SCI 발표논문

2025년 135편

452025

제1저자 양석훈, Xinyang Hu, Jinlong Zhang · 교신저자 구본권, Jian\'an Wang

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Angiography-derived fractional flow reserve versus intravascular ultrasound to guide percutaneous coronary intervention in patients with coronary artery disease (FLAVOUR II): a multicentre, randomised, non-inferiority trial.
Lancet. 2025;405(10488):1491-1504.

Abstract
BACKGROUND Revascularisation decisions based on angiography-derived fractional flow reserve (FFR) or optimisation of stent implantation with intravascular ultrasound yield superior clinical outcomes compared with percutaneous coronary intervention (PCI) guided by angiography alone. However, the differences in outcomes when a single approach is used for both purposes remain unclear. We aimed to assess the non-inferiority of angiography-derived FFR versus intravascular ultrasound guidance in terms of clinical outcomes at 12 months in patients with angiographically significant stenosis.
METHODS This investigator-initiated, open-label, multicentre, randomised, non-inferiority trial, which was done in 22 centres in China, enrolled patients aged 18 years or older with suspected ischaemic heart disease and with at least 50% stenosis in epicardial coronary arteries measuring at least 2·5 mm by visual estimation on coronary angiography. Patients were randomly assigned (1:1) to undergo PCI guided by either angiography-derived FFR or intravascular ultrasound, including revascularisation decisions and optimisation of the stent implantations based on prespecified PCI criteria and optimal PCI goals. Use of both modalities simultaneously was not permitted. Randomisation as performed using a web-based program and stratified based on the trial centre and the presence or absence of diabetes. The primary outcome was a composite of death, myocardial infarction, or revascularisation at 12 months in the intention-to-treat population, and the non-inferiority margin was 2·5 percentage points. This trial is registered with ClinicalTrials.gov, NCT04397211; long-term follow-up is ongoing.
FINDINGS Between May 29, 2020, and Sept 20, 2023, 1872 patients were enrolled. After 33 patients withdrew, 923 patients were randomly assigned to the angiography-derived FFR group and 916 to the intravascular ultrasound group. Median age of the study population was 66·0 years (IQR 58·0-72·0), and 1248 (67·9%) patients were male and 591 (32·1%) were female. Revascularisation was performed in 688 (69·5%) of 990 target vessels in the angiography-derived FFR group and 797 (81·0%) of 984 target vessels in the intravascular ultrasound group. At a median follow-up of 12 months (IQR 12-12), the primary outcome event occurred in 56 patients in the angiography-derived FFR group and 54 patients in the intravascular ultrasound group (6·3% vs 6·0%, absolute difference 0·2 percentage points [upper boundary of one-sided 97·5% CI 2·4], p_{non-inferiority}=0·022; hazard ratio 1·04 [95% CI 0·71 to 1·51]). Mortality did not differ between the two groups (1·8% in the angiography-derived FFR group vs 1·3% in the intravascular ultrasound group, absolute difference 0·4 percentage points [95% CI -0·7 to 1·6]; hazard ratio 1·34 [0·63 to 2·83], p=0·45). The incidence of recurrent angina was low in both groups: 26 (2·8%) of 923 patients in the angiography-derived FFR group and 35 (3·8%) of 916 patients in the intravascular ultrasound group.
INTERPRETATION The angiography-derived FFR-guided comprehensive PCI strategy, encompassing revascularisation decision making and stent optimisation, was non-inferior to intravascular ultrasound guidance. This finding might have implications for future guidelines on its role and application.
FUNDING National Natural Science Foundation of China, The Key R & D Projects of Zhejiang Province, and the RCT Program from The Second Affiliated Hospital of Zhejiang University School of Medicine.
PubMed IF 109 순환기내과
442025

제1저자 이병주 · 교신저자 박인규, 임수, 이대식

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Breath Analyzer for Real-Time Exercise Fat Burning Prediction: Oral and Alveolar Breath Insights with CNN.
ACS Sens. 2025;10(4):2510-2519.

Abstract
The increasing prevalence of obesity and metabolic disorders has created a significant demand for personalized devices that can effectively monitor fat metabolism. In this study, we developed an advanced breath analyzer system designed to provide real-time monitoring of exercise-induced fat burning by analyzing volatile organic compounds (VOCs) present in both oral and alveolar breath. Acetone in exhaled breath and β-hydroxybutyric acid (BOHB) in the blood are both biomarkers closely linked to the metabolic fat burning process occurring in the liver, particularly after exercise. The breath analyzer utilizes a sensor array to detect VOC patterns, with the data analyzed using a one-dimensional convolutional neural network (1D CNN) for an accurate prediction of BOHB levels in the blood. We collected and analyzed 30 exhaled breath samples with our analyzer and blood samples for BOHB from participants before and after exercise. The results showed a strong correlation between sensor responses and BOHB levels, with Pearson correlation coefficients of 0.99 across different postexercise time points. The 1D CNN model effectively estimated BOHB concentrations, achieving Pearson coefficients of 0.96 for the training data set and 0.86 for the test data set. Additionally, our findings confirm that alveolar air samples, which contain metabolic byproducts from deeper in the lungs, offer more reliable data for fat burning analysis than oral air samples. This noninvasive, real-time breath monitoring tool offers a promising solution for individuals demanding to optimize their exercise routines and track metabolic health with high precision and accuracy.
PubMed IF 10.9 내분비대사내과
432025

제1저자 권주성, 안형범 · 교신저자 서정원

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Developing a Machine Learning Model for Predicting 30-Day Major Adverse Cardiac and Cerebrovascular Events in Patients Undergoing Noncardiac Surgery: Retrospective Study.
J Med Internet Res. 2025;27:e66366.

Abstract
BACKGROUND Considering that most patients with low or no significant risk factors can safely undergo noncardiac surgery without additional cardiac evaluation, and given the excessive evaluations often performed in patients undergoing intermediate or higher risk noncardiac surgeries, practical preoperative risk assessment tools are essential to reduce unnecessary delays for urgent outpatient services and manage medical costs more efficiently.
OBJECTIVE This study aimed to use the Observational Medical Outcomes Partnership Common Data Model to develop a predictive model by applying machine learning algorithms that can effectively predict major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing noncardiac surgery.
METHODS This retrospective observational network study collected data by converting electronic health records into a standardized Observational Medical Outcomes Partnership Common Data Model format. The study was conducted in 2 tertiary hospitals. Data included demographic information, diagnoses, laboratory results, medications, surgical types, and clinical outcomes. A total of 46,225 patients were recruited from Seoul National University Bundang Hospital and 396,424 from Asan Medical Center. We selected patients aged 65 years and older undergoing noncardiac surgeries, excluding cardiac or emergency surgeries, and those with less than 30 days of observation. Using these observational health care data, we developed machine learning-based prediction models using the observational health data sciences and informatics open-source patient-level prediction package in R (version 4.1.0; R Foundation for Statistical Computing). A total of 5 machine learning algorithms, including random forest, were developed and validated internally and externally, with performance assessed through the area under the receiver operating characteristic curve (AUROC), the area under the precision-recall curve, and calibration plots.
RESULTS All machine learning prediction models surpassed the Revised Cardiac Risk Index in MACCE prediction performance (AUROC=0.704). Random forest showed the best results, achieving AUROC values of 0.897 (95% CI 0.883-0.911) internally and 0.817 (95% CI 0.815-0.819) externally, with an area under the precision-recall curve of 0.095. Among 46,225 patients of the Seoul National University Bundang Hospital, MACCE occurred in 4.9% (2256/46,225), including myocardial infarction (907/46,225, 2%) and stroke (799/46,225, 1.7%), while in-hospital mortality was 0.9% (419/46,225). For Asan Medical Center, 6.3% (24,861/396,424) of patients experienced MACCE, with 1.5% (6017/396,424) stroke and 3% (11,875/396,424) in-hospital mortality. Furthermore, the significance of predictors linked to previous diagnoses and laboratory measurements underscored their critical role in effectively predicting perioperative risk.
CONCLUSIONS Our prediction models outperformed the widely used Revised Cardiac Risk Index in predicting MACCE within 30 days after noncardiac surgery, demonstrating superior calibration and generalizability across institutions. Its use can optimize preoperative evaluations, minimize unnecessary testing, and streamline perioperative care, significantly improving patient outcomes and resource use. We anticipate that applying this model to actual electronic health records will benefit clinical practice.
PubMed IF 8.2 순환기내과
422025

제1저자 류호인, 김성렬 · 교신저자 남영희, 강혜련

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Clinical characteristics and risk factors for escalation to anaphylaxis from non-severe drug hypersensitivity reaction.
Clin Transl Allergy. 2025;15(4):e70047.

