Purpose: Osteosynthesis of a clavicular fracture can obtain good clinical results even with conservative treatment. The development of surgical techniques and improvements in internal fixation have led to the use of metal plates and screws. Although there are intramedullary nails or minimally invasive plate osteosynthesis that can reduce soft tissue damage, these techniques are not used often because most require a skin incision about the length of the metal plate to be inserted. This study compared the postoperative pain to determine the appropriate injection depth. Materials and Methods: A prospective, single-institute, single-blind, randomized study was designed. The patients in the study had clavicular fractures and who underwent the removal of implant. The patients judged to have difficulty indicating pain were excluded.Ropivacaine was injected between plate fixation and muscle suturing. The visual analog scale (VAS) pain score, patient-controlled analgesia (PCA) use, and additional pain medication usage were measured after surgery and every 4 hours. Results: Thirty-four clavicle shaft fracture patients were classified into 16 patients in the subcutaneous injection group and 18 in the muscle injection group. Seventeen implant removal patients were divided into eight patients in the subcutaneous injection group and another nine in the muscle injection group. In the fracture group, the mean VAS for the subcutaneous injection group was 4.20±2.68 immediately after surgery, 4.47±1.85 at 4 hours, 1.93±1.44 at 24 hours, and 1.60±1.35 at 48 hours. The mean VAS for the muscle injection group was 4.23±1.59 immediately after surgery, 3.00±1.47 at 4 hours, 1.69±1.03 at 24 hours, and 1.31±1.11 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.332). In the implant removal group, the mean VAS for the subcutaneous injection group was 4.75±1.58 immediately after surgery, 3.75±1.04 at 4 hours, 1.75±0.89 at 24 hours, and 1.75±0.89 at 48 hours. The mean VAS for the muscle injection group was 3.78±1.20 immediately after surgery, 3.22±0.83 at 4 hours, 1.89±1.17 at 24 hours, and 1.11±1.01 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.181). Conclusion The postoperative VAS pain score and PCA usage were not statistically significant regardless of the ropivacaine injection site in clavicular surgery, but each group had significantly different VAS pain scores and PCA usage according to time after surgery. In addition, the muscle injection group tended to have a lower average VAS than the subcutaneous injection group in the implant removal patient group.

Background: The 2023 Obesity Fact Sheet aims to present an updated overview of obesity prevalence across all age groups, including children and adolescents. Methods: This study included individuals aged ≥20 years (n=16,941,423 in 2021) who underwent health checkups provided by the Korean National Health Insurance Service between 2012 and 2021. The prevalence of obesity and abdominal obesity was standardized by age and sex using data from the 2010 population and housing census. For children and adolescents (6 to 18 years) (n= 884 in 2021), we used the Korea National Health and Nutrition Examination Survey (2012 to 2021), and obesity was defined by the corresponding sex- and agespecific body mass index percentile of 95th or greater based on the 2017 Korean National Growth Chart for Children and Adolescents. Results: The overall prevalence of obesity in 2021 is 38.4% (49.2% in men and 27.8% in women), which is a 1.27-fold increase from 30.2% in 2012. The prevalence of obesity has increased across all age groups, particularly among those aged 20, 30, and 80 years. The prevalence of class III obesity substantially increased from 0.35% (men) and 0.42% (women) in 2012 to 1.21% and 0.97% in 2021, with 3.46- and 2.31-fold increases, respectively.This increase was particularly pronounced in young adults. The prevalence of obesity in children and adolescents has surged from 9.7% in 2012 to 19.3% in 2021, with a greater increase among boys. Conclusion Our study provides information on the current status of obesity prevalence based on the 2023 Obesity Fact Sheet, emphasizing the urgency of implementing timely strategies to reverse this increasing trend.

