SCI 발표논문

1. 32982021

   제1저자 김정한, 김인호 · 교신저자 박완범, 김택수

   Kim JH, Kim I, Kang CK, Jun KI, Yoo SH, Chun JY, Jung J, Kim YJ, Kim DY, Jo HB, Kim DY, Koh Y, Shin DY, Hong J, Kim NJ, Yoon SS, Kim TS, Park WB, Oh MD

   Enhanced antimicrobial stewardship based on rapid phenotypic antimicrobial susceptibility testing for bacteraemia in patients with haematological malignancies: a randomized controlled trial.

   Clin Microbiol Infect. 2021;27(1):69-75.

   Abstract

   OBJECTIVES Recently, rapid phenotypic antimicrobial susceptibility testing (AST) based on microscopic imaging analysis has been developed. The aim of this study was to determine whether implementation of antimicrobial stewardship programmes (ASP) based on rapid phenotypic AST can increase the proportion of patients with haematological malignancies who receive optimal targeted antibiotics during early periods of bacteraemia.

   METHODS This randomized controlled trial enrolled patients with haematological malignancies and at least one positive blood culture. Patients were randomly assigned 1:1 to conventional (n = 60) or rapid phenotypic (n = 56) AST. The primary outcome was the proportion of patients receiving optimal targeted antibiotics 72 hr after blood collection for culture.

   RESULTS The percentage receiving optimal targeted antibiotics at 72 hr was significantly higher in the rapid phenotypic AST group (45/56, 80.4%) than in conventional AST group (34/60, 56.7%) (relative risk (RR) 1.42, 95% confidence interval (CI) 1.09-1.83). The percentage receiving unnecessary broad-spectrum antibiotics at 72 hr was significantly lower (7/26, 12.5% vs 18/60, 30.0%; RR 0.42, 95% CI 0.19-0.92) and the mean time to optimal targeted antibiotic treatment was significantly shorter (38.1, standard deviation (SD) 38.2 vs 72.8, SD 93.0 hr; p < 0.001) in the rapid phenotypic AST group. The mean time from blood collection to the AST result was significantly shorter in the rapid phenotypic AST group (48.3, SD 17.6 vs 83.1, SD 22.2 hr).

   DISCUSSION ASP based on rapid phenotypic AST can rapidly optimize antibiotic treatment for bacteraemia in patients with haematological malignancy. Rapid phenotypic AST can improve antimicrobial stewardship in immunocompromised patients.

   PubMed IF 8.7 감염내과
2. 32972021

   제1저자 오미진 · 교신저자 변자민

   Oh MJ, Shin DY, Koh Y, Hong J, Kim I, Yoon SS, Byun JM

   A Pilot Study of Allogeneic Hematopoietic Stem Cell Transplantation for Intermediated-risk Acute Myeloid Leukemia Patients.

   In Vivo. 2021;35(1):617-622.

   Abstract

   BACKGROUND/AIM For intermediate risk acute myeloid leukemia patients, allogeneic hematopoietic stem cell transplantation (alloSCT) and chemotherapy are equally recommended as consolidation after first complete remission (CR1). In real-world, alloSCT might not be readily available, but there is paucity of data on the optimal timing of alloSCT for these patients.

   PATIENTS AND METHODS In this pilot study, we compared the outcomes of 13 patients undergoing alloSCT in CR1 with 13 patients undergoing alloSCT after relapse (non-CR1) to examine whether upfront alloSCT yields a better prognosis.

   RESULTS There were no differences between the two groups with regards to relapse-free survival (p=0.507) and overall survival (p=0.798). There were more chronic graft-versus-host-disease (GVHD) in the CR1 group compared to the non-CR group (p=0.001), but no difference in acute GVHD.

   CONCLUSION The outcome of alloSCT after relapse is not inferior to that of alloSCT in CR1, supporting the role of alloSCT after relapse in the setting of limited donors and resources.

   PubMed IF 1.8 혈액종양내과
3. 32962021

   제1저자 정은희 · 교신저자 변자민

   Jung EH, Shin DY, Hong J, Kim I, Yoon SS, Koh Y, Byun JM

   Identification of an Optimal Population for Allogeneic Hematopoietic Stem Cell Transplantation in Patients With Mature T and NK Cell Neoplasms.

   In Vivo. 2021;35(4):2379-2390.

   Abstract

   BACKGROUND/AIM The prognosis of mature T and natural killer (NK) cell neoplasms still remains dismal, despite the advancements in the understanding of the heterogeneous features of these diseases. As allogeneic stem cell transplantation (alloSCT) is an attractive salvage option for relapsed/refractory patients, we conducted this study to identify those who might benefit the most from alloSCT.

