SCI 발표논문

1. 2752020

   제1저자 김학령 · 교신저자 조상호

   Kim HL, Jo SH, Kim HJ, Lee MH, Seo WW, Baek SH

   Sex differences in clinical characteristics and long-term outcomes in patients with vasospastic angina: results from the VA-Korea registry, a prospective multi-center cohort.

   Biol Sex Differ. 2020;11(1):66.

   Abstract

   BACKGROUND Sex differences in clinical characteristics and prognosis of vasospastic angina (VA) have not been well elucidated. This study was performed to investigate sex-specific characteristics and predictors for long-term clinical outcomes in patients with VA.

   METHODS We analyzed 1838 patients (55 years and 62% male) who were diagnosed with definite (n = 680) or intermediate (n = 1212) VA in ergonovine provocation test from a nation-wide VA registry. The primary study end-point was composite events including cardiac death, acute coronary syndrome, ventricular tachycardia or fibrillation, and atrioventricular block during clinical follow-up.

   RESULTS Male patients were younger, and there were more smokers and alcohol drinkers in male patients than in female patients. During the median follow-up period of 760 days (interquartile range, 336-1105 days), there were 73 cases (3.97%) of composite events. There was no sex difference in the occurrence of composite events (log-rank p = 0.649). Concomitant significant (≥ 50%) organic coronary stenosis was associated with worse clinical outcomes in both male (hazard ration [HR], 1.97; 95% confidence interval [CI], 1.01-3.85; p = 0.047) and female (HR, 3.26; 95% CI, 1.07-9.89; p = 0.037) patients. Obesity (body mass index ≥ 25 kg/m²) was associated with better prognosis in female VA patients (HR, 0.22; 95% CI, 0.07-0.68; p = 0.008). Even when only patients with definite diagnosis of VA were considered, there was no significant sex difference in clinical outcomes (log-rank p = 0.876).

   CONCLUSIONS In VA patients, there were several different clinical characteristics according to sex; however, long-term clinical outcome was similar between sexes. Significant organic coronary stenosis in both sexes and low body mass index (< 25 kg/m²) in females were associated with worse prognosis in VA patients.

   PubMed IF 5.3 순환기내과
2. 2742020

   제1저자 강지훈 · 교신저자 김효수

   Kang J, Yun JP, Ki YJ, Lee HS, Han JK, Yang HM, Park KW, Kang HJ, Koo BK, Kim HS

   A New Hemodynamic Index Predicting Paravalvular Regurgitation After TAVR: Dicrotic AR Index.

   JACC Cardiovasc Interv. 2020;13(22):2711-2713.

   PubMed IF 12.7 순환기내과
3. 2732020

   제1저자 강은애, 최혜인 · 교신저자 김주성, 박병순

   Kang EA, Choi HI, Hong SW, Kang S, Jegal HY, Choi EW, Park BS, Kim JS

   Extracellular Vesicles Derived from Kefir Grain Lactobacillus Ameliorate Intestinal Inflammation via Regulation of Proinflammatory Pathway and Tight Junction Integrity.

   Biomedicines. 2020;8(11):biomedicines8110522.

   Abstract

   The aim of this study was to demonstrate the anti-inflammatory effect of Lactobacillus kefirgranum PRCC-1301-derived extracellular vesicles (PRCC-1301 EVs) on intestinal inflammation and intestinal barrier function. Human intestinal epithelial cells (IECs) Caco-2 were treated with PRCC-1301 EVs and then stimulated with dextran sulfate sodium (DSS). Real-time RT-PCR revealed that PRCC-1301 EVs inhibited the expression of pro-inflammatory cytokines in Caco-2 cells. PRCC-1301 EVs enhanced intestinal barrier function by maintaining intestinal cell integrity and the tight junction. Loss of Zo-1, claudin-1, and occludin in Caco-2 cells and the colitis tissues was recovered after PRCC-1301 EVs treatment, as evidenced by immunofluorescence analysis. Acute murine colitis was induced using 4% DSS and chronic colitis was generated in piroxicam-treated IL-10^-/- mice. PRCC-1301 EVs attenuated body weight loss, colon shortening, and histological damage in acute and chronic colitis models in mice. Immunohistochemistry revealed that phosphorylated NF-κB p65 and IκBα were reduced in the colon tissue sections treated with PRCC-1301 EVs. Our results suggest that PRCC-1301 EVs may have an anti-inflammatory effect on colitis by inhibiting the NF-κB pathway and improving intestinal barrier function.

   PubMed IF 4.5 소화기내과
4. 2722020

   제1저자 박세훈, 한경도 · 교신저자 김동기

   Park S, Han K, Lee S, Kim Y, Lee Y, Kang MW, Park S, Kim YC, Han SS, Lee H, Lee JP, Joo KW, Lim CS, Kim YS, Kim DK

   Association Between Moderate-to-Vigorous Physical Activity and the Risk of Major Adverse Cardiovascular Events or Mortality in People With Various Metabolic Syndrome Status: A Nationwide Population-Based Cohort Study Including 6 Million People.

   J Am Heart Assoc. 2020;9(22):e016806.

   Abstract

   Background A population-scale evidence for the association between moderate-to-vigorous physical activity (MV-PA) and risks of major adverse cardiovascular event (MACE) or all-cause mortality in people with various metabolic syndrome (MetS) status is warranted. Methods and Results We performed a nationwide retrospective cohort study based on the claims database of South Korea. We included people who received ≥3 national health screenings from 2009 to 2013 without a previous MACE history. We determined the MetS status of 6 108 077 people: MetS-chronic (N=864 063), MetS-developed (N=348 163), MetS-recovery (N=348 313), and MetS-free (N=4 547 538). The exposure was self-reported MV-PA frequencies. The outcome was incident MACEs or all-cause mortality. The incidence rate ratios (IRR) were calculated with adjustments for clinical/demographic characteristics. During the median follow-up of 4.28 years, 78 770 and 51 840 people experienced MACEs or died, respectively. Those who engaged in MV-PA had a significantly lower risk of MACEs or all-cause mortality than those not engaged in MV-PA in every spectrum of MetS. Even among those who were free from MetS (for MACEs, IRR 0.94 [0.92-0.97], for all-cause mortality, IRR 0.85 [0.82-0.87]) or who had already recovered from MetS (for MACEs, IRR 0.89 [0.84-0.95], for all-cause mortality, IRR 0.74 [0.68-0.81]), 1 to 2 days per week of MV-PA were significantly associated with lower risk of the adverse outcomes when compared with not being engaged in MV-PA. Those who were engaged in MV-PA more frequently also had significantly lower risks of MACEs or all-cause mortality. Conclusions This nationwide study suggests that MV-PA may be recommended to the general population regardless of recent MetS status.

