SCI 발표논문

2018년 245편

2152018

제1저자 서현민/차명진 · 교신저자 최의근/박용민

, , , , , , , , ,
Reciprocal relationship between herpes zoster and cardiovascular diseases: A nationwide population-based case-control study in Korea.
J Dermatol. 2018;45(11):1312-1318.

Abstract
Recently, herpes zoster (HZ) has been identified as a risk factor for stroke, but there have been few studies on the relationship between HZ and other cardiovascular diseases (CVD), including myocardial infarction (MI) and heart failure (HF). The purpose of this study was to investigate the risk of HZ occurrence after CVD and the occurrence of CVD after HZ. This was a retrospective case-control study based on the National Health Insurance System claims database for 20 311 patients with HZ and 13 980 patients with CVD and 1:5 age- and sex-matched control subjects for each from January 2006 to December 2013. We evaluated the reciprocal relationship between HZ and CVD including MI, ischemic stroke and HF. Severe HZ requiring hospitalization independently increased the risk of subsequent MI (hazard ratio [HR], 1.831; 95% confidence interval [CI], 1.354-2.476)], ischemic stroke (HR, 1.523; 95% CI, 1.212-1.915) and HF (HR, 2.034; 95% CI, 1.615-2.562) during the study period. Likewise, patients with an episode of MI, ischemic stroke or HF were also at increased risk of HZ hospitalization (after MI: HR, 1.625; 95% CI, 1.144-2.308; after stroke: HR, 1.518; 95% CI, 1.177-1.957; and after HF: HR, 1.485, 95% CI 1.041-2.117). Our results suggest that there is a significant reciprocal relationship between severe HZ requiring hospitalization and CVD including MI, ischemic stroke and HF.
PubMed IF 2.3 순환기내과
2142018

제1저자 최홍미 · 교신저자 김형관

,
Progressive nature of myocardial fibrosis in pediatric hypertrophic cardiomyopathy: from mutation carrier to myocardial fibrosis.
Ann Transl Med. 2018;6(Suppl 1):S52.

PubMed IF 3.689 순환기내과
2132018

제1저자 신동우, 최윤진 · 교신저자 이동호

, , , , , , ,
Secondary Breast, Ovarian, and Uterine Cancers After Colorectal Cancer: A Nationwide Population-Based Cohort Study in Korea.
Dis Colon Rectum. 2018;61(11):1250-1257.

Abstract
BACKGROUND The risk of a second primary cancer has increased along with the increasing life expectancies of colorectal cancer survivors.
OBJECTIVE We aimed to evaluate the incidence rate and risk factors of breast and gynecological (ovarian, uterine cervix/corpus) cancers among female colorectal cancer survivors.
DESIGN This is a retrospective population-based cohort study.
SETTINGS This study used data from the National Health Insurance Corporation of Korea.
PATIENTS Each patient with colorectal cancer diagnosed from 2007 to 2012 was followed until 2015 and compared with age-matched women without colorectal cancer at a 1:5 ratio.
MAIN OUTCOME MEASURES The primary outcome was de novo breast/gynecological cancer. Patients with available medical checkup data were included in an additional analysis.
RESULTS We analyzed 56,682 patients with colorectal cancer and 288,119 age-matched noncolorectal cancer controls. The risk of breast/gynecological cancer was higher among patients with colorectal cancer than among controls (HR, 2.91; p < 0.001). The association with colorectal cancer was the highest for ovarian cancer (HR, 6.72), followed by uterine corpus cancer (HR, 3.99), cervical cancer (HR, 2.82), and breast cancer (HR, 1.85). This association remained consistent in the subgroup analysis of medical checkup data (14,190 patients with colorectal cancer, 71,933 controls). Among patients with colorectal cancer, those aged <55 years had a higher risk of breast/gynecological cancers than those aged >55 years (HR, 3.51 vs 2.59), and those with dyslipidemia had a higher risk of breast cancer than those without dyslipidemia (HR, 2.66 vs 2.06).
LIMITATIONS This was a retrospective, population-based study. A prospectively designed study is needed to validate our conclusions.
CONCLUSIONS Compared with the general population, patients with colorectal cancer carry a higher risk of developing secondary breast, ovarian, and uterine cancers. See Video Abstract at http://links.lww.com/DCR/A731.
PubMed IF 3.1 소화기내과
2122018

제1저자 정수지 · 교신저자 강혜련

, , , , , , ,
A new non-dilution rapid desensitization protocol successfully applied to all-grade platinum hypersensitivity.
Cancer Chemother Pharmacol. 2018;82(5):777-785.

Abstract
PURPOSE Desensitization is a safe alternative for patients with hypersensitivity reactions (HSRs) to platinum-based chemotherapeutic agents and widely used in real practice by employing stepwise administration of multiple serial dilutions of the culprit drugs. However, its labor-intensive nature has required a simpler protocol that is easier to prepare and perform.
METHODS We performed an observational study of patients with platinum HSR who underwent a new non-dilution one-bag desensitization protocol. Premedication consisted of Montelukast as well as H1 and H2 blockers. The outcomes and safety profiles of a new protocol were assessed.
RESULTS A total of 36 patients were recruited (oxaliplatin 23, carboplatin 9, and cisplatin 4) and the most common grade of HSR presented was grade 2 (61.1%), followed by grade 3 (25%), and grade 1 (13.9%). Of 175 desensitization procedures, all cases were successfully completed in re-administration of culprit chemotherapeutic platinum agents; 146 (83.4%) had no breakthrough reactions (BTRs) while 29 (16.6%) did. Most BTRs were mild reactions (grade 1, 51.7%) or moderate reactions (grade 2, 44.8%) of Brown's Scale. Although there was one case of asymptomatic mild hypotension (grade 3, 3.5%), categorized as severe reaction, dyspnea, desaturation, and anaphylaxis did not occur. The proportion of severe HSRs was significantly lower than that of initial HSRs (3.5% vs. 25%, P = 0.0167).
CONCLUSIONS The new non-dilution desensitization protocol was safe and effective for re-administration of culprit platinum agents in patients with a history of HSRs. Therefore, this new protocol can be used as an alternative to existing protocols using multiple serial dilutions.
PubMed IF 2.5 알레르기내과
2112018

제1저자 박세훈 · 교신저자 이하정

, , , , , , , , , ,
Gestational Estimated Glomerular Filtration Rate and Adverse Maternofetal Outcomes.
Kidney Blood Press Res. 2018;43(5):1688-1698.