   PATIENTS AND METHODS This was a retrospective, single-center, longitudinal cohort study of patients who received alloSCT between December 2019 and January 2000.

   RESULTS The median relapse-free survival and overall survival were 4.4 and 10.0 months, respectively. Disease control status at alloSCT and number of previous treatments were associated with survival outcomes. The conditioning intensity did not significantly alter survival.

   CONCLUSION AlloSCT offers a cure chance for selected relapsed or refractory T and NK cell neoplasms, especially when used early and the disease is well controlled prior to transplantation.

   PubMed IF 1.8 혈액종양내과
4. 32952021

   제1저자 임주현 · 교신저자 김영선

   Lim JH, Kim YS, Lee JE, Youn J, Chung GE, Song JH, Yang SY, Kim JS

   Dietary pattern and its association with right-colonic diverticulosis.

   J Gastroenterol Hepatol. 2021;36(1):144-150.

   Abstract

   BACKGROUND AND AIM In East Asia, colonic diverticulosis develops most commonly in the right colon and is known to have different characteristics compared with left-sided one. This study was designed to investigate whether right-colonic diverticulosis is associated with posteriori dietary patterns.

   METHODS We retrospectively reviewed medical records of prospectively collected cohort that received health check-up in Korea between May 2011 and January 2012. Their anthropometric data, biochemical results, medication history, underlying diseases, colonoscopic findings, and dietary data obtained from semi-quantitative food-frequency questionnaire were analyzed. Three dietary patterns were identified using factor analysis: healthy dietary pattern (vegetables, fish, seaweed, fruits, and beans), meat dietary pattern (red meat, processed meat/fish, fried noodle, poultry, and cephalopods), and snack dietary pattern (bread, sweets, dairy products, nuts, and rice cake).

   RESULTS Out of the total 1911 patients, 203 (10.6%) had right-colonic diverticulosis, 21 (1.1%) had pan-colonic diverticulosis, and 12 (0.6%) had left-colonic diverticulosis. Among the total, none of the three patterns were associated with right-colonic diverticulosis, under adjustment with age, gender, body mass index, metabolic syndrome, and total energy intake. However, among women, meat dietary pattern was positively associated with right-colonic diverticulosis (odds ratio 1.866, 95% confidence interval: 1.0983-3.173, P = 0.021).

   CONCLUSION This study demonstrated that meat dietary pattern is positively associated with right-colonic diverticulosis among women.

   PubMed IF 3.5 소화기내과
5. 32942021

   제1저자 송경호, 김동민 · 교신저자 김의석

   Song KH, Kim DM, Lee H, Ham SY, Oh SM, Jeong H, Jung J, Kang CK, Park JY, Kang YM, Kim JY, Park JS, Park KU, Kim ES, Kim HB

   Dynamics of viral load and anti-SARS-CoV-2 antibodies in patients with positive RT-PCR results after recovery from COVID-19.

   Korean J Intern Med. 2021;36(1):11-14.

   Abstract

   Recently, the number of patients with coronavirus disease 2019 (COVID-19) who have tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), via the reverse transcription polymerase chain reaction (RT-PCR) test, after recovery has increased; this has caused a dilemma regarding the medical measures and policies. We evaluated the dynamics of viral load and anti-SARS-CoV-2 antibodies in four patients with positive RT-PCR results after recovery. In all patients, the highest levels of immunoglobulin G (IgG) and IgM antibodies were reached after about a month of the onset of the initial symptoms. Then, the IgG titers plateaued, and the IgM titers decreased, regardless of RT-PCR results. The IgG and IgM levels did not increase after the post-negative positive RT-PCR results in any of the patients. Our results reinforced that the post-negative positive RT-PCR results may be due to the detection of RNA particles rather than reinfection in individuals who have recovered from COVID-19.

   PubMed IF 2.2 감염내과
6. 32932021

   제1저자 강승주 · 교신저자 신철민

   Joo Kang S, Shin CM, Sung J, Kim N

   Association Between ALDH2 Polymorphism and Gastric Cancer Risk in Terms of Alcohol Consumption: A Meta-Analysis.

   Alcohol Clin Exp Res. 2021;45(1):6-14.

   Abstract

   BACKGROUND Alcohol may increase gastric cancer risk. Alcohol can be more carcinogenic in persons who possess inactive ALDH2. The aim of this meta-analysis was to evaluate whether ALDH2 polymorphism can affect alcohol-induced gastric carcinogenesis.

   METHODS We searched the PubMed, EMBASE, and Cochrane databases to identify relevant articles published between January 2000 and September 2019. Eligible articles were selected according to inclusion and exclusion criteria. The data were analyzed using Review Manager 5.3.

