SCI 발표논문

1. 45882026

   제1저자 신현재, 허문행 · 교신저자 김윤준

   Shin H, Hur MH, Baek YH, Lee CK, Cho YK, Lee JS, Jeong JY, Jung YJ, Kim JK, Kim MY, Seo YS, Chung WJ, Koh MS, Kim JH, Lee YB, Cho EJ, Lee JH, Yu SJ, Yoon JH, Kim YJ

   Efficacy and Safety of Switching from Entecavir to Tenofovir Alafenamide in Chronic Hepatitis B: A Multicenter Randomized Trial in Korea.

   Gut Liver. 2026;20(4):636-644.

   Abstract

   BACKGROUND/AIMS Tenofovir alafenamide (TAF) has emerged as a safe and effective alternative to entecavir (ETV) in the management of chronic hepatitis B (CHB). We aimed to evaluate the efficacy and safety of switching to TAF compared with maintaining ETV in patients with CHB who had achieved virologic suppression on ETV.

   METHODS In this multicenter, randomized, open-label, active-controlled, noninferiority clinical trial conducted at 13 Korean centers, 196 CHB patients who had experienced virologic suppression after ≥24 weeks of ETV therapy were randomized 1:1 to switch to TAF (n=95) or continue on ETV (n=101). The primary endpoint was the proportion of patients with hepatitis B virus (HBV) DNA <29 IU/mL at week 48 (per-protocol set). Secondary endpoints included alanine aminotransferase (ALT) normalization, hepatitis B surface antigen and hepatitis B e antigen serologic responses, and safety outcomes.

   RESULTS Among 188 patients in the per-protocol set (89 TAF, 99 ETV), the HBV suppression rate at week 48 was 100.0% in the TAF group and 99.0% in the ETV group (difference, 1.03%; one-sided 97.5% confidence interval, -0.96 to infinity). ALT normalization rates at week 48 were comparable between groups (55.0% in TAF vs 38.7% in ETV; p=0.26; American Association for the Study of Liver Diseases criteria). Hepatitis B e antigen seroconversion rates were also similar at week 48 (0.0% vs 12.5%; p=0.21). Safety profiles, including renal function, did not significantly differ between the two groups.

   CONCLUSIONS Switching from ETV to TAF was noninferior to continuing ETV in maintaining virologic suppression, with comparable biochemical, serologic, and safety outcomes. (ClinicalTrials. gov identifier NCT06000657).

   PubMed IF 4.1 소화기내과
2. 45872026

   제1저자 고영혜, 박찬순 · 교신저자 이희선, 박준빈

   Go YH^*, Park CS^*, Kim B, Kwak S, Rhee TM, Kim HK, Kim YJ, Han K, Lee H^*, Park JB^*

   Mental Disorders After Cardiac Implantable Electronic Device Implantation in Young Individuals.

   J Am Heart Assoc. 2026;15(13):e046715.

   Abstract

   BACKGROUND Increasing use of cardiac implantable electronic devices (CIEDs) has raised concerns about psychological distress in young adults. We evaluated the risk of incident mental disorders after CIED implantation.

   METHODS Using the Korean National Health Insurance database, we identified individuals aged 20 to 39 years who underwent health checkups in 2009 to 2012. Those receiving a new CIED within 4 years were included, and controls were selected by 1:5 matching for age, sex, and index year. The primary outcome was a composite of newly diagnosed mental disorders (mood disorders and anxiety/stress-related/somatoform disorders), and secondary outcomes were the individual components.

   RESULTS There were 569 CIED recipients (209 pacemakers, 360 implantable cardioverter-defibrillators) and 2821 matched controls analyzed. Over a median follow-up of 5.3 years, both the pacemaker and implantable cardioverter-defibrillator implantations were associated with a significantly higher risk of the primary outcome compared with no device (hazard ratio [HR], 1.63 [95% CI, 1.20-2.21] and HR, 1.80 [95% CI, 1.39-2.35], respectively). In head-to-head analyses, the risk of the primary outcome did not differ significantly between implantable cardioverter-defibrillator and pacemaker recipients (adjusted HR, 1.09 [95% CI, 0.75-1.59]). Risks of secondary outcomes were also increased in both device groups. CIED recipients had a 1.95-fold higher risk of mental disorders within 2 years postimplantation (95% CI, 1.45-2.62), and this elevated risk persisted beyond 2 years (HR, 1.54 [95% CI, 1.13-2.11]).

   CONCLUSIONS Among young individuals, both pacemaker and implantable cardioverter-defibrillator implantations were associated with increased risks of mental disorders, supporting proactive psychological screening and interventions.

   PubMed IF 6 순환기내과
3. 45862026

   제1저자 문홍란 · 교신저자 류현진, 오윤규

   Moon H, Kim YC, Park HC, Kim TM, Cho SY, Oh KH, Ahn C, Ryu H, Oh YK

   Association between nephrolithiasis and kidney disease progression in patients with autosomal dominant polycystic kidney disease: a prospective cohort study.

   Clin Kidney J. 2026;19(7):sfag195.

   Abstract

   BACKGROUND Nephrolithiasis is a common complication in autosomal dominant polycystic kidney disease (ADPKD), yet its impact on long-term kidney outcomes remains uncertain. Although experimental and retrospective studies suggest a potential role of kidney stones in accelerating disease progression, prospective evidence based on imaging-confirmed nephrolithiasis is limited.

   METHODS This prospective cohort study included 410 patients with ADPKD from the HOPE-PKD cohort who underwent baseline abdominal computed tomography (CT) within 1 year of enrollment. Nephrolithiasis was defined as radiopaque lesions located within the collecting system, whereas cyst wall calcifications were excluded based on established CT criteria. The primary outcome was initiation of renal replacement therapy (RRT) due to kidney failure. The secondary outcome was a composite of ≥50% decline in estimated glomerular filtration rate, doubling of serum creatinine, or initiation of RRT. Multivariable Cox proportional hazards models were constructed with adjustment for demographic, metabolic, genetic, and imaging-based risk factors, including imaging-based risk stratification.

   RESULTS During a median follow-up of 5.18 years, 51 (12.4%) and 96 (23.4%) participants reached the primary and secondary endpoints, respectively. After adjustment for demographic, metabolic, and disease severity factors, the stone group showed a significantly higher risk of both the primary [Hazard ratio (HR) 2.84; 95% Confidence interval (CI) 1.26-6.38; P = .012] and secondary (HR 1.83; 95% CI 1.03-3.27; P = .041) endpoints compared with the no-stone group. Associations appear to be more pronounced in males, individuals with higher body mass index, worse baseline kidney function, larger kidney volume, and PKD1 genotype.

   CONCLUSIONS Imaging-confirmed nephrolithiasis is independently associated with adverse kidney outcomes in patients with ADPKD. Early detection and targeted management of kidney stones may improve risk stratification and kidney prognosis in this population.

   PubMed IF 5.3 신장내과
4. 45852026

   제1저자 김연욱 · 교신저자 김연욱

   Kim YW, Park EJ, Kwak KI, Yoon TH, Kang HR, Joo DH, Lee YJ, Park JS, Lee JH, Lee CT

   Electronic cigarette use after smoking cessation and lung cancer risk.

   Nat Med. 2026;32(7):2410-2419.

   Abstract

   Electronic cigarettes (e-cigarettes) have gained popularity as a less harmful alternative to conventional cigarettes, yet their associations with lung cancer risk after smoking cessation remain uncertain. Here we evaluated 4,524,895 adults with a conventional smoking history who participated in the Korean National Health Screening Program in 2018 (baseline), with prior records from 2012-2014. Participants were classified as current smokers, short-term quitters or long-term quitters, and followed up to December 2023. Daily e-cigarette use at baseline was used to define post-cessation e-cigarette use. Lung cancer incidence and lung cancer-specific death (LCSD) were assessed using multivariable Cox models. Over 24,182,543 person-years, 35,887 lung cancers and 12,807 LCSD events occurred. Compared with complete quitters, e-cigarette use after smoking cessation was associated with higher risks of lung cancer incidence (adjusted hazard ratio (aHR) 1.56, 95% confidence interval (CI) 1.24-1.97) and LCSD (aHR 2.00, 95% CI 1.28-3.15). Associations were directionally consistent in short-term and long-term quitters and were prominent in the high-risk subgroup (incidence: aHR 1.91, 95% CI 1.44-2.53; LCSD: aHR 1.92, 95% CI 1.13-3.24). Although causality cannot be established, these findings suggest that e-cigarette use after smoking cessation may attenuate the benefits of complete cessation for lung cancer prevention.

