SCI 발표논문

1. 752025

   제1저자 양경모, 김규래 · 교신저자 김원, 정원일

   Yang K^*, Kim K^*, Ryu T, Shim YR, Kim HH, Choi SE, Kim MJ, Chung KPS, Lee E, Lee KW, Jeon J, Kim P, Kim YS, Ku T, Jeong H, Nam KT, Lim G, Choi DW, Kim SH, Eun HS, Kim W, Jeong WI

   Binge drinking triggers VGLUT3-mediated glutamate secretion and subsequent hepatic inflammation by activating mGluR5/NOX2 in Kupffer cells.

   Nat Commun. 2025;16(1):5546.

   Abstract

   Glutamate, a crucial player in hepatic amino acid metabolism, has been relatively unexplored in immune cell activation. We show in a study with male mice that hepatic glutamate accumulates in vesicles of perivenous hepatocytes through vesicular glutamate transporter 3 (VGLUT3), regulated by the aryl hydrocarbon receptor upon chronic alcohol intake. Additional binge drinking triggers the exocytosis of glutamate by altering the intracellular Ca²⁺ level, stimulating metabotropic glutamate receptor 5 (mGluR5) and subsequent NADPH oxidase 2 (NOX2)-mediated ROS production in Kupffer cells (KCs). This interaction between hepatocytes and KCs is facilitated by pseudosynapse formation, arising from alcohol-induced ballooning of perivenous hepatocytes. Genetic or pharmacological interference of mGluR5 or NOX2 in KCs alleviates alcohol-related steatohepatitis (ASH). Analysis of patient samples confirmed some of the findings from mice, showing that plasma glutamate concentration and VGLUT3 levels correlate with ASH development. Conclusively, our findings highlight glutamate storage and release in mediating ASH, particularly through the pseudosynapse between hepatocytes and KCs.

   PubMed IF 18.1 소화기내과
2. 742025

   제1저자 양석훈 · 교신저자 구본권

   Yang S, Jung JW, Park SH, Zhang J, Lee K, Hwang D, Lee KS, Na SH, Doh JH, Nam CW, Kim TH, Shin ES, Chun EJ, Choi SY, Kim HK, Hong YJ, Park HJ, Kim SY, Husic M, Lambrechtsen J, Jensen JM, Nørgaard BL, Andreini D, Maurovich-Horvat P, Merkely B, Penicka M, de Bruyne B, Ihdayhid A, Ko B, Tzimas G, Leipsic J, Sanz J, Rabbat MG, Katchi F, Shah M, Tanaka N, Nakazato R, Asano T, Terashima M, Takashima H, Amano T, Sobue Y, Matsuo H, Otake H, Kubo T, Takahata M, Akasaka T, Kido T, Mochizuki T, Yokoi H, Okonogi T, Kawasaki T, Nakao K, Sakamoto T, Yonetsu T, Kakuta T, Yamauchi Y, Taylor CA, Bax JJ, Shaw LJ, Stone PH, Narula J, Koo BK

   Prognostic Time Frame of Plaque and Hemodynamic Characteristics and Integrative Risk Prediction for Acute Coronary Syndrome.

   JACC Cardiovasc Imaging. 2025;18(7):784-795.

   Abstract

   BACKGROUND The relevant time frame for predicting future acute coronary syndrome (ACS) based on coronary lesion characteristics remains uncertain.

   OBJECTIVES The aim of this study was to investigate the association of lesion characteristics with test-to-event time and their prognostic impact on ACS.

   METHODS The EMERALD II (Exploring the Mechanism of Plaque Rupture in Acute Coronary Syndrome Using Coronary CT Angiography and Computational Fluid Dynamics II) study analyzed 351 patients who underwent coronary computed tomography angiography (CTA) and experienced ACS between 1 month and 3 years of follow-up. Lesions identified on coronary CTA were classified as culprit (n = 363) or nonculprit (n = 2,088) on the basis of invasive coronary angiography findings at the time of ACS. Core laboratory coronary CTA analyses assessed 4 domains: degree of stenosis, plaque burden, number of adverse plaque characteristics (APC) (low-attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign), and changes in coronary CTA-derived fractional flow reserve across the lesion (ΔFFR_CT). Patients were categorized into short (<1 year), mid (1-2 years), and long (2-3 years) test-to-event time groups.

   RESULTS Patient characteristics, including cardiovascular risk factors, did not differ across short, mid, and long test-to-event groups (P > 0.05 for all), and the proportion of ACS culprit lesions was similar (P = 0.552). Among culprit lesions, shorter test-to-event time was associated with higher luminal stenosis, plaque burden, and ΔFFR_CT (P for trend < 0.001 for all). The predictability for ACS culprit lesions based on the combined 4 characteristics tended to decrease over time and significantly reduced beyond 2 years (AUC: 0.851 vs 0.741; P = 0.006). In predicting ACS risk within test-to-event time <2 years using obstructive lesions (stenosis ≥ 50%), APC ≥2, plaque burden ≥70%, and ΔFFR_CT ≥0.10, the risk was elevated compared to the average proportion of lesions becoming ACS culprit (12.1%) in the following subsets: lesions with 4 characteristics (proportion of lesions becoming ACS culprit: 49.3%; P < 0.001), lesions with 3 characteristics (obstructive lesions with plaque burden ≥70% and either ΔFFR_CT ≥0.10 [proportion of lesions becoming ACS culprit: 33.0%; P < 0.001] or APC ≥2 [proportion of lesions becoming ACS culprit: 31.2%; P < 0.001]), and lesions with 2 characteristics (plaque burden ≥70% and ΔFFR_CT ≥0.10; proportion of lesions becoming ACS culprit: 21.5%; P = 0.016).

   CONCLUSIONS Increased luminal stenosis, plaque burden, and ΔFFR_CT were associated with shorter test-to-ACS event time. The prognostic impact of lumen, plaque, and local hemodynamic characteristics was most relevant to ACS risk within a 2-year period, with higher risk observed when specific combinations of them were present. (Exploring the Mechanism of Plaque Rupture in Acute Coronary Syndrome Using Coronary CT Angiography and Computational Fluid Dynamics II [EMERALD II] Study; NCT03591328).

   PubMed IF 19 순환기내과
3. 732025

   제1저자 김연욱 · 교신저자 김연욱

   Kim YW, Kim HJ, Kwon BS, Lee YJ, Song MJ, Yoon SH, Lim SY, Lee YJ, Park JS, Cho YJ, Lee KH, Chung JH, Han YB, Maldonado F, Ahn SY, Park Y, Joo DH, Lee JH, Lee CT

   Diagnostic Yield and Synergistic Impact of Needle Aspiration and Forceps Biopsy With Electromagnetic Navigation Bronchoscopy for Peripheral Pulmonary Lesions: A Randomized Controlled Trial.

   Chest. 2025;168(1):236-247.

   Abstract

   BACKGROUND Electromagnetic navigation bronchoscopy (ENB) is an advanced imaging-guided technique used to diagnose peripheral pulmonary lesions. However, the optimal strategy for selecting biopsy devices remains unclear.

   RESEARCH QUESTION Does the combination of needle aspiration and forceps biopsy improve diagnostic yield compared with using a single device alone?

   STUDY DESIGN AND METHODS We conducted a randomized crossover study during ENB performed under moderate sedation. This trial recruited participants with peripheral pulmonary lesions requiring biopsy who were eligible for elective ENB. ENB-guided needle aspiration and forceps biopsy were sequentially performed in a randomized order. The primary outcome was diagnostic yield, defined as the percentage of patients for whom the biopsy provided a specific diagnosis able to inform patient management. The diagnostic yield achieved by each biopsy modality individually and in combination was evaluated.

   RESULTS Between December 1, 2021, and November 13, 2023, 142 participants were enrolled and underwent the study procedures. Complete follow-up data were obtained for 140 participants. Diagnostic yield was 44.4% (63 of 142) for forceps biopsy, 51.4% (73 of 142) for needle aspiration (P = .221 vs forceps), and 66.9% (95 of 142) for the combination (P < .001 vs forceps alone, P < .001 vs needle alone). Sensitivities for malignancy were 47.5% (57 of 120) for forceps biopsy and 58.3% (70 of 120) for needle aspiration (P = .074). The combination of the 2 modalities resulted in a significantly improved sensitivity of 71.7% (86 of 120) compared with either individual modality (P < .001 vs forceps alone and needle alone). Pneumothorax occurred in 3.5% (5 of 142) of patients, and 1.4% (2 of 142) developed pneumothorax requiring tube drainage.