   RESULTS A total of 7 case-control studies on ALDH2 rs671 polymorphism consisting of 3,251 gastric cancer cases and 4,943 controls were included in the analysis. Inactive ALDH2 genotypes (G/A or A/A) were associated with an increased risk of gastric cancer (odds ratio [OR] = 1.26, 95% confidence interval [CI]: 1.04 to 1.52, p = 0.02, I² = 64%), compared with active ALDH2 (G/G genotype). Subgroup analysis by alcohol consumption showed that inactive ALDH2 increased risk for gastric cancer in moderate to heavy drinkers (OR = 1.85, 95% CI: 1.52 to 2.25, p < 0.01, I² = 6%) more than in nondrinkers or mild drinkers (OR = 1.19; 95% CI: 1.05 to 1.36, p < 0.01, I² = 6%). Moderate/heavy alcohol consumption increased gastric cancer risk in individuals with inactive ALDH2 (OR = 2.23, 95% CI: 1.63 to 3.05, p < 0.01, I² = 30%) more than those with active ALDH2 (OR = 1.40, 95% CI: 0.98 to 2.01, p = 0.07, I² = 85%).

   CONCLUSIONS The ALDH2 polymorphism modifies the risk of gastric cancer. Moderate/heavy drinkers are more susceptible to gastric cancer than non-drinkers or light drinkers with inactive ALDH2.

   PubMed IF 3.455 소화기내과
7. 32922021

   제1저자 박우찬 · 교신저자 오도연

   Park W, Bang JH, Nam AR, Jin MH, Seo H, Kim JM, Oh KS, Kim TY, Oh DY

   Prognostic Value of Serum Soluble Programmed Death-Ligand 1 and Dynamics During Chemotherapy in Advanced Gastric Cancer Patients.

   Cancer Res Treat. 2021;53(1):199-206.

   Abstract

   PURPOSE The soluble form programmed death-ligand 1 (sPDL1) has immunosuppressive properties and is being studied as a candidate biomarker for immuno-oncology drug development. We measured the serum sPDL1 at pre-and post-chemotherapy and evaluated its prognostic implication and dynamics during chemotherapy in advanced gastric cancer (GC).

   MATERIALS AND METHODS We prospectively enrolled 68 GC patients who were candidates for palliative standard first-line chemotherapy, and serially collected blood at baseline and after one cycle of chemotherapy, at the best response and after disease progression. sPDL1 was measured using an enzyme-linked immunosorbent assay. Response to chemotherapy, overall survival (OS), progressionfree survival (PFS) and other prognostic factors including neutrophil-lymphocyte ratio (NLR) were obtained. The cut-off value of sPDL1 levels for survival analysis was found using C-statistics.

   RESULTS The median baseline sPDL1 was 0.8 ng/mL (range, 0.06 to 6.06 ng/mL). The median OS and PFS were 14.9 months and 8.0 months, respectively. sPDL1 and NLR showed a weak positive correlation (Spearman's rho=0.301, p=0.013). Patients with low levels of sPDL1 at diagnosis (< 1.92 ng/mL) showed a better OS and PFS than patients with a high sPDL1. The baseline sPDL1 before treatment was higher in the progressive disease group than in the stable disease and partial response groups. Patients whose sPDL1 increased after the first cycle of chemotherapy showed worse PFS and OS. Following disease progression, sPDL1 increased compared with the baseline.

   CONCLUSION sPDL1 at prechemotherapy confers a prognostic value for PFS and OS in GC patients under palliative first-line chemotherapy. Dynamics of sPDL1 during chemotherapy correlates with disease progression.

   PubMed IF 4.2 혈액종양내과
8. 32912021

   제1저자 최미홍 · 교신저자 이경훈

   Choi M, Han J, Yang BR, Jang MJ, Kim M, Lee DW, Kim TY, Im SA, Lee HB, Moon HG, Han W, Noh DY, Lee KH

   Association of Insulin, Metformin, and Statin with Mortality in Breast Cancer Patients.

   Cancer Res Treat. 2021;53(1):65-76.

   Abstract

   PURPOSE This study investigated the association of insulin, metformin, and statin use with survival and whether the association was modified by the hormone receptor status of the tumor in patients with breast cancer.

   MATERIALS AND METHODS We studied 7,452 patients who had undergone surgery for breast cancer at Seoul National University Hospital from 2008 to 2015 using the nationwide claims database. Exposure was defined as a recorded prescription of each drug within 12 months before the diagnosis of breast cancer.

