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.

Background: Nine years have passed since the Journal of Bone Metabolism (JBM) was launched as an English journal in 2012; it was finally included in Scopus in January 2019. Therefore, this study aimed to provide evidence of increased international recognition based on journal metrics and reflect on its efforts to be recognized as a top-notch journal. Methods: Databases, such as the Web of Science (WoS), Scopus, Korean Citation Index (KCI), and citation indicators, including the impact factor (IF) and SCImago journal rank (SJR) were reviewed and calculated according to years, and the results were drawn. Furthermore, country-wise contributions and top-cited articles were also investigated. Results: The JBM 2020 IF was 2.17 in the WoS. The 2020 SJR in Scopus was 0.334, with a ranking of 165/219 (75.3%) in the Endocrinology, Diabetes, and Metabolism category. The 2020 KCI was 0.42. Of 263 articles, 260 were citable (98.9%), and of 176 original articles, 15 (8.5%) were supported by research grants. The total citation of JBM has increased from 16 in 2014 to 141 in 2020; however, its KCI remained stationary from 0.29 in 2015 to 0.42 in 2020. Conclusions Currently, JBM is increasingly cited by international researchers than Korean researchers, indicating that the journal’s content is valued at an international level. Its inclusion in PubMed Central appears to have increased its international relevance; however, publishing English-only articles may hinder its use domestically. Therefore, efforts should be made to increase citation rates and enhance domestic readership.

Background: Nine years have passed since the Journal of Bone Metabolism (JBM) was launched as an English journal in 2012; it was finally included in Scopus in January 2019. Therefore, this study aimed to provide evidence of increased international recognition based on journal metrics and reflect on its efforts to be recognized as a top-notch journal. Methods: Databases, such as the Web of Science (WoS), Scopus, Korean Citation Index (KCI), and citation indicators, including the impact factor (IF) and SCImago journal rank (SJR) were reviewed and calculated according to years, and the results were drawn. Furthermore, country-wise contributions and top-cited articles were also investigated. Results: The JBM 2020 IF was 2.17 in the WoS. The 2020 SJR in Scopus was 0.334, with a ranking of 165/219 (75.3%) in the Endocrinology, Diabetes, and Metabolism category. The 2020 KCI was 0.42. Of 263 articles, 260 were citable (98.9%), and of 176 original articles, 15 (8.5%) were supported by research grants. The total citation of JBM has increased from 16 in 2014 to 141 in 2020; however, its KCI remained stationary from 0.29 in 2015 to 0.42 in 2020. Conclusions Currently, JBM is increasingly cited by international researchers than Korean researchers, indicating that the journal’s content is valued at an international level. Its inclusion in PubMed Central appears to have increased its international relevance; however, publishing English-only articles may hinder its use domestically. Therefore, efforts should be made to increase citation rates and enhance domestic readership.

Despite advancements in treating ruptured cerebral aneurysms, an aneurysmal subarachnoid hemorrhage (aSAH) is still a grave cerebrovascular disease associated with a high rate of morbidity and mortality. Based on the literature published to date, worldwide academic and governmental committees have developed clinical practice guidelines (CPGs) to propose standards for disease management in order to achieve the best treatment outcomes for aSAHs. In 2013, the Korean Society of Cerebrovascular Surgeons issued a Korean version of the CPGs for aSAHs. The group researched all articles and major foreign CPGs published in English until December 2015 using several search engines. Based on these articles, levels of evidence and grades of recommendations were determined by our society as well as by other related Quality Control Committees from neurointervention, neurology and rehabilitation medicine. The Korean version of the CPGs for aSAHs includes risk factors, diagnosis, initial management, medical and surgical management to prevent rebleeding, management of delayed cerebral ischemia and vasospasm, treatment of hydrocephalus, treatment of medical complications and early rehabilitation. The CPGs are not the absolute standard but are the present reference as the evidence is still incomplete, each environment of clinical practice is different, and there is a high probability of variation in the current recommendations. The CPGs will be useful in the fields of clinical practice and research.
Aneurysm ; Brain Ischemia ; Cerebrovascular Disorders ; Diagnosis ; Disease Management ; Hydrocephalus ; Intracranial Aneurysm ; Mortality ; Neurology ; Quality Control ; Rehabilitation ; Risk Factors ; Search Engine ; Subarachnoid Hemorrhage ; Surgeons

“Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” is the 3rd edition of clinical practice guideline (CPG) for stroke rehabilitation in Korea, which updates the 2nd edition published in 2014. Forty-two specialists in stroke rehabilitation from 21 universities and 4 rehabilitation hospitals and 4 consultants participated in this update. The purpose of this CPG is to provide optimum practical guidelines for stroke rehabilitation teams to make a decision when they manage stroke patients and ultimately, to help stroke patients obtain maximal functional recovery and return to the society. The recent two CPGs from Canada (2015) and USA (2016) and articles that were published following the 2nd edition were used to develop this 3rd edition of CPG for stroke rehabilitation in Korea. The chosen articles' level of evidence and grade of recommendation were decided by the criteria of Scotland (2010) and the formal consensus was derived by the nominal group technique. The levels of evidence range from 1++ to 4 and the grades of recommendation range from A to D. Good Practice Point was recommended as best practice based on the clinical experience of the guideline developmental group. The draft of the developed CPG was reviewed by the experts group in the public hearings and then revised. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” consists of ‘Chapter 1; Introduction of Stroke Rehabilitation’, ‘Chapter 2; Rehabilitation for Stroke Syndrome, ‘Chapter 3; Rehabilitation for Returning to the Society’, and ‘Chapter 4; Advanced Technique for Stroke Rehabilitation’. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” will provide direction and standardization for acute, subacute and chronic stroke rehabilitation in Korea.
Canada ; Consensus ; Consultants ; Humans ; Korea* ; Practice Guidelines as Topic ; Rehabilitation* ; Scotland ; Specialization ; Stroke*

BACKGROUND: This study aims to identify the monthly average medical expenses of public pension recipients, and analyze the determinants of total health and medical expenses and Western and Oriental medicine expenses, medical service expenses, and medical supplies expenses. METHODS: This study used the fifth year data of 2013 out of the raw data of the Korean Retirement and Income Study collected by the National Pension Research Institute. This study conducted t-test, analysis of variance, and linear regression to verify publicly the relevance between pension recipients' general characteristics and health and medical expenses status using IBM SPSS ver. 21.0 for data analysis. RESULTS: It was analyzed that there is a difference in the spending of expenditure and health care costs according to public pension recipients. Medical expenses of the national pensioners was higher compared to the special corporate pensioners. The national pensioner is related expenditure size, education level, family members living together, residential areas, status of spouse, number of chronic illness, and status of limitation in daily life with psychological health status. CONCLUSION: Therefore, fairness does not occur fire to the medical use between the special corporate pensioners and national pensioners, aggressive of government such as health policy and financial support for the retiree pension policy that reflects the reality intervention would be required.
Academies and Institutes ; Chronic Disease ; Education ; Equipment and Supplies ; Financial Support ; Fires ; Health Care Costs ; Health Expenditures ; Health Policy ; Humans ; Linear Models ; Medicine, East Asian Traditional ; Pensions* ; Retirement ; Spouses ; Statistics as Topic