   INTERPRETATION Our results show that when performing ENB under moderate sedation, the combination of needle aspiration and forceps biopsy significantly improves the diagnostic yield and sensitivity for malignancy compared with each modality alone, with a favorable safety profile. These results indicate that a multimodal approach using needles and forceps is a valid diagnostic strategy for ENB.

   CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT05110131; URL: www.

   CLINICALTRIALS gov.

   PubMed IF 9.8 호흡기내과
4. 722025

   제1저자 김지원, 경동수 · 교신저자 이근욱

   Kim JW, Kyung DS, Ko WY, Kim HP, Hwang SH, Kim KJ, Lee JH, Seo J, Kang M, Jung EH, Suh KJ, Kim SH, Kim JW, Kim YJ, Kim JH, Lee KW

   Pairwise analysis of plasma cell-free DNA before and after palliative second-line paclitaxel plus ramucirumab treatment in patients with metastatic gastric cancer.

   Gastric Cancer. 2025;28(4):620-630.

   Abstract

   BACKGROUND This study compared plasma cell-free DNA (cfDNA) and tumor tissue DNA (ttDNA) to explore the clinical applicability of cfDNA in patients with metastatic gastric cancer (mGC) receiving palliative second-line paclitaxel + ramucirumab treatment.

   METHODS Targeted sequencing of 106 genes was conducted using germline DNA and cfDNA at baseline (baseline-cfDNA) and progressive disease (PD-cfDNA). The results were compared with those of ttDNA-based cancer panel data.

   RESULTS Of 76 consecutive patients, 46 (27 males; median age 57.5 [range, 32-73] years) who had all three samples were included. Combined analysis of ttDNA and baseline-cfDNA revealed that TP53 (58.7%) was the most frequently mutated gene, followed by CDH1 (26.1%), KRAS (21.7%), and APC (13.0%). For these genes, the sensitivity and positive predictive value of baseline-cfDNA over ttDNA were 71.8% and 51.9%, respectively. When baseline-cfDNA and PD-cfDNA results were combined, 34 patients (73.9%) were found to have additional mutations compared with ttDNA results alone. PD-cfDNA analysis revealed 14 novel pathogenic mutations in ten patients (21.7%). At baseline, patients with a high circulating tumor DNA fraction concentration showed a significantly shorter progression-free survival (PFS) (P = 0.016) in univariable and multivariable analyses. High maximal variant allele frequency (VAF) (P = 0.022), high sum of VAF (P = 0.028), and high TP53 VAF (P = 0.022) were associated with worse PFS in univariable analysis.

   CONCLUSIONS Although cfDNA alone cannot replace ttDNA entirely, cfDNA analysis revealed additional mutations. Notably, PD-cfDNA analysis revealed novel pathogenic mutations that emerged during treatment. Moreover, the baseline circulating tumor DNA fraction concentration and VAF values were associated with longer PFS.

   PubMed IF 6.1 소화기내과
5. 712025

   제1저자 Bingtian Dong, Ruiling He, Shenghong Ju, Yuping Chen, Ivica Grgurevic, Jianzhong Ma, Ying Guo, Huizhen Fan, and Qiang Yan · 교신저자 김원, Xiaolong Qi

   Dong B, He R, Ju S, Chen Y, Grgurevic I, Ma J, Guo Y, Fan H, Yan Q, Liu C, Xu H, Madir A, Podrug K, Wang J, Qian L, Geng Z, Liu S, Ren T, Zhang G, Wang K, Su M, Chen F, Ma S, Zhang L, Tong Z, Zhou Y, Li X, He F, Huan H, Wang W, Liang Y, Tang J, Ai F, Wang T, Zheng L, Zhao Z, Ji J, Liu W, Xu J, Liu B, Wang X, Zhang Y, Yan Q, Liu H, Chen X, Zhang S, Wang Y, Liu Y, Yin L, Liu Y, Huang Y, Bian L, An P, Zhang X, Zhang S, Shao J, Zhang X, Rao W, Zhang C, Dietrich CF, Kim W, Qi X

   Fibrosis-4plus score: a novel machine learning-based tool for screening high-risk varices in compensated cirrhosis (CHESS2004): an international multicenter study.

   Clin Mol Hepatol. 2025;31(3):881-898.

   Abstract

   BACKGROUND/AIMS A large percentage of patients undergoing esophagogastroduodenoscopy (EGD) screening do not have esophageal varices (EV) or have only small EV. We evaluated a large, international, multicenter cohort to develop a novel score, termed FIB-4plus, by combining the fibrosis-4 (FIB-4) score, liver stiffness measurement (LSM), and spleen stiffness measurement (SSM) to identify high-risk EV (HRV) in compensated cirrhosis.

   METHODS This international cohort study involved patients with compensated cirrhosis from 17 Chinese hospitals and one Croatian institution (NCT04546360). Two-dimensional shear wave elastography-derived LSM and SSM values, and components of the FIB-4 score (i.e., age, aspartate aminotransferase, alanine aminotransferase, and platelet count [PLT]) were combined using machine learning algorithms (logistic regression [LR] and extreme gradient boosting [XGBoost]) to develop the LR-FIB-4plus and XGBoost-FIB-4plus models, respectively. Shapley Additive exPlanations method was used to interpret the model predictions.

   RESULTS We analyzed data from 502 patients with compensated cirrhosis who underwent EGD screening. The XGBoost-FIB-4plus score demonstrated superior predictive performance for HRV, with an area under the receiver operating characteristic curve (AUROC) of 0.927 (95% confidence interval [CI] 0.897-0.957) in the training cohort (n=268), and 0.919 (95% CI 0.843-0.995) and 0.902 (95% CI 0.820-0.984) in the first (n=118) and second (n=82) external validation cohorts, respectively. Additionally, the XGBoost-FIB-4plus score exhibited high AUROC values for predicting EV across all cohorts. The FIB-4plus score outperformed the individual parameters (LSM, SSM, PLT, and FIB-4).

   CONCLUSION The FIB-4plus score effectively predicted EV and HRV in patients with compensated cirrhosis, providing clinicians with a valuable tool for optimizing patient management and outcomes.

   PubMed IF 21.7 소화기내과
6. 702025

   제1저자 임수, 남가은 · 교신저자 Arya M Sharma

   Lim S^*, Nam GE^*, Sharma AM

   Differences between Type 2 Diabetes Mellitus and Obesity Management: Medical, Social, and Public Health Perspectives.

   Diabetes Metab J. 2025;49(4):565-579.

   Abstract

   Obesity and type 2 diabetes mellitus (T2DM) are among the most urgent global public health challenges, yet differ markedly in recognition and management across medical, social, infrastructure, and policy domains. T2DM is supported by clear diagnostic criteria, defined treatment targets, and broad acceptance as a chronic disease. In contrast, obesity is assessed using imprecise metrics like body mass index, lacks standardized treatment goals, and is often misunderstood as a lifestyle issue rather than a chronic, relapsing disease. This misconception contributes to stigma, discrimination, and unrealistic patient expectations. T2DM receives substantial research funding, comprehensive clinical guidelines, and structured medical education, with strong support from large professional societies and multidisciplinary care models. Obesity care remains underfunded, inconsistently delivered, and underrepresented in medical training. Public health and policy efforts strongly favor T2DM, providing coordinated programs, insurance coverage, and regulatory oversight. Conversely, obesity is marginalized, with limited policy influence and a largely unregulated commercial weight-loss industry. Bridging these disparities requires adopting lessons from T2DM management-such as evidence-based guidelines, improved provider training, expanded insurance coverage, and public health strategies-to enhance obesity care and recognize it as a chronic disease requiring long-term, structured management.

   PubMed IF 8.2 내분비대사내과
7. 692025

   제1저자 김선미, 한경도 · 교신저자 최수연

   Kim S^*, Han K^*, Choi SY, Kim MJ, Yang SY, Choi SH, Yim JY, Kim JJ, Kim MJ

   Pregravid Weight Gain Is Associated with an Increased Risk of Gestational Diabetes.

   Diabetes Metab J. 2025;49(4):826-836.

   Abstract

   BACKGRUOUND Studies have reported a significant association between pregravid weight gain and the subsequent development of gestational diabetes mellitus (GDM) in various populations. The current study aims to investigate this relationship using data from the Korean National Health Insurance Service database.