   RESULTS Patients with prior insulin or statin use were more likely to be older than 50 years at diagnosis and had a higher comorbidity index than those without it (p < 0.01 for both). The hazard ratio (HR) for death with insulin use was 5.7 (p < 0.01), and the effect was attenuated with both insulin and metformin exposure with an HR of 1.2 (p=0.60). In the subgroup analyses, a heightened risk of death with insulin was further prominent with an HR of 17.9 (p < 0.01) and was offset by co-administration of metformin with an HR of 1.3 (p=0.67) in patients with estrogen receptor (ER)-negative breast cancer. Statin use was associated with increased overall mortality only in patients with ER-positive breast cancer with HR for death of 1.5 (p=0.05).

   CONCLUSION Insulin or statin use before the diagnosis of breast cancer was associated with an increase in all-cause mortality. Subsequent analyses suggested that metformin or statin use may have been protective in patients with ER-negative disease, which warrants further studies.

   PubMed IF 4.2 혈액종양내과
9. 32902021

   제1저자 이진호 · 교신저자 오국환

   Lee J, Tsogbadrakh B, Yang S, Ryu H, Kang E, Kang M, Kang HG, Ahn C, Oh KH

   Klotho ameliorates diabetic nephropathy via LKB1-AMPK-PGC1α-mediated renal mitochondrial protection.

   Biochem Biophys Res Commun. 2021;534:1040-1046.

   Abstract

   Diabetic nephropathy (DN) is associated with renal mitochondrial injury and decreased renal klotho expression. Klotho is known as an aging suppressor, and mitochondrial dysfunction is the hallmark of aging. Peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α) is a master regulator of mitochondrial biogenesis, and adenosine monophosphate-activated protein kinase (AMPK) is known as a guardian of mitochondria. Here, we report that recombinant soluble klotho protein (rKL) protects against DN in db/db mice via PGC1α-AMPK-mediated mitochondrial recovery in the kidney. We injected rKL into db/db and db/m mice for 8 weeks and collected the serum and kidney tissue. We treated murine renal tubular cells with rKL in vitro, with and without exposure to 30 mM high glucose (HG). rKL treatment ameliorated major disorders from diabetes, such as obesity, hyperglycemia, and intrarenal reactive oxygen species (ROS) generation, in db/db mice. rKL also diminished albuminuria, recovered renal proximal tubular mitochondria, increased renal p-AMPK and PGC1α, and down-regulated mTOR/TGF-β in db/db mice. In S1 mouse proximal tubular cells, rKL treatment ameliorated HG-mediated cellular and mitochondrial damage and enhanced oxidative phosphorylation, with an increase in PGC1α-AMPK-induced mitochondrial recovery. Our data suggest that klotho exerts a mitochondrial protective effect in diabetic kidney disease by inducing AMPK-PGC1α expression.

   PubMed IF 2.5 신장내과
10. 32892021

    제1저자 장은선 · 교신저자 정숙향

    Jang ES, Hwang SH, Kim JW, Jeong SH

    Effectiveness of 4-Week Oral Taurine Treatment for Muscle Cramps in Patients with Liver Cirrhosis: A Single-Arm Pilot Study.

    Yonsei Med J. 2021;62(1):21-28.

    Abstract

    PURPOSE Painful muscle cramps are a common complication in liver cirrhosis patients, and no effective treatment is available. This pilot study aimed to evaluate whether taurine supplementation improves muscle cramps in Korean cirrhotic patients.

    MATERIALS AND METHODS Ten cirrhotic patients who experienced muscle cramps one or more times/week were enrolled in this prospective single-arm study and administered with an oral taurine solution (1 g/50 mL) thrice a day for 4 weeks. Taurine was discontinued for the subsequent 4 weeks. The frequency and intensity of muscle cramps were evaluated using a questionnaire at weeks 0, 2, 4, 6, and 8 after the start of treatment.

    RESULTS At baseline, the median frequency of muscle cramps was six times/week, and all patients had severe pain. Muscle cramp scores (frequency×intensity) decreased in seven patients by weeks 4 and 8 after treatment initiation. Compared to baseline muscle cramp scores [median 21, interquartile range (IQR): 8-84], median muscle cramp scores were lower at week 4 (6.5, IQR: 3-12, p=0.126) and week 8 (5, IQR: 1.5-56, p=0.066). All five patients whose baseline plasma taurine levels were below the normal limit showed increased taurine levels at week 4; 60% of them experienced improvements in their muscle cramps. Of the five patients with normal or higher taurine levels, 80% experienced an improvement in symptoms at week 4. The safety and tolerability of the 4-week taurine therapy were excellent.

    CONCLUSION Oral taurine therapy for 4 weeks improved muscle cramps safely in cirrhotic patients.

    PubMed IF 3.1 소화기내과
11. 32882021

    제1저자 정수지 · 교신저자 박흥우

    Chung SJ, Ahn KM, Oh JH, Shim JS, Park HW

    Incidence rates of severe cutaneous adverse reactions due to antiseizure medication: A nationwide study using health claims data in Korea.