   PubMed IF 52.5 호흡기내과
5. 45842026

   제1저자 김연욱 · 교신저자 김연욱

   Kim YW, Yoon TH, Kwak KI, Han M, Park EJ, Lee CT

   Screening Eligibility and Survival Among Patients With Lung Cancer in Korea.

   JAMA Netw Open. 2026;9(7):e2624143.

   Abstract

   IMPORTANCE Lung cancer screening has demonstrated survival benefits among heavy smokers, forming the basis of current age- and smoking intensity-based eligibility criteria. However, applicability of these criteria in Asia remains uncertain, where many cases occur outside current criteria, including among persons with no smoking history.

   OBJECTIVE To evaluate the proportions, characteristics, and survival outcomes of Korean patients with lung cancer according to international screening eligibility.

   DESIGN, SETTING, AND PARTICIPANTS This nationwide, population-based cohort study included individuals newly diagnosed with lung cancer in Korea between 2013 and 2018, prior to implementation of the national lung cancer screening program. Participants were followed up until December 31, 2021. Patients were classified as meeting the 2023 American Cancer Society screening eligibility criteria (aged 50-80 years with a smoking history of ≥20 pack-years [PY]) were compared with individuals with less than 20 PY, and persons with no smoking history within the same age range. Data were analyzed from August to December 2025.

   EXPOSURES Age and smoking intensity in PY.

   MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality. Lung cancer-specific mortality was evaluated as a secondary outcome.

   RESULTS Of 89 860 patients with lung cancer (mean [SD] age at diagnosis 67.8 [10.2]; 63 003 [70.1%] male), 31 804 (35.4%) met screening eligibility criteria, 39 627 (44.1%) had no smoking history, and 4232 (4.7%) were aged younger than 50 years. Among individuals aged 50 to 80 years, screening eligibility differed markedly by sex, with 31 277 men (56.8%) and 527 women (2.3%) meeting the screening criteria. Distant metastatic disease was present in 13 023 patients (40.9%) in the screening-eligible group, 5233 patients (41.1%) with less than 20 PY, and 12 192 patients (36.9%) with no smoking history. Compared with the screening-eligible group, risks of both all-cause and lung cancer-specific mortality were significantly lower among individuals with less than 20 PY of smoking (all-cause mortality: adjusted hazard ratio [aHR], 0.95; 95% CI, 0.93-0.98; lung cancer-specific mortality: adjusted subdistribution HR [aSHR], 0.96; 95% CI, 0.93-0.99) and individuals with no smoking history (all-cause mortality: aHR, 0.86; 95% CI, 0.84-0.88; lung cancer-specific mortality: aSHR, 0.86; 95% CI, 0.84-0.88) aged 50 to 80 years.

   CONCLUSIONS AND RELEVANCE In this cohort study of Korean patients with lung cancer, international screening guidelines excluded 64.6% of patients, a substantial proportion of whom had no smoking history. Ineligible patients had lower mortality risk than screening-eligible patients. These findings suggest that population-specific strategies are needed to improve early detection among individuals not captured by current screening criteria.

   PubMed IF 11.7 호흡기내과
6. 45832026

   제1저자 이윤석, 백우현 · 교신저자 황진혁, 우상명

   Lee YS, Paik WH, Jung MK, Chun JW, Choi YH, Park JK, Paik KH, Lee IS, Woo SM, Hwang JH

   Morphologic Features and Clinical Outcomes of Acinar Cell Carcinoma of the Pancreas: A Multicenter Retrospective Study of 37 Patients in South Korea.

   Curr Oncol. 2026;33(6):curroncol33060367.

   Abstract

   Background: The clinical characteristics of pancreatic acinar cell carcinoma (ACC) remain poorly defined due to its rarity. This study aimed to evaluate the morphological features and clinical outcomes of pancreatic ACC. Method: This multicenter retrospective study analyzed clinical data from seven referral hospitals. Electronic medical records were comprehensively reviewed to extract patient data. Survival outcomes were calculated from the date of pathologic confirmation of ACC. Results: Of the 37 patients, 28 (75.7%) were male. The age distribution at diagnosis ranged widely from 12 to 86 years, with a median of 62.0 years; seven patients (18.9%) were aged under 50 years. Morphologically, 24 patients (64.9%) presented with solid masses, whereas four had cystic masses and four exhibited mixed solid and cystic components. Regarding tumor resectability, 19 patients (51.4%) had resectable disease, 7 (18.9%) were locally advanced, and 11 (29.7%) were metastatic. In terms of treatment, 22 patients (59.4%) underwent surgical resection, 12 (32.4%) received palliative chemotherapy, and the remainder received best supportive care. In the surgical resection group, the median OS was not reached, demonstrating significantly prolonged survival (mean OS, 7.6 years; 5-year OS rate, 51%). In contrast, the median OS was 0.9 years in the palliative chemotherapy group and 0.1 years in the best supportive care group (p = 0.040). Conclusions: Pancreatic ACC showed a broad age distribution, with approximately 20% of patients aged <50 years, and pleomorphic morphological features, including solid, cystic, and mixed patterns. Patients who underwent surgical resection demonstrated favorable long-term survival outcomes compared to historical data for pancreatic ductal adenocarcinoma.

   PubMed IF 3.6 소화기내과
7. 45822026

   제1저자 이소령, 고영혜 · 교신저자 최의근

   Lee SR, Go YH, Choi EK, Rha HW, Jeong MH, Choi J, Lee KY, Ahn HJ, Kwon S, Kim B, Jang MJ, Han KD, Oh S, Lip GYH

   Switching from warfarin to direct oral anticoagulants in frail elderly Asian patients with atrial fibrillation: a Korean nationwide study.

   Eur Heart J. 2026;47(23):2937-2947.

   Abstract

   BACKGROUND AND AIMS A recent European trial found that in frail elderly patients with atrial fibrillation (AF), switching from well-managed warfarin to direct oral anticoagulants (DOACs) was associated with higher bleeding risk. This study aimed to evaluate the safety and effectiveness of switching from warfarin to DOACs in frail elderly Asian AF patients.

   METHODS The Korean national claims database was used to identify AF patients aged ≥75 years who were prescribed warfarin between January 2013 and August 2015, had Hospital Frailty Risk Score ≥ 5, and experienced no major bleeding or thromboembolic events during this period. To evaluate the effect of switching from warfarin to a DOAC, a time-varying approach based on anticoagulant exposure was applied. The primary outcome was major bleeding. Secondary outcomes included thromboembolic events, net clinical outcome (NCO; composite of major bleeding and thromboembolic events), and all-cause death.

   RESULTS Among 12 461 patients, 9112 patients remained on warfarin, whereas 3349 switched to DOACs at least once. During a total follow-up of 11 842 person-years, DOAC treatment was associated with higher risks of major bleeding (hazard ratio 1.36, 95% confidence interval 1.01-1.81), thromboembolic events (1.61, 1.30-2.00), NCO (1.58, 1.29-1.94), and all-cause death (1.20, 1.02-1.42). In various subgroup analyses, DOAC treatment tended to show higher risks of all outcomes compared with warfarin treatment.

   CONCLUSIONS In frail elderly Asian AF patients stably maintained on warfarin, switching to DOACs was associated with higher risks of adverse clinical events, suggesting the need for careful consideration before routine switching.

   PubMed IF 45.3 순환기내과
8. 45812026

   제1저자 조혜진, 김아영, 노현수 · 교신저자 김원, 한창엽

   Jo HJ, Kim A, Rho H, Park AK, Kim GH, Jo SJ, Yuxin H, Hong YJ, Yeon JM, Yu HC, Song MY, Park J, Jeong YH, Hong SE, Yeon HJ, Oh DY, Scherer PE, Choi CS, Lee DH, Ki SH, Kang KW, Choi M, Park BH, Bae EJ, Kim SG, Kim W, Han CY

   Iron overload in steatotic hepatocytes drives systemic metabolic dysfunction via alterations in hepatokine production.

   J Clin Invest. 2026;136(12):196374.