Abstract
BACKGROUND Drug hypersensitivity reaction (DHR) poses significant challenges in clinical practice, with some patients experiencing more severe reactions upon re-exposure. Understanding the factors contributing to escalation into more severe reactions is crucial for improving patient safety. This study aimed to investigate the clinical characteristics and risk factors associated with the progression from non-severe DHR to anaphylaxis.
METHODS A multicenter retrospective study was conducted using data from a drug-induced anaphylaxis registry across 10 university hospitals in Korea. Clinical data, including information on culprit drugs, DHR history, and the severity of reactions, were assessed.
RESULTS Among 494 cases of drug-induced anaphylaxis, 417 cases (84.4%) occurred without prior DHR, while 77 cases (15.6%) had a history of non-severe DHR. Of these, 43 cases had a previous DHR to a drug of the same class, and 34 cases involved DHR to drugs of different classes. In the group with prior DHR to a drug of the same class, anaphylaxis occurring in daily life was significantly more common compared to those reacting to a different class of drug or those with no prior DHR (48.8% vs. 23.5% or 22.5%, p = 0.008 and < 0.001, respectively). Non-steroidal anti-inflammatory drugs (NSAIDs), H2 blockers, and penicillins were identified as risk factors for anaphylaxis evolving from non-severe DHR.
CONCLUSION Enhanced vigilance is required for patients with a history of non-severe DHR to NSAIDs, H2 blockers, and penicillins as re-exposure may lead to the progress to anaphylaxis.
PubMed IF 4.2 알레르기내과
412025

제1저자 고지원, 김진영 · 교신저자 임석아

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Harnessing Institutionally Developed Clinical Targeted Sequencing to Improve Patient Survival in Breast Cancer: A Seven-Year Experience.
Cancer Res Treat. 2025;57(2):443-456.

Abstract
PURPOSE Considering the high disease burden and unique features of Asian patients with breast cancer (BC), it is essential to have a comprehensive view of genetic characteristics in this population. An institutional targeted sequencing platform was developed through the Korea Research-Driven Hospitals project and was incorporated into clinical practice. This study explores the use of targeted next-generation sequencing (NGS) and its outcomes in patients with advanced/metastatic BC in the real world.
MATERIALS AND METHODS We reviewed the results of NGS tests administered to BC patients using a customized sequencing platform-FiRST Cancer Panel (FCP)-over 7 years. We systematically described clinical translation of FCP for precise diagnostics, personalized therapeutic strategies, and unraveling disease pathogenesis.
RESULTS NGS tests were conducted on 548 samples from 522 patients with BC. Ninety-seven point six percentage of tested samples harbored at least one pathogenic alteration. The common alterations included mutations in TP53 (56.2%), PIK3CA (31.2%), GATA3 (13.8%), BRCA2 (10.2%), and amplifications of CCND1 (10.8%), FGF19 (10.0%), and ERBB2 (9.5%). NGS analysis of ERBB2 amplification correlated well with human epidermal growth factor receptor 2 immunohistochemistry and in situ hybridization. RNA panel analyses found potentially actionable and prognostic fusion genes. FCP effectively screened for potentially germline pathogenic/likely pathogenic mutation. Ten point three percent of BC patients received matched therapy guided by NGS, resulting in a significant overall survival advantage (p=0.022), especially for metastatic BCs.
CONCLUSION Clinical NGS provided multifaceted benefits, deepening our understanding of the disease, improving diagnostic precision, and paving the way for targeted therapies. The concrete advantages of FCP highlight the importance of multi-gene testing for BC, especially for metastatic conditions.
PubMed IF 4.2 혈액종양내과
402025

제1저자 김정연 · 교신저자 김천형, 이은영

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Mitochondrial transplantation as a novel therapeutic approach in idiopathic inflammatory myopathy.
Ann Rheum Dis. 2025;84(4):609-619.

Abstract
OBJECTIVES This study aimed to investigate the efficacy of mitochondrial transplantation as a therapeutic intervention for idiopathic inflammatory myopathy (IIM). This study used a comprehensive approach, incorporating both in vitro and in vivo IIM models, and conducted a first-in-human clinical trial to assess the effectiveness and safety of mitochondria isolated from human umbilical cord mesenchymal stem cells (PN-101).
METHODS Mitochondria isolated from umbilical cord mesenchymal stem cells were designated as PN-101. The efficacy of PN-101 was assessed using myoblasts derived from patients with IIM and C2C12 mouse perforin/granzyme B-treated myoblasts as an in vitro IIM model. PN-101's effect on IIM was examined using C protein-induced myositis (CIM) mice as an in vivo model. The efficacy and safety of PN-101 were evaluated in a phase 1/2a clinical trial involving 9 adult patients with refractory polymyositis or dermatomyositis.
RESULTS The myoblasts derived from patients with IIM exhibited defects in mitochondrial function and myogenesis. PN-101 transplantation enhances muscle differentiation and mitochondrial function in IIM myoblasts. PN-101 also enhanced intracellular adenosine triphosphate content, cell viability, and myogenesis in C2C12 perforin/granzyme B-treated myoblasts. In an in vivo model, PN-101 reduced myositis severity by exhibiting anti-inflammatory effects and restoring the CIM-induced metabolic shift. In a phase 1/2a prospective clinical trial involving adult patients with refractory IIM, PN-101 demonstrated no severe adverse drug reactions and showed at least minimal improvement in the International Myositis Assessment and Clinical Studies Group (IMACS)-Total Improvement Scores (TISs) compared with baseline.
CONCLUSIONS PN-101 transplantation could serve as a novel treatment for IIM by enhancing mitochondrial repair and reducing inflammation in muscle tissues.
PubMed IF 24 류마티스내과
392025

제1저자 장윤영 · 교신저자 강은정, 이하정

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Clinical Significance of Incident Osteoporotic Fractures After Kidney Transplantation: A National Korean Cohort Study.
Am J Kidney Dis. 2025;85(4):409-420.e1.

Abstract
RATIONALE & OBJECTIVE Recipients of kidney allografts are at risk of osteoporotic fractures (OF), but the association of OF with transplant patient outcomes remains uncertain due to common coexisting risks and complex medical conditions. This study sought to assess whether the overall incidences of OF among recipients of kidney allografts compared to that of patients receiving maintenance dialysis for kidney failure.
STUDY DESIGN A national retrospective cohort study.
SETTING & PARTICIPANTS 145,090 Korean patients newly diagnosed with kidney failure between 2009 and 2019.
EXPOSURE Kidney transplantation versus dialysis resulting in OF, and OF increasing risk of death.
OUTCOME Incident OF overall and by site (hip, spine, forearm, and humerus); death.
ANALYTICAL APPROACH Comparison of patients receiving maintenance dialysis with recipients of kidney allografts matched by age, sex, year of new index date, duration of dialysis, and presence of hypertension and diabetes mellitus. Cause-specific Cox proportional hazards regression models estimated the association between modality of kidney replacement therapy and OF. Cox models incorporating OF as a time-updated covariate were used to estimate the association of OF and mortality.
RESULTS A total of 11,413 pairs were matched. Over the entire study period, 541 (4.7%) OFs in allograft recipients and 657 (5.8%) in matched dialysis comparators occurred, respectively. After 5.5 years of follow-up evaluation, the risk of incident OF was lower in kidney transplant recipients compared with matched dialysis comparators (adjusted hazard ratio[AHR], 0.73 [95% CI, 0.64-0.84], P<0.001). The differences in fracture rates were primarily driven by differences in hip fractures. Incident OF was associated with increased mortality risk (AHR, 2.18 [95% CI, 1.57-3.02], P<0.001) and death-censored allograft failure (AHR, 1.42 [95% CI, 1.02-1.97], P=0.040).
LIMITATIONS Use of claims data, and no data on bone mineral density or hyperparathyroidism; the definition of OF that was used encompassed traumatic fractures.
CONCLUSIONS Kidney allograft recipients have a lower rate of incident OF compared with dialysis patients, but when OF occurs it is associated with a higher rate of death and allograft loss.
PubMed IF 9.4 신장내과
382025

제1저자 정영애, 이승미 · 교신저자 황금숙, 박중신, 김원

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Metabolomic profiling reveals early biomarkers of gestational diabetes mellitus and associated hepatic steatosis.
Cardiovasc Diabetol. 2025;24(1):125.