    Epilepsia. 2021;62(1):250-257.

    Abstract

    OBJECTIVE Antiseizure medications (ASMs) can rarely result in severe, sometimes fatal, cutaneous adverse reactions. To date, few studies have reported on the incidence rates (IRs) of severe cutaneous adverse reactions (SCARs) due to ASM use. This study aimed to determine the IRs of SCAR resulting from the use of seven commonly prescribed ASMs, carbamazepine (CBZ), phenytoin (PHT), oxcarbazepine (OXC), lamotrigine (LMT), zonisamide (ZNS), levetiracetam (LVT), and topiramate (TPM), and to compare the associated risks among the drugs.

    METHODS Using a nationwide health claims database, we selected all the patients prescribed with one of the target ASMs. We defined a SCAR case as the first hospitalization with one of three specific codes provided by the International Classification of Diseases, 10th revision (L511, L512, and L27). We then calculated the IR of SCARs according to each target ASM.

    RESULTS The IR of SCARs for each ASM was as follows: 870/1 000 000 person-years (PYs) for CBZ, 5750/1 000 000 PYs for PHT, 1490/1 000 000 PYs for OXC, 3860/1 000 000 PYs for LMT, 1540/1 000 000 PYs for ZNS, 830/1 000 000 PYs for LVT, and 400/1 000 000 PYs for TPM. Concomitant use of antibiotics and nonsteroidal anti-inflammatory drugs significantly increased the risk of SCARs with OXC, LVT, or TPM use. Comorbid skin disease was associated with a significantly higher IR of SCARs from CBZ, PHT, OXC, LMT, or LVT use.

    SIGNIFICANCE This is the first study in Asia to determine the IRs of SCARs for various ASMs and compare the rates across drugs using a large dataset. The results from this study should help clinicians select safer ASMs in practice.

    PubMed IF 5.6 알레르기내과
12. 32872021

    제1저자 이소희 · 교신저자 박흥우

    Lee SH, Ahn KM, Lee SY, Kim SS, Park HW

    Blood Eosinophil Count as a Predictor of Lung Function Decline in Healthy Individuals.

    J Allergy Clin Immunol Pract. 2021;9(1):394-399.e1.

    Abstract

    BACKGROUND Little is known about the effect of blood eosinophil count (BEC) on a decline in lung function in healthy individuals.

    OBJECTIVE Using a well-established health screening database, we assessed the associations between BEC and a decline in lung function, measured as the forced expiratory volume in 1 second (FEV₁).

    METHODS Serial BEC and FEV₁ data were analyzed using linear mixed models adjusted for gender, height, and smoking status. The association between BEC consistency and a decline in FEV₁ was evaluated in subpopulation analyses.

    RESULTS A total of 4634 individuals were enrolled. The mean number of health screenings was 7.49 over an average of 11.74 years of observation. A higher log2-transformed BEC was significantly associated with a greater decline in FEV₁ that was stronger in nonsmokers (P = 8.56 × 10^-8) than in smokers (P = 1.52 × 10^-3). In subpopulation analyses of 2018 individuals with consistent BECs, those with BECs consistently ≥100/μL (P = 4.58 × 10^-6), ≥200/μL (P = 3.53 × 10^-7), and ≥300/μL (P = 1.12 × 10^-3) had a significantly higher dose-dependent FEV₁ decline than those with BECs consistently <100/μL. A BEC threshold of 100/μL in nonsmokers and 200/μL in smokers may predict an accelerated decline in FEV₁.

    CONCLUSIONS BEC is associated with a decline in FEV₁, and a consistently high BEC is an independent risk factor for an accelerated decline in FEV₁. These results suggest the use of the BEC to identify healthy individuals at high risk for developing chronic lung disease, which in turn may enable a tailored preventive strategy.

    PubMed IF 6.6 알레르기내과
13. 32862020

    제1저자 김형준 · 교신저자 이창현, 이창훈

    Kim HJ, Lee HW, Park J, Lee CH, Lee CH.

    Short-term exposure to fine particulate matter and pneumonia-related hospitalizations: a systematic review and meta-analysis.

    Environ Res Lett. 2020;15(12):123012..

    IF 6.096 호흡기내과
14. 32852020

    제1저자 선우성혁, 한상인 · 교신저자 이승표, 현택환, 김대형

    Sunwoo SH, Han SI, Kang H, Cho YS, Jung D, Lim C, Lim C, Cha MJ, Lee SP, Hyeon T, Kim DH.

