Prospects for major ports in the Far East

동북아시아 지역은 유럽과 북아메리카 지역에 이어 3번째로 큰 경제 블록을 형성하고 있으며 해상무역에 있어서도 세계 컨테이너 항만 Top 5중 4개항만이 이 지역에 위치할 정도로 해상교역에서도 큰 축을 이루고 있는 지역이다. 특히, 동북아시아 지역의 경우, 중국의 WTO 가입 및 북중국 지역의 대형항만에 대한 집중적 투자 등으로 인해 타 항만들과 허브포트에 대한 경쟁이 불가피한 실정이다. 이러한 경쟁구도에는 부산항 역시 포함되어 있으며, 북중국 항만 개발의 선봉에 있는 상하이항의 경우 부산항을 제1의 타겟으로 설정하고 있다. 또한 1994년 고베 대지진으로 막대한 피해를 입었던 일본의 항만들도 현재 복구를 넘어 동북아 허브항만 경쟁에 나서기 위한 막바지 준비가 한창이다. 이에 본 연구는 동북아의 경제와 물류환경변화 등을 살펴본 다음 동북아 허브 항만을 노리는 부산항 중국의 상하이항 청도항 일본의 도쿄항 그리고 대만의 카오슝항을 대상으로 개발현황 및 관련 지표 등을 통해 경쟁력을 분석하였으며 향후 전개 방향에 따른 부산항의 대책을 살펴보았다. 현재 전 세계에서 가장 역동적인 경제 성장 지역인 동북아는 한국, 일본, 중국경제권을 중심으로 형성되어있으며 향후에도 이러한 경제성장이 지속될 것으로 전망된다. 중국은 2001년 WTO에 가입한 이후 평균12.5%의 경제성장률을 기록하고 있으며, 이것은 세계에서 가장 높은 수치이다. 중국의 지속적인 고도성장과 대외교역이 급증하는 추세에 따라 향후 한국 중국 일본의 동북아 3국이 핵심경제 주체로 활약할 것이고 현재도 그런 추세에 있다. 이런 경제성장과 함께 물류 중심지, 허브항만에 대한 경쟁도 심화되고 있다. 물류중심지란 글로벌화 되는 세계경제 속에서 지역 경제권의 중심지로서 지역경제권내에서 물류기능의 중심지가 되는 곳이며 기타 지역경제권과 중개기지 역할을 하는 지역경제의 관문역할을 하는 곳이기 때문이다. 항만간 경쟁력을 분석하기 위해 항만 인프라, 물동량, 배후부지, 항만 비용, 항만서비스를 비교하였다. 항만인프라의 경우 상하이항이 2005년 12월 5선석을 추가 개장하는 것을 필두로 대부분의 항만들이 2020까지 대규모의 항만 시설 증가를 계획하고 있다. 이로써 중국 항만의 고질적인 체선과 시설부족 현상은 해소될 것으로 전망된다. 컨테이너 물동량의 경우 부산항 환적화물의 과반수를 차지하는 중국 환적화물이 감소하는 추세에 있고 북중국 항으로 직기항하는 선사들이 늘어나면서 중국환적화물의 감소추세는 지속될 것으로 전망된다. 그러나 일본 내륙수송의 고비용문제등으로 부산을 이용하는 일본 환적화물의 증가로 현재 환적화물의 증가세는 다소 둔화되었지만 물동량은 꾸준히 증가하는 추세이다. 부산항의 결정적인 문제점 중의 하나는 배부물류단지의 절대적인 부족이다. 상하이는 배후물류단지에 5천여개가 넘는 물류기업을 유치하여 운영하고 있으며 카오슝항의 경우도 역외환적센타, 수출가공구 등을 운영하며 물동량을 창출하고 있다. 항만비용의 경우 상하이, 부산, 카오슝, 일본 순으로 높은 것으로 조사되었다. 항만서비스 항목의 경우 선사들의 항만 효율지수를 참조하면 대만, 일본, 한국, 중국순으로 선호하는 것으로 나타났다. 이런 요인들을 분석해 본 결과 상하이항은 수년 내에 동북아 허브항만으로서의 역할을 수행할 것으로 예상된다. 또한 북중국 항만들의 대규모 시설정비와 물동량 증가 그리고 선사들의 직기항 증가로 현재 부산항을 이용하는 중국 환적화물들은 머지않아 중국에서 처리될 것이다. 이런 상황 속에서 부산항이 살아남기 위한 전략들은 다음과 같다. 항만을 개발할 때 전용터미널을 통한 대형선사들의 투자를 유치하는 것이다. 두 번째는 정기적인 피더서비스를 제공함으로써 환적화물들을 유지하는 것이다. 특히 일본항로에 정기적인 피더서비스를 제공할 때 일본 환적화물을 유치할 수 있을 것이다. 항만부가가치산업을 육성하기 위하여 세계적인 물류기업들을 물류배후단지에 유치하고 또한 국내의 물류기업들을 세계적인 기업으로 육성시키는 방법이 있다. 두 번째는 화물들을 재가공 하여 부가가치를 높이는 방법이다. 단순히 항만의 물동량을 높이는 것은 혼잡을 발생시킬 뿐이다. 일단 들어온 화물들은 포장 가공 라벨링 등의 재가공을 통하여 부가가치를 창출하는 것이야 말로 양보다는 실리를 취하는 것이라 할 수 있겠다. 앞에서 언급한 다양한 마케팅 전략들을 이용하여 부산항은 치열해지는 동북아시아 항만들 간의 경쟁에서 살아남을 수 있을 것이다.1. Introduction = 1 2. The change in the Far East = 3 2.1 The progress and prospects of container volume in the world = 3 2.2 The change of economy in the Far East = 4 2.3 The change of logistics in the Far East = 6 2.4 Change of shipping and port environment = 7 3. Competitive analysis among Far East ports = 10 3.1 Present situation = 10 3.1.1 Ports of China = 10 3.1.1.1 Port of Shanghai = 12 3.1.1.2 Port of Qingdao = 13 3.1.2 Ports of Japan = 14 3.1.3 Ports of Taiwan = 16 3.1.4 Ports of Korea = 17 3.2 Competitive analysis = 20 3.2.1 Port Infrastructure = 21 3.2.2 Port throughput = 23 3.2.3 Logistics Park = 25 3.2.4 Port cost = 28 3.2.5 The service of Port = 28 4. Some Cases in European Ports and Asian port = 30 4.1 Port of Rotterdam = 30 4.2 Port of Singapore = 33 5. Prospects for major ports in the Far East and some marketing strategies for Busan port = 36 5.1 Prospects for major ports in Far East = 36 5.2 The some marketing strategies for Busan port = 38 5.2.1 A strategy to attract big shipping companies = 39 5.2.2 Raising ports related industries = 39 5.2.3 Attracting transshipment cargo and multilateral market = 41 6. Conclusion = 4