Purpose: Osteosynthesis of a clavicular fracture can obtain good clinical results even with conservative treatment. The development of surgical techniques and improvements in internal fixation have led to the use of metal plates and screws. Although there are intramedullary nails or minimally invasive plate osteosynthesis that can reduce soft tissue damage, these techniques are not used often because most require a skin incision about the length of the metal plate to be inserted. This study compared the postoperative pain to determine the appropriate injection depth. Materials and Methods: A prospective, single-institute, single-blind, randomized study was designed. The patients in the study had clavicular fractures and who underwent the removal of implant. The patients judged to have difficulty indicating pain were excluded.Ropivacaine was injected between plate fixation and muscle suturing. The visual analog scale (VAS) pain score, patient-controlled analgesia (PCA) use, and additional pain medication usage were measured after surgery and every 4 hours. Results: Thirty-four clavicle shaft fracture patients were classified into 16 patients in the subcutaneous injection group and 18 in the muscle injection group. Seventeen implant removal patients were divided into eight patients in the subcutaneous injection group and another nine in the muscle injection group. In the fracture group, the mean VAS for the subcutaneous injection group was 4.20±2.68 immediately after surgery, 4.47±1.85 at 4 hours, 1.93±1.44 at 24 hours, and 1.60±1.35 at 48 hours. The mean VAS for the muscle injection group was 4.23±1.59 immediately after surgery, 3.00±1.47 at 4 hours, 1.69±1.03 at 24 hours, and 1.31±1.11 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.332). In the implant removal group, the mean VAS for the subcutaneous injection group was 4.75±1.58 immediately after surgery, 3.75±1.04 at 4 hours, 1.75±0.89 at 24 hours, and 1.75±0.89 at 48 hours. The mean VAS for the muscle injection group was 3.78±1.20 immediately after surgery, 3.22±0.83 at 4 hours, 1.89±1.17 at 24 hours, and 1.11±1.01 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.181). Conclusion The postoperative VAS pain score and PCA usage were not statistically significant regardless of the ropivacaine injection site in clavicular surgery, but each group had significantly different VAS pain scores and PCA usage according to time after surgery. In addition, the muscle injection group tended to have a lower average VAS than the subcutaneous injection group in the implant removal patient group.

Background: The 2023 Obesity Fact Sheet aims to present an updated overview of obesity prevalence across all age groups, including children and adolescents. Methods: This study included individuals aged ≥20 years (n=16,941,423 in 2021) who underwent health checkups provided by the Korean National Health Insurance Service between 2012 and 2021. The prevalence of obesity and abdominal obesity was standardized by age and sex using data from the 2010 population and housing census. For children and adolescents (6 to 18 years) (n= 884 in 2021), we used the Korea National Health and Nutrition Examination Survey (2012 to 2021), and obesity was defined by the corresponding sex- and agespecific body mass index percentile of 95th or greater based on the 2017 Korean National Growth Chart for Children and Adolescents. Results: The overall prevalence of obesity in 2021 is 38.4% (49.2% in men and 27.8% in women), which is a 1.27-fold increase from 30.2% in 2012. The prevalence of obesity has increased across all age groups, particularly among those aged 20, 30, and 80 years. The prevalence of class III obesity substantially increased from 0.35% (men) and 0.42% (women) in 2012 to 1.21% and 0.97% in 2021, with 3.46- and 2.31-fold increases, respectively.This increase was particularly pronounced in young adults. The prevalence of obesity in children and adolescents has surged from 9.7% in 2012 to 19.3% in 2021, with a greater increase among boys. Conclusion Our study provides information on the current status of obesity prevalence based on the 2023 Obesity Fact Sheet, emphasizing the urgency of implementing timely strategies to reverse this increasing trend.

Background: The 2023 Obesity Fact Sheet aims to present an updated overview of obesity prevalence across all age groups, including children and adolescents. Methods: This study included individuals aged ≥20 years (n=16,941,423 in 2021) who underwent health checkups provided by the Korean National Health Insurance Service between 2012 and 2021. The prevalence of obesity and abdominal obesity was standardized by age and sex using data from the 2010 population and housing census. For children and adolescents (6 to 18 years) (n= 884 in 2021), we used the Korea National Health and Nutrition Examination Survey (2012 to 2021), and obesity was defined by the corresponding sex- and agespecific body mass index percentile of 95th or greater based on the 2017 Korean National Growth Chart for Children and Adolescents. Results: The overall prevalence of obesity in 2021 is 38.4% (49.2% in men and 27.8% in women), which is a 1.27-fold increase from 30.2% in 2012. The prevalence of obesity has increased across all age groups, particularly among those aged 20, 30, and 80 years. The prevalence of class III obesity substantially increased from 0.35% (men) and 0.42% (women) in 2012 to 1.21% and 0.97% in 2021, with 3.46- and 2.31-fold increases, respectively.This increase was particularly pronounced in young adults. The prevalence of obesity in children and adolescents has surged from 9.7% in 2012 to 19.3% in 2021, with a greater increase among boys. Conclusion Our study provides information on the current status of obesity prevalence based on the 2023 Obesity Fact Sheet, emphasizing the urgency of implementing timely strategies to reverse this increasing trend.