   PubMed IF 6 신장내과
5. 2712020

   제1저자 전유경 · 교신저자 고성준, 김지원

   Jun YK, Kwon SH, Yoon HT, Park H, Soh H, Lee HJ, Im JP, Kim JS, Kim JW, Koh SJ

   Toll-like receptor 4 regulates intestinal fibrosis via cytokine expression and epithelial-mesenchymal transition.

   Sci Rep. 2020;10(1):19867.

   Abstract

   Intestinal fibrosis induced by chronic and recurrent colitis, which is exacerbated by bowel stenosis, stricture, and obstruction, is challenging to treat. Toll-like receptor 4 (TLR4) stimulates innate and acquired immunity in response to specific microbial components, but the role of TLR4 in intestinal fibrosis is largely unknown. We investigated its role in intestinal fibrosis using not only a murine fibrosis model but also human myofibroblasts and intestinal epithelial cells. Colon fibrosis was induced in TLR4-deficient (TLR4^-/-) mice and its wild-type counterparts with 3% dextran sulfate sodium. Absence of TLR4 gene attenuated chronic inflammation and colonic macrophages infiltration; intestinal fibrosis and collagen deposition were suppressed. Also, the production of tumor necrosis factor-α, interleukin-12p40, and transforming growth factor-β was reduced in TLR4-deficient peritoneal macrophages. TLR4 was silenced in CCD-18Co cells by small interfering RNA (siRNA), and matrix metalloproteinase-1, tissue inhibitor of metalloproteinase, and collagen α1 expression was evaluated. Role of TLR4 in epithelial-mesenchymal transition (EMT) was evaluated in HCT116 cells. Suppression of TLR4 transcription by siRNAs affected myofibroblasts activity, collagen synthesis, and EMT in the human cancer cell line. Thus, we suggest that TLR4 can be an essential mediator in intestinal chronic inflammation and fibrosis, indicating that TLR4 signaling is a potential therapeutic target for intestinal fibrosis.

   PubMed IF 4.9 소화기내과
6. 2702020

   제1저자 장은선 · 교신저자 정숙향

   Jang ES, Kim KA, Kim YS, Kim IH, Lee BS, Lee YJ, Chung WJ, Jeong SH

   Real-Life Effectiveness and Safety of Sofosbuvir-Based Therapy in Genotype 2 Chronic Hepatitis C Patients in South Korea, with Emphasis on the Ribavirin Dose.

   Gut Liver. 2020;14(6):775-782.

   Abstract

   BACKGROUND/AIMS Sofosbuvir (SOF)-based therapy has been used in Korean patients with chronic hepatitis C virus (HCV) infection since January 2016. This study aimed to investigate the real-life effectiveness and safety of SOF-based therapy in genotype 2 HCV infection.

   METHODS From January to December 2016, 458 genotype 2 HCV-infected patients who received ≥1 dose of SOF-based therapy were consecutively enrolled in seven tertiary hospitals. Sustained virologic response (SVR) rates and safety were determined by intention- to-treat (ITT) and per-protocol (PP) analyses.

   RESULTS The mean age of the patients was 61.0 years; 183 (40%) were male, and 13.1% showed a high viral load (>6,000,000 IU/ mL). Among the 378 treatment-naïve patients, the SVR rates were 94.2% (ITT) and 96.7% (PP). Among the 80 treatmentexperienced patients, the SVR rates were 96.3% (ITT) and 98.7% (PP). Patients with a relatively high fibrosis-4 index score (>3.25) had similar SVR rates to those with a relatively low score (p=0.756). A total of 314 patients (68.6%) were treated with a reduced ribavirin dose at the prescriber's discretion, but they showed similar SVR rates to those treated with the weight-based dose (ITT: 95.5% and 92.3%, PP: 97.4% and 96.3%, respectively). Adverse events were observed in 191 patients (41.7%), including 86 (18.8%) with anemia, but only one (0.2%) discontinued antiviral therapy due to nausea.

   CONCLUSIONS SOF-based therapy showed high real-life efficacy and tolerability in Korean patients with genotype 2 chronic HCV infection, regardless of previous antiviral treatment experience and fibrosis score. A reduced ribavirin dose can be considered in this patient cohort.

   PubMed IF 4.1 소화기내과
7. 2692020

   제1저자 최광현 · 교신저자 정숙향

   Choi GH, Jang ES, Kim JW, Jeong SH

   A Survey of the Knowledge of and Testing Rate for Hepatitis C in the General Population in South Korea.

   Gut Liver. 2020;14(6):808-816.

   Abstract

   BACKGROUND/AIMS To eliminate hepatitis C virus (HCV) infection, improving public knowledge of and access to HCV screening and treatment is essential. The aim of this study was to evaluate the knowledge of and testing rate for HCV and the opinions about the inclusion of the HCV test in the National Health Examination (NHE) among the general population in South Korea.

   METHODS A telephone interview survey was conducted by an independent research company using a 16 item-questionnaire (demographics, knowledge of HCV, testing and results, need for screening) in May 2019. The sample population consisted of 1,003 adult Korean residents adjusted by age, sex, and area according to the standard Korean population in 2019.

   RESULTS Among the 1,003 participants (505 women, mean age of 47.9 years), 56.4% recognized HCV; 44.4% understood that HCV is transmittable, and 56.8% thought that HCV is curable by medication. The recognition rate tended to increase with an increasing level of education. Testing for anti-HCV antibodies was reported by 91 people (9.1%); among them, 10 people (11.0%) reported a positive result, and eight people received treatment. The common reasons for HCV testing were a health check-up (58.5%), a physician's recommendation (11.0%) and elevated liver enzyme levels (10.7%). The majority of the population (75.1%) agreed with the integration of HCV into the NHE.

   CONCLUSIONS The level of knowledge of HCV is suboptimal, and the self-reported testing rate for HCV is less than 10%; however, once HCV infection is diagnosed, the treatment rate seems to be high in South Korea. More active campaigns and effective screening are needed.

   PubMed IF 4.1 소화기내과
8. 2682020

   제1저자 김희진 · 교신저자 김나영, 이옥재

   Kim HJ, Kim N, Park JH, Choi S, Shin CM, Lee OJ

   Helicobacter pylori Eradication Induced Constant Decrease in Interleukin- 1B Expression over More Than 5 Years in Patients with Gastric Cancer and Dysplasia.

   Gut Liver. 2020;14(6):735-745.

   Abstract

   BACKGROUND/AIMS Helicobacter pylori (Hp) suppresses gastric acid secretion by repressing the expression of the H⁺, K⁺-adenosine triphosphatase (H⁺, K⁺-ATPase) and stimulating interleukin-1 (IL-1β; encoded by IL-1B). This study was aimed at evaluating the expression of the H⁺, K⁺-ATPase and IL-1β after Hp eradication.

   METHODS Two hundred twentyone subjects were categorized as Hp-negative (n=84) or Hppositive (n=137) according to the results of Hp tests (histology, CLO test, culturing, and serology). The mRNA expression levels of IL-1B and ATP4A (the gene encoding the α-subunit of H⁺, K⁺-ATPase) were measured in biopsy specimens from the gastric corpus using real-time polymerase chain reaction.