Reclassification of Korean patients with polymyositis and dermatomyositis based on the Bohan and Peter criteria by the 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies

Background/aims: We investigated the concordance rate of the classification of polymyositis (PM) and dermatomyositis (DM) between the Bohan and Peter criteria and the 2017 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for idiopathic inflammatory myopathies (IIMs) (the 2017 EULAR/ACR criteria) in Korean patients. Methods: We retrospectively reviewed the medical records of 137 patients with PM and DM. We finally included 72 PM patients and 49 DM patients who fulfilled the Bohan and Peter criteria for PM and DM and reclassified them by the 2017 EULAR/ ACR criteria. Results: Three patients (4.2%) with probable PM were newly reclassified as non-IIM due to a total score of 5.3 or smaller. Meanwhile, one patient with possible PM was newly reclassified as probable PM due to the presence of dysphagia. In addition, eight patients (16.3%) with possible DM with DM-specific typical skin rash were newly reclassified as amyopathic DM (ADM) due to the absence of proximal muscle weakness. The concordance rate of the classification between the Bohan and Peter criteria and the 2017 EULAR/ACR criteria was 95.8% for PM patients and 83.7% for DM patients. Conclusion: The Bohan and Peter criteria were comparable to the 2017 EULAR/ ACR criteria for classifying PM and DM in Korean patients. Considering the convenience of the Bohan and Peter criteria in the real clinical settings, we suggest that the old criteria should be preferentially applied and then performing muscle biopsy should be considered in a patient suspected of PM without antihistidyl tRNA synthetase (anti-Jo-1). Moreover, we suggest that ADM could also clinically be classified by the old criteria.ope