   Abstract

   Iron overload has emerged as a significant risk factor for metabolic dysfunction-associated steatotic liver disease (MASLD), a growing global health concern. Despite this association, the precise mechanisms by which hepatic iron and its regulatory genes connect liver pathology to systemic metabolic dysfunction remain elusive. Here, we demonstrate that humoral signals originating from iron-overloaded hepatocytes acted as critical mediators driving systemic metabolic dysfunction in MASLD. Ferroportin (FPN, SLC40A1), the sole cellular iron exporter, exhibited markedly reduced expression in hepatocytes of both patients with MASLD and mouse models of the disease, concomitant with hepatic iron accumulation. Functionally, hepatocyte-specific FPN deletion significantly exacerbated diet-induced obesity and insulin resistance, with these metabolic perturbations accompanied by decreased energy expenditure and impaired thermogenic capacity. Mechanistically, we establish that hepatic iron accumulation resulting from FPN deficiency enhanced the production of 2 specific hepatokines, fetuin-A and LECT2, through activation of the transcription factor FoxO1. Notably, therapeutic interventions - including genetic silencing of these hepatokines, hepatocyte-specific FPN overexpression, or oral iron chelation - effectively reversed the metabolic dysfunction phenotypes. These findings provide critical insights into the pathophysiological mechanisms linking MASLD to systemic metabolic disorders and highlight promising therapeutic strategies to combat these diseases.

   PubMed IF 14.3 소화기내과
9. 45802026

   제1저자 박찬순, 류강표 · 교신저자 고영일, 박준빈

   Park CS, Ryu G, Ahn HJ, Sun C, Lee SP, Kim HK, Kim YJ, Jeon SY, Lee HB, Moon HG, Han W, Lee DW, Lee KH, Han SW, Im SA, Lee SE, Jaiswal S, Koh Y, Park JB

   Clonal Hematopoiesis and Risk of Trastuzumab-Related Cardiotoxic Effects.

   JAMA Oncol. 2026;12(6):572-580.

   Abstract

   IMPORTANCE Clonal hematopoiesis of indeterminate potential (CHIP) is linked to an increased incidence of cardiovascular and malignant diseases.

   OBJECTIVE To determine whether CHIP is associated with cardiotoxic effects in patients with breast cancer receiving trastuzumab.

   DESIGN, SETTING, AND PARTICIPANTS Analyses of human cohorts with complementary animal experimentation were performed using a nationwide population-based cohort (UK Biobank), 1 tertiary referral center (Seoul National University Hospital [SNUH]), and a controlled laboratory setting. UK Biobank participants were enrolled between 2006 and 2010, and SNUH patients were enrolled from January 2004 to March 2024. Data were analyzed from March 2021 to February 2026.

   MAIN OUTCOME MEASURES Incident heart failure (HF) in the UK Biobank cohort and trastuzumab-related cardiotoxic effects in the SNUH cohort were the main outcome measures. Trastuzumab-related cardiotoxic effects were defined using established clinical criteria (European Society of Cardiology [ESC], Canadian Trastuzumab Working Group, and Cardiac Review and Evaluation Committee [CREC]). Fine-Gray competing risk models were used to account for death and myocardial infarction; multivariable models were adjusted for age and cardiovascular risk factors in both cohorts, with additional adjustment for anthracycline use in the SNUH cohort. Changes in left ventricular ejection fraction (LVEF) were assessed in Tet2-deficient bone marrow chimeric mice following trastuzumab exposure.

   RESULTS Overall, 15 729 patients with breast cancer from the UK Biobank cohort (mean [SD] age, 58.8 [7.3] years; 107 [0.68%] male) and 454 female patients with breast cancer who received trastuzumab from the SNUH cohort (mean [SD] age, 52.0 [9.6] years) were included. The corresponding 2-year cumulative incidence values for trastuzumab-related cardiotoxic effects were 15.7% vs 5.0% by ESC criteria (Gray test P = .001), 19.9% vs 10.8% by Canadian criteria (P = .01), and 20.9% vs 11.3% by CREC criteria (P = .02). Using the ESC definition, CHIP positivity (variant allele frequency ≥1.0%) was associated with cardiotoxic effects in multivariable competing risk analysis (adjusted subdistribution hazard ratio, 1.91; 95% CI, 1.32-2.76). Tet2-deficient mice demonstrated a significant LVEF reduction following trastuzumab treatment (effect size, -4.2%; 95% CI, -7.91 to -0.49; P = .03); other experimental groups showed no significant change.

   CONCLUSIONS AND RELEVANCE In this cohort study, the presence of CHIP was associated with increased susceptibility to trastuzumab-related cardiotoxic effects.

   PubMed IF 23.9 순환기내과
10. 45792026

    제1저자 박제연, 이동호 · 교신저자 유수종

    Park J, Lee DH, Ko Y, Shin H, Hur MH, Lee YB, Cho EJ, Lee JH, Kim YJ, Yoon JH, Yu SJ

    Adverse Event Monitoring with Imaging: Prognostic Significance in Atezolizumab plus Bevacizumab Therapy for Unresectable Hepatocellular Carcinoma.

    Liver Cancer. 2026;15(3):439-454.

    Abstract

    INTRODUCTION Immune checkpoint inhibitors (ICIs) have emerged as the first-line systemic therapy for unresectable hepatocellular carcinoma (HCC). Emerging evidence suggests that immune-related adverse events (irAEs) may be associated with improved ICI efficacy. This study evaluated the impact of adverse events during atezolizumab plus bevacizumab therapy on clinical outcomes in patients with unresectable HCC.

    METHODS This retrospective study included consecutive patients receiving first-line atezolizumab plus bevacizumab for unresectable HCC. IrAEs and bevacizumab-related adverse events were assessed using the National Cancer Institute's Common Terminology Criteria for Adverse Events (version 5.0). Imaging studies conducted during treatment were reviewed to identify asymptomatic, imaging-detected adverse events. Overall survival (OS) was the primary endpoint and was analyzed using time-dependent Cox regression. The secondary endpoint was the disease control rate (DCR).

    RESULTS Among the 198 enrolled patients, 12 had imaging-detected irAEs without symptoms (asymptomatic AE group), whereas 56 experienced clinical symptoms of irAEs (n = 28), bevacizumab-related adverse events (n = 19) or both (n = 9) (symptomatic AE group). The OS rates at 6, 12, 18, and 24 months were 100.0%, 82.5%, 82.5%, and 82.5%, respectively, in the asymptomatic AE group; 89.1%, 64.1%, 41.7%, and 40.5%, respectively, in the symptomatic AE group; and 72.3%, 48.3%, 31.3%, and 19.4%, respectively, for the non-AE group. Compared with the non-AE group, both the asymptomatic and symptomatic AE groups showed significantly improved OS in the inverse probability of treatment weighting-adjusted time-dependent Cox regression analysis (p = 0.02). The DCR was significantly greater in the asymptomatic AE group (100.0%) and the symptomatic AE group (91.8%) than in the non-AE group (60.0%) (p < 0.001).

    CONCLUSION Adverse events during atezolizumab plus bevacizumab therapy are associated with improved OS and treatment response in unresectable HCC patients. Asymptomatic imaging-detected irAEs may serve as prognostic factors, highlighting the value of proactive imaging in patient management.

    PubMed IF 10.5 소화기내과
11. 45782026

    제1저자 이찬미, 정지원 · 교신저자 구남수, 안정훈, 송경호

    Lee CM, Jung J, Lee E, Lee S, Cho SY, Choe PG, Lee R, Kim YK, Choi HJ, Kim JH, Kim CJ, Kwak YG, Park KH, Kim YS, Cheon S, Park SY, Kim HB, Ku NS, Ahn J, Song KH, Korea INfectious Diseases (KIND) Study Group

    Disease burden of carbapenem-resistant Enterobacterales infections in Korea.

    J Hosp Infect. 2026;172:89-96.

    Abstract

    BACKGROUND Carbapenem-resistant Enterobacterales (CRE) poses a significant public health threat. In Korea, the current surveillance systems do not distinguish between colonisation and infection. This study evaluated the clinical and socioeconomic burden of CRE infections in Korea.

    METHODS This retrospective study was conducted at 15 medical institutions. All patients with CRE-positive clinical specimens in 2022 were classified as either 'CRE-infected' or 'colonised'. Clinical data and medical costs were collected for the 'CRE-infected' cohort. A predictive logistic regression model based on sex, age, presence of bacteraemia, and bacterial species was developed to estimate the nationwide incidence of CRE infections. For cases of CRE bacteraemia, the clinical information of the matched control groups (no-infection, 3rd-generation-cephalosporin [3GC]-susceptible infection, and 3GC-resistant infection) was collected.