Abstract
BACKGROUND/AIMS The association between gestational estimated glomerular filtration rate (eGFR) and adverse pregnancy outcomes has not been fully investigated.
METHODS This observational cohort study included pregnancy cases of singleton mothers whose serum creatinine levels were measured during pregnancy at two tertiary hospitals in Korea from 2000 to 2015. Those with identified substantial renal function impairment (eGFR < 60 mL/min/1.73 m2 at baseline, during, or after pregnancy) were excluded. The Chronic Kidney Disease Epidemiology Collaboration equation was used for the eGFR calculation. We computed the time-averaged eGFR during gestation to determine representative values when there were multiple measurements. We studied the following three gestational complications: preterm birth (< 37 weeks' gestational age), low birth weight (< 2.5 kg), and preeclampsia.
RESULTS Among the 12,899 studied pregnancies, 4,360 cases experienced one or more gestational complications. The adjusted odds ratio (aOR) and 95% confidence interval of composite gestational complications for eGFR ranges other than the reference range of 120-150 mL/ min/1.73m2 were: ≥150 mL/min/1.73m2, aOR 1.64 (1.38-1.95), P< 0.001; 90-120 mL/min/1.73m2, aOR 1.41 (1.28-1.56), P< 0.001; and 60-90 mL/min/1.73m2, aOR 2.56 (1.70-3.84), P< 0.001. Incidence of preterm birth or low birth weight showed similar U-shaped association with eGFR values; otherwise, preeclampsia or small for gestational age occurred more often in mothers with a lower gestational eGFR than in those with a higher value.
CONCLUSION Considering the unique association between gestational eGFR and pregnancy outcomes, carefully interpreting these results may help predict obstetric complications.
PubMed IF 2.1 신장내과
2102018

제1저자 이주명 · 교신저자 구본권

, , , , , , , , , , , , , , , , , , , , ,
Prognostic Implications of Relative Increase and Final Fractional Flow Reserve in Patients With Stent Implantation.
JACC Cardiovasc Interv. 2018;11(20):2099-2109.

Abstract
OBJECTIVES The study sought to investigate the prognostic implications of relative increase of fractional flow reserve (FFR) with PCI in combination with post-percutaneous coronary intervention (PCI) FFR.
BACKGROUND FFR, measured after PCI has been shown to possess prognostic implications. The relative increase of FFR with PCI can be determined by the interaction of baseline disease pattern, adequacy of PCI, and residual disease burden in a target vessel. However, the role of relative increase of FFR with PCI has not yet been evaluated.
METHODS A total of 621 patients who underwent PCI using second-generation drug-eluting stents based on low pre-PCI FFR (≤0.80) and available post-PCI FFR were analyzed. The relative increase of FFR was calculated by %FFR increase with PCI ([post-PCI FFR - pre-PCI FFR]/pre-PCI FFR × 100). Patients were divided according to the optimal cutoff values of post-PCI FFR (<0.84) and %FFR increase (≤15%). The primary outcome was target vessel failure (TVF) (a composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target vessel revascularization) at 2 years.
RESULTS Among the total population, 66.0% showed high post-PCI FFR (≥0.84) and 69.2% showed high %FFR increase (>15%). Patients with low post-PCI FFR showed a higher risk of 2-year TVF than did those with high post-PCI FFR (9.1% vs. 2.6%; hazard ratio [HR]: 3.367; 95% confidence interval [CI]: 1.412 to 8.025; p = 0.006). Patients with low %FFR increase also showed a higher risk of 2-year TVF compared with those with high %FFR increase (9.2% vs. 3.0%; HR: 3.613; 95% CI: 1.543 to 8.458; p = 0.003). Among the high post-PCI FFR group, there were no significant differences in clinical outcomes according to %FFR increase. Conversely, among the low post-PCI FFR group, those with low %FFR increase showed a significantly higher risk of TVF than did those with high %FFR increase (14.3% vs. 4.1%; HR: 4.334; 95% CI: 1.205 to 15.594; p = 0.025). Percent FFR increase significantly increased discriminant and reclassification ability for the occurrence of TVF when added to a model with clinical risk factors and post-PCI FFR (C-index 0.783 vs. 0.734; relative integrated discrimination improvement 0.702; p = 0.009; category-free net reclassification index 0.479; p = 0.031).
CONCLUSIONS Percent FFR increase with PCI showed similar prognostic implications with post-PCI FFR. Adding the relative increase of FFR to post-PCI FFR would enable better discrimination of high-risk patients after stent implantation. (Influence of FFR on the Clinical Outcome After Percutaneous Coronary Intervention [PERSPECTIVE]; NCT01873560).
PubMed IF 12.7 순환기내과
2092018

제1저자 이원재, 서정원 · 교신저자 연태진

, , , , , ,
Effect of tailored use of tirofiban in patients with Non-ST-elevation acute coronary syndrome undergoing percutaneous coronary intervention: a randomized controlled trial.
BMC Cardiovasc Disord. 2018;18(1):201.

Abstract
BACKGROUND We conducted a randomized controlled trial to investigate whether an additional platelet inhibition with tirofiban would reduce the extent of myocardial damage and prevent periprocedural myonecrosis in patients with Non-ST-elevation acute coronary syndrome (NSTE-ACS) with a high residual platelet activity (HPR).
METHODS Patients with an HPR, defined as P₂Y₁₂ reaction unit (PRU) > 230, were randomly assigned to group A (tirofiban treatment, n = 30) or C1 (n = 30) and patients without an HPR to C2 (n = 78). Periprocedural myocardial damage was assessed using the area under the curve (AUC) of serial cardiac enzyme levels from the time of the procedure to post-36 h. Periprocedural myonecrosis incidence was evaluated.
RESULTS The troponin I AUC was not different between the groups (197.2 [41.5395.7], 37.9 [8.9313.9], 121.3 [43.7481.8] h∙ng/mL; p = 0.088). The results did not change when the baseline levels were adjusted (365.3 [279.5, 451.1], 293.0 [207.1, 379.0], and 298.0 [244.7, 351.3] h∙ng/mL; p = 0.487). The rate of periprocedural myonecrosis was also not different between the groups (53.0% vs. 50.0% vs. 33.3%, p = 0.092). The CK-MB isoenzyme analysis showed similar results. No difference in complications was noted.
CONCLUSION Additional tirofiban administration was not beneficial to patients with NSTE-ACS even with an HPR.
TRIAL REGISTRATION Clinical trial no. NCT03114995 , registered 11 April, 2017, retrospectively.
PubMed IF 3.1 순환기내과
2082018

제1저자 강지훈 · 교신저자 조현재

, , , , , , , , , , , , , , ,
Effects of Widespread Inotrope Use in Acute Heart Failure Patients.
J Clin Med. 2018;7(10):jcm7100368.