   METHODS We conducted a retrospective nationwide population-based cohort study, involving 159,798 women who gave birth between 2015 and 2017 and had undergone two national health screening examinations: 1 year (index checkup) and 3 years before (baseline checkup) their respective estimated conception date. Participants were categorized into five groups based on the extent of weight change between the two examinations: more than 10%, 5% to 10%, -5% to 5% (reference group), -10% to -5%, and more than -10%. The study assessed the association between pregravid weight change and GDM risk.

   RESULTS Among the 146,363 women analyzed, 11,012 (7.52%) were diagnosed with GDM. Multiple regression analysis revealed that women who gained 5% to 10% of their weight had a 12% increased risk of GDM (adjusted odds ratio [aOR], 1.12; 95% confidence interval [CI], 1.06 to 1.17), while those who gained ≥10% had a 34% higher risk (aOR, 1.34; 95% CI, 1.26 to 1.43). Notably, pregravid weight gain was particularly associated with GDM risk in non-obese or non-metabolic syndrome groups at index checkup.

   CONCLUSION Pregravid weight gain showed a dose-dependent association with a higher risk of GDM. This association was more pronounced in non-obese individuals emphasizing the importance of minimizing pregravid weight gain for GDM prevention, even in non-obese women.

   PubMed IF 8.2 순환기내과
8. 682025

   제1저자 홍성은 · 교신저자 김원, 최무림

   Hong SE, Mun SJ, Lee YJ, Yoo T, Suh KS, Kang KW, Son MJ, Kim W^*, Choi M^*

   Single-cell eQTL analysis identifies genetic variation underlying metabolic dysfunction-associated steatohepatitis.

   Nat Genet. 2025;57(7):1638-1648.

   Abstract

   Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized for its medical and socioeconomic impacts, driven by diverse genetic and environmental factors. Here, to address the urgent need for individually tailored therapies, we show results from single-cell expression quantitative trait locus (sc-eQTL) analysis on liver biopsies from 25 patients with MASLD and 23 controls. This approach identified over 3,500 sc-eQTLs across major liver cell types and cell-state-interacting eQTLs (ieQTLs) with significant enrichment for disease heritability (for MASLD trait, ieQTL enrichment odds ratio 10.27). We integrated transcription factors as upstream regulators of ieQTLs, revealing 601 functional units ('quartets') composed of transcription factors, cell states, SNP components of ieQTL (ieSNPs) and Gene component of ieQTL (ieGenes). From these results, we pinpoint the loss of an eQTL in EFHD1 during hepatocyte maladaptation associated with genotype-specific regulation by FOXO1, further contributing to the risk of MASLD. Our approach underscores the role of eQTL analysis in capturing crucial genetic variations that influence gene expression and clinical outcomes in complex diseases.

   PubMed IF 25.5 소화기내과
9. 672025

   제1저자 전유경 · 교신저자 안소연, 윤혁

   Jun YK, Choi Y, Shin CM, Park YS, Kim N, Lee DH, Ahn S^*, Yoon H^*

   Impact of early aggressive treatment on long-term biochemical marker patterns in inflammatory bowel disease.

   J Gastroenterol. 2025;60(7):854-865.

   Abstract

   BACKGROUNDS The disease course of inflammatory bowel disease (IBD) is highly variable; early and precise identification of patients with poor outcomes is crucial. We aimed to classify the long-term disease course of IBD using biochemical markers and evaluate the clinical factors associated with different disease courses.

   METHODS A latent class mixed model was employed to identify distinct trajectories of C-reactive protein (CRP) and fecal calprotectin (FCP) levels in 256 and 635 patients with Crohn's disease (CD) and ulcerative colitis (UC), respectively, from a tertiary hospital cohort. Multinomial logistic regression was used to evaluate the relationships between various trajectories and clinical variables.

   RESULTS Three trajectories were identified for CD and UC: class 1, early and sustained biochemical remission; class 2, delayed remission; and class 3, prolonged difficulty in achieving remission for > 5 years. For patients with CD, early immunomodulator initiation was associated with a high likelihood of belonging to class 1 in the CRP trajectory analysis, whereas early advanced therapy increased the probability of belonging to class 1 in the FCP trajectory analysis. CRP trajectory analysis showed no significant associations in patients with UC. Younger age at diagnosis and early immunomodulator initiation were associated with higher odds of being in class 2 or 3, whereas current smoking was associated with a high likelihood of being in class 1 in the FCP trajectory analysis.

   CONCLUSIONS Early aggressive medical treatment for CD may lead to long-term biochemical remission, whereas no similar association was observed in UC.

   PubMed IF 5.7 소화기내과
10. 662025

    제1저자 윤영현, 정기영 · 교신저자 고성준, 최형진

    Yun YH, Chung KY, Lee Y, Sung TS, Ko D, Ryoo SB, Kim HY, Park KJ, Im JP, Kim BG, Kim JS, Koh SJ, Choi HJ

    AI-powered 3D pathology protocol enhances enteric nervous system visualization and quantification for clinical diagnostics.

    Theranostics. 2025;15(15):7440-7453.

    Abstract

    Rationale: Accurate diagnosis and understanding of gastrointestinal (GI) diseases such as ulcerative colitis and Hirschsprung's disease remain challenging due to the limitations of traditional two-dimensional (2D) histopathology in capturing the intricate three-dimensional (3D) architecture and dynamic microenvironment of GI tissues. This study explores the potential of integrating 3D imaging techniques with artificial intelligence (AI)-based analysis to improve histological evaluation and diagnostic accuracy. Methods: Using advanced imaging and computational tools, we identified critical structural and functional details of the enteric nervous system and associated tissues that are often missed by 2D approaches. Results: The results showed that 3D imaging coupled with AI significantly improves diagnostic accuracy and provides new insights into disease mechanisms, enabling earlier and more precise detection of pathological changes. In addition, this approach enhances our understanding of the pathophysiology of GI diseases, bridging gaps in both clinical and basic research. Conclusions: These findings underscore the transformative potential of 3D imaging and AI to revolutionize diagnostic workflows and advance our knowledge of GI diseases, ultimately contributing to improved patient outcomes and innovative research methodologies.

    PubMed IF 14.9 소화기내과
11. 652025

    제1저자 류현호, 이소령 · 교신저자 최의근, 한경도

    Ryu H^*, Lee SR^*, Choi EK, Go YH, Lee KY, Choi J, Han S, Kim JH, Ahn HJ, Kwon S, Kim BS, Han KD, Oh S, Lip GYH

    Impact of steatotic liver diseases on diabetes mellitus risk in patients with atrial fibrillation: a nationwide population study.

    Cardiovasc Diabetol. 2025;24(1):242.

    Abstract

    BACKGROUND Atrial fibrillation (AF) frequently coexists with diabetes mellitus (DM), leading to a worse prognosis if both are present. Steatotic liver disease (SLD) may also predispose to DM, but its impact among AF patients is unclear. We aimed to determine whether metabolic dysfunction-associated SLD (MASLD), MASLD with increased alcohol intake (MetALD), or alcohol-related liver disease (ALD) elevates DM risk in AF.

    METHODS Non-diabetic individuals who developed AF between 2010 and 2018 from the Korean National Health Insurance Service database were included. Patients with a fatty liver index (FLI) < 30 were classified as non-SLD, whereas those with FLI ≥ 30 and at least one cardiometabolic risk factors were categorized as MASLD, MetALD, or ALD based on daily alcohol intake. Incident DM hazard ratios (HRs) were estimated with Cox regression models.

    RESULTS Among 195,195 patients (mean age 64.4 ± 13.0 years, 57.5% male); 108,918 (55.8%) in non-SLD, 71,795 (36.8%) in MASLD, 7644 (3.9%) in MetALD, and 6838 (3.5%) in ALD, respectively. Over a mean follow-up of 6.0 ± 2.9 years, 25,632 (13.0%) developed DM. Compared with non-SLD, the adjusted HRs with 95% confidence intervals (CIs) for incident DM were 1.930 (1.879-1.983), 1.789 (1.682-1.904), and 1.932 (1.817-2.054) for MASLD, MetALD, and ALD, respectively. In the age 20-39 years group, adjusted HRs with 95% CIs were 5.844 (4.501-7.587), 5.354 (3.681-7.787), and 7.033 (4.660-10.615), respectively.

    CONCLUSION SLD confers an increased risk of new-onset DM in AF patients, especially in younger adults. Implementing management strategies to prevent DM in AF patients with SLD might mitigate the risk of DM and its potential impact on AF-related outcomes.