Abstract
BACKGROUND This study aims to identify early metabolomic biomarkers of gestational diabetes mellitus (GDM) and evaluate their association with hepatic steatosis.
METHODS We compared maternal serum metabolomic profiles between women who developed GDM (n = 118) and matched controls (n = 118) during the first (10-14 gestational weeks) and second (24-28 gestational weeks) trimesters using ultra-performance liquid chromatography coupled with mass spectrometry. Mediation analysis was performed to evaluate the mediating role of metabolic dysfunction-associated steatotic liver disease (MASLD) in the relationship between metabolites and subsequent development of GDM. A refined prediction model was developed to predict GDM using established clinical factors and selected metabolites.
RESULTS Significant alterations in circulating metabolites, including amino acids, bile acids, and phospholipids, were observed in the GDM group compared to controls during early pregnancy. Mediation analysis revealed that several metabolites, including glycocholic acid (proportion mediated (PM) = 31.9%), butanoyl carnitine (PM = 25.7%), and uric acid (PM = 22.4%), had significant indirect effects on GDM incidence mediated by hepatic steatosis. The refined prediction model composed of clinical factors and selected metabolites in the first trimester demonstrated higher performance in predicting GDM development than the established prediction model composed solely of clinical factors (AUC, 0.85 vs. 0.63, p < 0.001).
CONCLUSIONS Women who developed GDM exhibited altered metabolomic profiles from early pregnancy, which showed a significant correlation with GDM, with MASLD as a mediator. Selected metabolomic biomarkers may serve as predictive markers and potential targets for early risk assessment and intervention in GDM.
RESEARCH INSIGHTS WHAT IS CURRENTLY KNOWN ABOUT THIS TOPIC?: Gestational diabetes mellitus (GDM) is a common pregnancy complication with significant health risks. Early identification of women at high risk for GDM is crucial for timely intervention and improved outcomes. WHAT IS THE KEY RESEARCH QUESTION?: What alterations in circulating metabolites during early pregnancy are associated with subsequent GDM development? Does metabolic dysfunction-associated steatotic liver disease (MASLD) mediate the association between specific metabolites and GDM risk? WHAT IS NEW?: Significant alterations in bile acids, amino acids, phosphatidylethanolamines, and phosphatidylinositols were observed in early pregnancy sera of women who later developed GDM. MASLD significantly mediated the effects of several metabolites on GDM risk, with mediation proportions ranging from 9.7 to 31.9%. A refined prediction model composed of clinical factors and metabolites significantly improved the performance in predicting GDM development. HOW MIGHT THIS STUDY INFLUENCE CLINICAL PRACTICE?: These results provide new insights into early metabolic alterations associated with GDM development and highlight the potential mediating role of MASLD. This comprehensive metabolomic approach may contribute to the development of improved risk prediction models and targeted interventions for GDM prevention.
PubMed IF 15.6 소화기내과
372025

제1저자 김중엽, 황현택 · 교신저자 임재준

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Relationship Between Clarithromycin Minimum Inhibitory Concentrations and Treatment Responses in Mycobacterium avium Complex Pulmonary Disease.
Clin Infect Dis. 2025;80(3):637-643.

Abstract
BACKGROUND Mycobacterium avium complex pulmonary disease (MAC-PD) is a chronic lung condition with rapidly increasing prevalence worldwide. Macrolides like azithromycin and clarithromycin are the backbone of long-term antibiotic therapy for progressive MAC-PD. The impact of minimum inhibitory concentrations (MICs), especially within the susceptible range, for macrolides on treatment responses remains unclear.
METHODS We analyzed adult patients who started treatment for MAC-PD between 1 March 2009 and 1 March 2022 at Seoul National University Hospital. Patients were categorized into 4 groups according to the clarithromycin MICs of their causative strains at treatment initiation. Logistic regression was employed to evaluate the impact of clarithromycin MICs on the likelihood of microbiological cure. Companion drugs and their MICs, alongside clinical characteristics like age, sex, body mass index, cavity presence, acid-fast bacilli smear positivity, causative species, and erythrocyte sedimentation rate were adjusted in multivariable analysis.
RESULTS Four-hundred thirty-six patients (median age, 65 years; 34% men) were included. Microbiological cure rates were 51.8%, 51.9%, 50.0%, and 18.2% for patients with clarithromycin MICs ≤0.5, 1-2, 4-8, and ≥32 µg/mL, respectively (P = .181). No significant differences in microbiological cure rates were observed across varying levels of clarithromycin MICs within the susceptible range (≤8 µg/mL). Relative to patients with clarithromycin-susceptible strains, patients with MICs ≥32 µg/mL had an odds ratio of 0.25 for achieving microbiological cure (95% confidence interval [CI]: 0.06-1.07; P = .06).
CONCLUSIONS Treatment responses were comparable among patients with strains having clarithromycin MICs within the susceptible range but were likely to be worse for patients with strains having MICs ≥32 µg/mL.
PubMed IF 8.3 순환기내과
362025

제1저자 곽순구 · 교신저자 이승표, 김대희

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Sex-Specific Association of Left Ventricular Function With Mortality in Severe Mitral Regurgitation.
JAMA Netw Open. 2025;8(3):e252420.

Abstract
IMPORTANCE The association between left ventricular (LV) systolic dysfunction and adverse outcomes in patients with severe degenerative mitral regurgitation (MR) may vary by sex.
OBJECTIVE To investigate the sex-specific association of LV systolic function with mortality in patients with severe degenerative MR.
DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included consecutive patients who underwent surgery for severe degenerative MR at 2 tertiary hospitals in South Korea from 2006 to 2020. Preoperative LV ejection fraction (LVEF) and LV global longitudinal strain (LV-GLS) were measured, with absolute LV-GLS values reported. Patients were stratified by LVEF (≤55%, >55% to ≤60%, and >60%) and LV-GLS (<19.9%, ≥19.9% to <23.4%, and ≥23.4%) tertiles. Mortality status was verified through December 2023, with a median (IQR) follow-up duration of 8.2 (5.3-12.2) years. Data analysis was conducted in March 2024.
EXPOSURES Surgical MV repair or replacement.
MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality after MV surgery. Restricted cubic spline (RCS) curves visualized the association between LVEF, LV-GLS, and mortality for each sex.
RESULTS Among 1686 patients, 1088 (64.5%) were men and 598 (35.5%) were women. Women were older than men (median [IQR] age, 62 [51-70] vs 54 [45-63] years) and had higher LVEF and LV-GLS than men did. During the follow-up, 220 (13.0%) deaths occurred (117 men [10.8%]; 103 women [17.2%]). In Kaplan-Meier curves, mortality in men increased in the lowest LVEF (≤55%) and LV-GLS (<19.9%) groups, whereas women exhibited an earlier increase in mortality at higher LVEF (55%-60%) and LV-GLS (19.9%-23.4%) levels. Multivariable Cox analyses showed a higher mortality risk associated with LVEF less than or equal to 55% (adjusted hazard ratio [HR], 3.48; 95% CI, 1.84-6.58; P < .001) and 55% to 60% (adjusted HR, 2.21; 95% CI, 1.36-3.58; P = .001) compared with LVEF greater than 60% in women, but not in men (P for interaction by sex = .02). RCS curves showed an earlier increase in mortality risk at higher LVEF and LV-GLS levels in women. Similar trends were observed in asymptomatic patients.
CONCLUSIONS AND RELEVANCE In this cohort study of patients with severe degenerative MR, women had an earlier increase in mortality risk associated with LV systolic dysfunction, suggesting the need to consider sex-specific criteria for early surgery in asymptomatic patients.
PubMed IF 11.7 순환기내과
352025

제1저자 장하영, 최보윤 · 교신저자 강혜련, 오정미

, , , ,
Risk Factors of Hypersensitivity Reactions to Carboplatin: A Systematic Review and Meta-Analysis.
J Allergy Clin Immunol Pract. 2025;13(3):610-618.e10.