    FINDINGS Among the 4848 reported CRE cases, 1087 (22.4%) were classified as infections, including 586 bacteraemia cases. The most common infection sites were intra-abdominal (34.0%) and pulmonary (31.3%). Carbapenemase-producing Enterobacterales accounted for 74.2% of cases, with Klebsiella pneumoniae carbapenemase (84.4%) being the most prevalent. The 30-day and 90-day mortality rates were 29.3% and 40.8%, respectively. The predictive model estimated 7117 CRE infections nationwide, including 1897 cases of bacteraemia. The economic burden of CRE infections in 2022 was estimated to be $517,738,296, with excess costs ranging from $108,382,302 to $401,186,712, compared with carbapenem-susceptible infections and cases without infection.

    CONCLUSIONS This study highlights the substantial clinical and socioeconomic burden of CRE infections in Korea. Given the continued increase in reported CRE cases even after 2022, urgent measures are required to address this growing public health challenge.

    PubMed IF 3.4 감염내과
12. 45772026

    제1저자 차승아 · 교신저자 신동엽

    Cha S, Shin DY, Hong J, Koh Y, Byun JM, Kim I, Yoon SS

    Role of salvage allogeneic transplantation for relapsed or refractory AML in nonremission: insights from real-world practice.

    Cytotherapy. 2026;28(6):102067.

    Abstract

    BACKGROUND Relapsed and refractory (R/R) acute myeloid leukemia (AML) represents a significant therapeutic challenge, with limited treatment options and poor survival outcomes. While salvage allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only curative strategy with potential efficacy for these patients, its application in patients who fail to achieve complete remission (CR) before transplantation remains controversial due to historically poor survival rates. To date, there is no consensus on how to optimize transplantation strategies for this high-risk cohort, necessitating urgent real-world evidence to guide clinical practice.

    OBJECTIVES This study seeks to evaluate the feasibility, efficacy, and prognostic factors associated with salvage allo-HSCT in R/R AML patients in non-CR status, providing valuable insights into its role as a potential therapeutic strategy when other options are exhausted.

    METHODS This retrospective study analyzed 120 R/R AML patients who underwent allo-HSCT in non-CR status at Seoul National University Hospital between 2005 and 2024. Overall survival (OS) was estimated using the Kaplan-Meier method, while relapse and nonrelapse mortality (NRM) were assessed within a competing-risks framework. Prognostic factors were analyzed using univariate and multivariate Cox regression models.

    RESULTS The median OS was 5.2 months, with a 3-year OS probability of 23%. At three years, the cumulative incidence of relapse was 45.7%, while NRM reached 51.1%. In multivariable analysis, several variables retained independent associations with poorer survival, including age ≥ 50 years (HR 2.90, 95% CI 1.59-5.29; P = 0.001), adverse cytogenetics (HR 2.39, 95% CI 1.46-3.91; P = 0.001), and a bone marrow blast count ≥ 20% at the time of transplantation (HR 1.86, 95% CI 1.15-3.02; P = 0.012). Among post-transplant complications, severe acute graft-versus host disease (GVHD) was associated with markedly inferior survival, whereas chronic GVHD did not significantly affect OS.

    CONCLUSIONS Salvage allo-HSCT in non-CR shows substantial variability in outcomes, highlighting the importance of careful patient and donor selection, particularly regarding age, cytogenetic risk, disease burden, and donor type. Severe acute GVHD was clearly associated with markedly worse survival. These findings highlight the need for individualized donor choice and early control of acute GVHD to improve outcomes in this high-risk group.

    PubMed IF 4.5 혈액종양내과
13. 45762026

    제1저자 유가인, 이소령 · 교신저자 조민수, 김태훈

    Yu GI, Lee SR, Kim TH, Cho MS, Kim D, Yu HT, Lee JM, Uhm JS, Choi EK, Kim J, Joung B, Pak HN, Lee MH

    Feasibility and Safety on Left Bundle Branch Area Pacing With Standard Stylet-Driven Lead: ACHIEVE-SYNC Multicenter Prospective Observational Cohort Study.

    J Arrhythm. 2026;42(3):e70345.

    Abstract

    BACKGROUND Right ventricular pacing increases the risk of dyssynchrony, which raises the need for more physiological pacing strategies. Left bundle branch area pacing (LBBAP) has emerged, with most early studies utilizing lumen-less pacing leads. The feasibility and safety of LBBAP using conventional stylet-driven pacing lead (SDL) have been reported. We present prospective multicenter data, particularly in Asian clinical settings.

    METHODS The ACHIEVE-SYNC pilot study was a multicenter prospective observational cohort study conducted across several tertiary hospitals in South Korea. Patients with standard indications for pacemaker implantation underwent LBBAP using a 5.6Fr SDL with an extendable screw. Procedural success rate and LBBAP-related complications were evaluated. Pacing parameters, electrocardiographic features, and echocardiographic outcomes were assessed up to 12 months after implantation.

    RESULTS LBBAP using SDL was successful in 100 of 101 (99.0%) patients. LBBAP lead-related adverse event occurred in 1 case (0.99%), which was lead dislodgement. The median pacing threshold at 12-month follow-up was 0.8 [0.7-1.0] V at 0.5 ms. At 12-month follow-up, the mean QRS duration changed from 119.2 ± 28.6 ms to 131.2 ± 23.8 ms. The mean left ventricular ejection fraction was 61.3% ± 8.5% before the procedure and 61.3% ± 7.5% at 12-month follow-up.

    CONCLUSIONS In this prospective multicenter registry, LBBAP using SDL demonstrated a near-complete procedural success rate and a high incidence of confirmed Left bundle branch capture. Lead performance remained stable during long-term follow-up, and adverse events were rare, supporting the safety and technical feasibility of this approach in routine clinical practice.

    PubMed IF 1.9 순환기내과
14. 45752026

    제1저자 김이애, 장희준, 김문영 · 교신저자 박수영, 김상균, 김원

    Kim GA, Jang H, Kim MY, Park JH, Park JG, Cho EY, Jeong JY, Jeong S, Han SK, Kwon H, Jung Y, Hwang GS, Lee YR, Park SY, Kim SG, Kim W

    Multicenter Prospective Cohort Study on Clinical Outcomes and Fibrosis Patterns in Biopsy-Proven Steatotic Liver Disease Subtypes.

    Gastroenterology. 2026;170(7):1571-1583.

    Abstract

    BACKGROUND & AIMS Clinical outcomes and histologic characteristics of biopsy-proven steatotic liver disease (SLD) subtypes remain understudied. We investigated clinical outcomes and fibrosis patterns in metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-related liver disease (MetALD), and alcohol-associated liver disease (ALD).

    METHODS This multicenter prospective cohort study enrolled 2551 individuals with biopsy-proven SLD or non-SLD controls between 2010 and 2023. Risks of all-cause mortality, liver-related events (LREs), cardiovascular disease, and extrahepatic malignancies were assessed using Fine-Gray models. Artificial intelligence (AI)-based quantitative fibrosis analysis using second harmonic generation imaging was performed on 88 liver biopsies (28 MASLD, 30 MetALD, and 30 ALD) to assess zone-specific collagen distribution patterns.

    RESULTS During a median follow-up of 43.8 months, 166 deaths and 162 LREs occurred. Compared with non-SLD, MetALD (adjusted subdistribution hazard ratio [ASHR], 3.05; 95% confidence interval [CI], 1.08-8.58) and ALD (ASHR, 5.80; 95% CI, 2.26-14.87) demonstrated substantially increased all-cause mortality risk. MetALD (ASHR, 6.13; 95% CI, 1.33-28.20) and ALD (ASHR, 10.96; 95% CI, 2.55-47.14) also exhibited elevated LRE risk. In the advanced fibrosis (≥F3) subgroup, ALD demonstrated higher mortality and LRE risks than MASLD. AI-based analysis revealed that MetALD and ALD exhibited significantly higher collagen density in periportal and zone 2 regions compared with MASLD, despite comparable conventional fibrosis stages.

    CONCLUSIONS MetALD and ALD are independently associated with substantially increased all-cause mortality and LRE risks compared with non-SLD. Distinct zone-specific collagen patterns identified by AI analysis suggest unique fibrotic progression pathways in MetALD and ALD, supporting the need for tailored risk stratification and targeted management strategies.

    PubMed IF 29.7 소화기내과
15. 45742026

    제1저자 김예진, 최용훈 · 교신저자 김나영

    Kim Y, Choi Y, Kim N, Jeon EB, Kong SH, Lee JH, Lee HK, Jun YK, Yoon H, Shin CM, Park YS, Lee DH, Ahn S

    Preventive Effect of Helicobacter pylori Eradication on Osteoporosis in Females: A 20-Year Prospective Observational Cohort Study.