Abstract
Current guidelines recommend that inotropes should not be used in patients with normal systolic blood pressure (SBP). However, this is not supported with concrete evidence. We aimed to evaluate the effect of inotropes in acute heart failure (HF) patients from a nationwide HF registry. A total of 5625 patients from the Korean Acute Heart Failure (KorAHF) registry were analyzed. The primary outcomes were in-hospital adverse events and 1-month mortality. Among the total population, 1703 (31.1%) received inotropes during admission. Inotrope users had a higher event rate than non-users (in-hospital adverse events: 13.3% vs. 1.4%, p < 0.001; 1-month mortality: 5.5% vs. 2.5%, p < 0.001), while inotrope use was an independent predictor for clinical outcomes (in-hospital adverse events: OR_adjusted 5.459, 95% CI 3.622⁻8.227, p < 0.001; 1-month mortality: HR_adjusted 1.839, 95% CI 1.227⁻2.757, p = 0.003). Subgroup analysis showed that inotrope use was an independent predictor for detrimental outcomes only in patients with normal initial SBP (≥90 mmHg) (in-hospital adverse events: OR_adjusted 5.931, 95% CI 3.864⁻9.104, p < 0.001; 1-month mortality: HR_adjusted 3.584, 95% CI 1.280⁻10.037, p = 0.015), and a propensity score-matched population showed consistent results. Clinicians should be cautious with the usage of inotropes in acute heart failure patients, especially in those with a normal SBP.
PubMed IF 3.3 순환기내과
2072018

제1저자 임선희 · 교신저자 김나영

, , , , , , , , , , , , ,
Trends in the seroprevalence of Helicobacter pylori infection and its putative eradication rate over 18 years in Korea: A cross-sectional nationwide multicenter study.
PLoS One. 2018;13(10):e0204762.

Abstract
The aims of this study were to demonstrate the trends in seropositivity and the eradication therapy rate for Helicobacter pylori (H. pylori) over an 18-year period in an asymptomatic Korean population and to explore the factors associated with H. pylori seropositivity and its eradication therapy. In total, 23,770 subjects (aged 17-97 years) from a health examination center participated in this cross-sectional study from January 2016 to June 2017. Questionnaires that included questions about the participants' H. pylori eradication therapy history were collected, and anti-H. pylori IgG antibodies were measured. Among the eligible subjects, the seroprevalence of H. pylori infection was 41.5%. The H. pylori eradication therapy rate increased continuously from 2005 (13.9%) to 2011 (19.3%) and then increased again until the first half of 2017 (23.5%) (P < 0.001). After exclusion of subjects with a history of gastric surgery, gastric cancer, H. pylori eradication therapy, or gastric symptoms, H. pylori seropositivity was 43.9% in 16,885 subjects, which was significantly lower than the seropositivities in 1998 (66.9%), 2005 (59.6%), and 2011 (54.4%). The risk factors associated with H. pylori seropositivity according to multivariable analysis were male sex (odds ratio (OR) 1.34, 95% confidence interval (CI): 1.23-1.46), medium educational level (OR 1.17, 95% CI: 1.05-1.31), medium household income level (OR 1.10, 95% CI: 1.03-1.19), and age of 60-69 years (OR 8.78, 95% CI: 6.41-11.85). The observed downward trend in H. pylori seroprevalence and increase in H. pylori eradication over the 18-year period will affect upper gastrointestinal disorders in South Korea.
PubMed IF 2.8 소화기내과
2062018

제1저자 손대원 · 교신저자 손대원

, , , ,
Viewpoints in the diagnosis and treatment of cardiac sarcoidosis: Proposed modification of current guidelines.
Clin Cardiol. 2018;41(10):1386-1394.

Abstract
Isolated cardiac sarcoidosis is a generally accepted disease condition, and the low yield of endomyocardial biopsy because of patchy involvement is also well known. However, current guidelines still require histologic confirmation of granuloma for the diagnosis of cardiac sarcoidosis, either in myocardial or extra-cardiac tissues. Therefore, only a presumptive diagnosis of chronic multifocal myocarditis of unknown origin can be made in a large number of patients in whom the only considerable diagnosis is cardiac sarcoidosis based on current knowledge. Even if these patients are treated with the same treatment scheme as that for cardiac sarcoidosis, which may not cause harm in the absence of a definite diagnosis, the true spectrum of cardiac sarcoidosis could not be determined for deciding the optimal treatment strategy. In addition, the current recommendations for dose, duration of initial steroid therapy, and treatment in patients who did not respond to initial steroid therapy are not easy to follow in real-world practice. We would like to propose a scoring system for the diagnosis of cardiac sarcoidosis and suggest our adoption or modification of the diverse current recommendations.
PubMed IF 2.8 순환기내과
2052018

제1저자 손준혁,이희승 · 교신저자 이상협

, , , , , , ,
Revision of bilateral self-expandable metallic stents placed using the stent-in-stent technique for malignant hilar biliary obstruction.
Hepatobiliary Pancreat Dis Int. 2018;17(5):437-442.

Abstract
BACKGROUND Endoscopic biliary decompression using bilateral self-expandable metallic stent (SEMS) placed using the stent-in-stent (SIS) technique is considered favorable for unresectable malignant hilar biliary obstruction (MHBO). However, occlusion of the bilateral SIS placement is frequent and revision can be challenging. This study was performed to investigate the efficacy, the long-term patency and the appropriate approach for revision of occluded bilateral SIS placement in unresectable MHBO.
METHODS From January 2011 to July 2016, thirty-eight patients with unresectable MHBO underwent revision of occluded bilateral SIS placement. Clinical data including success rates and patency of revision, were retrospectively analyzed.
RESULTS The technical success rate of revision was 76.3%. The clinical success rate of revision was 51.7% and mean patency of revision was 49.1 days. No significant predictive factor for clinical failure of revision was observed. The cell size of SEMS was not found to have significant effects on clinical success rates or revision patency.
CONCLUSIONS Revision of occluded bilateral SIS placement for MHBO showed fair patency and clinical success rate. Revision method and cell size of SEMS were not found to influence clinical outcomes.
PubMed IF 3.9 소화기내과
2042018

제1저자 이종찬 · 교신저자 김재환

, , , , , , , , , ,
Outcome of endoscopic retrograde cholangiopancreatography in patients with clinically defined decompensated liver cirrhosis.
J Dig Dis. 2018;19(10):605-613.