Abstract
BACKGROUND The development of hypersensitivity reactions (HSRs) to carboplatin can interrupt anticancer treatment and may shorten patient survival. Several studies have evaluated the risk factors for carboplatin HSRs, but the results have been inconclusive.
OBJECTIVE This systematic review and meta-analysis aimed to establish a consensus on the risk factors of HSRs to carboplatin in patients with cancer.
METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, relevant studies were searched across MEDLINE, Embase, and Korean Medical Database. Inclusion criteria focused on original articles of case-control or cohort studies that evaluated risk factors for carboplatin HSRs in patients with cancer. Exclusion criteria targeted articles with incomplete or overlapping data. The latest search and quality assessment of the included studies, using the Newcastle-Ottawa scale, was performed on February 1, 2023.
RESULTS Among 1,182 articles identified, 19 studies were included in the final systematic review and meta-analysis. The identified risk factors for carboplatin hypersensitivity included a history of allergy to medicines, food, or environmental factors (odds ratio [OR] = 1.76; 95% CI, 1.46-2.12), BRCA mutation (OR = 4.03; 95% CI, 2.00-8.13), carboplatin free interval of 12 months or more (OR = 4.93; 95% CI, 2.89-8.40), increased cumulative dose (standardized mean difference, 0.58; 95% CI, 0.41-0.75), relapse (OR = 2.26; 95% CI, 1.58-3.25), and younger age (standardized mean difference, -0.15; 95% CI, -0.26 to -0.03).
CONCLUSIONS To our knowledge, this meta-analysis provides the first comprehensive quantitative evaluation of risk factors for carboplatin HSRs in patients with cancer. These findings can guide the development of personalized risk assessment tools and preventive strategies, potentially improving patient safety and treatment outcomes in carboplatin-based chemotherapy.
PubMed IF 6.6 알레르기내과
342025

제1저자 전중원 · 교신저자 이상협, 김윤희

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ATR inhibition promotes synergistic antitumor effect in platinum-resistant pancreatic cancer.
Biochim Biophys Acta Mol Basis Dis. 2025;1871(3):167625.

Abstract
BACKGROUND Oxaliplatin is a commonly used platinum-based chemotherapy drug for patients with pancreatic cancer (PC). Drug resistance is a major challenge in PC treatment, underscoring the urgent need for new approaches. Targeting DNA damage repair, one of the factors responsible for platinum resistance, is an attractive strategy to overcome drug resistance. This study aimed to investigate the potential of the ATR inhibitor BAY 1895344 in improving the drug responsiveness of oxaliplatin-resistant PC.
METHODS Oxaliplatin-resistant PC cells (CFPAC-1 and Capan-2) were selected and treated with oxaliplatin, BAY 1895344, or a combination of both in vivo and in vitro. Their combinatorial effects on the DNA damage response (DDR) signaling pathway, apoptosis, and extent of DNA damage were evaluated using appropriate methods. Patient response was predicted using organoid models.
RESULTS Combination treatment with BAY 1895344 and oxaliplatin exhibited a synergistic effect on both PC cell lines, with the effect being more pronounced on Capan-2. Additionally, the combination treatment substantially suppressed phospho-Chk1, a coordinator of DDR and cell cycle checkpoints. Mechanistically, ATR inhibition augmented the DNA damage induced by oxaliplatin, leading to mitotic catastrophe and cell death. Furthermore, in an in vivo study using a tumor-bearing xenograft mouse model, the combination treatment markedly reduced tumor growth. This synergistic effect was confirmed in patient-derived organoids with poor response to oxaliplatin.
CONCLUSION ATR inhibition enhanced the anticancer effect of oxaliplatin, suggesting that this combination treatment could be an effective therapeutic strategy for overcoming platinum resistance in PC.
PubMed IF 5 소화기내과
332025

제1저자 손민지 · 교신저자 임수

, ,
Effects of choline alfoscerate on cognitive function and quality of life in type 2 diabetes: A double-blind, randomized, placebo-controlled trial.
Diabetes Obes Metab. 2025;27(3):1350-1358.

Abstract
AIMS This study evaluated the effects of choline alfoscerate on cognitive function and quality of life in T2DM patients with mild cognitive decrements.
MATERIALS AND METHODS In a double-blind, randomized, placebo-controlled trial, we recruited 36 individuals with T2DM and mild cognitive impairment which was assessed by the Mini-Mental State Examination (MMSE) score of 25-28, and randomly assigned them to receive either 1200 mg/day of choline alfoscerate or a placebo. Four additional questionnaires-the 36-Item Short Form Survey, the modified Informant Questionnaire on Cognitive Decline in the Elderly, the Korean version of Activities of Daily Living, and the Patient Health Questionnaire-were investigated at 6 and 12 months and analysed via mixed-effects models for repeated measures.
RESULTS The mean age of study participants was 71.8 ± 5.3 years and 69.4% women. Six-month treatment with choline alfoscerate resulted in a non-significant increase in the MMSE score from 26.2 ± 1.3 to 26.9 ± 2.0, whereas the placebo group showed a non-significant decline from 26.6 ± 1.3 to 25.9 ± 2.3, resulting in a mean difference of +1.4 between the two groups (p = 0.059). At 12 months, the mean difference increased to +1.7 with statistical significance (p < 0.001). Physical health, as measured by the SF-36 survey, was significantly better in the choline alfoscerate group than in the placebo group.
CONCLUSIONS Choline alfoscerate 1200 mg once daily treatment showed marginal improvement in cognitive function in T2DM patients with mild cognitive impairment at 6 months but leading to significance at 12 months compared to placebo, suggesting its potential as an adjunct therapy for managing early cognitive decline.
PubMed IF 6.1 내분비대사내과
322025

제1저자 안창호, 김태우 · 교신저자 김정희

, , , , , , , , ,
Two-Stage Deep Learning Model for Adrenal Nodule Detection on CT Images: A Retrospective Study.
Radiology. 2025;314(3):e231650.

Abstract
Background The detection and classification of adrenal nodules are crucial for their management. Purpose To develop and test a deep learning model to automatically depict adrenal nodules on abdominal CT images and to simulate triaging performance in combination with human interpretation. Materials and Methods This retrospective study (January 2000-December 2020) used an internal dataset enriched with adrenal nodules for model training and testing and an external dataset reflecting real-world practice for further simulated testing in combination with human interpretation. The deep learning model had a two-stage architecture, a sequential detection and segmentation model, trained separately for the right and left adrenal glands. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) for nodule detection and intersection over union for nodule segmentation. Results Of a total of 995 patients in the internal dataset, the AUCs for detecting right and left adrenal nodules in internal test set 1 (n = 153) were 0.98 (95% CI: 0.96, 1.00; P < .001) and 0.93 (95% CI: 0.87, 0.98; P < .001), respectively. These values were 0.98 (95% CI: 0.97, 0.99; P < .001) and 0.97 (95% CI: 0.96, 0.97; P < .001) in the external test set (n = 12 080) and 0.90 (95% CI: 0.84, 0.95; P < .001) and 0.89 (95% CI: 0.85, 0.94; P < .001) in internal test set 2 (n = 1214). The median intersection over union was 0.64 (IQR, 0.43-0.71) and 0.53 (IQR, 0.40-0.64) for right and left adrenal nodules, respectively. Combining the model with human interpretation achieved high sensitivity (up to 100%) and specificity (up to 99%), with triaging performance from 0.77 to 0.98. Conclusion The deep learning model demonstrated high performance and has the potential to improve detection of incidental adrenal nodules. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Malayeri and Turkbey in this issue.
PubMed IF 17.6 내분비대사내과
312025

제1저자 서경훈 · 교신저자 이승환, 임수

, ,
Beyond Body Mass Index: New Criteria for a Holistic Approach to Clinical Obesity.
Diabetes Metab J. 2025;49(2):165-168.

PubMed IF 8.2 내분비대사내과
302025

제1저자 오도연 · 교신저자 오도연

, , , , , , , , , , , , , , , , ,
Bintrafusp alfa and chemotherapy as first-line treatment in biliary tract cancer: A randomized phase 2/3 trial.
Hepatology. 2025;81(3):823-836.