   RESULTS The Hp-positive group had significantly higher IL-1B mRNA levels than the whole Hp-negative group and the intestinal metaplasia (IM)-negative subgroup. After Hp eradication, the difference between the Hp-negative and Hperadicated groups disappeared, including in the IM-negative subgroup. The IL-1B mRNA level did not significantly change from the baseline level. Within the gastric cancer (GC)/dysplasia subgroup, the IL-1B mRNA levels at 1, 2, 3-4, and ≥5 years after Hp eradication were significantly lower than the baseline level. The difference in ATP4A mRNA levels between the Hp-negative and Hp-positive groups was not significant at baseline, and the changes in the ATP4A mRNA levels after Hp eradication compared to the baseline levels in the whole group and subgroups stratified by the presence of IM and GC/dysplasia were not significant.

   CONCLUSIONS Infection with Hp has an effect on the level of IL-1B mRNA in IM-negative subjects. The continuous reduction in the IL-1B mRNA level in patients with GC/dysplasia after Hp eradication contributes to the prevention of metachronous GC after Hp eradication.

   PubMed IF 4.1 소화기내과
9. 2672020

   제1저자 김연욱 · 교신저자 이춘택

   Kim YW, Kang HR, Kwon BS, Lim SY, Lee YJ, Park JS, Cho YJ, Yoon HI, Lee KW, Lee JH, Lee CT

   Low-dose chest computed tomographic screening and invasive diagnosis of pulmonary nodules for lung cancer in never-smokers.

   Eur Respir J. 2020;56(5):13993003.00177-2020.

   Abstract

   BACKGROUND Although lung cancer screening using low-dose computed tomography (LDCT) is now widely used in clinical practice, the characteristics and outcomes of diagnostic procedures related to screen-detected nodules in never-smokers remain unclear. We aimed to determine the incidence of nodules considered for invasive biopsy and evaluate the final diagnoses and procedure-related complications in never-smokers in comparison to ever-smokers who underwent LDCT screening.

   METHODS We evaluated 37 436 asymptomatic adults (17 968 never-smokers and 19 468 ever-smokers) who underwent LDCT screening for lung cancer between January 2009 and December 2018 at a tertiary centre in South Korea. The rates of invasive diagnostic procedures for detected nodules and related complications, and the diagnostic outcomes were determined in the never-smoker and ever-smoker groups.

   RESULTS Among the never-smokers, 2908 (16.2%) out of 17 968 had positive nodules. Overall, 139 (0.77%) out of 17 968 never-smokers and 194 (1.00%) out of 19 468 ever-smokers underwent invasive biopsy (p=0.022). Lung cancer was diagnosed in 84 (0.47%) out of 17 968 never-smokers and 123 (0.63%) out of 19 468 ever-smokers (p=0.032). The proportions of participants diagnosed with benign disease after invasive biopsy (false-positive) were 50 (0.28%) out of 17 968 and 69 (0.35%) out of 19 468 in the never-smoker and ever-smoker groups, respectively (p=0.191). Multivariate analyses revealed no significant associations of smoking with the risk of a false-positive diagnosis (OR 0.98, 95% CI 0.62-1.57) and complications (OR 1.33, 95% CI 0.65-3.73) after biopsy. Of the 84 never-smokers with lung cancer, 82 (97.6%) had adenocarcinoma, and 75 (89.3%) were in stage I with a favourable prognosis.

   CONCLUSIONS LDCT screening in never-smokers resulted in a notable detection rate of lung nodules, which warranted invasive biopsy. The lung cancer detection rate was lower in never-smokers than in ever-smokers. However, no significant differences in the false-positive and complication rates were observed between the two groups. Accordingly, a more specifically tailored management strategy is needed for screen-detected nodules in Asian never-smokers.

   PubMed IF 23.8 호흡기내과
10. 2662020

    제1저자 곽낙원 · 교신저자 임재준

    Kwak N, Lee JH, Kim HJ, Kim SA, Yim JJ

    New-onset nontuberculous mycobacterial pulmonary disease in bronchiectasis: tracking the clinical and radiographic changes.

    BMC Pulm Med. 2020;20(1):293.

    Abstract

    BACKGROUND The close association between bronchiectasis and nontuberculous mycobacterial pulmonary disease (NTM-PD) is well-known. However, the clinical impact of subsequent new-onset NTM-PD in bronchiectasis patients has not been elucidated. The aim of this study is to investigate the clinical courses and radiographic changes of patients with bronchiectasis in whom NTM-PD subsequently developed.

    METHODS A total of 221 patients with bronchiectasis who had participated in a non-NTM bronchiectasis cohort between July 1st 2011 and August 31st 2019 at Seoul National University Hospital were included in this study. The data of patients in whom NTM-PD developed during this observation period were analyzed; specifically, changes in the Bronchiectasis Severity Index (BSI) and lesions on computerized tomography (CT) scan of the chest arising during the observation period.

    RESULTS During the observation period, NTM was isolated from 35 patients. A total of 31 patients (14.0%) satisfied the diagnostic criteria of NTM-PD. The median time from enrollment in the cohort to the development of subsequent NTM-PD was 37 months (Interquartile range [IQR], 18-78 months). Mycobacterium avium complex was the most common pathogen (80.6%). Twelve patients underwent antibiotic treatment for NTM-PD with a median interval of 20 months (IQR, 13-30) from the time of NTM-PD diagnosis. When NTM-PD developed, the severity and extent of bronchiectasis, cellular bronchiolitis, and the extent of nodules worsened on CT scans, while BSI did not change.

    CONCLUSIONS NTM-PD can develop in previously negative bronchiectasis patients. It is associated with worsening radiographic lesions. Active screening of non-NTM bronchiectasis patients for new-onset NTM infection should be considered, especially if radiographic findings worsen. The BSI is not a reliable predictor of new-onset NTM-PD.

    TRIAL REGISTRATION This study was performed at Seoul National University Hospital ( NCT01616745 ).

    PubMed IF 3.1 호흡기내과
11. 2652020

    제1저자 Camille E Powe · 교신저자 곽수헌

    Powe CE, Kwak SH

    Genetic Studies of Gestational Diabetes and Glucose Metabolism in Pregnancy.

    Curr Diab Rep. 2020;20(12):69.

    Abstract

    PURPOSE OF REVIEW In this review, we summarize studies investigating genetics of gestational diabetes mellitus (GDM) and glucose metabolism in pregnancy. We describe these studies in the context of the larger body of literature on type 2 diabetes (T2D) and glycemic trait genomics.