Abstract
OBJECTIVE Decompensated liver cirrhosis (LC) can negatively affect the outcome of endoscopic retrograde cholangiopancreatography (ERCP). We aimed to compare the efficacy and safety of ERCP in patients with clinically defined compensated and decompensated LC.
METHODS In a single tertiary hospital, 146 endoscopic sphincterotomy-naive patients with LC who underwent ERCP between 2005 and 2016 were reviewed. Patients with LC who had experienced variceal bleeding, ascites or hepatic encephalopathy were included in the decompensated LC group. Cannulation, technical and clinical successes, and major post-ERCP adverse events including bleeding, pancreatitis, cholangitis and perforation were compared between the two groups.
RESULTS Patients were divided into compensated and decompensated LC groups. Their baseline characteristics were not different, except for comorbid malignancy (22.3 % vs 38.5%, P = 0.038) and preprocedural transfusion (7.4% vs 36.5%, P < 0.001). The cannulation (97,9% vs 94.2%, P = 0.348) and technical (95.7% vs 88.5%, P = 0.167) success rates were not different. The clinical success rate was lower in the decompensated LC group (95.7% and 78.8%, P = 0.003), mainly due to comorbid hepatobiliary malignancy. Post-ERCP pancreatitis (6.4% vs 30.8%, P = 0.008) and cholangitis (18.1% vs 32.7%, P = 0.046) rates were higher in the decompensated LC group.
CONCLUSIONS Despite lower clinical success rates due to comorbid hepatobiliary malignancy, ERCP in patients with decompensated LC is technically feasible. Because postprocedural cholangitis and pancreatitis are more frequent in patients with decompensated LC, greater procedural precautions are needed in these patients.
PubMed IF 2.7 소화기내과
2032018

제1저자 홍승욱 · 교신저자 천재영

, , , , ,
Aloe vera Is Effective and Safe in Short-term Treatment of Irritable Bowel Syndrome: A Systematic Review and Meta-analysis.
J Neurogastroenterol Motil. 2018;24(4):528-535.

Abstract
BACKGROUND/AIMS To evaluate the efficacy and safety of Aloe vera (AV) in patients with irritable bowel syndrome (IBS).
METHODS We searched the MEDLINE, EMBASE, and Cochrane databases for studies dated between 1st January 1960 and 30th December 2017. Eligible randomized controlled trials (RCTs) compared AV to placebo in patients with IBS. The primary outcome was standardized mean difference of the change in severity of IBS symptoms as measured by patient-rated scales. Secondary outcomes included response rate of IBS symptoms and adverse events. Heterogeneity among studies was assessed using Cochrane's Q and I² statistics.
RESULTS Three RCTs with a total of 151 patients with IBS were included. The meta-analysis showed a significant difference for patients with AV compared to those with placebo regarding improvement in IBS symptom score (standardized mean difference, 0.41; 95% CI, 0.07-0.75; P = 0.020). Using intention-to-treat analysis, the AV patients showed significantly better response rates of IBS symptoms compared to placebo (pooled risk ratio, 1.69; 95% CI, 1.05-2.73; P = 0.030). No adverse events related with AV were found in included studies. There was no significant heterogeneity of effects across studies (P = 0.900; I² = 0%).
CONCLUSION AV is effective and safe for the treatment of patients with IBS compared to placebo.
PubMed IF 3.7 소화기내과
2022018

제1저자 김영선 · 교신저자 김나영

,
Sex-Gender Differences in Irritable Bowel Syndrome.
J Neurogastroenterol Motil. 2018;24(4):544-558.

Abstract
Because of the sex-gender differences that are shown in a diversity of physiological and psychological factors, it can be speculated that the clinical presentation of symptoms as well as treatment strategies in women and men with irritable bowel syndrome (IBS) may differ. Studies have revealed that IBS is more common in women than men. As for the IBS subtype, IBS with constipation is significantly more prevalent among women than men. Sex hormones and gender differences may play important roles in the pathophysiology of IBS. However, its pathophysiologic mechanisms still remain largely unknown, and therapeutic implications are limited. Moreover, women IBS patients have been reported to feel more fatigue, depression, anxiety, and lower quality of life than men IBS patients. Furthermore, there has been evidence of differences in the appropriate treatment efficacy to IBS in men and women, although relatively few men are enrolled in most relevant clinical trials. A more sex-gender-oriented approach in the medical care setting could improve understanding of heterogeneous patients suffering from IBS. An individualized and multicomponent approach including sex and gender issues might help improve the treatment of IBS.
PubMed IF 3.7 소화기내과
2012018

제1저자 김성은 · 교신저자 김나영

, , , , , , , , , , , , , , , , ,
Prevalence and Risk Factors of Functional Dyspepsia in Health Check-up Population: A Nationwide Multicenter Prospective Study.
J Neurogastroenterol Motil. 2018;24(4):603-613.

Abstract
BACKGROUND/AIMS Functional dyspepsia (FD) is one of the most common gastrointestinal disorders, and FD imposes social and economic burden worldwide. The aim of this study is to identify the prevalence and risk factors of FD in health check-up population in tertiary centers in Korea.
METHODS A nationwide multicenter prospective study was performed at 9 tertiary healthcare centers in Korea between September 2016 and June 2017. A total of 2525 subjects were investigated based on endoscopic findings and questionnaires with the Rome III criteria, and Helicobacter pylori serology (IgG).
RESULTS A total of 1714 subjects without organic disease were enrolled. The mean (± SD) age was 51.5 (± 12.7) years, and 917 patients (53.5%) were female. The proportion of H. pylori seropositivity was 51.0% (874/1714). The prevalence of FD was 10.3% (176/1714), and the subtypes of postprandial distress syndrome alone, epigastric pain syndrome alone, and postprandial distress syndrome-epigastric pain syndrome overlap were 4.8%, 3.0%, and 2.5%, respectively. Multivariate analysis showed that female gender (OR, 1.58; 95% CI, 1.14-2.21) and education below college level (OR, 1.45; 95% CI, 1.01-2.07) were related to FD. Multivariate analysis based on age 60 showed female gender as a significant (OR, 2.90; 95% CI, 1.06-7.94) factor in the group ≥ 60 years.
CONCLUSIONS The prevalence of FD was 10.3% in the health check-up population in Korea. Female sex and education below college level were risk factors for FD. Female sex is a risk factor for FD in old age, underscoring the need for close attention in this age group.
PubMed IF 3.7 소화기내과
2002018

제1저자 Brito JP,문재훈 · 교신저자 박영주,Tuttle

, , , , , , , , , , , , ,
Thyroid Cancer Treatment Choice: A Pilot Study of a Tool to Facilitate Conversations with Patients with Papillary Microcarcinomas Considering Treatment Options.
Thyroid. 2018;28(10):1325-1331.