Red Blood Cell Distribution Width Can Predict Vasculitis Activity and Poor Prognosis in Granulomatosis with Polyangiitis

PURPOSE: We investigated whether red blood cell distribution width (RDW) predicts vasculitis activity based on Birmingham vasculitis activity score (BVAS) or BVAS for granulomatosis with polyangiitis (GPA) at diagnosis and poor prognosis during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). MATERIALS AND METHODS: We reviewed the medical records of 150 patients with AAV. We defined severe GPA as BVAS for GPA >/=7 (the highest quartile). Correlation and standardised correlation coefficients were analysed by linear regression tests. The differences between groups were evaluated by Mann-Whitney test. Relative risk (RR) was assessed by chi square test and Cox hazards model. RESULTS: RDW was correlated only with the vasculitis activity of GPA among patients with AAV. An increase in RDW was associated with the absence of ear nose throat (ENT) manifestation, but not proteinase 3-ANCA. Significant differences were noted in cumulative refractory free survival according to RDW >/=15.4% (p=0.007) and the absence of ENT manifestation (p=0.036). Multivariate Cox hazards analysis identified RDW >/=15.4% as the only significant predictor of refractory disease in GPA (RR 17.573). CONCLUSION: RDW predicts vasculitis activity in GPA, and RDW >/=15.4% at diagnosis may increase the risk of severe GPA at diagnosis and predict refractory diseases during follow-up.ope

Delta Neutrophil Index Is Associated with Vasculitis Activity and Risk of Relapse in ANCA-Associated Vasculitis

PURPOSE: Delta neutrophil index (DNI) represents the immature granulocytes count associated with neutrophil-consumption. We investigated whether DNI might be associated with Birmingham vasculitis activity score (BVAS) at diagnosis and could predict relapse during the follow-up in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). MATERIALS AND METHODS: We reviewed the medical records of 97 patients having DNI results. Twenty patients had granulomatosis with polyangiitis (GPA), 58 had microscopic polyangiitis (MPA), and 19 had eosinophilic GPA (EGPA). We collected clinical and laboratory data including BVAS, five factor score (FFS), and DNI. The correlation coefficient and cumulative relapse free survival rate were obtained. The optimal cut-off of DNI was extrapolated by calculating the area under the receiver operator characteristic curve. RESULTS: DNI was significantly related to cross-sectional BVAS. Furthermore, among continuous variables, only DNI could reflect BVAS of GPA and MPA, but not EGPA. Severe AAV was defined as BVAS >/=20 (the highest quartile). At diagnosis, patients having DNI >/=0.65% had a significantly higher risk of severe GPA and MPA than those having not (relative risk 4.255) at diagnosis. During the follow-up, DNI >/=0.65% could predict the higher relapse rate. CONCLUSION: DNI could reflect BVAS at diagnosis and furthermore, DNI >/=0.65% could not only identify severe AAV at diagnosis, but also predict relapse during the follow-up in patients with GPA and MPA.ope

Comparison of the Clinical Implications among Five Different Nutritional Indices in Patients with Lupus Nephritis

Systemic lupus erythematosus (SLE) is characterized with aberrant responses in the immune systems and lupus nephritis (LN) is one of the most serious complications of SLE. This study evaluated the clinical significance of different nutritional indices in 207 renal biopsy-proven LN patients. The clinical and laboratory data were reviewed, and five different nutritional indices were calculated: (i) Controlling nutritional status (CONUT) score; (ii) prognostic nutritional index (PNI); (iii) nutritional risk index; (iv) neutrophil-to-lymphocyte ratio; and (v) body mass index. The factors associated with end-stage renal failure (ESRF) were assessed using a Cox-proportional hazard analysis. The patients with ESRF had significantly lower median PNI (31.1 vs. 34.7, p = 0.012) than those without ESRF at baseline. The CONUT score and PNI had the highest correlation between the SLE disease activity index-2000 (r = 0.467 and p = -0.356, all p 35.41 (p = 0.003). Among nutritional indices, the CONUT score and PNI better correlated with disease activity and PNI was associated with ESRF.ope

Serum Amyloid A Is a Biomarker of Disease Activity and Health-Related Quality-of-Life in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