    RECENT FINDINGS We reviewed 23 genetic association studies for GDM and performed a meta-analysis, which revealed variants at eight T2D loci significantly associated with GDM after the Bonferroni correction. These studies suggest that GDM and T2D share a number of genetic risk loci. Only two unbiased genome-wide association studies (GWASs) have successfully revealed genetic associations for GDM and related glycemic traits in pregnancy. A GWAS for GDM in Korean women identified two loci (near CDKAL1 and MTNR1B) known to be associated with T2D, though the association of the MTNR1B locus with GDM appears to be stronger than that for T2D. A multi-ethnic GWAS for glycemic traits in pregnancy identified two novel loci (near HKDC1 and BACE2) which appear to be associated with post-load glucose and fasting c-peptide specifically in pregnant women. There are ongoing efforts to use this genetic information, in the form of polygenic scores, to predict risk of GDM and postpartum T2D. The body of literature examining genetic associations with GDM is limited, especially when compared to the available literature on T2D and glycemic trait genomics. Additional genetic discovery for glucose metabolism in pregnant women will require larger pregnancy cohorts and international collaborative efforts. Studies on the clinical implications of these findings are also warranted.

    PubMed IF 7.2 내분비대사내과
12. 2642020

    제1저자 강창경, 김항래 · 교신저자 박완범, 김홍빈

    Kang CK, Kim HR, Song KH, Keam B, Choi SJ, Choe PG, Kim ES, Kim NJ, Kim YJ, Park WB, Kim HB, Oh MD

    Cell-Mediated Immunogenicity of Influenza Vaccination in Patients With Cancer Receiving Immune Checkpoint Inhibitors.

    J Infect Dis. 2020;222(11):1902-1909.

    Abstract

    BACKGROUND We assessed cell-mediated immune (CMI) responses of influenza vaccination in patients with cancer receiving immune checkpoint inhibitors (ICIs), which remain elusive.

    METHODS Vaccine-elicited CMI responses in patients receiving ICIs or cytotoxic agents were investigated by flow cytometry. Polyfunctional cells were defined as T cells that express 2 or more of interleukin 2 (IL-2), interleukin 4 (IL-4), interferon gamma (IFN-γ), and CD107a. An adequate CMI response was defined as an increase of polyfunctional T cells against both H1N1 and H3N2 strains.

    RESULTS When comparing ICI (n = 11) and cytotoxic chemotherapy (n = 29) groups, H1N1-specific IL-4 or IFN-γ-expressing CD4+ T cells, IL-2, IL-4, IFN-γ, or CD107a-expressing CD8+ T cells, H3N2-specific IFN-γ-expressing CD4+ T cells, and CD107a-expressing CD8+ T cells were more frequent in the ICI group. Fold changes in polyfunctional H3N2-specific CD4+ (median, 156.0 vs 95.7; P = .005) and CD8+ (155.0 vs 103.4; P = .044) T cells were greater in the ICI group. ICI administration was strongly associated with an adequate CMI response for both CD4+ and CD8+ T cells (P = .003).

    CONCLUSIONS CMI responses following influenza vaccination were stronger in the ICI group than in the cytotoxic chemotherapy group. Influenza vaccination should be strongly recommended in patients with cancer receiving ICIs.

    PubMed IF 4.1 감염내과
13. 2632020

    제1저자 장의진 · 교신저자 김남중

    Chang E, Song KH, Park WB, Bang JH, Kim ES, Park SW, Kim NJ

    The Importance of Proper History Taking: Asking a Fever Pattern in Patients with Vivax Malaria.

    J Korean Med Sci. 2020;35(43):e386.

    Abstract

    Characteristic fever patterns of malarial infection are clues for diagnosis. However, checking fever patterns in febrile patients has been usually missed, and unnecessary tests have been performed. We reviewed electrical medical record to check whether history-taking included questions on fever pattern in febrile patients. Main outcomes were time interval between visit and diagnosis of vivax malaria and proportion of patients who had taken unnecessary tests. Among 134 vivax malarial patients, asking about fever pattern was done in 64 (47.8%). Median time interval between visit and diagnosis was significantly shorter in patients whose fever pattern was asked than those not asked (3.2 hours vs. 18.6 hours; P < 0.001). Unnecessary diagnostic tests were conducted in 27% (17/64) of patients asked about fever pattern and 71% (50/70) in patients not asked (P < 0.001). Proper history-taking can reduce time elapsed for diagnosis and performing unnecessary diagnostic tests in vivax malaria.

    PubMed IF 3.2 감염내과
14. 2622020

    제1저자 이소령 · 교신저자 최의근

    Lee SR, Choi EK, Ahn HJ, Han KD, Oh S, Lip GYH

    Association between clustering of unhealthy lifestyle factors and risk of new-onset atrial fibrillation: a nationwide population-based study.

    Sci Rep. 2020;10(1):19224.

    Abstract

    We aimed to investigate the association between the combination of unhealthy lifestyle and risk of AF. Subjects aged 66 years who underwent health examination from 2009 to 2015 were included. The cohort was divided into 8 groups by the combination of unhealthy lifestyle including current smoking, heavy drinking (> 30 g/day), and lack of regular exercise, and followed up for new-onset AF till December 31, 2017. Among 1,719,401 subjects, 47,334 had incident AF (5.5 per 1000 person-years) during a 5-year mean follow-up period. Lack of regular exercise was the most powerful factor to be associated with a higher risk of AF as a single factor (adjusted hazard ratio 1.11, 95% confidence interval 1.08-1.13). Amongst combinations of two unhealthy lifestyle factors, current smoking with heavy drinking, lack of regular exercise with heavy drinking, and lack of regular exercise with current smoking were associated with a 6%, 15%, and 20% higher risks of AF, respectively. A cluster of three unhealthy lifestyle components was associated with a 22% higher risk of AF. Increased numbers of unhealthy lifestyle factors were associated with a higher risk of incident AF. These findings support the promotion of a healthy lifestyle to lower the risk of new-onset AF.

    PubMed IF 4.9 순환기내과
15. 2612020

    제1저자 곽낙원 · 교신저자 임재준

    Kwak N, Winters N, Campbell JR, Chan ED, Gegia M, Lange C, Lee M, Milanov V, Menzies D, Yim JJ

    Changes in treatment for multidrug-resistant tuberculosis according to national income.

    Eur Respir J. 2020;56(5):13993003.01394-2020.