Abstract
BACKGROUND AND AIMS We compared the safety and efficacy of bintrafusp alfa (BA) in combination with gemcitabine+cisplatin (GemCis), to those of GemCis alone, in patients with biliary tract cancer.
APPROACH AND RESULTS This randomized, double-blind, placebo-controlled, adaptive design phase 2/3 trial (NCT04066491) included adults who are treatment-naive with locally advanced/metastatic biliary tract cancer. Patients (N = 297) were randomized to receive an IV infusion of BA (2400 mg once/3 wk) plus GemCis (gemcitabine 1000 mg/m 2 +cisplatin 25 mg/m 2 on days 1 and 8/3 wk; 8 cycles) (BA group, n = 148) or placebo+GemCis (placebo group, n = 149). The primary end point was overall survival (OS). For adaptation analysis (phase 2-phase 3; data cutoff: May 20, 2021), efficacy was assessed in the first 150 patients who were antibiotic-naive when 80 progression-free survival events had occurred and ≥ 19 weeks of follow-up had been completed (BA, n = 73; placebo, n = 77). Median OS (95% CI) for the BA (11.5 mo [9.3-not estimable]) and placebo (11.5 mo [10.0-not estimable]) groups was comparable (hazard ration 1.23 [95% CI 0.66-2.28]; p = 0.7394); OS data maturity was 27.2% (41 events/151 patients). The most common grade ≥3 treatment-related adverse event was anemia (BA, 26.0%; placebo, 22.8%). Bleeding adverse events were reported more frequently in the BA group (28.8%) versus the placebo group (7.4%). Deaths within 60 days of the first dose were reported in 7.5% and 1.3% of patients in the BA and placebo groups, respectively.
CONCLUSIONS BA+GemCis did not provide a clinically meaningful benefit compared with GemCis alone as first-line treatment for biliary tract cancer, and the study was discontinued early (terminated: August 20, 2021).
PubMed IF 18 혈액종양내과
292025

제1저자 안화영, 이민정 · 교신저자 조선욱

, , , , , , , , , ,
Selenium vs Control for Graves Ophthalmopathy in a Selenium-Sufficient Area: A Randomized Clinical Trial.
JAMA Ophthalmol. 2025;143(4):287-94.

Abstract
IMPORTANCE Graves ophthalmopathy significantly diminishes patients' quality of life due to its immune-mediated inflammatory effects on the orbital tissues. Selenium, with its antioxidative properties, has shown potential for improving Graves ophthalmopathy progression and quality of life (QOL); however, its effectiveness in selenium-sufficient regions is not well established.
OBJECTIVE To determine whether selenium supplementation improves QOL in patients with mild to moderate Graves ophthalmopathy in selenium-sufficient regions.
DESIGN, SETTING, AND PARTICIPANTS The Efficacy of Selenium Supplementation for Mild-to-Moderate Graves' Ophthalmopathy in a Selenium-Sufficient Area (SeGOSS) trial was a randomized, open-label multicenter study. Eighty-four patients with mild to moderate Graves' ophthalmopathy were enrolled; 70 completed the study. Participants were selected based on Graves ophthalmopathy diagnosis and sufficient selenium levels. Data were analyzed from October 2023 to March 2024.
INTERVENTIONS Participants received selenium supplementation combined with vitamin B complex for 6 months.
MAIN OUTCOMES AND MEASURES The primary outcome was improvements in Graves ophthalmopathy QOL (GO-QOL) scores at 6 months. Secondary outcomes included changes in GO-QOL scores at 3 months, the proportion of patients showing improvement based on GO-QOL scores, clinical activity score, and ophthalmic examinations at 3 months and 6 months, and changes in thyroid autoantibodies at 3 months and 6 months.
RESULTS There was no improvement in changes in the total GO-QOL scores between the selenium group (31 female patients [83.8%] and 7 male patients [16.2%]; mean [SD] age, 40.8 [11.7] years) and control group (24 female patients [72.7%] and 9 male patients [27.3%]; mean [SD] age, 42.9 [14.2] years) for the primary outcome at 6 months (mean [SD], 12.2 [22.5] vs mean [SD], 11.2 [20.2]; difference, 0.9; 95% CI, -9.3 to 11.3; P = .85). However, at 3 months, a higher proportion of patients in the selenium group showed improved GO-QOL scores compared with the control group (78.4 vs 48.5%; difference, 0.30; 95% CI, 0.08-0.51; P = .01). The selenium group also had higher rates of improvement in proptosis reduction (49.5 vs 15.1%; difference, 0.31; 95% CI, 0.11-0.51; P = .01) at 3 months, though these effects were not sustained at 6 months.
CONCLUSIONS AND RELEVANCE These results suggest that selenium supplementation did not improve QOL or clinical parameters in patients with mild to moderate GO in selenium-sufficient regions at 6 months. Some potential QOL benefits noted at 3 months supports consideration of further investigation of selenium for patients seeking treatment for Graves ophthalmopathy .
TRIAL REGISTRATION Clinical Research Information Service Identifier KCT0004040.
PubMed IF 10.5 내분비대사내과
282025

제1저자 강현명, 김혜진, 정지원, 안진영, 송경호 · 교신저자 정혜원, 고재훈

, , , , , , , , , , , , , , , , , , ,
Natural Boosting and the Immunogenicity of the XBB.1.5 Monovalent Vaccine in the Coronavirus Disease 2019 Endemic Era: A Longitudinal Observational Study.
J Infect Dis. 2025;231(2):392-402.

Abstract
BACKGROUND With the transition from the coronavirus disease 2019 (COVID-19) pandemic into endemicity, changes in group immunity and the effect of updated XBB.1.5 monovalent vaccine (MonoV) need to be investigated.
METHODS A multicenter vaccine cohort was followed for 3 years, and the investigation period was classified into the pre-Omicron, Omicron, and endemic eras. Thirteen sampling points were assessed, including pre- and post-MonoV administration. Specimens were classified as vaccinated, molecularly or serologically diagnosed breakthrough infection (BI), natural boosting (NB), or waned.
RESULTS A total of 327 healthcare workers contributed 2645 blood samples from March 2021 to December 2023. The log10 anti-spike protein antibody (SAb) levels, elevated by vaccination, declined linearly in the pre-Omicron era, were maintained during the Omicron era due to BIs, and increased in the endemic era (slope = 0.02, P = .02) without additional vaccination. NB cases increased significantly across the epidemiologic eras. The incidence rate ratios were 2.72 (P < .001) for Omicron/pre-Omicron and 3.39 (P < .001) for endemic/Omicron. Plaque reduction neutralization test (PRNT) titers against circulating strains (XBB.1.5 and XBB.1.9.1) in the NB group maintained previous levels, but ratios to wild-type PRNT and fold changes exhibited significantly enhanced activity. The XBB.1.5 MonoV increased PRNT by 5.8-fold against XBB.1.5 and 6.6-fold against JN.1, showing stronger enhancement against subsequent epidemic strains than the bivalent vaccine.
CONCLUSIONS Group immunity in the COVID-19 endemic era exhibited maintained SAb levels and adjusted neutralizing activities through BI and NB. The XBB.1.5 MonoV significantly enhanced neutralizing activity against the vaccine strain and robust immunity against the subsequent epidemic JN.1 strain.
PubMed IF 4.1 감염내과
272025

제1저자 김성래 · 교신저자 박현선, 고성준

, ,
Association of childhood obesity or weight change with early-onset follicular occlusion triad in children.
Br J Dermatol. 2025;192(3):430-439.