    Gut Liver. 2026;20(3):385-396.

    Abstract

    BACKGROUND/AIMS The relationship between Helicobacter pylori (HP) eradication and osteoporosis development remains inadequately elucidated. This study aimed to ascertain whether HP eradication therapy confers protective effects against osteoporosis progression.

    METHODS Subjects without osteoporosis who underwent esophagogastroduodenoscopy with concurrent HP testing were prospectively recruited between May 2003 and February 2023 at Seoul National University Bundang Hospital. Participants were stratified into two cohorts: those with successful HP eradication and those without. Osteoporosis was diagnosed using dual-energy X-ray absorptiometry, and the risk of osteoporosis was assessed using Cox proportional hazards regression analysis.

    RESULTS The successfully eradicated cohort comprised 730 individuals (mean age, 56.4 years; 67.5% female), compared with 116 individuals (mean age, 56.2 years; 74.1% female) in the non-eradicated cohort. Osteoporosis occurred in 179 subjects (24.5%) in the eradicated group and in 40 subjects (34.5%) in the non-eradicated group. Significant risk factors for osteoporosis included female sex (hazard ratio [HR], 3.12; 95% confidence interval [CI], 1.93 to 5.05; p<0.001), advanced age (HR, 1.08; 95% CI, 1.06 to 1.10 per year; p<0.001), and persistent HP infection (HR, 1.60; 95% CI, 1.13 to 2.28; p=0.009). In subgroup analyses according to sex and age, HP eradication demonstrated a significant reduction in osteoporosis risk in females (p=0.005) than in males, especially among females aged ≥50 years (p=0.003). However, this change was not pronounced in males.

    CONCLUSIONS HP eradication may serve as a preventive intervention against osteoporosis development, particularly among female subjects (ClinicalTrials.gov: NCT06818591).

    PubMed IF 4.1 소화기내과
16. 45732026

    제1저자 김소연 · 교신저자 조재영

    Kim SY, Sim YJ, Cho J

    Obstructive sleep apnea and venous thromboembolism risk: a nationwide population-based study.

    Sleep. 2026;49(5):8305739.

    Abstract

    STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a risk factor for cardiovascular disease and prothrombotic conditions. However, OSA's relationship with venous thromboembolism (VTE) remains unclear, as previous works have made only limited adjustments for potential confounders. This study aims to evaluate the incidence and risk of VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT), in OSA patients.

    METHODS In this nationwide, population-based cohort study using Korea's National Health Insurance Database, adults newly diagnosed with OSA were matched up to 1:5 with individuals without sleep apnea using propensity scores. Matching variables included age, sex, income, smoking history, body mass index, physical activity, and key comorbidities. The primary outcome was the incidence of VTE. Cox proportional hazard regression models were used to estimate the hazard ratios (HRs) for VTE.

    RESULTS During a follow-up period of 7.5 ± 2.0 years (mean ± SD), 2214 incident VTE were identified among 133 245 patients with OSA, corresponding to an incidence rate of 287.5 per 100 000 person-years. This rate was higher than the incidence rate of 205.0 per 100 000 person-years observed in 629 994 matched controls. OSA was associated with a higher risk of VTE (HR, 1.68; 95% CI = 1.60% to 1.75%), including PE (HR, 1.82; 95% CI = 1.71% to 1.93%) and DVT (HR, 1.54; 95% CI = 1.44% to 1.65%). The study's findings remained consistent in subgroup analyses across sociodemographic and comorbid factors and in sensitivity analyses excluding individuals with a history of cancer.

    CONCLUSIONS OSA is independently associated with an increased risk of VTE, including both PE and DVT. Statement of Significance Evidence regarding the association between obstructive sleep apnea (OSA) and venous thromboembolism (VTE) is limited, as previous studies have only partially adjusted for potential confounders. This population-based cohort study identified a higher incidence of VTE among individuals with OSA compared to controls, who were propensity score-matched based on various sociodemographic and comorbid factors. The study's findings remained consistent in subgroup analyses across sociodemographic and comorbid factors, as well as in sensitivity analyses excluding individuals with a history of cancer.

    PubMed IF 7 호흡기내과
17. 45722026

    제1저자 박정우 · 교신저자 최무림, 김원, 강건욱

    Park J, Kim T, Shim WS, Hong SE, Park M, Oh S, Koo BK, Lee DH, Joo SK, Yoo T, Lee YJ, Lim SC, Seo SY, Kim KM, Nieto N, Choi M, Kim W, Kang KW

    ADAMTS4 elicits myeloid-derived immune cell recruitment and liver fibrogenesis in metabolic dysfunction-associated steatotic liver disease.

    Signal Transduct Target Ther. 2026;11(1):10.1038/s41392-026-02679-4.

    Abstract

    A disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS4) has been implicated in arthritis and lung fibroblast activation; however, its role in liver homeostasis and fibrogenesis remains largely unexplored. Here, we investigated the functional significance of ADAMTS4 in liver fibrosis. We found that hepatic ADAMTS4 mRNA expression was significantly elevated in patients with fibrotic steatohepatitis. In mouse models of liver fibrosis, genetic deletion of ADAMTS4 protected against liver fibrogenesis, accompanied by a marked reduction in the recruitment of myeloid-derived infiltrating macrophages. Mechanistically, ADAMTS4-mediated cleavage of versican generated versikine, which promoted macrophage migration and differentiation toward a pro-inflammatory phenotype in vitro. In addition, tumor necrosis factor (TNF)α significantly increased both the mRNA expression and protein secretion of ADAMTS4. Furthermore, ADAMTS4 directly induced collagen accumulation through activation of signal transducer and activator of transcription 3 (STAT3) in LX2 cells. To explore the potential genetic regulation of ADAMTS4 expression, we performed response-eQTL analysis in patients with metabolic dysfunction-associated steatotic liver disease and identified a single-nucleotide polymorphism associated with increased ADAMTS4 expression in a subset of patients carrying a specific genotype. Collectively, our findings identify ADAMTS4 as a critical regulatory factor that promotes the recruitment of myeloid-derived infiltrating macrophages and collagen accumulation during liver fibrogenesis, suggesting that targeting ADAMTS4 may represent a potential therapeutic strategy for liver fibrosis.

    PubMed IF 81.2 소화기내과
18. 45712026

    제1저자 임재현 · 교신저자 이승표, 김경희

    Lim J, Lee MS, Suh JH, Kang S, Lee HS, Jang JH, Son JM, Kwon JM, Kim YJ, Kim KH, Lee SP

    Artificial Intelligence-Enabled ECG for Elevated E/e' on Echocardiography: Hemodynamic Relevance and Prognostic Value.

    J Am Heart Assoc. 2026;15(9):e046989.

    Abstract

    BACKGROUND Left ventricular filling pressure is associated with heart failure symptoms and a key prognostic marker and therapeutic target, but a scalable, accessible, and affordable tool for its noninvasive, serial estimation remains lacking. We developed an artificial intelligence (AI) model using a standard 12-lead ECG to detect increased E/e', a general surrogate of elevated left ventricular filling pressure on echocardiography.

    METHODS The AI model was built upon a foundation model trained with >1 million multiethnic ECGs and fine-tuned through a development cohort of 225 737 ECGs and 115 982 echocardiogram records from 92 775 unique patients across 2 tertiary hospitals. The model performance was assessed in a separate internal test set (n=9278) and an independent external cohort from another tertiary hospital (n=17 926). Prognostic significance of the AI-ECG output was evaluated in these hospital cohorts, as well as the UK Biobank (n=43 347). Finally, we validated the model output against invasively measured left ventricular filling pressure through cardiac catheterization (n=60).

    RESULTS The AI-ECG model detected increased E/e' with an area under the curve of 0.868 (95% CI, 0.859-0.877) and 0.850 (95% CI, 0.841-0.858) in the internal and external test cohorts, respectively. The AI-ECG output value demonstrated a strong correlation with invasively measured left ventricular end-diastolic pressure (Pearson's r=0.655) and was significantly associated with incident heart failure and mortality.

    CONCLUSIONS The AI-ECG may enable identification of patients with increased left ventricular filling pressure and provide powerful prognostic information. Further prospective studies are warranted to evaluate its clinical utility.