Purpose: Osteosynthesis of a clavicular fracture can obtain good clinical results even with conservative treatment. The development of surgical techniques and improvements in internal fixation have led to the use of metal plates and screws. Although there are intramedullary nails or minimally invasive plate osteosynthesis that can reduce soft tissue damage, these techniques are not used often because most require a skin incision about the length of the metal plate to be inserted. This study compared the postoperative pain to determine the appropriate injection depth. Materials and Methods: A prospective, single-institute, single-blind, randomized study was designed. The patients in the study had clavicular fractures and who underwent the removal of implant. The patients judged to have difficulty indicating pain were excluded.Ropivacaine was injected between plate fixation and muscle suturing. The visual analog scale (VAS) pain score, patient-controlled analgesia (PCA) use, and additional pain medication usage were measured after surgery and every 4 hours. Results: Thirty-four clavicle shaft fracture patients were classified into 16 patients in the subcutaneous injection group and 18 in the muscle injection group. Seventeen implant removal patients were divided into eight patients in the subcutaneous injection group and another nine in the muscle injection group. In the fracture group, the mean VAS for the subcutaneous injection group was 4.20±2.68 immediately after surgery, 4.47±1.85 at 4 hours, 1.93±1.44 at 24 hours, and 1.60±1.35 at 48 hours. The mean VAS for the muscle injection group was 4.23±1.59 immediately after surgery, 3.00±1.47 at 4 hours, 1.69±1.03 at 24 hours, and 1.31±1.11 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.332). In the implant removal group, the mean VAS for the subcutaneous injection group was 4.75±1.58 immediately after surgery, 3.75±1.04 at 4 hours, 1.75±0.89 at 24 hours, and 1.75±0.89 at 48 hours. The mean VAS for the muscle injection group was 3.78±1.20 immediately after surgery, 3.22±0.83 at 4 hours, 1.89±1.17 at 24 hours, and 1.11±1.01 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.181). Conclusion The postoperative VAS pain score and PCA usage were not statistically significant regardless of the ropivacaine injection site in clavicular surgery, but each group had significantly different VAS pain scores and PCA usage according to time after surgery. In addition, the muscle injection group tended to have a lower average VAS than the subcutaneous injection group in the implant removal patient group.

Purpose: The role of allogeneic stem cell transplantation (alloSCT) in multiple myeloma (MM) treatment remains controversial. We conducted a retrospective, multicenter, nationwide study in Korea to evaluate the outcomes of alloSCT in Asian patients with MM. Materials and Methods: Overall, 109 patients with MM who underwent alloSCT between 2003 and 2020 were included in this study. Data were collected from the Korean Multiple Myeloma Working Party Registry. Results: The overall response rate and stringent complete response plus complete response (CR) rates were 67.0 and 46.8%, respectively, after alloSCT. At a median follow-up of 32.5 months, the 3-year probability of progression-free survival (PFS) and overall survival (OS) rates were 69.3% and 71.8%, respectively. The 3-year probabilities of OS rates in the upfront alloSCT, tandem auto-alloSCT, and later alloSCT groups were 75.0%, 88.9%, and 61.1%, respectively. Patients who achieved CR before or after alloSCT had significantly longer OS (89.8 vs. 18 months and 89.8 vs. 15.2 months, respectively). Even though patients who did not achieve CR prior to alloSCT, those who achieve CR after alloSCT had improved PFS and OS compared to those who had no achievement of CR both prior and after alloSCT. Patients who underwent alloSCT with 1-2 prior treatment lines had improved PFS (22.4 vs. 4.5 months) and OS (45.6 vs. 15.3 months) compared to those with three or more prior treatment lines. Conclusion AlloSCT may be a promising therapeutic option especially for younger, chemosensitive patients with earlier implementation from relapse.

Purpose: High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard management for relapsed or high-risk non-Hodgkin’s lymphoma (NHL). We reported the busulfan, melphalan, and etoposide (BuME) conditioning regimen was effective in patients with relapsed or high-risk NHL. Moreover, the busulfan, cyclophosphamide, and etoposide (BuCE) conditioning regimen has been used widely in ASCT for NHL. Therefore, based on these encouraging results, this randomized phase II multicenter trial compared the outcomes of BuME and BuCE as conditioning therapies for ASCT in patients with NHL. Materials and Methods: Patients were randomly assigned to receive either BuME (n=36) or BuCE (n=39). The BuME regimen was comprised of busulfan (3.2 mg/kg/day, intravenously) administered on days –7, –6, and –5, etoposide (400 mg/m2 intravenously) on days –5 and –4, and melphalan (50 mg/m2/day intravenously) on days –3 and –2. The BuCE regimen was comprised of busulfan (3.2 mg/kg/day intravenously) on days –7, –6, and –5, etoposide (400 mg/m2/day intravenously) on days –5 and –4, and cyclophosphamide (50 mg/kg/day intravenously) on days –3 and –2. The primary endpoint was 2-year progression-free survival (PFS). Results: Seventy-five patients were enrolled. Eleven patients (30.5%) in the BuME group and 13 patients (33.3%) in the BuCE group had disease progression or died. The 2-year PFS rate was 65.4% in the BuME group and 60.6% in the BuCE group (p=0.746). There were no non-relapse mortalities within 100 days after transplantation. Conclusion There were no significant differences in PFS between the two groups. Therefore, busulfan-based conditioning regimens, BuME and BuCE, may be important treatment substitutes for the BCNU-containing regimens.