Abstract
BACKGROUND The 2015 American Thyroid Association guidelines recognize active surveillance as an alternative to immediate surgery in patients with papillary microcarcinomas (PMCs). As a way to incorporate active surveillance as one of the management options for patients with PMCs, we developed and tested a tool to support conversations between clinicians and patients with PMCs considering treatment options.
METHODS Thyroid Cancer Treatment Choice was developed using an iterative process based on the principles of interaction, design, and participatory action research. To evaluate the impact of the tool on treatment choice, a prospective study was conducted in two thyroid cancer clinics in Seongnam-si and Seoul, South Korea. Both clinics had the expertise to offer active surveillance as well as immediate surgery. One clinic was trained in the use of the conversation aid, while the other clinic continued to care for patients without access to the conversation aid.
RESULTS Between May 2016 and April 2017, 278 patients, mostly women (n = 220, 79%), were included in the study; 152 (53%) received care at the clinic using the conversation aid. Age, sex, and mean (±SD) tumor size (6.6 ± 1.6 mm and 6.5 ± 1.9 mm) distributions were similar across clinics. Overall, 233 (84%) patients opted for active surveillance and 53 (16%) for thyroid surgery. Patients in the conversation aid group were more likely to choose active surveillance than the patients seen in the usual care clinic (relative risk = 1.16 [confidence interval 1.04-1.29]). Of all patients opting for active surveillance, more patients in the conversation aid group had thyroid cancer nodules >5 mm than in the usual care group (81% vs. 67%; p = 0.013).
CONCLUSIONS Thyroid Cancer Treatment Choice is an evidence-based tool that supports the presentation of treatment options for PMCs. Pilot testing suggests that this conversation tool increases acceptance of active surveillance, suggesting that this option is an acceptable and preferable alternative for informed patients. Further studies are warranted to confirm this finding.
PubMed IF 6.6 내분비대사내과
1992018

제1저자 방영주 · 교신저자 방영주

, , , , , , , , , , , , , , , , , , ,
Phase III, randomised trial of avelumab versus physician's choice of chemotherapy as third-line treatment of patients with advanced gastric or gastro-oesophageal junction cancer: primary analysis of JAVELIN Gastric 300.
Ann Oncol. 2018;29(10):2052-2060.

Abstract
BACKGROUND There currently are no internationally recognised treatment guidelines for patients with advanced gastric cancer/gastro-oesophageal junction cancer (GC/GEJC) in whom two prior lines of therapy have failed. The randomised, phase III JAVELIN Gastric 300 trial compared avelumab versus physician's choice of chemotherapy as third-line therapy in patients with advanced GC/GEJC.
PATIENTS AND METHODS Patients with unresectable, recurrent, locally advanced, or metastatic GC/GEJC were recruited at 147 sites globally. All patients were randomised to receive either avelumab 10 mg/kg by intravenous infusion every 2 weeks or physician's choice of chemotherapy (paclitaxel 80 mg/m2 on days 1, 8, and 15 or irinotecan 150 mg/m2 on days 1 and 15, each of a 4-week treatment cycle); patients ineligible for chemotherapy received best supportive care. The primary end point was overall survival (OS). Secondary end points included progression-free survival (PFS), objective response rate (ORR), and safety.
RESULTS A total of 371 patients were randomised. The trial did not meet its primary end point of improving OS {median, 4.6 versus 5.0 months; hazard ratio (HR)=1.1 [95% confidence interval (CI) 0.9-1.4]; P = 0.81} or the secondary end points of PFS [median, 1.4 versus 2.7 months; HR=1.73 (95% CI 1.4-2.2); P > 0.99] or ORR (2.2% versus 4.3%) in the avelumab versus chemotherapy arms, respectively. Treatment-related adverse events (TRAEs) of any grade occurred in 90 patients (48.9%) and 131 patients (74.0%) in the avelumab and chemotherapy arms, respectively. Grade ≥3 TRAEs occurred in 17 patients (9.2%) in the avelumab arm and in 56 patients (31.6%) in the chemotherapy arm.
CONCLUSIONS Treatment of patients with GC/GEJC with single-agent avelumab in the third-line setting did not result in an improvement in OS or PFS compared with chemotherapy. Avelumab showed a more manageable safety profile than chemotherapy.
TRIAL REGISTRATION ClinicalTrials.gov: NCT02625623.
PubMed IF 80.4 혈액종양내과
1982018

제1저자 박효은 · 교신저자 정고은

, , , , , ,
Usefulness of controlled attenuation parameter for detecting increased arterial stiffness in general population.
Dig Liver Dis. 2018;50(10):1062-1067.

Abstract
BACKGROUND Liver fibroscan has recently been suggested as an alternative method to measure liver steatosis noninvasively. In this study, we evaluated usefulness of controlled attenuation parameter (CAP) for detecting increased arterial stiffness in general population.
METHODS A total of 515 asymptomatic patients without potential cause of liver disease who had liver fibroscan and cardio-ankle vascular index (CAVI) during their health check-up exams were included. A cut off of CAP ≥222 dB/m was used to define fatty liver and CAVI ≥ 8 for increased arterial stiffness.
RESULTS Both unadjusted and adjusted regression analyses showed significant association between fatty liver and increased arterial stiffness [unadjusted Odds ratio (OR) 1.896, 95% CI 1.305-2.754, p = .001 for CAP ≥ 222 dB/m alone]. With all traditional cardiovascular risk factors such as age, gender, body mass index, hypertension, diabetes mellitus, hypercholesterolemia and smoking adjusted, CAP ≥ 222 dB/m still showed significant association with increased arterial stiffness (OR 2.309, 95% CI 1.419-3.756, p = .001). The correlation between CAP-defined fatty liver and arterial stiffness was especially strong in subjects without diabetes (OR 2.959, 95% CI 1.709-5.122, p < 0.001).
CONCLUSION CAP ≥ 222 dB/m is independently associated with increased arterial stiffness. As increased arterial stiffness is a surrogate and prognosticator for cardiovascular disease, surveillance using liver fibroscan may help screen and further stratify risk of patients.
PubMed IF 4.9 소화기내과
1972018

제1저자 김낙현 · 교신저자 박완범,김홍빈

, , , , , , , , , , , , , ,
Effects of Phage Endolysin SAL200 Combined with Antibiotics on Staphylococcus aureus Infection.
Antimicrob Agents Chemother. 2018;62(10):AAC.00731-18.

Abstract
Phages and their derivatives are increasingly being reconsidered for use in the treatment of bacterial infections due to the rising rates of antibiotic resistance. We assessed the antistaphylococcal effect of the endolysin SAL200 in combination with standard-of-care (SOC) antibiotics. The activity of SAL200 when it was combined with SOC antibiotics was assessed in vitro by checkerboard and time-kill assays and in vivo with murine bacteremia and Galleria mellonella infection models. SAL200 reduced the SOC antibiotic MICs and showed a ≥3-log₁₀-CFU/ml reduction of Staphylococcus aureus counts within 30 min in time-kill assays. Combinations of SAL200 and SOC antibiotics achieved a sustained decrease of >2 log₁₀ CFU/ml. SAL200 significantly lowered the blood bacterial density within 1 h by >1 log₁₀ CFU/ml in bacteremic mice (P < 0.05 versus untreated mice), and SAL200 and SOC antibiotic combinations achieved the lowest levels of bacteremia. The bacterial density in splenic tissue at 72 h postinfection was the lowest in mice treated with SAL200 and SOC antibiotic combinations. SAL200 combined with SOC antibiotics also improved Galleria mellonella larva survival at 96 h postinfection. The combination of the phage endolysin SAL200 with SOC antistaphylococcal antibiotics showed synergistic effects in vitro and in vivo The combination of SAL200 with SOC antibiotics could help in the treatment of difficult-to-treat S. aureus infections.
PubMed IF 4.2 감염내과
1962018

제1저자 이주연 · 교신저자 송영욱

, , , , , , , , ,
Apolipoprotein B binds to enolase-1 and aggravates inflammation in rheumatoid arthritis.
Ann Rheum Dis. 2018;77(10):1480-1489.