    PubMed IF 6 순환기내과
19. 45702026

    제1저자 이나영 · 교신저자 김원, 구자현

    Lee NY, Choi MG, Ryu HJ, Min YJ, Kim SM, Chung Y, Koo BK, Kang YP, Kim W, Koo JH

    Liver Stiffness Directs Intrahepatic Cholesterol Accumulation Through YAP/TAZ in Metabolic Dysfunction-Associated Steatotic Liver Disease.

    Adv Sci (Weinh). 2026;13(25):e00379.

    Abstract

    Elevated liver stiffness is closely associated with morbidity and mortality in metabolic dysfunction-associated steatotic liver disease (MASLD). However, the contribution of increased stiffness to impaired liver function is poorly understood. Here, we demonstrate that hepatic cholesterol levels are determined by the stiffness of the liver. In the human MASLD cohort and a mouse model, intrahepatic cholesterol levels strongly correlated with liver stiffness. We show that a stiff matrix promotes spontaneous accumulation of cholesterol in isolated hepatocytes. As the underlying mechanism, we found that Liver X receptor alpha (LXRα) is mechanosensitively repressed. Activation of Yes-associated protein (YAP) and Transcriptional coactivator with PDZ-binding motif (TAZ) by exposure to stiff substrate, serum stimulation, low-density culture, or deletion of Large tumor suppressor kinase 1 and 2 (LATS1/2) robustly repressed LXRα activity. In the nucleus, YAP disrupted heterodimerization of LXRα with Retinoid X receptor alpha (RXRα) independently of their transcriptional activity. Consistently, hepatocyte-specific ablation of Yap/Taz facilitated hepatic cholesterol efflux and delayed cholesterol-induced fibrosis progression in mice. Transcriptomic analysis of MASLD patient livers confirmed a strong inverse correlation between LXRα target gene expression and liver stiffness as well as YAP/TAZ activity. These findings reveal the mechanosensitive regulation of hepatic cholesterol levels in MASLD, suggesting liver stiffness as a causal factor for hepatocyte dysfunction.

    PubMed IF 14.1 소화기내과
20. 45692026

    제1저자 안효정, 오세일 · 교신저자 오세일

    Ahn HJ^*, Paeng JC^*, Kim K, Park CS, Lee SR, Choi EK, Oh S

    Increased Right Atrial FDG Uptake in Persistent Atrial Fibrillation: Insights Across Young vs. Old Age Groups.

    Korean Circ J. 2026;56(5):373-385.

    Abstract

    BACKGROUND AND OBJECTIVES The atrial metabolic profile and underlying pathophysiology of young-onset atrial fibrillation (AF) may differ from those of old-onset AF, but age-related alterations in atrial metabolism remain poorly understood. We explored potential age-related atrial metabolic differences using ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging.

    METHODS We prospectively performed FDG PET with myocardial suppression in 40 young-onset and 40 old-onset AF patients. FDG uptake of the right and left atrium (RA and LA) was assessed visually (grade 0-3) and quantitatively using target-to-background ratio (TBR).

    RESULTS The mean age was 59.3±13.5 (young-onset, 47.0±5.2; old-onset, 71.6±5.5) years, with a median AF duration of 3.6 (0.8-6.8) years. Among 80 patients (41 paroxysmal, 39 persistent AF), the distribution of AF type was similar between age groups (p=0.121). A total of 51 patients (63.7%) showed atrial FDG uptake ≥mild (grade≥1). No significant age-related differences were observed in visual FDG uptake or TBR in either atrial wall or appendage. Current drinking and persistent AF type were independently associated with increased atrial FDG uptake, primarily in the RA. Persistent AF was consistently associated with elevated RA uptake across age groups (adjusted odds ratio, 10.2, 95% confidence interval, 1.9-55.3; p=0.007). Quantitative analysis revealed significantly higher RA-to-LA metabolic ratios in persistent AF, consistent across age groups.

    CONCLUSIONS Atrial FDG uptake patterns did not differ by age in patients with AF. Increased RA FDG uptake in persistent AF was consistently observed, suggesting a shared metabolic alteration underlying AF progression transcending age-related pathological differences.

    PubMed IF 3.4 순환기내과
21. 45682026

    제1저자 오진경, 곽순구 · 교신저자 이승표, 김대희

    Oh JK, Kwak S, Park CS, Sun BJ, Lee S, Park JB, Kim HK, Kim YJ, Song JM, Kang DH, Song JK, Park JH, Cho GY, Lee SP, Kim DH

    Integrated Atrial and Ventricular Strain Assessment in Patients With Severe Degenerative Mitral Regurgitation Undergoing Surgery.

    JACC Cardiovasc Imaging. 2026;19(5):588-599.

    Abstract

    BACKGROUND Current guidelines for degenerative mitral regurgitation (MR) emphasize left ventricular (LV) dysfunction. However, subclinical alterations in left atrial (LA) or LV strain may manifest earlier in severe MR.

    OBJECTIVES This study sought to determine whether combined LA and LV strain measurements improve long-term mortality prediction in severe degenerative MR, especially in asymptomatic individuals.

    METHODS This retrospective derivation cohort included 1,314 patients (mean age: 55 ± 13 years; 35% women) who underwent valve repair or replacement for severe MR. Preoperative peak atrial longitudinal strain (PALS) and LV-global longitudinal strain (GLS) were measured. Patients were categorized into 4 groups by using spline-derived thresholds (PALS: <21.4%; LV-GLS: >-20.5%). The primary outcome was all-cause mortality (median follow-up, 8.4 years). External validation included 605 independent patients.

    RESULTS Impaired PALS (adjusted HR [aHR]: 2.11; P < 0.001) and impaired LV-GLS (aHR: 1.66; P = 0.008) were independently associated with high mortality. The group with both impaired PALS and LV-GLS demonstrated the worst outcome (aHR: 2.50; P < 0.001). In asymptomatic patients (n = 900), the combined use of both strain parameters outperformed traditional LV dysfunction criteria (LV ejection fraction ≤60% or LV end-systolic dimension ≥40 mm), thereby significantly improving net reclassification (net reclassification index = 0.436; P < 0.001) and discrimination (integrated discrimination improvement = 0.024; P = 0.003). Subgroup analyses demonstrated that the prognostic contribution of each strain parameter varied by the functional status of the other chamber. External validation confirmed these associations.

    CONCLUSIONS Concomitant impairment of both PALS and LV-GLS identified patients at the highest mortality risk. These findings support an integrated atrial-ventricular strain assessment to improve prognostic stratification, particularly in asymptomatic patients with severe degenerative MR who are undergoing MV surgery.

    PubMed IF 19 순환기내과
22. 45672026

    제1저자 안효정, 이소령 · 교신저자 최의근

    Ahn HJ, Lee SR, Kwon S, Rhee TM, Lee YS, Han SJ, Kang KW, Shim J, Yu HT, Oh IY, Park HS, Park JK, Jang SW, Lee SH, Roh SY, Chun KJ, Park HW, Lee KY, Oh S, Choi EK, GUARD-OAC Trial Investigators

    Design and rationale of the GUARD-OAC: A randomized controlled trial evaluating proton pump inhibitor cotherapy for gastrointestinal protection in patients requiring direct oral anticoagulants.

    Am Heart J. 2026;295:107341.

    Abstract

    BACKGROUND Direct oral anticoagulants (DOACs) are the cornerstone of thromboembolic prevention in patients with atrial fibrillation, venous thromboembolism, or other cardiovascular conditions. However, DOAC use is associated with an increased risk of bleeding, with gastrointestinal (GI) bleeding being the most common site of major bleeding. Proton pump inhibitors (PPIs) are reasonably used during combined antithrombotic therapy or based on individual bleeding risk; nonetheless, evidence supporting their benefit in patients receiving DOAC therapy remains limited.

    METHODS The Gastrointestinal protection Using proton-pump inhibitor in pAtients who RequireD Oral AntiCoagulants (GUARD-OAC) trial is a prospective, multicenter, open-label, randomized controlled trial evaluating the GI protective effect of PPI coadministration with DOAC. Eligible participants are patients with cardio- or cerebrovascular disease requiring long-term anticoagulation (≥1 year), who are currently receiving or initiating DOAC therapy, and have a HAS-BLED score of ≥1. The primary outcome is a composite of upper GI clinical events, including bleeding, symptomatic gastroduodenal ulcer, persistent pain of presumed GI origin with underlying multiple erosive disease, obstruction, or perforation. The secondary outcomes are the individual components of the primary outcome, GI symptoms or signs, cardiovascular or all bleeding events, and all-cause mortality. Assuming a 40% relative risk reduction of the primary outcome in the PPI plus DOAC group compared to the DOAC alone group, a total of 3,846 patients will be enrolled and followed for one year. A Clinical Events Committee will adjudicate clinical outcomes and adverse events for causality and attribution, and an independent Data Safety Monitoring Board will oversee the study. The GUARD-OAC trial is funded by the Ministry of Health & Welfare, Republic of Korea.