Abstract
BACKGROUND The effects of childhood obesity or weight gain on the development of early-onset follicular occlusion triad (FOT), which includes hidradenitis suppurativa (HS), acne conglobata (AC) and dissecting cellulitis of the scalp (DCS) in children, remain unknown.
OBJECTIVES To investigate the association between body mass index (BMI) and changes in BMI and the development of early-onset FOT in children.
METHODS This nationwide population-based longitudinal cohort study included a cohort of 2 012 928 Korean children who underwent two consecutive health examinations at 30-36 months and 42-48 months of age, respectively, between 2009 and 2020. BMI and changes in BMI were derived during these health screenings. We performed multivariate Cox proportional hazards regression analyses to estimate the risk of early-onset FOT, including HS, AC and DCS.
RESULTS During follow-up, 1283 FOT events, including 143 cases of HS, 1068 cases of AC and 72 cases of DCS, were identified. Children with obesity had an elevated risk of early-onset FOT than those with a normal weight [FOT: adjusted hazard ratio (aHR) 1.49, 95% confidence interval (CI) 1.21-1.84; HS: aHR 2.30, 95% CI 1.39-3.82; AC: aHR 1.36, 95% CI 1.07-1.73]. BMI gain was correlated with an elevated risk of early-onset FOT, particularly HS, whereas BMI loss was linked to a decreased risk of early-onset FOT, especially HS. Children who developed obesity had an increased risk of early-onset FOT (aHR 1.51, 95% CI 1.07-2.14) vs. those who maintained a normal weight. Children with obesity who reduced to a normal weight exhibited a decreased risk of early-onset FOT [FOT: aHR 0.41, 95% CI 0.17-0.96 (Ptrend = 0.02); HS: Ptrend = 0.05] than children with obesity who retained their weight.
CONCLUSIONS Childhood obesity is associated with an elevated risk of early-onset FOT, including HS and AC. Weight gain is correlated with an increased risk of early-onset FOT, especially HS, while weight loss is associated with a decreased risk of early-onset FOT, particularly HS. Implementing purposeful weight-reduction strategies may be helpful in preventing the development of early-onset FOT.
PubMed IF 8.2 소화기내과
262025

제1저자 오미진 · 교신저자 조수정

, , , , , , , , , , , ,
Application of artificial intelligence in the detection of Borrmann type 4 advanced gastric cancer in upper endoscopy (with video).
Cancer. 2025;131(4):e35768.

Abstract
BACKGROUND Borrmann type-4 (B-4) advanced gastric cancer is challenging to diagnose through routine endoscopy, leading to a poor prognosis. The objective of this study was to develop an artificial intelligence (AI)-based system capable of detecting B-4 gastric cancers using upper endoscopy.
METHODS Endoscopic images from 259 patients who were diagnosed with B-4 gastric cancer and 595 controls who had benign conditions were retrospectively collected from Seoul National University Hospital for training and testing. Internal validation involved prospectively collected endoscopic videos from eight patients with B-4 gastric cancer and 148 controls. For external validation, endoscopic images and videos from patients with B-4 gastric cancer and controls at the Seoul National University Bundang Hospital were used. To calculate patient-based accuracy, sensitivity, and specificity, a diagnosis of B-4 was made for patients in whom greater than 50% of the images were identified as B-4 gastric cancer.
RESULTS The accuracy of the patient-based diagnosis was highest in the internal image test set, with accuracy, sensitivity, and specificity of 93.22%, 92.86%, and 93.39%, respectively. The accuracy of the model in the internal validation videos, the external validation images, and the external validation videos was 91.03%, 91.86%, and 86.71%, respectively. Notably, in both the internal and external video sets, the AI model demonstrated 100% sensitivity for diagnosing patients who had B-4 gastric cancer.
CONCLUSIONS An innovative AI-based model was developed to identify B-4 gastric cancer using endoscopic images. This AI model is specialized for the highly sensitive detection of rare B-4 gastric cancer and is expected to assist clinicians in real-time endoscopy.
PubMed IF 5.6 소화기내과
252025

제1저자 이소령, 이경연 · 교신저자 최의근

, , , , , , , , , , , , , , ,
Perioperative Factor Xa Inhibitor Discontinuation for Patients Undergoing Procedures With Minimal or Low Bleeding Risk.
JAMA Netw Open. 2025;8(2):e2458742.

Abstract
IMPORTANCE Discontinuation of oral anticoagulant treatment is common in clinical practice due to concerns about bleeding, even for procedures with minimal to low bleeding risk.
OBJECTIVE To explore whether perioperative discontinuation of factor Xa inhibitors is associated with major bleeding and thromboembolic events in patients with atrial fibrillation (AF) undergoing procedures with minimal to low bleeding risk.
DESIGN, SETTING, AND PARTICIPANTS This prospective, multicenter, single-arm cohort study conducted in Korea included patients with AF who planned to undergo a procedure with minimal to low bleeding risk between September 25, 2020, and April 5, 2024.
EXPOSURE The PERIXa (Perioperative Factor Xa Inhibitor Discontinuation in Patients With Atrial Fibrillation Undergoing Minimal to Low Bleed Risk Procedures) protocol recommending giving the last dose of factor Xa inhibitor (ie, apixaban, edoxaban, or rivaroxaban) 24 hours before the procedure (ie, endoscopy, dental procedure, or ocular surgery) and restarting treatment with the inhibitor the next day.
MAIN OUTCOMES AND MEASURES The primary outcome was major bleeding, and the secondary outcome included a composite of thromboembolic events 30 days after the index procedure with minimal to low bleeding risk.
RESULTS In total, 1902 patients were included in the modified intention-to-treat analysis set encompassing all patients who underwent the intended procedure (mean [SD] age, 70.4 [8.8] years; 1135 [59.7%] male; mean [SD] CHA2DS2-VASc [congestive heart failure, hypertension, age 75 years or older, diabetes, stroke, vascular disease, age 65-74 years, and female sex; range, 0-9, with higher scores indicating higher risk of stroke] score, 2.8 [1.3]; mean [SD] HAS-BLED [hypertension, kidney or liver disease, stroke history, prior bleeding, unstable international normalized ratio, age >65 years, and drug or alcohol use; range, 0-9, with higher scores indicating higher risk of bleeding] score, 1.6 [0.7]). Among them, 921 (48.4%) were receiving apixaban, 616 (32.4%) were receiving edoxaban, and 365 (19.2%) were receiving rivaroxaban. Of the total procedures, 948 (49.8%) were endoscopy, 820 (43.1%) were dental procedures, and 120 (6.3%) were ocular surgery. The 30-day event rate of major bleeding was 0.1% (n = 2), and there were no composite thromboembolic events. The results were consistent in the per-protocol analysis, and no differences were observed by procedure category or factor Xa inhibitor type.
CONCLUSIONS AND RELEVANCE In this cohort study, patients with AF receiving a factor Xa inhibitor and undergoing a procedure with minimal to low bleeding risk had low rates of major bleeding and thromboembolism when following the standardized PERIXa protocol for perioperative management of oral anticoagulant treatment, suggesting that this may be a safe and reasonable option for this patient population.
PubMed IF 11.7 순환기내과
242025

제1저자 박지석, 김지연 · 교신저자 전재익, 윤연이

, , , , , , , , , , ,
Artificial intelligence-enhanced comprehensive assessment of the aortic valve stenosis continuum in echocardiography.
EBioMedicine. 2025;112:105560.

Abstract
BACKGROUND Transthoracic echocardiography (TTE) is the primary modality for diagnosing aortic stenosis (AS), yet it requires skilled operators and can be resource-intensive. We developed and validated an artificial intelligence (AI)-based system for evaluating AS that is effective in both resource-limited and advanced settings.
METHODS We created a dual-pathway AI system for AS evaluation using a nationwide echocardiographic dataset (developmental dataset, n = 8427): 1) a deep learning (DL)-based AS continuum assessment algorithm using limited 2D TTE videos, and 2) automating conventional AS evaluation. We performed internal (internal test dataset [ITDS], n = 841) and external validation (distinct hospital dataset [DHDS], n = 1696; temporally distinct dataset [TDDS], n = 772) for diagnostic value across various stages of AS and prognostic value for composite endpoints (cardiovascular death, heart failure, and aortic valve replacement).
FINDINGS The DL index for the AS continuum (DLi-ASc, range 0-100) increased with worsening AS severity and demonstrated excellent discrimination for any AS (AUC 0.91-0.99), significant AS (0.95-0.98), and severe AS (0.97-0.99). DLi-ASc was independent predictor for composite endpoint (adjusted hazard ratios 2.19, 1.64, and 1.61 per 10-point increase in ITDS, DHDS, and TDDS, respectively). Automatic measurement of conventional AS parameters demonstrated excellent correlation with manual measurement, resulting in high accuracy for AS staging (98.2% for ITDS, 82.1% for DHDS, and 96.8% for TDDS) and comparable prognostic value to manually-derived parameters.
INTERPRETATION The AI-based system provides accurate and prognostically valuable AS assessment, suitable for various clinical settings. Further validation studies are planned to confirm its effectiveness across diverse environments.
FUNDING This work was supported by a grant from the Institute of Information & Communications Technology Planning & Evaluation (IITP) funded by the Korea government (Ministry of Science and ICT; MSIT, Republic of Korea) (No. 2022000972, Development of a Flexible Mobile Healthcare Software Platform Using 5G MEC); and the Medical AI Clinic Program through the National IT Industry Promotion Agency (NIPA) funded by the MSIT, Republic of Korea (Grant No.: H0904-24-1002).
PubMed IF 11.2 순환기내과
232025

제1저자 김유혁, 윤지완 · 교신저자 조영민

, , , , , , ,
Artificial intelligence-based body composition analysis using computed tomography images predicts both prevalence and incidence of diabetes mellitus.
J Diabetes Investig. 2025;16(2):272-284.