Abstract
OBJECTIVE Immune cells from patients with rheumatoid arthritis (RA) express more enolase-1 (ENO1) on their surface than those from healthy subjects, and they elicit an enhanced inflammatory response. This study is aimed to identify the ligands of ENO1 that could promote inflammatory loops in vitro and enhance the arthritis severity in vivo.
METHODS ENO1-binding proteins in RA synovial fluid were identified by mass spectromety, and affinity to ENO1 was evaluated by means of a ligand blotting and binding assay, surface plasmon resonance and confocal microscopy. Proinflammatory response by the interaction between ENO1 and apolipoprotein B (apoB) was tested in vitro and in vivo using peripheral blood mononuclear cells and a K/BxN serum transfer arthritis model and low-density lipoproteins receptor (LDLR) knockout mice.
RESULTS ApoB in the synovid fluid of patients with RA was identified as a specific ligand to ENO1 with a higher affinity than plasminogen, a known ENO1 ligand. ApoB binding to ENO1 on monocytes elicited the production of tumour necrosis factor-α, interleukins (IL)-1β and IL-6 through both p38 mitogen-activated protein kinase and NF-κB pathways. In the K/BxN serum transfer arthritis model, administration of apoB increased the production of proinflammatory cytokines and exaggerated arthritis severity. The severity of K/BxN serum transfer arthritis in LDLR knockout mice was comparable with wild-type mice.
CONCLUSIONS A key component of atherogenic lipids, apoB, aggravated arthritis by potentiating the inflammatory response via its interaction with ENO1 expressed on the surface of immune cells. This suggests a novel mechanism by which lipid metabolism regulates chronic inflammation in RA.
PubMed IF 24 류마티스내과
1952018

제1저자 채세현 · 교신저자 박경수

, , , , , , , , , , , , , , , ,
A mitochondrial proteome profile indicative of type 2 diabetes mellitus in skeletal muscles.
Exp Mol Med. 2018;50(9):1-14.

Abstract
The pathogenesis of type 2 diabetes mellitus (T2DM) is closely associated with mitochondrial functions in insulin-responsive tissues. The mitochondrial proteome, compared with the mitochondrial genome, which only contains 37 genes in humans, can provide more comprehensive information for thousands of mitochondrial proteins regarding T2DM-associated mitochondrial functions. However, T2DM-associated protein signatures in insulin-responsive tissues are still unclear. Here, we performed extensive proteome profiling of mitochondria from skeletal muscles in nine T2DM patients and nine nondiabetic controls. A comparison of the mitochondrial proteomes identified 335 differentially expressed proteins (DEPs) between T2DM and nondiabetic samples. Functional and network analyses of the DEPs showed that mitochondrial metabolic processes were downregulated and mitochondria-associated ER membrane (MAM) processes were upregulated. Of the DEPs, we selected two (NDUFS3 and COX2) for downregulated oxidative phosphorylation and three (CALR, SORT, and RAB1A) for upregulated calcium and protein transport as representative mitochondrial and MAM processes, respectively, and then confirmed their differential expression in independent mouse and human samples. Therefore, we propose that these five proteins be used as a potential protein profile that is indicative of the dysregulation of mitochondrial functions in T2DM, representing downregulated oxidative phosphorylation and upregulated MAM functions.
PubMed IF 17.5 내분비대사내과
1942018

제1저자 이선민 · 교신저자 김나영

, , , ,
Microbial Changes and Host Response in F344 Rat Colon Depending on Sex and Age Following a High-Fat Diet.
Front Microbiol. 2018;9:2236.

Abstract
Gut microbiota, an important component that affects host health, change rapidly and directly in response to altered diet composition. Recently, the role of diet-microbiome interaction on the development of colon cancer has been the focus of interest. Colon cancer occurs more frequently in an aged population, and in males. However, the effect of dietary changes on the gut microbiome has been studied mainly in young males, even though it may vary with age and sex. The aim of this study was to investigate microbial changes and host response in the colons of male and female 6-week-old (young) and 2-year-old (old) Fisher-344 rats exposed to a high-fat diet (HFD). Our results showed that exposure to HFD for 8 weeks decreased the species richness of microbiota (Chao1) and increased Firmicutes/Bacteroidetes ratio only in aged rats, and not in young rats. Sex differences underlying the alteration by HFD in the gut microbiome were observed in the microbiome of aged rats. For instance, the abundance ratio of Akkermansia muciniphila and Desulfovibrio spp. increased in response to HFD in young rats and female aged rats, but not in male aged rats. Histological inflammation and cell proliferation of colon mucosa (indexed by Ki67) were significantly increased by HFD even in young rats; aged rats showed significantly higher cell proliferation in the HFD group than in the control. The HFD-induced decrease of species richness and the increase in specific species (Desulfovibrio spp. and Clostridium lavalense), which produce carcinogenic compounds such as H₂S and N-nitroso compounds, were significantly correlated with Ki67 index. In colon mucosa, the concentration of myeloperoxidase was increased by HFD only in males, and not in females. In conclusion, the results suggest a link between HFD-induced gut dysbiosis (particularly the low species richness and high abundance ratios of Desulfovibrio spp. and C. lavalense) and cell proliferation of colon mucosa (indicated by Ki67 IHC). In addition, sex differences influence the response of gut microbiome to HFD particularly in old age. Such sex differences in the gut microbiota might be related to sex differences in inflammation in the colon mucosa.
PubMed IF 5.8 소화기내과
1932018

제1저자 최윤진 · 교신저자 이동호

, , , , , ,
Is nonalcoholic fatty liver disease associated with the development of prostate cancer? A nationwide study with 10,516,985 Korean men.
PLoS One. 2018;13(9):e0201308.