OBJECTIVE: To investigate the characteristics of foot deformities in patients with Charcot-Marie-Tooth (CMT) disease compared with normal persons according to severity of disease. METHOD: Sixty-two patients with CMT disease were recruited for this study. The normal control group was composed of 28 healthy people without any foot deformity. Patients were classified into a mild group and a moderate group according to the CMT neuropathy score. Ten typical radiological angles representing foot deformities such as pes equinus and pes varus were measured. The CMT group angles were compared with those of the normal control group, and those of the mild group were also compared with those of the moderate group. RESULTS: The lateral (Lat.) talo-first metatarsal angle, anteroposterior talo-first metatarsal angle, Lat. calcaneal-first metatarsal angle, Lat. naviocuboid overlap, Lat. calcaneal pitch, Lat. tibiocalcaneal angle, and Lat. talocalcaneal angle in the CMT group showed a significant difference compared to the normal control group (p<0.05). These findings revealed CMT patients have pes cavus, forefoot adduction, midfoot supination and pes varus deformity. Compared to the mild group, the moderate group significantly showed an increased Lat. calcaneal pitch and decreased Lat. calcaneal-first metatarsal angle, Lat. tibiocalcaneal angle, Lat. talocalcaneal angle, and Lat. talo-first metatarsal angle (p<0.05). These findings revealed that the pes cavus deformity of CMT patients tend to be worse with disease severity. CONCLUSION: The characteristic equinovarus foot deformity patterns in CMT patients were revealed and these deformities tended to be worse with disease severity. Radiographic measures may be useful for the investigation of foot deformities in CMT patients.
Charcot-Marie-Tooth Disease ; Clubfoot ; Congenital Abnormalities ; Foot ; Foot Deformities ; Humans ; Metatarsal Bones ; Supination

OBJECTIVE: The purpose of this study was to examine smoking status and the relates factors in the rural elderly. METHODS: This study was conducted with 2,421 elderly people(male 1,273 and female 1,148) residing in the selected 25 villages, and face-to-face interviews with the subjects were made from January 1 through March 30, 2002. RESULTS: The average age of the male subjects was 72.7 and that of the female subjects 72.8. The investigation of smoking states showed that for male subjects, smokers accounted for 49.4%, nonsmokers 26.9%, and abstainers from smoking 23.7% and that for female subjects, smokers accounted for 18.3%, nonsmokers 75.4%, and abstainers from smoking 6.3%. The level of 'low ADL' was significantly higher in abstainers. In men, smoking rate had higher in alone, non-job, queerstreet, 'high ADL'. In women, smoking rate had higher in younger age, queerstreet, unhealthy, 'high ADL'. CONCLUSIONS: The smoking rate of the elderly was relatively high, especially at abstainers. The smoking status of elderly was correlated with age, family type, job, economic status by self-assessment, Self-recognition of health status, ADL level.
Activities of Daily Living ; Aged ; Female ; Humans ; Male ; Self-Assessment ; Smoke ; Smoking

BACKGROUND: The paradoxical response refers to an enlargement of old lesions or unexpected new ones during apparently adequate antituberculous therapy. This response has been reported in cases of intracranial tuberculoma, tuberculous lymphadenopathy, tuberculous pleurisy and pulmonary tuberculosis. However, there are few reports on its frequency and clinical characteristics. METHOD: This study enrolled 205 patients who were treated with first line antituberculous agents for more than 6 months. We retrospectively studied 155 patients with pulmonary tuberculosis and 57 patients with pleural tuberculosis (7 patients had both) from July 1998 to March 2000. The patients were divided into the paradoxical response group and the non-paradoxical group. The clinical characteristics of the paradoxical group were investigated. Statistical analysis was done with an independent sample T-test and Chi-squared test. RESULT: 29 of the 205 patients(14.1%) had paradoxical response. Among the 29 patients, there were 19 pulmonary tuberculosis, 8 tuberculous pleurisy(2 patients had both). Paradoxical response appeared 32 days (mean 35 days in pulmonary tuberculosis, mean 25 days in tuberculous pleurisy) after the beginning of chemotherapy. The duration to regress less than half of initial chest lesion was 114 days in pulmonary tuberculosis and 124 days in tuberculous pleurisy, respectively. Most common clinical manifestation of paradoxical response patients was coughing in both pulmonary tuberculosis and tuberculous pleurisy. Male sex, high blood WBC count and high level of pleural fluid LDH were related with paradoxical response. CONCLUSION: These findings suggest that presponse usually appears 1 month and disappears within 4 months after the beginning of anti-tuberculous chemotherapy. Paradoxical response was relatively correlated with male sex, high blood WBC count and high level of pleural fluid LDH.
Male ; Humans