Abstract
AIM/INTRODUCTION We assess the efficacy of artificial intelligence (AI)-based, fully automated, volumetric body composition metrics in predicting the risk of diabetes.
MATERIALS AND METHODS This was a cross-sectional and 10-year retrospective longitudinal study. The cross-sectional analysis included health check-up data of 15,330 subjects with abdominal computed tomography (CT) images between January 1, 2011, and September 30, 2012. Of these, 10,570 subjects with available follow-up data were included in the longitudinal analyses. The volume of each body segment included in the abdominal CT images was measured using AI-based image analysis software.
RESULTS Visceral fat (VF) proportion and VF/subcutaneous fat (SF) ratio increased with age, and both strongly predicted the presence and risk of developing diabetes. Optimal cut-offs for VF proportion were 24% for men and 16% for women, while VF/SF ratio values were 1.2 for men and 0.5 for women. The subjects with higher VF/SF ratio and VF proportion were associated with a greater risk of having diabetes (adjusted OR 2.0 [95% CI 1.7-2.4] in men; 2.9 [2.2-3.9] in women). In subjects with normal glucose tolerance, higher VF proportion and VF/SF ratio were associated with higher risk of developing prediabetes or diabetes (adjusted HR 1.3 [95% CI 1.1-1.4] in men; 1.4 [1.2-1.7] in women). These trends were consistently observed across each specified cut-off value.
CONCLUSIONS AI-based volumetric analysis of abdominal CT images can be useful in obtaining body composition data and predicting the risk of diabetes.
PubMed IF 3.6 내분비대사내과
222025

제1저자 양석훈 · 교신저자 구본권

, , , , , , , , , , , , , , , , , , , , ,
Predictors for Vulnerable Plaque in Functionally Significant Lesions.
JACC Cardiovasc Imaging. 2025;18(2):195-206.

Abstract
BACKGROUND Vulnerable plaque presents prognostic implications in addition to functional significance.
OBJECTIVES The aim of this study was to identify relevant features of vulnerable plaque in functionally significant lesions.
METHODS In this multicenter, prospective study conducted across 5 countries, including patients who had invasive fractional flow reserve (FFR) ≤0.80, a total of 95 patients with available pullback pressure gradient (PPG) and plaque analysis on coronary computed tomographic angiography and optical coherence tomography were analyzed. Vulnerable plaque was defined as the presence of plaque rupture or thin-cap fibroatheroma on optical coherence tomography. Among the 25 clinical characteristics, invasive angiographic findings, physiological indexes, and coronary computed tomographic angiographic findings, significant predictors of vulnerable plaque were identified.
RESULTS Mean percentage diameter stenosis, FFR, and PPG were 77.8% ± 14.6%, 0.66 ± 0.13, and 0.65 ± 0.13, respectively. Vulnerable plaque was present in 53 lesions (55.8%). PPG and FFR were identified as significant predictors of vulnerable plaque (P < 0.05 for all). PPG >0.65 and FFR ≤0.70 were significantly related to a higher probability of vulnerable plaque after adjustment for each other (OR: 6.75 [95% CI: 2.39-19.1]; P < 0.001] for PPG >0.65; OR: 4.61 [95% CI: 1.66-12.8]; P = 0.003 for FFR ≤0.70). When categorizing lesions according to combined PPG >0.65 and FFR ≤0.70, the prevalence of vulnerable plaque was 20.0%, 57.1%, 66.7%, and 88.2% in the order of PPG ≤0.65 and FFR >0.70, PPG ≤0.65 and FFR ≤0.70, PPG >0.65 and FFR >0.70, and PPG >0.65 and FFR ≤0.70 (P for trend < 0.001), respectively.
CONCLUSIONS Among low-FFR lesions, the presence of vulnerable plaque can be predicted by PPG combined with FFR without additional anatomical or plaque characteristics. (Precise Percutaneous Coronary Intervention Plan [P3] Study; NCT03782688).
PubMed IF 19 순환기내과
212025

제1저자 이현정 · 교신저자 이승표

, , , , , , , , , , , , , ,
Diffuse Interstitial Fibrosis of the Myocardium Predicts Outcome in Moderate and Asymptomatic Severe Aortic Stenosis.
JACC Cardiovasc Imaging. 2025;18(2):180-191.

Abstract
BACKGROUND Patients with moderate or asymptomatic severe aortic stenosis (AS) are at risk of cardiovascular events.
OBJECTIVES The authors investigated the utility of cardiac magnetic resonance (CMR) to identify drivers of outcome in patients with moderate or asymptomatic severe AS.
METHODS A prospective, international, multicenter cohort (n = 457) of patients with moderate (aortic valve area [AVA]: 1.0-1.5 cm²) or asymptomatic severe AS (AVA ≤1.0 cm² and NYHA functional class I-II) patients underwent CMR. Diffuse interstitial fibrosis and scar in the myocardium were analyzed with extracellular volume fraction (ECV%) and late gadolinium enhancement (LGE). The outcome was a composite of mortality and heart failure admission.
RESULTS Median ECV% was 26.6% (IQR: 24.4%-29.9%), and LGE was present in 31.5% (median 0.8%; IQR: 0.1%-1.7%). Greater AS severity was associated with greater left ventricular mass and diastolic dysfunction, but not with ECV% or LGE. During a median 5.7 years of follow-up, 83 events occurred. Patients with events had higher ECV% (median ECV% 26.3% vs 28.2%; P = 0.003). Patients in the highest ECV% tertiles (ECV% >28.6%) had worse outcomes both in the entire cohort and in those with NYHA functional class I moderate or severe AS, and ECV% was independently associated with outcome (adjusted HR: 1.05; P = 0.039). The ECV% had significant incremental prognostic value when added to parameters of AS severity and cardiac function, comorbidities, aortic valve replacement, and LGE (P < 0.05).
CONCLUSIONS Increased diffuse interstitial fibrosis of the myocardium is associated with poor outcomes in patients with moderate and asymptomatic severe AS and can help identify those who require closer surveillance for adverse outcomes.
PubMed IF 19 순환기내과
202025

제1저자 김정희 · 교신저자 윤지원

, , , , , , ,
Body composition and cardiometabolic risks of patients with adrenal tumours in relation to hormonal activity: a large cross-sectional single-centre study.
Eur J Endocrinol. 2025;192(2):141-149.

Abstract
OBJECTIVE We aimed to examine how different types of adrenal hormone excess influence body composition.
DESIGN A retrospective, cross-sectional, single-centre study.
METHODS We retrospectively enrolled 2971 consecutive adults with adrenal tumours and age-, sex-, and body mass index-matched controls at a 1:3 ratio. The area and attenuation of skeletal muscle and fat at the L3 vertebrae were measured using computed tomography-based analysis software. Prevalence ratios of cardiometabolic outcomes were calculated using the Poisson regression.
RESULTS Patients with non-functioning adenoma (n = 1354) and mild autonomous cortisol secretion (MACS; n = 786) showed similar body compositions. Patients with overt Cushing's syndrome (CS) had the highest visceral fat (VF) area to skeletal muscle area ratio (1.14), while pheochromocytoma (PHEO) patients had the lowest (0.52). Muscle attenuation was lowest in CS and highest in PHEO (32.6 vs 41.5 Hounsfield units, P < .001). Mild autonomous cortisol secretion patients had higher risks of hypertension and dyslipidaemia than non-functioning adenoma patients. Non-functioning adenoma and MACS patients had higher VF area and lower muscle/fat attenuation compared with controls, while primary aldosteronism patients had body compositions similar to controls, except for higher fat attenuation.
CONCLUSIONS Adrenal tumours are associated with altered body composition. Even patients with non-functioning adenoma and MACS had increased VF area and lower muscle and fat attenuation compared with controls, indicating potential cardiometabolic risks.
PubMed IF 6.7 내분비대사내과
192025

제1저자 최정민, 이소령 · 교신저자 최의근

, , , , , , , , , , , , , ,
Clinical outcomes of Asian patients with newly diagnosed atrial fibrillation and previously diagnosed atrial fibrillation: Insights from the CODE-AF Registry.
Heart Rhythm. 2025;22(2):424-431.