    Abstract

    The aim of this study was to analyse temporal changes in treatments for and outcomes of multidrug-resistant (MDR)/rifampin-resistant (RR)-tuberculosis (TB) in the context of national economic status.We analysed data collected by the Collaborative Group for the Meta-Analysis of Individual Patient Data in MDR-TB Treatment on MDR/RR-TB patients from 37 countries. The data were stratified by three national income levels (low-/lower-middle, upper-middle and high) and grouped by time of treatment initiation (2001-2003, 2004-2006, 2007-2009, 2010-2012 and 2013-2015). Temporal trends over the study period were analysed. The probability of treatment success in different income groups over time was calculated using generalised linear mixed models with random effects.In total, 9036 patients were included in the analysis. Over the study period, use of group A drugs (levofloxacin/moxifloxacin, bedaquiline and linezolid) recommended by the World Health Organization increased and treatment outcomes improved in all income groups. Between 2001-2003 and 2013-2015, treatment success rates increased from 60% to 78% in low-/lower-middle-income countries, from 40% to 67% in upper-middle-income countries, and from 73% to 81% in high-income countries. In earlier years, the probability of treatment success in upper-middle-income countries was lower than that in low-/lower-middle-income countries, but no difference was observed after 2010. However, high-income countries had persistently higher probability of treatment success compared to upper-middle income countries.Improved treatment outcomes and greater uptake of group A drugs were observed over time for patients with MDR/RR-TB at all income levels. However, treatment outcomes are still unsatisfactory, especially in upper-middle-income countries.

    PubMed IF 23.8 호흡기내과
16. 2602020

    제1저자 문준호, 강명균 · 교신저자 임수

    Moon JH, Kang MK, Choi CE, Min J, Lee HY, Lim S

    Validation of a wearable cuff-less wristwatch-type blood pressure monitoring device.

    Sci Rep. 2020;10(1):19015.

    Abstract

    Ambulatory blood pressure (BP) monitoring is recommended to improve the management of hypertension. Here, we investigated the accuracy of BP estimated using a wearable cuff-less device, InBodyWATCH, compared with BP measured using a manual sphygmomanometer. Thirty-five adults were enrolled (age 57.1 ± 17.9 years). The BP was estimated using InBodyWATCH with an individualized estimation based on a neural network model. Three paired sets of BPs from the two devices were compared using correlation analysis and Bland-Altman plots (n = 105 paired BP readings). The correlations for both systolic and diastolic BP (SBP and DBP) between the two devices were high (r = 0.964 and 0.939, both P < 0.001). The mean difference was 2.2 ± 6.1 mmHg for SBP and -0.2 ± 4.2 mmHg for DBP; these were not significant (P = 0.472 for SBP and P = 0.880 for DBP). The proportions of estimated SBP/DBP obtained from the InBodyWATCH within ± 5 mmHg of manual SBP/DBP were 71.4%/83.8%; within ± 10 mmHg they were 86.7%/98.1%; and within ± 15 mmHg they were 97.1%/99.0%. The estimated BP from this wearable cuff-less device correlated highly with the manual BP and showed good accuracy, suggesting its potential to be used in ambulatory BP monitoring.

    PubMed IF 4.9 내분비대사내과
17. 2592020

    제1저자 김지은 · 교신저자 이하정

    Kim JE, Kim HE, Cho H, Park JI, Kwak MJ, Kim BY, Yang SH, Lee JP, Kim DK, Joo KW, Kim YS, Kim BS, Lee H

    Effect of the similarity of gut microbiota composition between donor and recipient on graft function after living donor kidney transplantation.

    Sci Rep. 2020;10(1):18881.

    Abstract

    Graft outcomes of unrelated donor kidney transplant are comparable with those of related donor kidney transplant despite their genetic distance. This study aimed to identify whether the similarity of donor-recipient gut microbiota composition affects early transplant outcomes. Stool samples from 67 pairs of kidney transplant recipients and donors were collected. Gut microbiota differences between donors and recipients were determined using weighted UniFrac distance. Among the donor-recipient pairs, 30 (44.8%) pairs were related, while 37 (55.2%) were unrelated. The unrelated pairs, especially spousal pairs, had similar microbial composition, and they more frequently shared their meals than related pairs did. The weighted UniFrac distance showed an inverse correlation with the 6-month allograft function (p = 0.034); the correlation was significant in the unrelated pairs (p = 0.003). In the unrelated pairs, the microbial distance showed an excellent accuracy in predicting the estimated glomerular filtration rate of < 60 mL/min/1.73 m² at 6-months post-transplantation and was better than human leukocyte antigen incompatibility and rejection. The incidence of infection within 6 months post-transplantation increased in the recipients having dissimilar microbiota with donors compared to the other recipients. Thus, pre-transplantation microbial similarity in unrelated donors and recipients may be associated with 6-month allograft function.

    PubMed IF 4.9 신장내과
18. 2582020

    제1저자 신수임, 이창훈 · 교신저자 이진우

    Sin S, Lee CH, Choi SM, Han KD, Lee J

    Metabolic Syndrome and Risk of Lung Cancer: An Analysis of Korean National Health Insurance Corporation Database.

    J Clin Endocrinol Metab. 2020;105(11):5899082.

    Abstract

    INTRODUCTION Metabolic syndrome is known to increase the risk of several cancers. However, the association between lung cancer and metabolic syndrome remains unclear. Thus, we investigated the impact of metabolic syndrome on the incidence of lung cancer.

    METHODS This study enrolled participants in a health screening program provided by the Korean National Health Insurance Service between January 2009 and December 2012. The incidence of lung cancer was observed until December 2016. We analyzed the risk of lung cancer according to the presence of metabolic syndrome, metabolic syndrome components, and number of metabolic syndrome components.

    RESULTS During the study, 45 635 new cases of lung cancer were recorded among 9 586 753 participants. The presence of metabolic syndrome and all its components was positively associated with the risk of lung cancer in men after multivariate adjustment (hazard ratio [HR] of metabolic syndrome 1.15; 95% confidence interval [CI], 1.12-1.18). The risk of lung cancer increased with the number of components present. The effect of metabolic syndrome on the increasing risk of lung cancer is may be higher in underweight male ever-smokers than in other participants.

    CONCLUSION Metabolic syndrome was associated with an increased risk of lung cancer in men. Moreover, the higher the number of metabolic syndrome components, the higher the risk of lung cancer.

    PubMed IF 5.4 호흡기내과
19. 2572020

    제1저자 조구영 · 교신저자 조구영

    Cho GY, Hwang IC

    Left Atrial Strain Measurement: A New Normal for Diastolic Assessment?

    JACC Cardiovasc Imaging. 2020;13(11):2327-2329.

    PubMed IF 19 순환기내과
20. 2562020

    제1저자 장범섭, 차명진 · 교신저자 장지현

    Jang BS, Cha MJ, Kim HJ, Oh S, Wu HG, Kim E, Kim BH, Kim JS, Chang JH

    Heart substructural dosimetric parameters and risk of cardiac events after definitive chemoradiotherapy for stage III non-small cell lung cancer.

    Radiother Oncol. 2020;152:126-132.

    Abstract

    INTRODUCTION We evaluated the incidence of cardiac events after chemoradiotherapy in patients with stage III non-small cell lung cancer (NSCLC) based on baseline cardiovascular risk and the heart substructures' radiation dose.

