1,325 patients (1,560 cases) who underwent mobile-bearing medial UKA and were followed-up for more than 1 year were included in this study. We analyzed the complications of UKA retrospectively, and investigated the mode of complications, mean time to reoperation, and method of treatment. RESULTS: We observed a total of 101 complications (6.5%) after mobile-bearing UKA. The most prevalent complication was dislocation of mobile-bearing (n=52, 3.3%), accounting for more than half of the complications. Other complications include component loosening (n=16, 1.0%), progression of arthritis in lateral compartment (n=9, 0.6%), polyethylene wear and breakage (n=5, 0.3%), periprosthetic fracture (n=4, 0.3%), impingement (n=3, 0.2%), medial collateral ligament (MCL) injury (n=2, 0.1%), arthrofibrosis (n=1, 0.1%), unexplained pain (n=1, 0.1%) and infection (n=8, 0.5%). At a mean of 5.2 years post-UKA, complications occurred in our patients. The mean time interval from UKA to the development of mobile-bearing dislocation, component loosening, and progression of arthritis to the lateral compartment was a 4.3 years, 6.5 years, and 11.2 years, respectively. Complications were treated with a conversion to total knee arthroplasty in 68 cases, revision UKA in 1 case, and simple bearing change in 23 cases. Remaining complications were treated with arthroscopic management (n=3), MCL repair (n=2), open reduction and internal fixation (n=2), closed reduction and internal fixation (n=1), and manipulation (n=1). CONCLUSION: The incidence of mobile-bearing dislocation after mobile-bearing UKA was especially higher in Korean patients. However, the progression of arthritis in the lateral compartment and polyethylene wear were relatively lower compared with Western counterparts. Therefore, it is encouraged that Korean patients are provided with sufficient preparation for mobile-bearing dislocation and education prior to surgery when performing mobile-bearing UKA.