    Stretchable Low‐Impedance Nanocomposite Comprised of Ag–Au Core–Shell Nanowires and Pt Black for Epicardial Recording and Stimulation.

    Adv Mater Technol. 2020;5:1900768.

    IF 5.395 순환기내과
15. 32842020

    제1저자 손경희 · 교신저자 이하나, 강혜련

    Sohn KH, Baek MG, Choi SM, Bae B, Kim RY, Kim YC, Kim HY, Yi H, Kang HR

    Alteration of Lung and Gut Microbiota in IL-13-Transgenic Mice Simulating Chronic Asthma.

    J Microbiol Biotechnol. 2020;30(12):1819-1826.

    Abstract

    Increasing evidence suggests a potential role of microbial colonization in the inception of chronic airway diseases. However, it is not clear whether the lung and gut microbiome dysbiosis is coincidental or a result of mutual interaction. In this study, we investigated the airway microbiome in interleukin 13 (IL-13)-rich lung environment and related alterations of the gut microbiome. IL-13- overexpressing transgenic (TG) mice presented enhanced eosinophilic inflammatory responses and mucus production, together with airway hyperresponsiveness and subepithelial fibrosis. While bronchoalveolar lavage fluid and cecum samples obtained from 10-week-old IL-13 TG mice and their C57BL/6 wild-type (WT) littermates showed no significant differences in alpha diversity of lung and gut microbiome, they presented altered beta diversity in both lung and gut microbiota in the IL-13 TG mice compared to the WT mice. Lung-specific IL-13 overexpression also altered the composition of the gut as well as the lung microbiome. In particular, IL-13 TG mice showed an increased proportion of Proteobacteria and Cyanobacteria and a decreased amount of Bacteroidetes in the lungs, and depletion of Firmicutes and Proteobacteria in the gut. The patterns of polymicrobial interaction within the lung microbiota were different between WT and IL-13 TG mice. For instance, in IL-13 TG mice, lung Mesorhizobium significantly affected the alpha diversity of both lung and gut microbiomes. In summary, chronic asthma-like pathologic changes can alter the lung microbiota and affect the gut microbiome. These findings suggest that the lung-gut microbial axis might actually work in asthma.

    PubMed IF 3.4 알레르기내과
16. 32832020

    제1저자 박시연 · 교신저자 김태민, 조성엽

    Park S, Kim TM, Cho SY, Kim S, Oh Y, Kim M, Keam B, Kim DW, Heo DS

    Combined blockade of polo-like kinase and pan-RAF is effective against NRAS-mutant non-small cell lung cancer cells.

    Cancer Lett. 2020;495:135-144.

    Abstract

    NRAS mutation is rarely observed in non-small cell lung cancer (NSCLC) patients, and there are no approved treatments for NRAS-mutant NSCLC. Here, we evaluated the effect of pan-RAF inhibitors on human NRAS-mutant NSCLC cell lines and performed high-throughput screening using human kinome small interfering (si)RNA or CRISPR/Cas9 libraries to identify new targets for combination NSCLC treatment. Our results indicate that human NRAS-mutant NSCLC cells are moderately sensitive to pan-RAF inhibitors. High-throughput kinome screenings further showed that G2/M arrest, particularly following knockdown of polo-like kinase 1 (PLK1), can inhibit the growth of human NRAS-mutant NSCLC cells and those treated with the type II pan-RAF inhibitor LXH254. In addition, treatment with volasertib plus LXH254, resulting in dual blockade of PLK1 and pan-RAF, was found to be more effective than LXH254 monotherapy for inhibiting long-term cell viability, suggesting that this combination therapeutic strategy may lead to promising results in the clinic.

    PubMed IF 11.8 혈액종양내과
17. 32822020

    제1저자 정재훈 · 교신저자 김학령

    Chung J, Kim HL, Lee JP, Lim WH, Seo JB, Kim SH, Zo JH, Kim MA

    Association of the Serum Osteoprotegerin Level With Target Organ Damage in Patients at High Risk of Coronary Artery Disease.

    Circ J. 2020;85(1):69-76.

    Abstract

    BACKGROUND There is little data as to whether osteoprotegerin (OPG) is associated with target organ damage (TOD), so we evaluated the association in patients at high risk of coronary artery disease (CAD).