    PubMed IF 15.6 순환기내과
12. 642025

    제1저자 이소령 · 교신저자 최의근

    Lee SR, Choi EK, Lee KY, Choi J, Ahn HJ, Kwon S, On YK, Lee JH, Cho Y, Oh IY, Lim HE, Cho MS, Nam GB, Lip GYH, Oh S

    Reduction of AF Burden After Cryoballoon Ablation in Patients With Early Persistent AF: The COOL-PER Trial.

    JACC Clin Electrophysiol. 2025;11(6):1234-1247.

    Abstract

    BACKGROUND Limited data exist on reducing the atrial fibrillation (AF) burden, the regression from persistent to paroxysmal AF, and symptom improvement after cryoablation in patients with persistent AF.

    OBJECTIVES This study sought to evaluate the efficacy of cryoablation in reducing the AF burden, regression to paroxysmal AF, and symptom improvement in patients with early persistent AF.

    METHODS This investigator-initiated, multicenter, and prospective cohort study enrolled the patients with early persistent AF (≤3 years). All patients were inserted an implantable loop recorder at the time of trial entry. AF burden (percentage of time in AF) and actual AF type were evaluated during pre-cryoablation and 12-month follow-up after cryoablation. AF-related symptoms and quality of life were assessed.

    RESULTS A total of 130 patients were enrolled (median age 61 years [Q1-Q3: 54-67 years]; median duration of persistent AF 6 months [Q1-Q3: 4-10 months]). The mean AF burden before cryoablation was 77 ± 34% (25.4% of high-burden paroxysmal AF; 74.6% of implantable loop recorder-confirmed persistent AF), which was reduced to 9 ± 21% after 12-month follow-up (mean 68 ± 37% of AF burden reduction; P < 0.001). Of the total, 38.5% had no recurrence of AF, 43.1% had a recurrence of paroxysmal AF, and 18.5% had a recurrence of persistent AF. Among those with confirmed persistent AF at baseline, 76% of patients showed regression to paroxysmal AF or no recurrence. After cryoablation, 77% of patients improved AF-related symptoms and quality of life as assessed by 36-Item Short Form Survey questionnaires.

    CONCLUSIONS In patients with early persistent AF, cryoablation significantly reduced AF burden and achieved regression of AF type followed by symptom improvement. (Cryoablation for Pulmonary Vein Isolation Alone in Patients with Early Persistent AF Assessed by Continuous Monitoring [COOL-PER]; NCT05507749).

    PubMed IF 7.2 순환기내과
13. 632025

    제1저자 김경민 · 교신저자 임수

    Kim KM, Choi JH, Han B, Hur YI, Son JW, Nam GE, Kang JH, Cho YJ, Kim WJ, Lim S

    Efficacy of phentermine/topiramate extended release in weight management and metabolic profiles: A multicentre study in South Korea.

    Diabetes Obes Metab. 2025;27(6):3252-3261.

    Abstract

    AIMS Clinical trials have demonstrated the effectiveness of the phentermine and topiramate combination in weight management. This research evaluated the efficacy and safety of phentermine/topiramate extended release (ER) for weight management, focusing on alterations in body weight and metabolic parameters in routine clinical practice.

    MATERIALS AND METHODS We retrospectively included people with obesity who initiated phentermine/topiramate ER between January 2020 and April 2023 at 10 tertiary hospitals in South Korea. The study assessed body weight changes at 5-6 months and for those who continued, at 12 months, along with metabolic parameters. Total body weight was measured using calibrated electronic scales with participants in light indoor clothing.

    RESULTS The cohort included 1839 patients (540 men and 1299 women), with a 5-6-month continuation rate of 48%. At 5-6 months, the mean weight reduction was 7.9%, with sex-specific losses of 7.1% in men and 8.2% in women. Over 56% of participants achieved more than 5% weight loss, with 23% exceeding a 10% reduction. Younger participants, women and those with moderate to severe obesity exhibited more pronounced weight loss compared to older men and individuals with mild obesity, respectively. Concurrently, phentermine/topiramate ER treatment improved glucose regulation, lipid profiles and decreased blood pressure: the HbA1c decreased by 0.4 ± 0.9%, low-density lipoprotein (LDL) cholesterol by 10 ± 32 mg/dL and systolic blood pressure by 6 ± 15 mmHg (all p < 0.001). Treatment was well-tolerated, with a 15% incidence of mild adverse events like paresthesia, dry mouth and insomnia. At 12 months, patients who persisted in treatment (21%) experienced an average weight loss of 9.6%, with 65% surpassing a 5% weight loss.

    CONCLUSION The study suggests phentermine/topiramate ER is an effective option for obesity management in a South Korean population, though long-term adherence remains a challenge.

    PubMed IF 6.1 내분비대사내과
14. 622025

    제1저자 이태승, 최진호 · 교신저자 이상협

    Lee TS, Choi JH, Lee JM, Jeon H, Paik WH, Cho KB, Lee YS, Han JH, Joo JS, Jung MK, Lee J, Ahn DW, Park JM, Kim J, Lee JC, Cho EA, Lee SH

    A randomized non-inferiority trial investigating antibiotic adjustments based on blood culture in acute cholangitis.

    Clin Microbiol Infect. 2025;31(6):987-994.

    Abstract

    OBJECTIVES This study evaluated the adequacy of using blood cultures alone for antibiotic therapy in mild-to-moderate acute cholangitis after adequate biliary drainage.

    METHODS A prospective, multi-centre, non-inferiority, randomized trial was conducted from August 2015 to September 2023 across 12 tertiary hospitals in South Korea. Patients were randomly assigned 1:1 to groups. The control group was administered antibiotics based on blood and bile culture results, whereas the experimental group was treated based on blood culture results alone. The primary outcome was the rate of organ failure, assessed by the presence of shock, acute kidney injury, altered mental status, and acute respiratory distress. The secondary outcomes were all-cause mortality, frequency of re-interventions, antibiotic usage duration, and hospital stay. The non-inferiority margin was 10%.

    RESULTS Patients in the control group (n = 215) and experimental group (n = 213) were analysed. Organ failure occurred in 28 (13.0%) in the control and 27 (12.7%) in the experimental group (difference: -0.350% [95% CI, -6.690% to 5.990%], p > 0.999). Mortality rates were 3.3% in the control (seven patients) and 2.3% in the experimental group (five patients) (-0.908% [-4.033% to 2.216%], p 0.782). The reintervention rates were 31 (14.9%) in the control and 26 (12.2%) in the experimental groups (-2.677% [-9.155% to 3.801%], p 0.504). The antibiotic therapy duration was different (-1.500 days [-2.840 to -0.160], p 0.037) between the control (12.8 ± 8.0 days) and the experimental groups (11.3 ± 6.5 days), and the hospital stay was different (-1.900 days [-0.380 to 0.000], p 0.046) between the control (14.1 ± 11.0 days) and the experimental groups (12.2 ± 9.0 days).

    DISCUSSION This study confirms that relying on blood culture results alone for managing mild-to-moderate cholangitis is reasonable and may help reduce the unnecessary use of medical resources.

    PubMed IF 8.7 소화기내과
15. 612025

    제1저자 정광현 · 교신저자 이상협

    Chung KH, Lee SH

    Optimal tissue acquisition method for pancreatic mass.

    Dig Endosc. 2025;37(6):629-637.

    Abstract

    Pancreatic masses pose a diagnostic difficulty due to the technical complexities related to tissue acquisition. Endoscopic ultrasound (EUS)-guided tissue acquisition has transformed the field by allowing access to pancreatic lesions through fine-needle and biopsy. However, diagnostic accuracy differs based on tumor characteristics and procedural factors. This narrative review explores the nuances of tissue acquisition methods for pancreatic tumors, including factors such as tumor location, size, histological characteristics, and needle selection. It assesses the efficacy of different needle designs and maneuvers, including suction techniques and needle passes. Moreover, the diverse tissue preparation methods, including cytological smear, cell block, and direct histology, are discussed, highlighting the importance of tailored approaches based on tumor characteristics. Additionally, the roles of macroscopic on-site evaluation and rapid on-site evaluation in optimizing specimen adequacy are investigated. Furthermore, percutaneous ultrasound-guided biopsy is considered an alternative approach, particularly in settings where EUS is impractical. Additionally, the review emphasizes the emerging trend of using tissue for genetic testing and molecular analysis, requiring high-quality sample acquisition. Future directions in tissue acquisition techniques and their integration into clinical practice are discussed, providing promising avenues for pancreatic disease diagnosis and treatment.