Abstract
BACKGROUND Growing evidence supports that prostate cancer (PCa) is a metabolic syndrome-related cancer, but the evidence is lacking regarding the association between nonalcoholic fatty liver disease (NAFLD) and PCa. We aimed to investigate whether PCa is related with NAFLD in Korean adults.
METHODS Data from the National Health Insurance Corporation between 2009 and 2012 were analyzed using multivariate logistic regression method. NALFD was defined based on the fatty liver index (FLI) and hepatic steatosis index (HSI). Newly diagnosed PCa was identified using the claims data.
RESULTS NAFLD based on FLI and HSI was identified in 2,002,375 (19%) and 2,629,858 (25%) of 10,516,985 subjects, respectively. Each FLI ≥ 60 and HSI ≥ 36 was independently associated with the development of PCa after adjusting for other confounders (hazard ratio (HR) 1.09, 95% CI: 1.06-1.12 and HR 1.19, 95% CI: 1.16-1.23). The association was more prominent among those who were older (FLI, ≥ 65 years old and HSI, ≥ 40 years old), were not currently smoking, were presently consuming alcohol (< 30g/day) and had null components of metabolic syndrome than each counterpart. Non-obese persons with NAFLD defined by HSI had a higher risk of developing PCa than those with body mass index > 25 Kg/m2.
CONCLUSIONS NAFLD defined by FLI or HSI may help identify high-risk individuals for developing PCa particular in the elderly, even in the absence of obesity or metabolic syndrome. Future studies on this topic should necessarily be repeated based on ultrasonographic findings.
PubMed IF 2.8 소화기내과
1922018

제1저자 윤혁 · 교신저자 이동호

, , , , , , , , , , , , , , , , , , , , ,
Efficacy and Safety of UI05MSP015CT in Functional Dyspepsia: A Randomized, Controlled Trial.
Gut Liver. 2018;12(5):516-522.

Abstract
BACKGROUND/AIMS To evaluate the efficacy and safety of a controlled release, once-daily formulation of mosapride (UI05MSP015CT) in patients with functional dyspepsia (FD).
METHODS Patients with FD were randomly assigned (1:1) to receive either UI05MSP015CT (15 mg once a day, study group) or mosapride (5 mg three times a day, control group) and corresponding placebo for 4 weeks. The primary endpoint was a change in the gastrointestinal symptom score (GIS) evaluated at enrollment and after 4 weeks. Secondary endpoints were changes in the Nepean Dyspepsia Index-Korean version (NDI-K), rate of satisfactory symptom relief, and rate of adverse events.
RESULTS A total of 138 patients were enrolled (female, 73.9%; mean age, 44.0±15.4 years). After excluding patients who violated the study protocol, 59 and 58 patients from the study and control groups, respectively, were included in the per-protocol analysis. No difference was observed in drug compliance between the control and study groups (97.07%±4.52% vs 96.85%±6.05%, p=0.870). Changes in GIS scores were -9.69±6.44 and -10.01±5.92 in the study and control groups. The mean difference in GIS change between groups was 0.33 (95% confidence interval, -1.75 to 2.41), demonstrating non-inferiority of UI-05MSP015CT (p=0.755). The rate of satisfactory symptom relief was not different between the study and control groups (39.0% vs 56.9%, p=0.053). No differences in change in NDI-K score (14.3 vs 16.9, p=0.263) or rates of adverse events (12.9% vs. 4.4%, p=0.062) were observed between the study and control groups.
CONCLUSIONS Once-daily mosapride is not inferior to conventional mosapride in efficacy and is safe in patients with FD.
PubMed IF 4.1 소화기내과
1912018

제1저자 천재영,임종필 · 교신저자 김지원

, , , , , , , , , , , , ,
Association of Perianal Fistulas with Clinical Features and Prognosis of Crohn's Disease in Korea: Results from the CONNECT Study.
Gut Liver. 2018;12(5):544-554.

Abstract
BACKGROUND/AIMS The disease course and factors associated with poor prognosis in Korean patients with Crohn's disease (CD) have not been fully determined. The aim of this study was to explore potential associations between the clinical characteristics and long-term outcomes of CD and perianal fistulas in a Korean population.
METHODS The retrospective Crohn's Disease Clinical Network and Cohort (CONNECT) study enrolled patients diagnosed with CD between July 1982 and December 2008 from 32 hospitals. Those followed for ＜12 months were excluded. Clinical outcomes were CD-related surgery and complications, including nonperianal fistulas, strictures, and intra-abdominal abscesses.
RESULTS The mean follow-up period was 8.77 years (range, 1.0 to 25.8 years). A total of 1,193 CD patients were enrolled, of whom 465 (39.0%) experienced perianal fistulas. Perianal fistulizing CD was significantly associated with younger age, male gender, CD diagnosed at primary care clinics, and ileocolonic involvement. Both nonperianal fistulas (p=0.034) and intra-abdominal abscesses (p=0.020) were significantly more common in CD patients with perianal fistulas than in those without perianal fistulas. The rates of complicated strictures and CD-related surgery were similar between the groups. Independently associated factors of nonperianal fistulas were perianal fistulas (p=0.015), female gender (p=0.048), CD diagnosed at referral hospital (p=0.003), and upper gastrointestinal (UGI) involvement (p=0.001). Furthermore, perianal fistulas (p=0.048) and UGI involvement (p=0.012) were independently associated with the risk of intra-abdominal abscesses.
CONCLUSIONS Perianal fistulas predicted the development of nonperianal fistulas and intra-abdominal abscesses in Korean CD patients. Therefore, patients with perianal fistulizing CD should be carefully monitored for complicated fistulas or abscesses.
PubMed IF 4.1 소화기내과
1902018

제1저자 이민종 · 교신저자 김윤준

, , , , , , , , , , , , , , , , ,
Assessment of the Surveillance Interval at 1 Year after Curative Treatment in Hepatocellular Carcinoma: Risk Stratification.
Gut Liver. 2018;12(5):571-582.

Abstract
BACKGROUND/AIMS Guidelines recommend surveillance for hepatocellular carcinoma (HCC) recurrence at 3-month intervals during the first year after curative treatment and 6-month intervals thereafter in all patients. This strategy does not reflect individual risk of recurrence. We aimed to stratify risk of recurrence to optimize surveillance intervals 1 year after treatment.
METHODS We retrospectively analyzed 1,316 HCC patients treated with resection/radiofrequency ablation at Barcelona Clinic Liver Cancer stage 0/A. In patients without 1-year recurrence under 3-monthly surveillance, a new model for recurrence was developed using backward elimination methods: training (n=582)/validation cohorts (n=291). Overall survival (OS) according to risk stratified by the new model was compared according to surveillance intervals: 3-monthly versus 6-monthly (n=401) after lead time bias correction and propensity-score matching analyses.
RESULTS Among patients without 1-year recurrence, age and international normalized ratio values were significant factors for recurrence (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.00 to 1.03; p=0.009 and HR, 5.63; 95% CI, 2.24 to 14.18; p<0.001; respectively). High-risk patients stratified by the new model showed significantly higher recurrence rates than low-risk patients in the validation cohort (HR, 1.73; 95% CI, 1.18 to 2.53; p=0.005). After propensity-score matching between the 3-monthly and 6-monthly surveillance groups, OS in high-risk patients under 3-monthly surveillance was significantly higher than that under 6-monthly surveillance (p=0.04); however, OS in low-risk patients under 3-monthly surveillance was not significantly different from that under 6-monthly surveillance (p=0.17).
CONCLUSIONS In high-risk patients, 3-monthly surveillance can prolong survival compared to 6-monthly surveillance. However, in low-risk patients, 3-monthly surveillance might not be beneficial for survival compared to 6-monthly surveillance.
PubMed IF 4.1 소화기내과
1892018

제1저자 이윤빈,남준열 · 교신저자 이정훈

, , , , , , , , , , , , ,
Differential Effect of HCV Eradication and Fibrosis Grade on Hepatocellular Carcinoma and All-cause Mortality.
Sci Rep. 2018;8(1):13651.