In contrast to younger patients, old peoples frequently mainfest more than one pathologic process, mainly degenerative diseases and neoplasia. Nearly all have some degree of arteriosclerosis, even if this is not clinically diagnosed, and many have associated chronic cardiac, renal, hepatic, or pulmonary disease. The surgeon and the anesthesiologist must see theat their clinical decisions are tied to a physiologic understanding based on exact quantification of the specific hemodynamic, respiratiory, renal, and metabolic factors which may play a decisive role in influencing the final outcome to a major operative procedure. From May 1972 to Dec 1980, the Department of Anesthesiology, Hanyang University, College of Medicine had 517 geriatric patients(above 65 years) who received anesthesia and these were analyzed clinically according to age, sex, department, physical status, anesthetic technique and agent, anesthesia time, length of admission, laboratory studies(chest X-ray, EKG, arterial blood gas), and postoperative complications(mortality and causes of deathe). The results are as follows. 1) Out of 25,857 anesthetized patients 517(2.0%) were over 64 years of age and 290 were males(56.1%) and 227 females(43.9%). 2) In the surgical group, 246 cases (47.6%) were from general sugery: 81 cases(15.7%), orthopedic surgery: 78 cases (15.1%), urology: and 67 cases (12.9%), neurosurgery respectively. 3) In the classification of physical status, 33 cases(6.4%) were class 1, 269 cases(52.0%) class 2, 181 cases (35.0%) class 3, 28 cases (5.4%) class 4, and 6 cases (1.2%) class 5. Emergency cases were 137 cases(26.5%) and 380 cases (73.5%) were elective. 4) Concerning premedication-150cases(29.0%) were premedicated with atropine sulfate plus valium and 93 cases had no premedication. 5) There were 425 cases of general anesthesia (82.2%) and 92 cases of regional anesthesia (17.8%). The major anesthetic was halothane, 362 cases (70.0%). The technic in 419 cases( 81.0%) was circle type with endotracheal intubation. Anesthesia duration was within 1hour for 70 cases(13.5%), within 2 hours for 158 cases(30.0%), and within 3hours in 144 cases(27.9%). 6) Preoperative laboratory findings were as follows: The chest X-ray suggested that 199 cases (45.9%) were within normal limits, 56 cases (12.9%) had hypertensive heart disease, 56 cases (12.9%) had pulmonary tuberculosis, and 38 cases (5.1%) had senile lung fibrosis. The EKG which was done on 85% of the patients, ravealed that 193 cases (44.0%) were within normal limits, 61 cases(13.9%) showed left ventricular hypertrophy, and 38 cases(8.7%) had myocardial ischemia. In the preoperative arterial blood gas studies of 56 cases the results were almost all within normal limits. 7) Postoperative complications were as follows: 52 cases showed wound infection or bleeding, 20 cases had pneumonia, and 18 cases atelectasis. There were a number of miscellaneous complications. 8) The overall mortality rate was 5.8%. The difference of mortality rate related to the age was not statistically significant,(p>0.1) and the mortality rate related to physical status was statistically significant(p<0.005). 9) As the cause of death-11 cases (36.7%) had transtentorial herniation, 2 cases (6.7%) sepsis, 2 cases (6.7%) hypovolemia, and 1 case (3.3%) had pulmonary edema.
Anesthesia* ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesiology ; Arteriosclerosis ; Atropine ; Classification ; Diazepam ; Electrocardiography ; Emergencies ; Fibrosis ; Halothane ; Heart Diseases ; Hemodynamics ; Hemorrhage ; Humans ; Hypertrophy, Left Ventricular ; Hypovolemia ; Intubation, Intratracheal ; Lung ; Lung Diseases ; Mortality ; Myocardial Ischemia ; Neurosurgery ; Orthopedics ; Pneumonia ; Postoperative Complications ; Premedication ; Pulmonary Atelectasis ; Pulmonary Edema ; Sepsis ; Surgical Procedures, Operative ; Thorax ; Tuberculosis, Pulmonary ; Urology ; Wound Infection