    PubMed IF 3.6 소화기내과
16. 602025

    제1저자 김미소 · 교신저자 박흥우, 류기연

    Kim MS, Lee HW, Choi MS, Lee HS, Park HW, Rhew K

    Association Between Prevalence of Anemia and Asthma Severity.

    Allergy. 2025;80(6):1782-1784.

    PubMed IF 11.3 알레르기내과
17. 592025

    제1저자 박찬희, 김예솔, 남성현 · 교신저자 이승표, 선우성혁, 김대형

    Park C, Kim Y, Nam S, Kang H, Moon J, Kim JH, Cha GD, Lee SP, Sunwoo SH, Kim DH

    Liquid metal-based stretchable bioelectronic fiber for electrical stimulation and drug delivery in minimally invasive cardiac therapy.

    APL Bioeng. 2025;9(2):026118.

    Abstract

    Cardiovascular diseases, such as ventricular arrhythmias and heart failure, require timely and effective treatment to prevent disease progression and improve patient outcomes. Current therapeutics, including electrical shock and emergent cardiovascular medications, have significantly contributed to managing these conditions. However, due to their systemic side effects, there are ongoing demands for highly effective localized therapies. In this regard, a soft implantable device has been considered for cardiac applications, but invasiveness in their implantation procedure and difficulty in compact integration of multiple functions are unmet challenges. To address these issues, we develop a stretchable, multi-functional fiber designed for emergent cardiac intervention, offering electrogram recording, electrical modulation, and drug therapy directly at the epicardial surface. With temperature-dependent phase shifting properties of the liquid metal inside the fiber, the stiffened fiber can be implanted into the thoracic cavity without invasive surgery. Once implanted, the softened fiber provides multimodal therapies (e.g., chemotherapy and electrical therapy) tailored to the patient's condition. By tuning the delivery parameters based on continuous electrogram recording, effective and urgent cardiac interventions for severe arrhythmias are demonstrated in an in vivo rat model.

    PubMed IF 4.9 순환기내과
18. 582025

    제1저자 최진주, 곽윤진 · 교신저자 조수정

    Choi J^*, Kwak Y^*, Park M, Jo JY, Kang JH, Myeong-Cherl K, Kim HR, Kim G, Kong SH, Park DJ, Lee HS, Lee HJ, Kim JM, Kim SG, Yang HK, Ryu JK, Cho SJ

    Cancer-associated fibroblast-derived fibulin-5 promotes epithelial-mesenchymal transition in diffuse-type gastric cancer via cAMP response element-binding protein pathway, showing poor prognosis.

    Exp Mol Med. 2025;57(5):1106-1119.

    Abstract

    Diffuse-type gastric cancer (DGC), characterized by poorly cohesive cells within fibrotic stroma, is associated with advanced disease and poor prognosis. Here, to identify distinct biomarkers for DGC compared with intestinal-type gastric cancer, we constructed a comprehensive large-scale signaling network using RNA-sequencing data from three genomic databases (The Cancer Genome Atlas, GSE62254 and GSE26253), developed a mathematical model and conducted simulation analyses. For validation, we used tissue microarray blocks of gastric cancers with immunohistochemical staining, single-cell RNA sequencing, primary cultures of cancer-associated fibroblasts (CAFs) and organoids, and a co-culture system involving CAFs and cancer cells. Signaling network analysis identified six differentially activated signaling components across the database, including BIRC5, TTK, NEK2, FHL1, NR2F1 and FBLN5. Among the differentially activated signaling components, high tumoral expression of fibulin-5 protein encoded by FBLN5 correlated with poor overall and disease-specific survival rates in patients with DGC, even after adjusting for the tumor, node, metastases (TNM) stage. Fibulin-5, derived from CAFs within DGC stroma, promoted organoid growth and epithelial-mesenchymal transition (EMT) in DGC cell lines via the cAMP response element-binding protein (CREB) pathway in a CAF co-culture system. FBLN5 knockdown in CAFs reduced the aggressive phenotype of co-cultured DGC cells, while CREB inhibitors reversed EMT. Furthermore, levels of secreted FBLN5 in patient blood samples correlated with its expression in primary tumors. In summary, fibulin-5 secreted by CAFs and interacted with DGC cells promotes EMT and is clinically associated with poor patient outcomes. These findings suggest fibulin-5 as a potential prognostic marker and therapeutic target in patients with DGC.

    PubMed IF 17.5 소화기내과
19. 572025

    제1저자 김중엽, 이찬미 · 교신저자 강창경, 이진우

    Kim JY, Lee CM, Ahn YH, Lee HY, Lee SM, Jo HJ, Choe PG, Park WB, Kang CK, Lee J, Kim NJ

    Cytomegalovirus reactivation in the lower respiratory tract as an independent risk factor for mortality in critically Ill patients.

    Crit Care. 2025;29(1):177.

    Abstract

    BACKGROUND The clinical significance of cytomegalovirus reactivation in the lower respiratory tract (LRT) of critically ill patients remains unclear. We aimed to investigate the association between cytomegalovirus reactivation detected in LRT and intensive care unit (ICU) prognosis.

    METHODS This study included critically ill patients admitted to a medical ICU at a tertiary referral center in South Korea between January 2021 and June 2023. Cytomegalovirus load in LRT samples collected via bronchoscopy was measured within 7 days of admission. Detection of cytomegalovirus DNA in LRT was defined as reactivation. Associations between cytomegalovirus reactivation and ICU, in-hospital, 30-day, and 90-day mortality were assessed using multivariable Fine-Gray model adjusted for major clinical factors.

    RESULTS Of the 322 patients (median age 68 years, 66.8% male), 145 (45%) had cytomegalovirus reactivation in the LRT. Cytomegalovirus reactivation was independently associated with increased ICU (adjusted subdistribution hazard ratio [aSHR], 2.28; 95% confidence interval [CI], 1.46-3.56), in-hospital (aSHR, 2.00; 95% CI, 1.44-2.78), 30-day (aSHR, 2.11; 95% CI, 1.42-3.13), and 90-day mortality (aSHR, 2.05; 95% CI, 1.45-2.88). Anti-cytomegalovirus therapy was significantly associated with reduced ICU mortality in patients with radiologic findings suggestive of cytomegalovirus pneumonia (P for interaction = 0.001), but was linked to increased mortality in patients with positive bacterial cultures (P for interaction = 0.002).

    CONCLUSION Cytomegalovirus reactivation in the LRT is associated with poor outcomes in critically ill patients. Anti-cytomegalovirus therapy was not associated with overall survival outcomes; however, the subgroup with radiologic findings of cytomegalovirus pneumonia suggested benefits, while the subgroup with bacterial co-infections suggested harmful effects. Randomized controlled trials are needed.

    PubMed IF 11.4 호흡기내과
20. 562025

    제1저자 문인기, 이지나 · 교신저자 윤연이

    Moon I^*, Lee J^*, Lee SA, Jeong D, Jeon J, Jang Y, Jeong S, Kim J, Choi HM, Hwang IC, Hong Y, Cho GY, Yoon YE, Chang HJ

    Artificial Intelligence-Enhanced Analysis of Echocardiography-Based Radiomic Features for Myocardial Hypertrophy Detection and Etiology Differentiation.

    Circ Cardiovasc Imaging. 2025;18(5):e017436.

    Abstract

    BACKGROUND While echocardiography is pivotal for detecting left ventricular hypertrophy (LVH), it struggles with etiology differentiation. To enhance LVH assessment, we aimed to develop an artificial intelligence algorithm using echocardiography-based radiomics. This algorithm is designed to detect LVH and differentiate its common etiologies, such as hypertrophic cardiomyopathy (HCM), cardiac amyloidosis (CA), and hypertensive heart disease (HHD), based on echocardiographic images.

    METHODS The developmental data sets from multiple medical centers included 867 subjects, with an independent external test set from a single tertiary medical center containing 619 subjects. Radiomic feature analysis was conducted on 4 echocardiographic views, extracting both conventional and harmonization-driven myocardial textures along with myocardial geographic features. Then, we developed classification models for each condition. Variable contributions were evaluated using Shapley Additive Explanations analysis.