Abstract
Whether a sustained virological response (SVR) improves long-term outcomes in chronic hepatitis C patients with earlier-stage fibrosis has not been established. We investigated the differential effect of SVR on the risk of outcomes according to hepatic fibrosis grade. Fibrosis grade was categorised using FIB-4: <1.45, low-probability of significant fibrosis; 1.45-3.25, intermediate-probability; and ≥3.25, high-probability. Primary and secondary endpoints were hepatocellular carcinoma (HCC) occurrence and death, respectively. Among 1,373 included chronic hepatitis C patients, 744 patients were treated with interferon-based or -free regimens and 622 (83.6%) achieved SVR. SVR was independently associated with lower risk of HCC (vs. untreated: adjusted hazard ratio [aHR], 0.165; 95% confidence interval [CI], 0.077-0.350; P < 0.001) and overall death (vs. untreated; aHR, 0.146; 95% CI, 0.050-0.424; P < 0.001) during the median observation of 3.5 (interquartile range, 1.9-6.6) years. The SVR group had significantly lower risk of HCC than the untreated group among patients with intermediate-probability (n = 492: aHR, 0.171; 95% CI, 0.051-0.578; P = 0.004) and high-probability (n = 446: aHR, 0.243; 95% CI, 0.107-0.551; P < 0.001) of significant fibrosis. HRs were maintained after balancing with inverse probability weighting. SVR was associated with reduced risk of HCC development and all-cause mortality in patients with chronic hepatitis C.
PubMed IF 4.9 소화기내과
1882018

제1저자 이지현 · 교신저자 강시혁

, , , , , , , , , ,
Blood Pressure Control and Cardiovascular Outcomes: Real-world Implications of the 2017 ACC/AHA Hypertension Guideline.
Sci Rep. 2018;8(1):13155.

Abstract
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline lowered the threshold defining hypertension and treatment target from 140/90 mmHg to 130/80 mmHg. We compared the 2017 ACC/AHA guideline and the Eighth Joint National Committee (JNC8) report with regard to the current status of hypertension using the Korean National Health and Nutrition Examination Survey. The association between blood pressure (BP) control and long-term major cardiovascular outcomes (MACEs) was analyzed using the Korea National Health Insurance Service cohort. In the cross-sectional study with 15,784 adults, the prevalence of hypertension was expected to be 49.2 ± 0.6% based on the definition suggested by the 2017 ACC/AHA guideline versus 30.4 ± 0.6% based on the JNC8 report. In a longitudinal analysis with 373,800 hypertensive adults for the median follow-up periods of 11.0 years, the adults meeting the target goal BP goal of 2017 ACC/AHA guideline were associated with 21% reduced risk of MACEs compared with adults, not meeting 2017 ACC/AHA BP goal but meeting JNC8 target goal. In conclusion, substantial increase of prevalence of hypertension is expected by the 2017 ACC/AHA guideline. This study also suggests endorsing the aggressive approach would lead to an improvement in cardiovascular care.
PubMed IF 4.9 순환기내과
1872018

제1저자 박흥우 · 교신저자 박흥우

, , , , , , , ,
The Fas Signaling Pathway Is a Common Genetic Risk Factor for Severe Cutaneous Drug Adverse Reactions Across Diverse Drugs.
Allergy Asthma Immunol Res. 2018;10(5):555-561.

Abstract
PURPOSE Human leukocyte antigen (HLA) has been recognized as the most important genetic risk factor for severe cutaneous adverse drug reactions (SCARs) caused by certain drugs. However, cumulated observations suggest the presence of genetic risk factors for SCARs other than drug-specific HLA. We aimed to identify a common genetic risk factor of SCARs across multiple drugs.
METHODS We performed 2 independent genome-wide association studies (GWASs). A total of 68 and 38 subjects with a diagnosis of SCAR were enrolled in each GWAS. Their allele frequencies were compared to those of healthy subjects in Korea.
RESULTS No single nucleotide polymorphism (SNP) with genome-wide significance was found in either GWAS. We next selected and annotated the 200 top-ranked SNPs from each GWAS. These 2 sets of annotated genes were then entered into the web interface of ConsensusPathDB for a pathway-level analysis. The Fas signaling pathway was significantly over-represented in each gene set from the 2 GWASs.
CONCLUSIONS Our observations suggest that the Fas signaling pathway may be a common genetic risk factor for SCARs across multiple drugs.
PubMed IF 4.3 알레르기내과
1862018

제1저자 이승표 · 교신저자 Marco Perez

, , , , , , , , , , , , , ,
Incident Atrial Fibrillation Is Associated With MYH7 Sarcomeric Gene Variation in Hypertrophic Cardiomyopathy.
Circ Heart Fail. 2018;11(9):e005191.

Abstract
Background Although atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM) patients, the relationship between genetic variation and AF has been poorly defined. Characterizing genetic subtypes of HCM and their associations with AF may help to improve personalized medical care. We aimed to investigate the link between sarcomeric gene variation and incident AF in HCM patients. Methods and Results Patients from the multinational Sarcomeric Human Cardiomyopathy Registry were followed for incident AF. Those with likely pathogenic or pathogenic variants in sarcomeric genes were included. The AF incidence was ascertained by review of medical records and electrocardiograms at each investigative site. One thousand forty adult HCM patients, without baseline AF and with likely pathogenic or pathogenic variation in either MYH7 (n=296), MYBPC3 (n=659), or thin filament genes (n=85), were included. Compared with patients with variation in other sarcomeric genes, those with MYH7 variants were younger on first clinical encounter at the Sarcomeric Human Cardiomyopathy Registry site and more likely to be probands than the MYBPC3 variants. During an average follow-up of 7.2 years, 198 incident AF events occurred. Patients with likely pathogenic or pathogenic mutations in MYH7 had the highest incidence of AF after adjusting for age, sex, proband status, left atrial size, maximal wall thickness, and peak pressure gradient (hazard ratio, 1.7; 95% CI, 1.1-2.6; P=0.009). Conclusions During a mean follow-up of 7.2 years, new-onset AF developed in 19% of HCM patients with sarcomeric mutations. Compared with other sarcomeric genes, patients with likely pathogenic or pathogenic variation in MYH7 had a higher rate of incident AF independent of clinical and echocardiographic factors.
PubMed IF 8.3 순환기내과

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