    METHODS From 2008 to 2018, the cardiac events of 258 patients with stage III NSCLC who received definitive chemoradiotherapy were reviewed. The 10-year cardiovascular risk was calculated using the Atherosclerotic Cardiovascular Disease (ASCVD) scoring system. Dose-volume histograms were estimated for each cardiac chamber. A multivariate competing-risk regression analysis was conducted to assess each cardiac event's subhazard function (SHR).

    RESULTS The median follow-up was 27.5 months overall and 38.9 months for survivors. Among the 179 deaths, none was definitely related to cardiac conditions. Altogether, 32 cardiovascular events affected 27 patients (10.5%) after chemoradiotherapy. Ten were major cardiac adverse events, including heart failure (N = 6) and acute coronary syndrome (ACS, N = 4). Most cardiovascular events were related to well-known risk factors. However, the volume percentage of the left ventricle (LV) receiving 60 Gy (LV V60) > 0 was significantly associated with ACS (SHR = 9.49, 95% CI = 1.28-70.53, P = 0.028). In patients with high cardiovascular risk (ASCVD score > 7.5%), LV V60 > 0% remained a negative ACS prognostic factor (P = 0.003). Meanwhile, in patients with low cardiovascular risk, the LV radiation dose was not associated with ACS events (P = 0.242).

    CONCLUSIONS A high LV radiation dose could increase ACS events in patients with stage III NSCLC and high cardiovascular risk. Pre-treatment cardiac risk evaluation and individualized surveillance may help prevent cardiac events after chemoradiotherapy.

    PubMed IF 5.8 순환기내과
21. 2552020

    제1저자 구보경 · 교신저자 김원

    Koo BK, An JN, Joo SK, Kim D, Lee S, Bae JM, Park JH, Kim JH, Chang MS, Kim W

    Association Between a Polymorphism in MBOAT7 and Chronic Kidney Disease in Patients With Biopsy-Confirmed Nonalcoholic Fatty Liver Disease.

    Clin Gastroenterol Hepatol. 2020;18(12):2837-2839.e2.

    Abstract

    Nonalcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) share risk factors, and recent meta-analysis confirmed that NAFLD is an independent risk factor for incident CKD.¹ Genetic variants associated with NAFLD, such as patatin-like phospholipase domain-containing-3 (PNPLA3) rs738409² and transmembrane 6 superfamily member 2 (TM6SF2) rs5854292,² have been reported to be associated with renal function in NAFLD subjects.

    PubMed IF 16.2 소화기내과
22. 2542020

    제1저자 권순일, 이소령 · 교신저자 최의근

    Kwon S, Lee SR, Choi EK, Choe WS, Lee E, Jung JH, Han KD, Oh S, Lip GYH

    Non-vitamin K antagonist oral anticoagulants in very elderly east Asians with atrial fibrillation: A nationwide population-based study.

    Am Heart J. 2020;229:81-91.

    Abstract

    BACKGROUND The evidence of effectiveness and safety of the non-vitamin K antagonist oral anticoagulants (NOACs) among elderly East Asians is limited.

    OBJECTIVES We aimed to describe the effectiveness and safety outcomes associated with NOACs and warfarin among elderly Koreans aged ≥80 years.

    METHODS Using the Korean Health Insurance Review and Assessment service database, patients with atrial fibrillation (AF) who were naïve to index oral anticoagulant between 2015 and 2017 were included in this study (20,573 for NOACs and 4086 for warfarin). Two treatment groups were balanced using the inverse probability of treatment weighting (IPTW) method. The clinical outcomes including ischemic stroke, major bleeding including intracranial hemorrhage (ICH) and gastrointestinal bleeding (GIB), and a composite of these outcomes were evaluated.

    RESULTS Compared to warfarin, NOACs were associated with lower risks of ischemic stroke (hazard ratio 0.74 [95% confidence interval 0.62-0.89]), and composite outcome (0.78 [0.69-0.90]). NOACs showed nonsignificant trends towards to lower risks of GIB and major bleeding than warfarin. The risk of ICH of NOAC group was comparable with the warfarin group. Among NOACs, apixaban and edoxaban showed better composite outcomes than warfarin. Among the clinical outcomes, only ischemic stroke and the composite outcome had a significant interaction with age subgroups (80-89 years and ≥90 years, P-for-interaction = .097 and .040, respectively).

    CONCLUSION NOACs were associated with lower risks of ischemic stroke and the composite outcome (ischemic stroke and major bleeding) compared to warfarin in elderly East Asians. Physicians should be more confident in prescribing NOACs to elderly East Asians with AF.

    PubMed IF 3.4 순환기내과
23. 2532020

    제1저자 최용훈 · 교신저자 김나영

    Choi Y, Kim N, Yun CY, Choi YJ, Yoon H, Shin CM, Park YS, Ahn SH, Joong Park D, Lee HS, Kim JW, Kim JW, Lee KW, Chang W, Park JH, Lee YJ, Lee KH, Kim YH, Lee DH, Kim HH

    Effect of Helicobacter pylori eradication after subtotal gastrectomy on the survival rate of patients with gastric cancer: follow-up for up to 15 years.

    Gastric Cancer. 2020;23(6):1051-1063.

    Abstract

    OBJECTIVE Helicobacter pylori (HP) is known to play an important role in the development of gastric cancer (GC). The aim of this study was to analyze the effect of HP eradication on the survival rate and cancer recurrence in patients who underwent subtotal gastrectomy for GC.

    DESIGN Totally 1,031 patients diagnosed with gastric adenocarcinoma who received surgical treatment at the Seoul National University Bundang Hospital from 2003 to 2017 and positive for HP infection were analyzed. The overall and GC-related survival according to HP eradication were compared; risk factors for GC-specific death and cancer recurrence were analyzed, and propensity score matching (PSM) was performed.

    RESULTS Statistically significant benefits of overall and GC-specific survival were observed in the eradicated group compared to the non-eradicated group (P < 0.001), and these benefits were maintained after PSM (P < 0.001) in both of early and advance stage. In Cox proportional hazards multivariate analyses, cancer stage (stage II, adjusted hazard ratio [aHR] = 9.33, P < 0.001; stage III or IV, aHR = 26.17, P < 0.001), and HP positivity (aHR = 3.41, P = 0.001) were independent risk factors for GC-specific death; cancer stage (cancer stage II, aHR = 7.08, P < 0.001; cancer stage III or IV, aHR = 19.64, P < 0.001) and HP positivity (aHR = 2.70; P = 0.005) were independent risk factors for cancer recurrence.

    CONCLUSION Our results suggest that HP needed to be conducted more intensively in patients who are surgically treated for GC, regardless of cancer stage.

    PubMed IF 6.1 소화기내과
24. 2522020

    제1저자 박준빈 · 교신저자 김형관

    Park JB, Kim DH, Lee H, Hwang IC, Yoon YE, Park HE, Choi SY, Kim YJ, Cho GY, Han K, Ommen SR, Kim HK

    Obesity and metabolic health status are determinants for the clinical expression of hypertrophic cardiomyopathy.