    RESULTS The radiomics-based LightGBM model, selected from internal validation, maintained strong performance in the external test set (area under the curve of 0.96 for HCM, 0.89 for CA, and 0.86 for HHD). Compared with the logistic regression model using conventional echocardiographic parameters (left ventricular ejection fraction, left ventricular mass index, left atrial volume index, and E/e'), the final model demonstrated superior sensitivity (0.89 versus 0.80 for HCM, 0.80 versus 0.80 for CA, and 0.75 versus 0.33 for HHD) and F1-score (0.87 versus 0.57 for HCM, 0.84 versus 0.72 for CA, and 0.82 versus 0.50 for HHD). Feature analysis highlighted that harmonization-driven textures played a key role in differentiating HCM, while conventional textures and myocardial thickness were influential in differentiating CA and HHD.

    CONCLUSIONS This study confirms that artificial intelligence-enhanced echocardiography-based radiomics effectively differentiate the etiology of LVH, highlighting the potential of artificial intelligence-driven texture and geographic analysis in LVH evaluation.

    PubMed IF 9.1 순환기내과
21. 552025

    제1저자 곽순구 · 교신저자 Marc R Dweck, 이승표

    Kwak S, Singh A, Everett RJ, Treibel TA, Lim J, Won S, Williams MC, Loganathan K, Bing R, Craig N, Singh T, Joshi S, Lee H, Lee W, Kim YJ, Chin CWL, Fukui M, Al Musa T, Rigolli M, Tastet L, Dobson LE, Wiesemann S, Ferreira VM, Captur G, Lee S, Schulz-Menger J, Schelbert EB, Clavel MA, Park SJ, Pellegrini C, Hadamitzky M, Gerber BL, Newby DE, Myerson SG, Pibarot P, Cavalcante JL, McCann GP, Greenwood JP, Moon JC, Dweck MR, Lee SP

    Sex-Specific Association of Myocardial Fibrosis With Mortality in Patients With Aortic Stenosis.

    JAMA Cardiol. 2025;10(5):446-455.

    Abstract

    IMPORTANCE Myocardial fibrosis in aortic stenosis (AS) may exhibit sex differences. However, its prognostic significance in women with AS remains unclear.

    OBJECTIVE To investigate sex differences in myocardial fibrosis assessed by cardiovascular magnetic resonance (CMR) and evaluate its prognostic value in women and men with AS.

    DESIGN, SETTING, AND PARTICIPANTS Patients with severe AS who underwent CMR before aortic valve replacement (AVR) were prospectively enrolled from 13 international sites between March 2011 and September 2021. Myocardial fibrosis was evaluated using extracellular volume fraction (ECV%) and late gadolinium enhancement (LGE). The main analysis was conducted on patients without obstructive coronary artery disease (CAD), defined as those with no history of myocardial infarction and no concomitant coronary artery bypass grafting. Data were analyzed from December 2023 to February 2024.

    EXPOSURES Surgical or transcatheter AVR.

    MAIN OUTCOMES AND MEASURES The primary outcome was post-AVR all-cause mortality and the secondary outcome was cardiovascular mortality.

    RESULTS Of 822 patients, 670 were without obstructive CAD (368 men [55%] and 302 women [45%]). Among these, women and men had a similar age (median, 72 years vs 71 years, respectively), comorbidities, and AS severity. ECV% was similar between sexes; however, women had less LGE (both infarct and noninfarct LGE). After a median follow-up of 3.7 (IQR, 2.1-4.7) years, there were 76 deaths (11.3%), including 29 adjudicated cardiovascular deaths, in patients without obstructive CAD. Increasing ECV% and LGE were associated with higher all-cause and cardiovascular mortality in both sexes. Cox analyses demonstrated that both ECV% and LGE were associated with higher all-cause mortality without significant interaction by sex (women: adjusted hazard ratio [HR], 1.08 per 1% ECV% increase; 95% CI, 1.04-1.12; P < .001; men: adjusted HR, 1.01; 95% CI, 0.96-1.06; P = .66; P for interaction by sex = .09 and women: adjusted HR, 2.49 for the presence of LGE; 95% CI, 1.07-5.80; P = .03; men: adjusted HR, 1.82; 95% CI, 1.00-3.32; P = .04; P for interaction by sex = .68). In the entire population (n = 822), both noninfarct and infarct-related LGE were associated with increased mortality without significant interaction by sex.

    CONCLUSIONS AND RELEVANCE In this study, patients with severe AS who underwent AVR exhibited similar ECV% between sexes, while women had lower LGE. Increased myocardial fibrosis provided important prognostic value for both sexes.

    PubMed IF 15.2 순환기내과
22. 542025

    제1저자 윤민재 · 교신저자 최동주

    Yoon M, Hur T, Park SJ, Jo SH, Kim EJ, Kim SJ, Hussain M, Hua CH, Lee S, Choi DJ

    Self-Monitoring of Blood Pressure and Feedback via Mobile App in Treatment of Uncontrolled Hypertension: The SMART-BP Randomized Clinical Trial.

    Mayo Clin Proc. 2025;100(5):840-853.

    Abstract

    OBJECTIVE To evaluate the effects of mobile apps with tailored recommendations on changes in blood pressure (BP) and drug adherence.

    PATIENTS AND METHODS This study is a randomized, open-label, multicenter trial to evaluate the efficacy of self-monitoring of BP (SMBP) with a mobile application-based feedback algorithm (SMBP app with feedback) compared with SMBP alone. Patients with uncontrolled hypertension aged 19 years or older were randomly assigned. In the control group, the patients only measured their BP at home using the mobile app combined with a Bluetooth BP monitor and received standard care, whereas in the intervention group, the patients could also receive alerts for BP measurement and additional recommendations from the app using a feedback algorithm in response to the obtained BP value. The primary end point was the change in mean home systolic BP at 24 weeks.

    RESULTS From September 1, 2019, through July 8, 2020, 184 patients were randomized into 2 groups: SMBP app with feedback (n=97) and SMBP alone (n=87). At 24 weeks, the mean ± SD home systolic BP reduction from baseline was significantly greater in the SMBP app with feedback group than in the SMBP alone group (-22.4±13.5 vs -17.2±13.3 mm Hg; P=.02). The SMBP app with feedback group had higher drug adherence and proportion of adherence of 95% or greater than the SMBP alone group.

    CONCLUSION The SMBP app with feedback is superior to SMBP alone in terms of systolic BP reduction and improved drug adherence in patients with hypertension. Given the high cost of traditional interventions between patients and health care professionals, feedback through mobile apps could potentially be a useful tool in the management of hypertension.

    TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT04470284.

    PubMed IF 6.5 순환기내과
23. 532025

    제1저자 조인래 · 교신저자 이상협

    Cho IR, Lee SH, Kang J, Kim J, Lee TS, Lee MH, Lee MW, Choi JH, Paik WH, Ryu JK, Kim YT, Hong SK, Choi Y, Yi NJ, Lee KW, Suh KS

    Digital single-operator cholangioscopy for difficult anastomotic biliary strictures in living donor liver transplant recipients after failure of standard ERCP: SPYPASS-2 study (with videos).

    Gastrointest Endosc. 2025;101(5):979-987.e3.

    Abstract

    BACKGROUND AND AIMS Liver transplantation (LT) is a curative treatment for end-stage liver disease. Anastomotic biliary strictures (ABSs) are more common in living donor LT (LDLT). However, the success rate of ERCP for ABSs remains unsatisfactory. In this study, we evaluated the efficacy of single-operator cholangioscopy (SOC) for ABS treatment in LDLT recipients where standard ERCP failed to access the stricture.

    METHODS This prospective study included 40 LDLT patients undergoing ERCP with SOC (SpyGlass DS II; Boston Scientific Corp, Natick, Mass, USA) to treat ABSs when guidewire placement across the ABS was difficult during conventional ERCP (cannulation time >10 minutes) between October 2021 and May 2023. Our primary endpoint was technical success, defined as successful guidewire placement across the ABS and/or subsequent treatment. Secondary endpoints were rates of clinical success, adverse events, and reintervention.

    RESULTS The mean patient age was 59.7 ± 7.2 years, and the mean time from LDLT to the occurrence of ABS was 212 ± 230 days. Technical and clinical success were achieved in 92.5% (37/40) and 82.5% (33/40) of patients, respectively. The rates of post-ERCP cholangitis, pancreatitis, and bleeding were 10.0%, 15.0%, and 2.5%, respectively. Intestinal perforation did not occur, and all adverse events were mild in severity. Early stent migration within 1 month occurred in 2 patients (5.4%), and 4 patients (10.8%) required reintervention within 1 month.