Abstract
BACKGROUND Atrial fibrillation (AF) may have different clinical features in its early phase.
OBJECTIVE The purpose of this study was to compare the characteristics and clinical outcomes of early-phase AF with later-phase AF using a large multicenter prospective registry (CODE-AF [COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation]).
METHODS Patients enrolled between June 2016 and March 2021 were divided into 2 groups based on AF duration: (1) newly diagnosed (AF duration ≤90 days); and (2) previously diagnosed (AF duration >90 days). Baseline characteristics and clinical outcomes were compared.
RESULTS Among the 10,001 study participants (mean age 67.0 ± 14.5 years; 64% men), 22% were defined as newly diagnosed and 78% as previously diagnosed. Newly diagnosed patients had fewer comorbidities and more unhealthy social behaviors. Despite lower prescription rates of oral anticoagulant, direct oral anticoagulants were more frequently used. The newly diagnosed group also had a higher composite clinical outcome risk within 90 days (adjusted hazard ratio 1.81, 95% confidence interval 1.30-2.53, P <.001) and revealed a higher risk of all bleeding and heart failure admission within 90 days. No significant differences remained between the groups over 36-month follow-up.
CONCLUSION Patients with early-stage AF were younger and had fewer comorbidities. Although there was a higher risk of heart failure admissions and minor bleeding, the risks of death, stroke, and major bleeding were not significantly increased. Structured monitoring and management during the initial months are essential to address these risks.
PubMed IF 7 순환기내과
182025

제1저자 박준석, 우성진, 최영근 · 교신저자 박현선, 고성준

, , , , , , , , ,
Antibiotic usage within the first year of life has a protective effect against ulcerative colitis in South Korea: A nationwide cohort study.
Dig Liver Dis. 2025;57(2):616-623.

Abstract
BACKGROUND Antibiotic usage in early life has been proposed as a risk factor for inflammatory bowel disease, especially Crohn's disease. However, most studies were conducted in Western countries.
AIMS We evaluated the association between antibiotic usage and the incidence of inflammatory bowel disease in the Asian population.
METHODS This nationwide population-based retrospective cohort study included 2,941,889 South Korean infants born between 2007 and 2015, using the National Health Insurance Service database. We assessed whether antibiotic use was associated with the incidence of inflammatory bowel disease. Additionally, we conducted sensitivity analyses, considering protopathic bias and dietary variables. The Cox proportional hazards model was used.
RESULTS Among 2,941,889 infants, 2,566,390 (87 %) used antibiotics within a year after birth. Antibiotic usage within a year, number of antibiotic classes, and cumulative days of usage were shown to decrease the risk of ulcerative colitis. This association was particularly prominent with earlier antibiotic exposure. Penicillin was the only antibiotic class related to the reduced risk. The results were robust after adjusting for dietary variables and considering protopathic effect.
CONCLUSIONS Antibiotic exposure during the first year of life, particularly at a younger age, is linked to a reduced risk of early-onset ulcerative colitis in South Korea.
PubMed IF 4.9 소화기내과
172025

제1저자 허문행, Terry Cheuk-Fung Yip, 김승업, 이현웅, 이한아, 이형철 · 교신저자 이정훈

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A machine learning model to predict liver-related outcomes after the functional cure of chronic hepatitis B.
J Hepatol. 2025;82(2):235-244.

Abstract
BACKGROUND & AIMS The risk of hepatocellular carcinoma (HCC) and hepatic decompensation persists after hepatitis B surface antigen (HBsAg) seroclearance. This study aimed to develop and validate a machine learning model to predict the risk of liver-related outcomes (LROs) following HBsAg seroclearance.
METHODS A total of 4,787 consecutive patients who achieved HBsAg seroclearance between 2000 and 2022 were enrolled from six centers in South Korea and a territory-wide database in Hong Kong, comprising the training (n = 944), internal validation (n = 1,102), and external validation (n = 2,741) cohorts. Three machine learning-based models were developed and compared in each cohort. The primary outcome was the development of any LRO, including HCC, decompensation, and liver-related death.
RESULTS During a median follow-up of 55.2 (IQR 30.1-92.3) months, 123 LROs were confirmed (1.1%/person-year) in the Korean cohort. The model with the best predictive performance in the training cohort was selected as the final model (designated as PLAN-B-CURE), which was constructed using a gradient boosting algorithm and seven variables (age, sex, diabetes, alcohol consumption, cirrhosis, albumin, and platelet count). Compared to previous HCC prediction models, PLAN-B-CURE showed significantly superior accuracy in the training cohort (c-index: 0.82 vs. 0.63-0.70, all p <0.001; area under the receiver-operating characteristic curve: 0.86 vs. 0.62-0.72, all p <0.01; area under the precision-recall curve: 0.53 vs. 0.13-0.29, all p <0.01). PLAN-B-CURE showed a reliable calibration function (Hosmer-Lemeshow test p >0.05) and these results were reproduced in the internal and external validation cohorts.
CONCLUSION This novel machine learning model consisting of seven variables provides reliable risk prediction of LROs after HBsAg seroclearance that can be used for personalized surveillance.
IMPACT AND IMPLICATIONS Using large-scale multinational data, we developed a machine learning model to predict the risk of liver-related outcomes (i.e., hepatocellular carcinoma, decompensation, and liver-related death) after the functional cure of chronic hepatitis B (CHB). The new model named PLAN-B-CURE was constructed using seven variables (age, sex, alcohol consumption, diabetes, cirrhosis, serum albumin, and platelet count) and a gradient boosting machine algorithm, and it demonstrated significantly better predictive accuracy than previous models in both the training and validation cohorts. The inclusion of diabetes and significant alcohol intake as model inputs suggests the importance of metabolic risk factor management after the functional cure of CHB. Using seven readily available clinical factors, PLAN-B-CURE, the first machine learning-based model for risk prediction after the functional cure of CHB, may serve as a basis for individualized risk stratification.
PubMed IF 40.1 소화기내과
162025

제1저자 최유민, 김동현, 조은주 · 교신저자 유수종, 김범준

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The sV184A Variant in HBsAg Specific to HBV Subgenotype C2 Leads to Enhanced Viral Replication and Apoptotic Cell Death Induced by PERK-eIF2α-CHOP-Mediated ER Stress.
J Med Virol. 2025;97(2):e70253.

Abstract
HBV genotype C, particularly subgenotype C2, is associated with an elevated risk of HCC and aggressive disease activity. We previously identified a nonsynonymous sV184A variant in the HBsAg region, predominantly in HBV subgenotype C2. This study investigates the mechanistic role of the sV184A variant in promoting liver disease progression. Analysis of 109 chronically HBV-infected patients revealed that the sV184A variant correlates with significantly elevated HBV DNA. Both patient data and public database indicated that sV184A is associated with high frequency of BCP mutations, however, the high HBV DNA in the sV184A group are independent of the presence of BCP mutations. In vitro and in vivo studies demonstrated that the sV184A variant enhances HBV replication and induces ER stress via the PERK-eIF2α-CHOP pathway, leading to apoptosis. HBV large surface (LHB)(LHB) protein was found to be a key factor, responsible for the strong ER stress, as the sV184A variant increases LHB protein stability. Pharmacological inhibition of PERK signaling or mutation of the LHB mitigated HBV proliferation and apoptosis induced by the sV184A variant. The sV184A variant specific to HBV subgenotype C2 significantly promotes HBV replication and apoptosis, serving as a driver of advanced liver disease and potentially increasing mutation rates in affected patients.
PubMed IF 3.7 소화기내과

서울대학교병원 내과 교실이 발표한 SCI 논문입니다. 제목을 누르면 Abstract · 그림 등을, 저자 이름을 누르면 소속 · PubMed · ORCID 를 볼 수 있습니다. 굵은 이름은 동문과 연결된 저자입니다.