    METHODS AND RESULTS A total of 349 patients who underwent invasive coronary angiography (ICA) for suspected CAD were prospectively recruited. During the index admission, 6 TOD parameters were collected: extent of CAD, glomerular filtration rate (GFR), left ventricular mass index (LVMI), E/e', brachial-ankle pulse wave velocity (baPWV), and ankle-brachial index (ABI). Serum OPG levels were measured using enzyme-linked immunosorbent assay. The OPG level was significantly higher in patients with ≥1 TOD parameter than in those without (314±186 vs. 202±74 pg/mL, P<0.001). For each TOD parameter, the serum OPG level was significantly higher in patients with TOD than in those without (P<0.05 for each) except for ABI. In correlation analysis, OPG was significantly associated with GFR, LVMI, E/e', baPWV and ABI (P<0.05 for each). The OPG concentration increased proportionally with increasing TOD (P<0.001). Higher OPG concentrations (≥198 pg/mL) was significantly associated with the presence of TOD (odds ratio 3.22; 95% confidence interval 1.51-6.85; P=0.002) even after controlling for potential confounders.

    CONCLUSIONS Serum OPG level was significantly associated with a variety of TOD in patients undergoing ICA. OPG may be a useful marker for TOD and in the risk stratification of patients at high risk of CAD.

    PubMed IF 5.8 순환기내과
18. 32812020

    제1저자 김정희, 서수현 · 교신저자 이규언, 성문우

    Seo SH, Kim JH, Kim MJ, Cho SI, Kim SJ, Kang H, Shin CS, Park SS, Lee KE, Seong MW

    Whole Exome Sequencing Identifies Novel Genetic Alterations in Patients with Pheochromocytoma/Paraganglioma.

    Endocrinol Metab (Seoul). 2020;35(4):909-917.

    Abstract

    BACKGROUND Pheochromocytoma and paragangliomas (PPGL) are known as tumors with the highest level of heritability, approximately 30% of all cases. Clinical practice guidelines of PPGL recommend genetic testing for germline variants in all patients. In this study, we used whole exome sequencing to identify novel causative variants associated with PPGL to improve the detection of rare genetic variants in our cohort.

    METHODS Thirty-six tested negative for pathogenic variants in previous Sanger sequencing or targeted gene panel testing for PPGL underwent whole exome sequencing. Whole exome sequencing was performed using DNA samples enriched using TruSeq Custom Enrichment Kit and sequenced with MiSeq (Illumina Inc.). Sequencing alignment and variant calling were performed using SAMtools.

    RESULTS Among previously mutation undetected 36 patients, two likely pathogenic variants and 13 variants of uncertain significance (VUS) were detected in 32 pheochromocytoma-related genes. SDHA c.778G>A (p.Gly260Arg) was detected in a patient with head and neck paraganglioma, and KIF1B c.2787-2A>C in a patient with a bladder paraganglioma. Additionally, a likely pathogenic variant in BRCA2, VUS in TP53, and VUS in NFU1 were detected.

    CONCLUSION Exome sequencing further identified genetic alterations by 5.6% in previously mutation undetected patients in PPGL. Implementation of targeted gene sequencing consisted of extended genes of PPGL in routine clinical screening can support the level of comprehensive patient assessment.

    PubMed IF 5.1 내분비대사내과
19. 32802020

    제1저자 김지수 · 교신저자 Lionel B Ivashkiv, 이은영

    Kim JS, Choi M, Choi JY, Kim JY, Kim JY, Song JS, Ivashkiv LB, Lee EY

    Implication of the Association of Fibrinogen Citrullination and Osteoclastogenesis in Bone Destruction in Rheumatoid Arthritis.

    Cells. 2020;9(12):cells9122720.

    Abstract

    Immune complexes containing citrullinated fibrinogen are present in the sera and synovium of rheumatoid arthritis patients and potentially contribute to synovitis. However, fibrinogen can inhibit the osteoclastogenesis of precursor cells. We investigated the direct effect of citrullinated fibrinogen on osteoclastogenesis to understand the role of citrullination on bone erosion of rheumatoid arthritis patients. We evaluated the fibrinogen citrullination sites using mass spectrometry and quantified osteoclast-related protein and gene expression levels by Western blotting, microarray, and real-time polymerase chain reaction. Differences in spectral peaks were noted between fibrinogen and citrullinated fibrinogen at five sites in α-chains, two sites in β-chains, and one site in a γ-chain. Transcriptome changes induced by fibrinogen and citrullinated fibrinogen were identified and differentially expressed genes grouped into three distinctive modules. Fibrinogen was then citrullinated in vitro using peptidylarginine deiminase. When increasing doses of soluble fibrinogen and citrullinated fibrinogen were applied to human CD14+ monocytes, citrullination restored osteoclastogenesis-associated changes, including NF-ATc1 and ß3-integrin. Finally, citrullination rescued the number of osteoclasts by restoring fibrinogen-induced suppression of osteoclastogenesis. Taken together, the results indicate that the inhibitory function of fibrinogen on osteoclastogenesis is reversed by citrullination and suggest that citrullinated fibrinogen may contribute to erosive bone destruction in rheumatoid arthritis.