    CONCLUSIONS The GUARD-OAC trial is the first randomized controlled trial exploring the efficacy of PPI cotherapy in patients receiving DOACs, providing evidence that may inform future guidelines on GI protection in this population.

    TRIAL REGISTRATION Clinical Research Information Service, Identifier KCT0006848.

    PubMed IF 3.4 순환기내과
23. 45662026

    제1저자 공성혜, 최새미 · 교신저자 박성배, 김정희

    Kong SH^*, Choi S^*, Cho W, Park SB, Park SS, Choo J, Kim JH, Kim SW, Shin CS

    Enhancing vertebral fracture prediction using multitask deep learning computed tomography imaging of bone and muscle.

    Eur Radiol. 2026;36(5):4177-4186.

    Abstract

    OBJECTIVES To develop and externally validate a computed tomography (CT)-based multitask learning model to predict fracture risk.

    MATERIALS AND METHODS This study was conducted in two parts, using a multitasking learning approach. We developed a cross-sectional vertebral fracture (VF) detection model using abdominal CT scans of 2553 patients aged 50-80 years. Then, we leveraged this detection model within a multitask learning framework to develop a longitudinal VF prediction model over a 5-year follow-up period. External testing was performed on 1506 patients from two independent hospitals. The performance was compared between the single-task and multitask models, bone-only and bone+muscle images, and image-only and clinical models.

    RESULTS For the cross-sectional fracture detection model, the mean age of the patients was 76.2 years, and 66.7% were female. In the classification task for detection of VF, the model using both bone and muscle showed an area under the receiver operating characteristic curve (AUROC) of 0.82 in the development set and 0.80 in the external test sets. Using multitask learning, the bone + muscle image model showed a c-index of 0.68 and had superior performance than the bone-only model in the external test set for 2-year, 3-year, and 5-year AUROCs (0.79 vs. 0.75, 0.71 vs. 0.68, and 0.71 vs. 0.68, respectively, all p < 0.01). Also, the multitask model significantly outperformed the Fracture Risk Assessment Tool (FRAX) (c-index: 0.68 vs. 0.66, p < 0.01).

    CONCLUSION The CT-based multitask learning model integrating both bone and muscle data showed superior predictive performance for VFs compared with models using bone images only and traditional clinical models.

    KEY POINTS Question Vertebral fracture risk remains underestimated in many individuals undergoing CT scans for other reasons, highlighting the need for improved opportunistic prediction tools. Findings A multitask deep learning model integrating both bone and muscle features from CT scans demonstrated superior performance compared to bone-only and traditional clinical models, including FRAX. Clinical relevance The proposed model enables accurate vertebral fracture risk prediction using routinely acquired CT scans, facilitating early identification and intervention without the need for additional tests.

    PubMed IF 6 내분비대사내과
24. 45652026

    제1저자 양민석 · 교신저자 Kelan Tantisira

    Yang M, Srivastava U, Kho A, Tiwari A, Wang A, Piparia S, Weiss ST, McGeachie M, Tantisira K

    MicroRNA clustering in pediatric asthma reveals differential corticosteroid responsiveness.

    Pediatr Allergy Immunol. 2026;37(5):e70374.

    Abstract

    BACKGROUND Asthma is a heterogeneous disease with variable treatment responses. miRNAs play a critical role in asthma pathogenesis and may serve as biomarkers for distinct asthma endotypes. We tried to identify possible molecular asthma clusters based on miRNA expression profiles in pediatric patients from the Childhood Asthma Management Program (CAMP) cohort.

    METHODS We performed miRNA profiling and k-means clustering on 462 CAMP participants. Differential miRNA expression and pathway enrichment analyses were conducted to characterize cluster-associated molecular features. Clinical characteristics and budesonide-related changes in lung function were compared across clusters, including analyses stratified by peripheral blood eosinophil counts.

    RESULTS Three possible molecular clusters were identified, each with distinct miRNA expression patterns and enriched biological pathways. All clusters showed enrichment in IL-4/IL-13 signaling and PIP3/AKT pathways. Cluster 1 was characterized by Toll-like receptor-related signaling pathways, Cluster 2 by FOXO-mediated transcription pathways, and Cluster 3 by pathways associated with SCF-KIT signaling. Baseline demographic and clinical characteristics were largely similar across clusters. However, patterns of budesonide-related lung function change differed. Clusters 1 and 3 showed more favorable lung function profiles after budesonide treatment than Cluster 2. In Cluster 1, eosinophilic participants had a higher proportion of moderate asthma, whereas those without eosinophilia were more often classified as having mild asthma. In Cluster 3, eosinophilic participants had greater baseline airway hyperresponsiveness and lower baseline FEV₁/FVC but showed greater improvement in FEV₁/FVC after budesonide.

    CONCLUSION miRNA profiling identified possible molecular asthma clusters with different clinical, physiologic, and treatment-related patterns.

    PubMed IF 4.5 알레르기내과
25. 45642026

    제1저자 여무한, 이소령 · 교신저자 최의근, 최수연

    Yeo M, Lee SR, Park JH, Hwang SE, Kwon H, Lee H, Rhee TM, Oh B, Kim YS, Choi JK, Shin J, Chun H, Ahn HJ, Kwon S, Oh S, Choi SY, Choi EK

    7-Day Single-Lead Electrocardiogram Monitoring for Atrial Fibrillation Detection in Routine Health Screenings.

    JACC Asia. 2026;6(5):827-829.

    PubMed IF 6.1 순환기내과
26. 45632026

    제1저자 김용성, 박선영, 강승주 · 교신저자 김나영, 박무인

    Kim YS, Park SY, Kang SJ, Lee MW, Choi Y, Kim BY, Choi M, Shin CM, Kim YS, Kim N, Park MI, Gut Microbiota and Therapy Research Group of the Korean Society for Neurogastroenterology and Motility

    Clinical Guidance and Practical Recommendations for Probiotic Use in Patients With Irritable Bowel Syndrome, Functional Constipation, and Clostridioides difficile Infection Considering Sex-based Differences.

    J Neurogastroenterol Motil. 2026;32(2):198-216.

    Abstract

    Probiotics have gained increasing clinical attention as adjunctive treatment for lower gastrointestinal disorders. However, evidence supporting their therapeutic efficacy remains limited, particularly with regard to sex-related differences. This expert review provides evidence-based insights and practical recommendations for the use of probiotics in patients with irritable bowel syndrome (IBS), functional constipation (FC), and Clostridioides difficile infection (CDI), considering possible sex-related differences. Evidence from randomized controlled trials and meta-analyses indicates that probiotics can modestly improve global symptoms, abdominal pain, and bloating in IBS and enhance bowel movement frequency and stool consistency in FC. However, these effects are strain-specific and heterogeneous. Although clinical studies on probiotics in IBS have not confirmed significant sex-related differences, experimental animal studies using stress-induced IBS models have demonstrated sex-dependent responses to specific probiotic strains, supporting the biological plausibility of such differences. For CDI, the efficacy of probiotics in preventing primary or recurrent infections remains inconsistent across large trials, and current guidelines usually do not recommend their routine use. However, sex and age difference of immunology supports the clinical differences of CDI. Probiotics are generally considered safe for healthy individuals, although caution is advised in patients who are immunocompromised or critically ill. Clinicians should select probiotic products based on strain-specific clinical evidence, adequate viable doses, patient's characteristics, or patient's sex. In conclusion, probiotics might play a role as adjunctive therapy for IBS and FC, with variability in responses influenced by microbial, host, and potential sex-related factors. Further research is needed to establish optimized personalized probiotic strategies.

    PubMed IF 3.7 소화기내과
27. 45622026

    제1저자 한정규, 한경도 · 교신저자 한정규

    Han JK, Han K, Ki YJ, Song JE, Hwang D, Kang J, Yang HM, Park KW, Kang HJ, Koo BK, Kim HS

    Aerobic exercise and cardiovascular outcomes in patients with diabetes undergoing percutaneous coronary intervention: a nationwide population-based study.