    Eur J Prev Cardiol. 2020;27(17):1849-1857.

    Abstract

    AIMS We sought to investigate the association of obesity and metabolic health status with the incidence of clinical hypertrophic cardiomyopathy (HCM) diagnosis in the general population. Our goal was to identify modifiable risk factors to attenuate clinical expression of HCM, enabling management evolution from a mostly passive strategy of risk stratification to a proactive strategy of modifying disease expression.

    METHODS Using nationwide population-based data from the Korean National Health Insurance Service, 28,679,891 people who were free of prevalent HCM and who underwent health examinations between 2009 and 2015 were followed until 31 December 2016. The primary outcome was clinical HCM that was defined as incident diagnosis of HCM during the follow-up, after a blanking period of 12 months.

    RESULTS Over a median follow-up of 5.2 years, 0.027% (n = 7851) of the study participants were diagnosed as incident HCM. The incidence rate per 1000 person-years was 0.059. A significant association was found between body mass index (BMI) and the incidence of clinical HCM after multivariate adjustment, with a hazard ratio per 1 kg/m² increase in BMI of 1.063 (95% confidence interval 1.051-1.075). Metabolically unhealthy participants had a greater incidence of HCM than metabolically healthy participants, regardless of obesity status. The effect of BMI was more pronounced in several subgroups, including participants with no hypertension, those aged less than 65 years and men.

    CONCLUSION We found that individuals with obesity and/or metabolic abnormalities had a significantly higher incidence of clinical HCM diagnosis than their counterparts. Efforts to manage obesity and metabolic abnormalities may be important in modifying clinical expression of HCM.

    PubMed IF 10 순환기내과
25. 2512020

    제1저자 박세훈, 양승희 · 교신저자 이하정

    Park S, Yang SH, Jeong CW, Moon KC, Kim DK, Joo KW, Kim YS, Lee JW, Lee H

    RNA-Seq profiling of microdissected glomeruli identifies potential biomarkers for human IgA nephropathy.

    Am J Physiol Renal Physiol. 2020;319(5):F809-F821.

    Abstract

    Few studies have examined gene expression changes occurring in the glomeruli of IgA nephropathy (IgAN) using a sensitive transcriptomic profiling method such as RNA sequencing (RNA-Seq). We collected glomeruli from biopsy specimens from patients with IgAN with relatively preserved kidney function (estimated glomerular filtration rate ≥ 60 mL·min^-1·1.73 m^-2 and urine protein-to-creatinine ratio < 3 g/g) and from normal kidney cortexes by hand microdissection and performed RNA-Seq. Differentially expressed genes were identified, and gene ontology term annotation and pathway analysis were performed. Immunohistochemical labeling and primary mesangial cell cultures were performed to confirm the findings of RNA-Seq analysis. Fourteen patients with IgAN and ten controls were included in this study. Glomerulus-specific genes were highly abundant. Principal component analysis showed clear separation between the IgAN and control groups. There were 2,497 differentially expressed genes, of which 1,380 were upregulated and 1,117 were downregulated (false discovery rate < 0.01). The enriched gene ontology terms included motility/migration, protein/vesicle transport, and immune system, and kinase binding was the molecular function overrepresented in IgAN. B cell signaling, chemokine signal transduction, and Fcγ receptor-mediated phagocytosis were the canonical pathways overrepresented. In vitro experiments confirmed that spleen tyrosine kinase (SYK), reported as upregulated in the IgAN transcriptome, was also upregulated in glomeruli from an independent set of patients with IgAN and that treatment with patient-derived IgA1 increased the expression of SYK in mesangial cells. In conclusion, transcriptomic profiling of the IgAN glomerulus provides insights in the intraglomerular pathophysiology of IgAN before it reaches profound kidney dysfunction. SYK may have a pathogenetic role in IgAN.

    PubMed IF 3.6 신장내과
26. 2502020

    제1저자 윤준식, 이효영 · 교신저자 김윤준

    Yoon JS, Lee HY, Chung SW, Kim SW, Chang Y, Lee YB, Cho EJ, Lee JH, Yu SJ, Kim H, Yoon JH, Kim YJ

    Prognostic impact of concurrent nonalcoholic fatty liver disease in patients with chronic hepatitis B-related hepatocellular carcinoma.

    J Gastroenterol Hepatol. 2020;35(11):1960-1968.

    Abstract

    BACKGROUND AND AIM As the prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing globally, patients with both NAFLD and chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC) is also frequently found. This study aimed to investigate the clinical impact of concurrent NAFLD on the prognosis of patients with CHB-related HCC.

    METHODS Patients with CHB-related HCC who underwent surgical resection were consecutively selected from August 2009 to December 2013. The association between histologically proven concurrent NAFLD and clinical outcomes were analyzed. Propensity score (PS) matching was adapted to adjust for baseline characteristics. We also investigated the presence of nonalcoholic steatohepatitis (NASH) among patients with NAFLD and its association with clinical outcomes.

    RESULTS Among 338 CHB-related HCC patients selected, 196 patients (58.0%) were diagnosed with concurrent NAFLD. The median follow-up duration was 74.9 months. The patients with NAFLD tended to have better recurrence-free survival (RFS; log-rank, P = 0.16) and had significantly better overall survival (OS; log-rank, P = 0.004) than those without NAFLD. However, the survival benefit of the concurrent NAFLD was not significant in a multivariable Cox analysis (adjusted hazard ratio, 0.94; 95% confidence interval, 0.51-1.73, P = 0.84) or an analysis after PS matching (log-rank, P = 0.57). Regarding the presence or absence of NASH, no differences in the RFS (log-rank, P = 0.61) and OS (log-rank, P = 0.26) were found.

    CONCLUSIONS Concurrent NAFLD was not associated with both RFS and OS in patients with CHB-related HCC after adjusting for baseline characteristics. Moreover, NAFLD patients with NASH did not have significantly different clinical outcomes compared with NAFLD patients without NASH.

    PubMed IF 3.5 소화기내과
27. 2492020

    제1저자 최윤진 · 교신저자 이동호

    Choi YJ, Lee DH, Han KD

    Association between high fatty liver index and development of colorectal cancer: a nationwide cohort study with 21,592,374 Korean.

    Korean J Intern Med. 2020;35(6):1354-1363.

    Abstract

    BACKGROUND/AIMS In Korea, the incidence of colorectal cancer (CRC) and nonalcoholic fatty liver disease (NAFLD) has increased due to a westernized lifestyle. This study investigated whether a high fatty liver index that reflects NAFLD correlates with CRC.

    METHODS Data from the National Health Insurance Corporation 2009 to 2012 were analyzed. NAFLD disease was defined as a fatty liver index > 60 in the absence of alcohol consumption of ≥ 30 g/day.