Background: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disorder characterized by uncontrolled terminal complement activation. Eculizumab, a monoclonal antibody C5 inhibitor was introduced in Korea in 2009 and has been the standard treatment option for PNH. Methods: This study assessed the long-term efficacy/safety of eculizumab in PNH using real-world data from the Korean Health Insurance Review and Assessment Service. Eighty patients who initiated eculizumab from 2009–2020 were enrolled. Results: At eculizumab initiation, the median age was 51.5 years, lactate dehydrogenase (LDH) 6.8 × upper limit of normal, and granulocyte clone size 93.0%. All patients had at least one PNH-related complication before eculizumab initiation, including renal failure (n = 36), smooth muscle spasm (n = 24), thromboembolism (n = 20), and pulmonary hypertension (n = 15). The median (range) duration of eculizumab treatment was 52.7 (1.0, 127.3) months (338.6 total treated patient-years). Despite high disease activity in the study population before treatment initiation, overall survival was 96.2% and LDH levels were stabilized in most patients during treatment. PNH-related complications at treatment initiation were resolved in 44.4% of patients with renal failure, 95.8% with smooth muscle spasm, 70.0% with thromboembolism, and 26.7% with pulmonary hypertension. Extravascular hemolysis occurred in 28.8% of patients (n = 23; 0.09 per patient-year) and breakthrough hemolysis in 18.8% (n = 15; 0.06 per patient-year). No treatment discontinuation cases related to eculizumab were observed. Conclusion These data provided evidence for the long-term efficacy and safety of eculizumab in Korean PNH patients with high disease burdens.

Background: Targeted risk population has been highly vaccinated against pneumococcal diseases in South Korea. Despite this, the pneumococcal serotype distribution is evolving, which impedes efficient roll-out of vaccines. Methods: This prospective cohort study included patients aged ≥ 19 years with communityacquired pneumonia (CAP) from five university hospitals in South Korea between September 2018 and July 2021. The outcomes of interest were the demographic and clinical characteristics of patients with CAP, pneumococcal serotype distribution, and risk factors of 30-day mortality in patients with pneumococcal CAP (pCAP). Considering the high seroprevalence, we analyzed the clinical characteristics of serotype 3 pCAP. Results: A total of 5,009 patients hospitalized with CAP was included (mean age ± standard deviation, 70.3 ± 16.0 years; 3,159 [63.1%] men). Streptococcus pneumoniae was the leading causative agent of CAP (11.8% overall, 17.7% in individuals aged < 65 years with chronic medical conditions). Among the 280 serotyped Streptococcus pneumococcus, serotype 3 was the most common (10.0%), followed by serotypes 19A (8.9%), 34 (8.9%), and 35B (8.9%).Non-vaccine serotypes (serotype 35B [13.9%] and 34 [12.0%]) were the most prevalent in 108 individuals vaccinated with 23-valent pneumococcal polysaccharide vaccine (PPSV23).Serotype 3 was prevalent, irrespective of PPSV23 vaccination status, and more common in individuals with chronic lung disease (P = 0.008). Advanced age (adjusted odds ratio [aOR], 1.040; 95% confidence interval [CI], 1.011–1.071), long-term care facility residence (aOR, 2.161; 95% CI, 1.071–4.357), and bacteremia (aOR, 4.193; 95% CI, 1.604–10.962) were independent risk factors for 30-day mortality in patients with pCAP. PPSV23 vaccination reduced the risk of mortality (aOR, 0.507; 95% CI, 0.267–0.961). Conclusion Serotype 3 and 19A were still the most common serotypes of pCAP in South Korea despite the national immunization program of 13-valent pneumococcal conjugated vaccine in children and PPSV23 in old adults. PPSV23 vaccination might reduce the risk of mortality in patients with pCAP.