    Eur J Prev Cardiol. 2026;33(6):869-880.

    Abstract

    AIMS We investigated the impact of aerobic exercise on clinical outcomes in patients with diabetes undergoing percutaneous coronary intervention (PCI).

    METHODS AND RESULTS We analyzed a nationwide prospective population database from the Korean National Health Insurance System. We included 8225 patients with diabetes who had undergone PCI and documented their aerobic exercise habits before and after the procedure (mean interval: 2.0 years). The patients were categorized into four groups: persistent non-exercisers, new exercisers, exercise discontinuers, and exercise maintainers. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction, revascularization, and heart failure. We assessed the risk of clinical events using inverse probability-weighted Cox proportional hazards models. During a mean follow-up of 4.9 years, exercise maintainers, discontinuers, and new exercisers were associated with a significantly lower risk of MACE compared to non-exercisers. The lowest risk was observed in exercise maintainers (maintainers: aHR, 0.78; 95% CI: 0.71-0.86; discontinuers: aHR, 0.88; 95% CI: 0.79-0.98; new exercisers: aHR, 0.89; 95% CI: 0.80-1.00). A J-curve relationship between the amount of aerobic exercise and adverse clinical outcomes was observed, with the lowest risk identified at 1000-1499 MET-min/week. Benefits diminished with exercise intensity ≥1500 MET-min/week.

    CONCLUSION Aerobic exercise maintenance after PCI was associated with a reduced risk of cardiovascular events in patients with diabetes, with a moderate amount of exercise providing maximal benefit. Therefore, aerobic exercise is advisable for patients with diabetes undergoing PCI, and the optimal exercise dosage warrants further research.

    LAY SUMMARY This large-scale prospective population study, based on the Korean National Health Insurance System, demonstrated that maintaining aerobic exercise in patients with diabetes undergoing percutaneous coronary intervention is significantly associated with a lower risk of cardiovascular events.A J-curve relationship was observed between the amount of aerobic exercise and clinical outcomes, with the lowest risk observed at 1000-1499 MET-min/week for both new exercisers and the entire study population.However, exercising beyond 1500 MET-min/week offers diminishing returns, highlighting the need for balanced exercise intensity.

    PubMed IF 10 순환기내과
28. 45612026

    제1저자 박송이, 김상아 · 교신저자 신동엽

    Park S^*, Kim SA^*, Kim S, Kim SY, Lee JY, Byun JM, Hwang SM, Lee JO, Koh Y, Hong J, Chang YH, Kim HK, Bang SM, Kim I, Yoon SS, Shin DY

    Distinct immunophenotypic and clinical features of TP53-mutated acute myeloid leukemia: high CD34/CD41 expression and lower leukocyte counts.

    Ann Hematol. 2026;105(5):10.1007/s00277-026-07001-4.

    Abstract

    This study investigates the clinical and molecular characteristics of TP53-mutated acute myeloid leukemia (AML), associated with a poor prognosis. A retrospective analysis was conducted on 336 AML patients, focusing on the distinctions between TP53-mutated and non-mutated cases. Our findings reveal that TP53 mutations are linked to a higher proportion of leukemic blasts positive for the primitive stem cell markers CD34 and CD41 (with dual positive: 12.5% vs. 1.3%, p < 0.001), suggesting a more stem/progenitor cell-like nature. Patients with TP53-mutated AML exhibited lower white blood cell counts in peripheral blood (p = 0.016) and reduced blast proportion in bone marrow (with a median of 39.6% in TP53-mutated AML and 56.9% in TP53 wild-type AML, p = 0.01) at diagnosis. TP53-mutated AML was frequently found in therapy-related AML cases and occurred with fewer concurrent genetic mutations compared to non-mutated AML. In terms of outcomes, TP53 mutations corresponded with significantly lower composite complete response rates and shorter overall and progression-free survival. This study highlights the distinct clinical, molecular, and immunophenotypic features of TP53-mutated AML and emphasizes the need for improved therapeutic strategies for this high-risk subtype.

    PubMed IF 2.3 혈액종양내과
29. 45602026

    제1저자 박진아, 배은혜 · 교신저자 조재영

    Park J^*, Bae E^*, Sim YJ, Cho J

    The influence of habitual consumption of alcohol on the incidence of obstructive sleep apnea: a national population-based cohort study.

    Sleep Breath. 2026;30(2):10.1007/s11325-026-03684-1.

    Abstract

    PURPOSE: The objective of this nationwide population-based cohort study was to determine the association between habitual alcohol consumption and the incidence of newly diagnosed obstructive sleep apnea (OSA). METHODS: This study used data from the Korean National Health Insurance Service database and included individuals aged ≥ 40 years who underwent a health check-up in 2011 or 2012. Individuals with a prior history of sleep apnea were excluded. Habitual alcohol consumption was defined as a weekly alcohol intake greater than 0 g. The study outcome was the newly identified cases of OSA, which we evaluated using the Cox proportional hazards regression model. RESULTS: A total of 3,988,993 individuals (mean age, 54.5 years; male, 50.1%; mean body mass index [BMI], 24.0 kg/m²) were included, of whom 1,688,094 (42.3%) had habitual alcohol consumption. During a mean follow-up period of 9.7 years, 33,563 new cases of OSA were documented. Individuals with habitual alcohol consumption had an incidence rate of 108.9 per 100,000 person-years, whereas those without habitual alcohol consumption had a rate of 69.6 per 100,000 person-years. Following adjustment for covariates including age, sex, BMI, income, smoking status, physical activity, and the Charlson comorbidity index, the hazard ratio for incident OSA was 1.026 (95% confidence interval, 1.001–1.051). The association between habitual alcohol consumption and incident OSA was more prominent among males and those with underlying chronic kidney disease or a history of cancer. CONCLUSION: This large-scale Korean population-based cohort study revealed that habitual alcohol consumption is associated with an increased incidence of OSA.

    PubMed IF 2.4 호흡기내과
30. 45592026

    제1저자 윤민재, 김원세 · 교신저자 박진주

    Kim W^*, Yoon M^*, Kook W, Park JJ, Greenberg B

    Angiotensin-Neprilysin Inhibition and Renal Outcome in Men and Women With Heart Failure.

    J Am Heart Assoc. 2026;15(7):e047533.

    Abstract

    BACKGROUND Sacubitril/valsartan is known to reduce adverse renal outcomes and slow the decline in estimated glomerular filtration rate (eGFR) compared with renin-angiotensin system (RAS) inhibitors across the entire spectrum of heart failure. However, whether these renoprotective effects differ by sex has not been elucidated. Thus, we aimed to evaluate whether the treatment effect of sacubitril/valsartan versus RAS inhibitors on renal outcomes differs by sex.

    METHODS Data sets from the PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibition to Determine Impact on Global Mortality and Morbidity in Heart Failure; ejection fraction ≤40%, n=8399) and PARAGON-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin Receptor Blocker Global Outcomes in Heart Failure With Preserved Ejection Fraction; ejection fraction ≥45%, n=4796) trials were integrated in a prespecified pooled analysis. We evaluated the treatment effect (sacubitril/valsartan versus RAS inhibitors) on the prespecified renal composite outcome (death from renal failure, end-stage renal disease, or ≥50% reduction in eGFR) and changes in eGFR slope in female (n=4311) and male (n=8884) patients to determine whether sex modified the effect of sacubitril/valsartan on renal outcomes.

    RESULTS At baseline, women exhibited lower eGFR values than men (67.2±19.7 versus 72.6±20.4 mL/min/1.73 m², P<0.001). Compared with RAS inhibitors, sacubitril/valsartan reduced the renal composite outcome similarly in women (1.1% versus 2.2%, hazard ratio [HR], 0.51 [95% CI, 0.31-0.83]) and in men (1.0% versus 1.7%, HR, 0.60 [95% CI, 0.41-0.86]; P for interaction=0.60). Sacubitril/valsartan attenuated the decline in eGFR compared with RAS inhibitors similarly in women (-1.8 versus -2.2 mL/min/1.73 m² per year, P=0.006) and men (-1.6 versus -2.3 mL/min/1.73 m² per year, P<0.001) (P for interaction for difference in eGFR slopes=0.19).

    CONCLUSIONS Sacubitril/valsartan significantly reduces the incidence of renal composite outcome and decelerates the decline in eGFR compared with RAS inhibitors. The renoprotective effects of this drug are uniformly observed in both women and men.

    PubMed IF 6 순환기내과

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