Serum amyloid A (SAA) is one of the acute phase proteins synthesized in hepatocytes and secreted by various inflammation or infectious stimuli. We investigated the clinical implication of measuring SAA in patients with antineutrophil cytoplasmic antibody- (ANCA-) associated vasculitis (AAV). Seventy-five patients who had been classified as AAV and enrolled in our prospective observational cohort for AAV patients were included. Clinical and laboratory data were obtained on the day of blood sampling, and SAA was measured by ELISA kits. Birmingham Vasculitis Activity Score (BVAS) and Short-Form 36-Item Health Survey (SF-36) were assessed for disease activity and health-related quality-of-life (HRQoL) measures. We stratified patients into having high BVAS when the BVAS was over the median values, and those with either low SF-36 PCS or low SF-36 MCS were defined as having poor HRQoL. Multivariate logistic regression analysis was conducted to estimate independent predictors of high BVAS. The relative risk (RR) was analyzed using the contingency tables and the chi-squared test. SAA was positively correlated with BVAS (r = 0.642) and FFS (r = 0.367) and was inversely correlated with both the SF-36 physical component summary (r = -0.456) and mental component summary scores (r = -0.394). Furthermore, SAA was significantly correlated with acute phase reactants ESR (r = 0.611) and CRP (r = 0.629). Patients with high BVAS exhibited significantly higher SAA than those with low BVAS (1317.1 ng/mL vs. 423.1 ng/mL). In multivariable logistic regression analysis, serum albumin (odds ratio (OR) 0.132) and SAA > 1173.6 ng/mL (OR 15.132) were independently associated with high BVAS. The risk of having high BVAS and poor HRQoL in patients with SAA > 1173.6 ng/mL was higher than in those with SAA ≤ 1173.6 ng/mL (RR 3.419 and 1.493). Our results suggest that SAA might be a useful biomarker in assessing disease activity and HRQoL in AAV.ope

Risk of Stroke in Systemic Necrotizing Vasculitis: A Nationwide Study Using the National Claims Database

Objective: Evidences indicate that the risk of stroke is increased in autoimmune rheumatic diseases. This study aimed to investigate the incidence of stroke in patients with systemic necrotizing vasculitis (SNV) using the national health database. Methods: Data were obtained from the Korean National Claims database between 2010 and 2018 to identify incident SNV [anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) and polyarteritis nodosa (PAN)] cases. The standardized incidence ratio (SIR) and incidence rate ratio (IRR) were calculated to estimate the risk of stroke in patients with SNV compared to the general population and among disease subgroups. Time-dependent Cox's regression analysis was performed to identify risk factors for stroke. Results: Among 2644 incident SNV cases, 159 patients (6.0%) were affected by stroke. The overall risk of stroke was significantly higher in patients with SNV compared to the general population (SIR 8.42). Stroke event rates were the highest within the first year of SNV diagnosis (67.3%). Among disease subgroups, patients with microscopic polyangiitis (MPA) exhibited higher IRR compared to PAN (adjusted IRR 1.98). In Cox's hazard analysis, older age and MPA were associated with higher risk of stroke [hazard ratio (HR) 1.05 and 1.88], whereas the administration of cyclophosphamide, azathioprine/mizoribine, methotrexate, and statins were protective in stroke (HR 0.26, 0.34, 0.49, and 0.50, respectively). Conclusion: A considerable number of SNV patients experienced stroke, especially in the early phase of disease. Older age and MPA diagnosis were associated with elevated risk of stroke, while the administration of immunosuppressive agents and statins was beneficial in preventing stroke.ope

Incidence of Tuberculosis in Systemic Necrotizing Vasculitides: A Population-Based Study From an Intermediate-Burden Country