    CONCLUSIONS This study shows the efficacy and safety of SOC-facilitated management for difficult ABSs in LDLT patients after failure of standard ERCP. (Clinical trial registration number: NCT05065125.).

    PubMed IF 8 소화기내과
24. 522025

    제1저자 권순일, 이소령 · 교신저자 최의근

    Kwon S, Lee SR, Choi EK, Kim B, Han KD, Choi J, Lee KY, Ahn HJ, Oh S, Lip GYH

    Benefits of Early Catheter Ablation in Patients With Atrial Fibrillation: A Nationwide Cohort Study.

    JACC Clin Electrophysiol. 2025;11(5):956-965.

    Abstract

    BACKGROUND Although early rhythm control showed better clinical outcomes in patients with atrial fibrillation (AF), limited data exist on the relationship between the timing of atrial fibrillation catheter ablation (AFCA) and clinical outcomes.

    OBJECTIVES This study investigated the impact of early vs late AFCA on clinical outcomes.

    METHODS Using the Korean claims database, 944,710 AF patients without previous AFCA were investigated. These patients were categorized into 3 groups based on the duration from their AF diagnosis to AFCA: <1 year (early-AFCA), 1 to <3 years (intermediate-AFCA), and ≥3 years (late-AFCA). The study outcomes included ischemic stroke, heart failure (HF) hospitalization, myocardial infarction, major adverse cardiovascular events (comprising the aforementioned three), all-cause mortality, a composite outcome (encompassing all mentioned outcomes), and AF recurrence.

    RESULTS A total of 57,804 AF patients (38,536 without AFCA and 19,268 with AFCA; mean age 57.8 years; 73.5% men) were followed up for an average of 2.6 ± 1.5 years. AFCA was associated with lower risks across all study outcomes (HRs: 0.26-0.41 for all outcomes; all P < 0.001). Compared with the early-AFCA group, the intermediate- and late-AFCA groups showed higher risks of HF hospitalization and all-cause mortality. Additionally, the late-AFCA group had higher risks of major adverse cardiovascular events, composite outcomes, and AF recurrence than those of the early- and intermediate-AFCA groups. After weighing the propensity scores, the results were largely consistent with the primary analysis.

    CONCLUSIONS Early AFCA showed improved clinical outcomes, primarily caused by decreased risk of HF hospitalization and AF recurrence.

    PubMed IF 7.2 순환기내과
25. 512025

    제1저자 한정규, 이기환 · 교신저자 김효수, 신상훈

    Han JK^*, Lee K^*, Park SH, Yang S, Hwang D, Kang J, Yang HM, Park KW, Kang HJ, Koo BK, Hur SH, Kim W, Park SH, Han SH, Kim SH, Kim YH, Lee N, Lee SJ, Shin S, Kim HS

    Short-Term DAPT After Complex PCI With Third-Generation DES: A Post Hoc Analysis of the HOST-IDEA Trial.

    Circ Cardiovasc Interv. 2025;18(5):e014623.

    Abstract

    BACKGROUND The optimal duration of dual antiplatelet therapy (DAPT) after complex percutaneous coronary intervention (PCI) remains unclear. We aim to investigate the efficacy and safety of 3 to 6 months of DAPT over 12 months after complex PCI.

    METHODS A post hoc analysis of the HOST-IDEA (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Coronary Intervention With Next-Generation Drug-Eluting Stent Platforms and Abbreviated Dual Antiplatelet Therapy) randomized trial which enrolled patients undergoing PCI with third-generation drug-eluting stents was performed. Complex PCI was defined by any of the following: ≥3 stents implanted, ≥3 lesions treated, bifurcation PCI with 2-stenting, total stent length ≥60 mm, left main PCI, or heavy calcification. The major end points were target lesion failure, a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization for ischemic outcomes, and major bleeding, defined as BARC (Bleeding Academic Research Consortium) type 3 or 5, for bleeding outcomes at 12 months.

    RESULTS Among 1992 patients, 624 underwent complex PCI. The complex PCI group had clinical features associated with high bleeding risk. A shortened DAPT duration did not increase the risk of target lesion failure, with hazard ratios of 0.818 (95% CI, 0.403-1.659) for the complex PCI group and 1.282 (95% CI, 0.506-3.249) for the noncomplex PCI group (P_interaction=0.451). Conversely, it decreased the risk of major bleeding in the complex PCI group (hazard ratio, 0.269 [95% CI, 0.075-0.965]), but not in the noncomplex PCI group (hazard ratio, 1.534 [95% CI, 0.627-3.754], showing a significant interaction; P_interaction=0.029).

    CONCLUSIONS In patients undergoing complex PCI with a third-generation drug-eluting stent, a 3- to 6-month duration of DAPT was associated with a reduced risk of bleeding without an increased risk of ischemic events compared with 12-month DAPT.

    REGISTRATION URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02601157.

    PubMed IF 7.2 순환기내과
26. 502025

    제1저자 김순찬, 감가혜 · 교신저자 임석아, 구자록

    Kim SC^*, Kim GH^*, Park JH, Lee KH, Koh J, Kim TY, Lee DW, Kim YJ, Kim S, Park SY, Min A, Shin YK, Im SA, Ku JL

    Establishment and characterization of 24 breast cancer cell lines and 3 breast cancer organoids reveals molecular heterogeneity and drug response variability in malignant pleural effusion-derived models.

    Breast Cancer Res. 2025;27(1):66.

    Abstract

    Intratumoral heterogeneity of breast cancer cells causes undesired drug resistance and predispose to disease recurrence. We investigate the molecular heterogeneity of breast cancer cells derived from malignant pleural effusions (MPE) to understand variations in drug resistance and cellular evolution. MPE provides a unique environment, with cells experiencing significant microenvironmental changes that promote intratumoral heterogeneity and therapeutic resistance. By establishing 24 cell lines and 3 organoids from MPE samples of breast cancer patients, we performed extensive genomic, transcriptomic, and drug sensitivity analyses. Our findings reveal substantial genetic and transcriptomic diversity among MPE-derived cell lines, highlighting dynamic alterations in driver mutations and signaling pathways that correlate with variable drug responses. Notably, temporal and spatial heterogeneity within patient-derived samples emphasized the adaptability of breast cancer cells in MPE, as different subclones displayed distinct drug sensitivities. This work underscores the critical role of molecular profiling in understanding treatment resistance in breast cancer, presenting MPE-derived cell lines as valuable preclinical models for exploring personalized therapies in aggressive cancer phenotypes.

    PubMed IF 6.2 혈액종양내과
27. 492025

    제1저자 Martin Haluzík · 교신저자 Martin Haluzík, 임수

    Haluzík M, Cypryk K, Alvarez A, Lauand F, Corp Dit Genti V, Bakiner OS, Lim S

    Efficacy and safety of switching to iGlarLixi from premixed insulins in people with type 2 diabetes: The Soli-SWITCH study.

    Diabetes Obes Metab. 2025;27(5):2730-2739.

    Abstract

    AIMS To assess the efficacy and safety of switching from premixed insulin to a once-daily, fixed-ratio combination of insulin glargine 100 U/mL + lixisenatide (iGlarLixi) in people with type 2 diabetes (T2D).

    METHODS In this phase 4, 24-week, single-arm study, participants switched from once-daily or twice-daily premixed insulin to iGlarLixi (EudraCT number 2021-003711-25). Key inclusion criteria: ≥18 years; premixed insulin therapy for ≥3 months and < 10 years; ± 1-2 oral antidiabetic drugs (OADs); HbA1c ≥7.5% to ≤10.0%. The primary endpoint was the change in HbA1c from baseline to Week 24. Secondary endpoints included: participants achieving HbA1c <7% and change in body weight at Week 24, and safety.

    RESULTS Overall, 162 participants switched to iGlarLixi (89.5% from twice-daily premixed insulin); mean duration of diabetes was 15.7 (standard deviation [SD]: 8.3) years. Mean baseline HbA1c (8.5%) reduced by least squares (LS) mean of 1.2% (95% confidence interval [CI]: -1.4, -1.1) at Week 24, and 37.6% of participants had achieved an HbA1c target of <7% (95% CI: 30.0, 45.7). LS mean body weight change from baseline to Week 24 was -1.0 kg (95% CI: -1.6, -0.5). Fasting and post-prandial plasma glucose decreased from baseline to Week 24 by 45.6 mg/dL (SD ± 52.4) and 67.6 mg/dL (SD ± 65.1), respectively. Confirmed symptomatic hypoglycaemia occurred in 38.3% of participants (ADA level 1: 35.8%; level 2: 15.4%; level 3: 0.0%).