    RESULTS NAFLD was identified in 2,543,649 (11.8%) of 21,592,374 participants. CRC was identified in 19,785 (0.8%) of participants with NAFLD (fatty liver index ≥ 60) and in 80,871 (0.6%) participants without NAFLD (fatty liver index < 30). Multivariate logistic regression analysis demonstrated an independent association between NAFLD and CRC after adjusting for other confounders (hazard ratio, 1.13; odds ratio, 1.12 to 1.15). In subgroup analyses, fatty liver index ≥ 60 was associated with CRC regardless of body mass index, but the association was more prominent in persons with a normal index. NAFLD, in the absence of diabetes, hypertension, or dyslipidemia, was more highly associated with CRC than when one or more of these conditions are present.

    CONCLUSION CRC should be considered as a possibility in patients with fatty liver index ≥ 60, even in the absence of obesity or other metabolic syndromes.

    PubMed IF 2.2 소화기내과
28. 2482020

    제1저자 Hailian Quan, 오규철 · 교신저자 석승혁, 이해영

    Quan H, Oh GC, Seok SH, Lee HY

    Fimasartan, an angiotensin II receptor antagonist, ameliorates an in vivo zebrafish model of heart failure.

    Korean J Intern Med. 2020;35(6):1400-1410.

    Abstract

    BACKGROUND/AIMS Angiotensin II in the failing heart initially helps to maintain cardiac output and blood pressure, but ultimately accelerates its deterioration. In this study, we established a model of arrhythmia-induced heart failure (HF) in zebrafish and investigated the role of renin-angiotensin-aldosterone system (RAAS) modulation by using an angiotensin II type 1 receptor blocker, fimasartan, through the assessment of cellular and physiologic responses, morbidity, and mortality.

    METHODS HF was induced in zebrafish larvae by exposure to 20 μM terfenadine. Morphologic, physiologic, and functional parameters were assessed in the presence or absence of fimasartan treatment.

    RESULTS Zebrafish exposed to terfenadine showed marked dilatation of the ventricle and reduced systolic function. Treatment with terfenadine was associated with 10-fold higher expression of atrial natriuretic peptide (p < 0.001 vs. vehicle), increased p53 mRNA expression, and chromatin fragmentation in the TUNEL assay, all of which were significantly reduced by fimasartan treatment. Moreover, fimasartan improved fractional shortening (terfenadine + fimasartan 16.9% ± 3.1% vs. terfenadine + vehicle 11.4% ± 5.6%, p < 0.05) and blood flow (terfenadine + fimasartan 479.1 ± 124.1 nL/sec vs. terfenadine + vehicle 273.0 ± 109.0 nL/sec, p < 0.05). Finally, treatment with fimasartan remarkably reduced mortality (terfenadine + fimasartan 36.0% vs. terfenadine + vehicle 96.0%, p < 0.001).

    CONCLUSION Fimasartan effectively protected against the progression of HF in zebrafish by improving hemodynamic indices, which improved survival. A reduction in apoptotic cell death and an improvement in hemodynamics may be the mechanisms behind these effects. Further human studies are warranted to evaluate the possible role of fimasartan in the treatment of HF.

    PubMed IF 2.2 순환기내과
29. 2472020

    제1저자 박세훈 · 교신저자 이하정

    Park S, Kim M, Kim JE, Kim K, Park M, Kim YC, Joo KW, Kim YS, Lee H

    Characteristics of kidney transplantation recipients over time in South Korea.

    Korean J Intern Med. 2020;35(6):1457-1467.

    Abstract

    BACKGROUND/AIMS Detailed nationwide information regarding the recent status and time trends of kidney transplantation (KT) in South Korea is limited.

    METHODS We performed a nationwide, population-based cohort study using the national claims database of Korea. We included KT recipients from 2008 to 2016, and their demographic and clinical characteristics were collected. The prognostic outcome was graft failure consisted of patient death and death-censored graft failure (DCGF).

    RESULTS We studied 14,601 KT recipients with median follow-up duration of 3.96 years. The median age at the time of transplantation consistently increased from the past, and proportion of underlying diabetes mellitus prominently increased, reaching 35.6% in 2016. The preemptive KT accounted for approximately 30% of the total transplantation cases. The recipients showed a 10-year cumulative graft survival rate of 71.8%, consisting of 10-year DCGF free survival of 77.6% and patient survival of 92.8%. Age ≥ 20 and < 30 years, age ≥ 70 years, underlying history of diabetes, non-preemptive transplantation, and poor compliance on tacrolimus and mycophenolic acid were the significant risk factors associated with worse DCGF outcome. The economic cost of KT showed prominently increasing trends, reaching a total insured fee of > 60,000,000$ in 2016. However, the expansion was mainly burdened by the national insurance service but not by the patients.

    CONCLUSION In South Korea, the number of kidney transplantation in elderly or in patients with comorbidities has been increasing. Complex clinical factors were associated with medication compliance and patient prognosis.

    PubMed IF 2.2 신장내과
30. 2462020

    제1저자 박찬순 · 교신저자 이해영

    Park CS, Cho HJ, Choi EK, Lee SE, Kim MS, Kim JJ, Choi JO, Jeon ES, Hwang KK, Chae SC, Baek SH, Kang SM, Yoo B, Choi DJ, Ahn Y, Kim KH, Cho MC, Oh BH, Lee HY

    J-curve relationship between corrected QT interval and mortality in acute heart failure patients.

    Korean J Intern Med. 2020;35(6):1371-1384.

    Abstract

    BACKGROUND/AIMS This study investigated the prognostic power of corrected QT (QTc) interval in patients with acute heart failure (AHF) according to sex.

    METHODS We analyzed multicenter Korean Acute Heart Failure registry with patients with AHF admitted from 2011 to 2014. Among them, we analyzed 4,990 patients who were followed up to 5 years. Regarding QTc interval based on 12 lead electrocardiogram, patients were classified into quartiles according to sex.

    RESULTS During follow-up with median 43.7 months, 2,243 (44.9%) patients died. The relationship between corrected QT interval and all-cause mortality followed a J-curve relationship. In Kaplan-Meier analysis, both sex had lowest mortality in the second QTc quartile. There were significant prognostic differences between the second and the fourth quartiles in male (log-rank p = 0.002), but not in female (log-rank p = 0.338). After adjusting covariates, the third (hazard ratio [HR], 1.185; 95% confidence interval [CI], 1.001 to 1.404; p = 0.049) and the fourth (HR, 1.404; 95% CI, 1.091 to 1.535; p = 0.003) quartiles demonstrated increased risk of mortality compared to the second quartile in male. In female, however, there was no significant difference across quartiles. QTc interval was associated with 5-year all-cause mortality in J-shape with nadir of 440 to 450 ms in male and 470 to 480 ms in female.

    CONCLUSION QTc interval was an independent predictor of overall death in male, but its significance decreased in female. The relationship between QTc interval and all-cause mortality was J-shaped in both sex.

    PubMed IF 2.2 순환기내과

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