Objective: Tuberculosis (TB) has a significant impact on public health; however, its incidence in patients with systemic necrotizing vasculitides (SNV) remains unknown. Therefore, we evaluated the incidence of TB in patients with SNV using a nationwide claims database. Methods: The Health Insurance and Review Agency database was used to identify patients diagnosed with SNV between 2010 and 2018. The standardized incidence ratio (SIR) was calculated to compared the risk of TB between patients and the general population, based on the 2016 annual national TB report. The incidence of TB after SNV diagnosis was compared by estimating age- and sex- adjusted incidence rate ratio (IRR). A time-dependent Cox regression analysis was performed to estimate factors associated with TB. Results: Among the included 2,660 patients, 51 (1.9%) developed TB during the follow-up period. The risk of TB was significantly higher in patients with SNV [SIR 6.09, 95% confidence interval (CI) 4.53-8.00], both in men (SIR 5.95) and women (SIR 6.26), than in the general population; this increased risk was consistent in all disease subtypes, except eosinophilic granulomatosis with polyangiitis. Additionally, the incidence of TB was the highest in patients with SNV within the first 3 months after diagnosis (adjusted IRR: 8.90 compared to TB ≥ 12 months). In Cox regression analysis, the diagnosis of microscopic polyangiitis [hazard ratio (HR) 3.22, 95% CI 1.04-9.99], granulomatosis with polyangiitis (HR 4.63, 95% CI 1.53-14.02), and polyarteritis nodosa (HR 3.51, 95% CI 1.13-10.88) were independent factors associated with TB. Conclusion: Even when considering the high incidence of TB in the geographic region, the risk of TB increased in patients with SNV, with a difference based on disease subtypes. Moreover, taking into account of the high incidence of TB in SNV, vigilant monitoring for TB is required especially during the early disease period.ope

Comparison of clinical features and outcomes between patients with early and delayed lupus nephritis

Background: Lupus nephritis is associated with increased risk of end-stage renal disease (ESRD) and all-cause mortality. We evaluated the clinical features and outcomes of patients with early and delayed lupus nephritis. Methods: The medical records of 171 patients who met the 1997 revised classification criteria for systemic lupus erythematosus (SLE) with pathologic confirmation of lupus nephritis were reviewed. Early lupus nephritis was defined when lupus nephritis was histopathologically confirmed as the first clinical manifestation of SLE, whereas delayed lupus nephritis was defined as lupus nephritis that was identified after the diagnosis of SLE. Clinical and laboratory data, as well as kidney histopathology and medication usage were investigated. Kaplan-Meier and Cox-proportional hazard analysis was performed to compare the outcomes of early and delayed lupus nephritis and evaluate factors associated with ESRD and all-cause mortality. Results: Patients with early lupus nephritis had higher disease activity (median non-renal SLE disease activity index-2000, 6.0 vs. 4.0; p < 0.001) and more frequent skin rash, oral ulcer and serositis; however, the proportion of patients with higher renal chronicity index was greater in the delayed lupus nephritis group (p = 0.007). Nevertheless, no difference was found regarding ESRD and all-cause mortality between the groups. In Cox-proportional hazard analysis, C-reactive protein level, creatinine level and chronicity index were factors associated with ESRD, while age and haemoglobin level were associated with all-cause mortality. Conclusions: In conclusion, clinical outcomes of early and delayed lupus nephritis are not significantly different. Rigorous adherence to current treatment recommendations is essential for the treatment of lupus nephritis.ope

Evaluation of body composition using computed tomography in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis

Background/aims: Measures of body composition, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and skeletal muscle area (SMA), are considered important prognostic factors in chronic diseases. The association of these measures with auto-inflammatory disorders, such as anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), remains unclear. We investigated the clinical significance of VAT, SAT, and SMA in patients with AAV. Methods: Patients with AAV subjected to chest computed tomography (CT), abdominal CT, or positron emission tomography-CT on diagnosis of AAV were evaluated. Quantitative assessment of VAT, SAT, and SMA was performed at the third lumbar vertebral level and computed by summing the pixel attenuation for tissue-specific Hounsfield units in the corresponding region. Associations of VAT, SAT, and SMA with clinical and laboratory data and clinical outcome measures were evaluated. Results: Of the 117 patients, 61 (52.1%) were classified as having microscopic polyangiitis, 28 (23.9%) as granulomatosis with polyangiitis, and 28 (23.9%) as eosinophilic granulomatosis with polyangiitis. VAT significantly correlated with age, weight, body mass index (BMI), and Birmingham Vasculitis Activity Score, whereas SAT correlated with weight, BMI, and creatinine levels. A significant association was found between SMA and age, height, weight, BMI, and the Five-Factor Score. Cox proportional hazards analysis showed that creatinine levels (odds ratio [OR], 1.346; 95% confidence interval [CI], 1.034 to 1.753; p = 0.027) and high VAT (OR, 7.137; 95% CI, 1.343-37.946; p = 0.021) were independently associated with all-cause mortality during follow-up. Conclusion: Evaluation of VAT using CT is useful for estimating disease activity and all-cause mortality in patients with AAV.ope