    CONCLUSIONS iGlarLixi initiation was associated with improved glycaemic control, without body weight gain or increased hypoglycaemia over 24 weeks.

    PubMed IF 6.1 내분비대사내과
28. 482025

    제1저자 박민정 · 교신저자 김정희, 이승훈

    Park MJ, Park SS, Lee BH, Jang JS, Kim WW, Kim SJ, Lee YM, Lee KE, Sung TY, Seong MW, Lee W, Koh JM, Kim JH, Lee SH

    Phenotype of pheochromocytoma and paraganglioma by germline mutation: a Korean multicenter study.

    Endocr Relat Cancer. 2025;32(5):e240269.

    Abstract

    Recent advances in genetic testing have challenged the traditional genotype-phenotype correlation in pheochromocytomas and paragangliomas (PPGL). We aimed to characterize the genotype-phenotype correlations in PPGL in a large Korean cohort and compare our findings with those from other countries. We retrospectively analyzed 627 patients with PPGL from two centers who underwent genetic testing for germline pathogenic variants (PVs) from 2000 to 2023 to examine the prevalence of clusters and their correlation with specific phenotypes. Moreover, we systematically reviewed 44 studies that investigated the frequency of germline PVs based on geographical differences. Germline PVs were identified in 29.7% of patients (n = 186). The prevalence of cluster 1A, 1B and 2 PVs was 10.6% (n = 67), 8.0% (n = 50) and 11.1% (n = 69), respectively. Cluster 1 patients were presented with more aggressive features, including younger age at diagnosis (39 years), higher rates of extra-adrenal (44.4%), and metastatic (27.8%) tumors, than did the wild-type and cluster 2 groups (P < 0.001). Cluster 1A patients had significantly higher metastasis rates than cluster 1B patients (38.8 vs 12.5%; P < 0.001). The cluster 2 group showed a high recurrence risk but rarely developed metastases. The cluster 1-to-cluster 2 ratio among Koreans (1.7) was lower than that among Europeans (2.9) and North Americans (3.3). This study underscores the genetic and clinical heterogeneity of PPGL among Korean patients based on genetic clusters and highlights geographic variations in PVs. These findings have significant implications for risk stratification, surveillance and management strategies for patients with PPGL.

    PubMed IF 4.4 내분비대사내과
29. 472025

    제1저자 강지훈 · 교신저자 박경우

    Kang J, Chung J, Park KW, Bae JW, Lee H, Hwang D, Yang HM, Han KR, Moon KW, Kim U, Rhee MY, Kim DI, Kim SY, Lee SY, Lee SU, Kim SW, Kim SY, Han JK, Shin ES, Koo BK, Kim HS

    Long-Term Aspirin vs Clopidogrel After Coronary Stenting by Bleeding Risk and Procedural Complexity.

    JAMA Cardiol. 2025;10(5):427-436.

    Abstract

    IMPORTANCE Antiplatelet monotherapy in the chronic maintenance period for patients with high bleeding risk (HBR) and those who have undergone complex percutaneous coronary intervention (PCI) has not yet been explored.

    OBJECTIVE To compare clopidogrel vs aspirin monotherapy in patients with HBR and/or PCI complexity.

    DESIGN, SETTING, AND PARTICIPANTS This post hoc analysis of the multicenter HOST-EXAM Extended study, an open-label trial conducted across 37 sites in South Korea, enrolled patients from 2014 to 2018 with up to 5.9 years of follow-up. The analysis was conducted from February to November 2023. Patients who maintained dual antiplatelet therapy (DAPT) event-free for 6 to 18 months following PCI were included.

    INTERVENTIONS Patients were randomized to receive either clopidogrel or aspirin in a 1:1 ratio. Those with sufficient data to assess HBR or complex PCI were analyzed.

    MAIN OUTCOMES AND MEASURES Coprimary end points were thrombotic composite end point (cardiovascular death, nonfatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and definite/probable stent thrombosis) and any bleeding (Bleeding Academic Research Consortium type 2 to 5).

    RESULTS Of 3974 patients included (mean [SD] age, 63.4 [10.7] years; 2976 male [74.9%]), 866 had HBR (21.8%), and 849 underwent complex PCI (21.4%). Clopidogrel as compared with aspirin was associated with lower rates of thrombotic and bleeding events regardless of HBR and/or PCI complexity. For the thrombotic composite end point, the hazard ratio (HR) was 0.75 (95% CI, 0.53-1.04) among HBR vs 0.62 (95% CI, 0.48-0.80) among patients without HBR (P for interaction = 0.38) and 0.49 (95% CI, 0.32-0.77) among patients with complex PCI vs 0.74 (95% CI, 0.59-0.92) among patients with noncomplex PCI (P for interaction = 0.12). The reduction in bleeding by clopidogrel compared with aspirin was consistent among both patients with HBR (HR, 0.82; 95% CI, 0.56-1.21) and patients without HBR (HR, 0.58; 95% CI, 0.40-0.85; P for interaction = 0.20) and among patients undergoing complex PCI (HR, 0.79; 95% CI, 0.47-1.33) vs noncomplex PCI (HR, 0.68; 95% CI, 0.50-0.93; P for interaction = 0.62).

    CONCLUSIONS AND RELEVANCE In this study, in patients who experienced PCI and were event-free during 6 to 18 months of DAPT, the beneficial impact of clopidogrel monotherapy over aspirin monotherapy was consistent, regardless of bleeding risk and/or PCI complexity.

    TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02044250.

    PubMed IF 15.2
30. 462025

    제1저자 박세훈, 정수민 · 교신저자 김광수, 이하정

    Park S, Chung S, Kim Y, Yang SA, Kwon S, Cho JM, Lee MJ, Cho E, Ryu J, Kim S, Lee J, Yoon HJ, Choi E, Kim K, Lee H

    A deep-learning algorithm using real-time collected intraoperative vital sign signals for predicting acute kidney injury after major non-cardiac surgeries: A modelling study.

    PLoS Med. 2025;22(4):e1004566.

    Abstract

    BACKGROUND Postoperative acute kidney injury (PO-AKI) prediction models for non-cardiac major surgeries typically rely solely on preoperative clinical characteristics.

    METHODS AND FINDINGS In this study, we developed and externally validated a deep-learning-based model that integrates preoperative data with minute-scale intraoperative vital signs to predict PO-AKI. Using data from three hospitals, we constructed a convolutional neural network-based EfficientNet framework to analyze intraoperative data and created an ensemble model incorporating 103 baseline variables of demographics, medication use, comorbidities, and surgery-related characteristics. Model performance was compared with the conventional SPARK model from a previous study. Among 110,696 patients, 51,345 were included in the development cohort, and 59,351 in the external validation cohorts. The median age of the cohorts was 60, 61, and 66 years, respectively, with males comprising 54.9%, 50.8%, and 42.7% of each cohort. The intraoperative vital sign-based model demonstrated comparable predictive power (AUROC (Area Under the Receiver Operating Characteristic Curve): discovery cohort 0.707, validation cohort 0.637 and 0.607) to preoperative-only models (AUROC: discovery cohort 0.724, validation cohort 0.697 and 0.745). Adding 11 key clinical variables (e.g., age, sex, estimated glomerular filtration rate (eGFR), albuminuria, hyponatremia, hypoalbuminemia, anemia, diabetes, renin-angiotensin-aldosterone inhibitors, emergency surgery, and the estimated surgery time) improved the model's performance (AUROC: discovery cohort 0.765, validation cohort 0.716 and 0.761). The ensembled deep-learning model integrating both preoperative and intraoperative data achieved the highest predictive accuracy (AUROC: discovery cohort 0.795, validation cohort 0.762 and 0.786), outperforming the conventional SPARK model. The retrospective design in a single-nation cohort with non-inclusion of some potential AKI-associated variables is the main limitation of this study.

    CONCLUSIONS This deep-learning-based PO-AKI risk prediction model provides a comprehensive approach to evaluating PO-AKI risk prediction by combining preoperative clinical data with real-time intraoperative vital sign information, offering enhanced predictive performance for better clinical decision-making.

    PubMed IF 9.9 신장내과

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