    PubMed IF 6 류마티스내과
20. 32792020

    제1저자 이수진 · 교신저자 김동기, 한경도

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

    Impact of variability in estimated glomerular filtration rate on major clinical outcomes: A nationwide population-based study.

    PLoS One. 2020;15(12):e0244156.

    Abstract

    BACKGROUND The estimated glomerular filtration rate (eGFR), commonly estimated using the serum creatinine value, often fluctuates throughout the serial measurement. The clinical significance of GFR variation among the general population with normal renal function has not yet been demonstrated. Thus, we explored the impact of GFR variability on adverse clinical outcomes.

    METHODS A nationwide retrospective cohort study using the Korean National Health Insurance System database was performed. National health screening examinees who underwent creatinine measurement ≥3 times between 2012 and 2016 were considered. Those with eGFR under 60 mL/min/m2 were excluded. The fluctuation of eGFR was represented with variability independent of the mean (VIM) index; which was calculated by the standard deviation divided by the exponent of the regression coefficient of the mean. Then, the risks of myocardial infarction (MI), stroke and death were assessed according to the quartiles of the VIM.

    RESULTS Of total 3,538,500 participants, 0.29% of myocardial infarction (MI), 0.14% of stroke, 0.36% of deaths were observed during the median follow up of 3.27 years. Participants with the highest VIM index, which represents the highest eGFR variability, were significantly associated with an increased risk of MI (hazard ratio [HR]; 1.10, 95% confidence interval [95% CI]; 1.04-1.16), stroke (HR: 1.16; 95% CI 1.09-1.23), and death (HR: 1.18; 95% CI 1.12-1.24). The elevated risk of adverse events was consistent after the multivariate adjustment with potential confounding factors, except the risk of MI (HR 1.06; 95% 1.00-1.06).

    CONCLUSIONS Increased eGFR variability exhibited an association with major clinical outcomes, indicating that monitoring eGFR variability might be a useful parameter for predicting the adverse outcomes.

    PubMed IF 2.8 신장내과
21. 32782020

    제1저자 서정연, 신중곤 · 교신저자 김윤준, 신형두

    Seo JY, Shin JG, Youn BJ, Namgoong S, Cheong HS, Kim LH, Kim JO, Shin HD, Kim YJ

    A non-synonymous variant rs12614 of complement factor B associated with risk of chronic hepatitis B in a Korean population.

    BMC Med Genet. 2020;21(1):241.

    Abstract

    BACKGROUND Hepatitis B is known to cause several forms of liver diseases including chronic hepatitis B (CHB), and hepatocellular carcinoma. Previous genome-wide association study of CHB risk has demonstrated that rs12614 of complement factor B (CFB) was significantly associated with CHB risk. In this study, fine-mapping study of previously reported GWAS single nucleotide polymorphism (SNP; CFB rs12614) was performed to validate genetic effect of rs12614 on CHB susceptibility and identify possible additional causal variants around rs12614 in a Korean population. This association study was conducted in order to identify genetic effects of CFB single nucleotide polymorphisms (SNPs) and to identify additional independent CHB susceptible causal markers within a Korean population.

    METHODS A total of 10 CFB genetic polymorphisms were selected and genotyped in 1716 study subjects comprised of 955 CHB patients and 761 population controls.

    RESULTS A non-synonymous variant, rs12614 (Arg32Trp) in exon2 of CFB, had significant associations with risk of CHB (odds ratio = 0.43, P = 5.91 × 10^{- 10}). Additional linkage disequilibrium and conditional analysis confirmed that rs12614 had independent genetic effect on CHB susceptibility with previously identified CHB markers. The genetic risk scores (GRSs) were calculated and the CHB patients had higher GRSs than the population controls. Moreover, OR was found to increase significantly with cumulative GRS.

    CONCLUSIONS rs12614 showed significant genetic effect on CHB risk within the Korean population. As such rs12614 may be used as a possible causal genetic variant for CHB susceptibility.

    PubMed IF 1.585 소화기내과
22. 32772020

    제1저자 박혜윤 · 교신저자 송경호

    Park HY, Jung J, Park HY, Lee SH, Kim ES, Kim HB, Song KH

    Psychological Consequences of Survivors of COVID-19 Pneumonia 1 Month after Discharge.

    J Korean Med Sci. 2020;35(47):e409.

    Abstract

    As the coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, there are growing concerns about patients' mental health. We investigated psychological problems in COVID-19 patients assessed with self-reported questionnaires including the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 scale, and Impact of Event Scale-Revised Korean version. Ten patients who recovered from COVID-19 pneumonia without complications underwent self-reported questionnaires about 1 month after discharge. Of them, 10% reported depression and posttraumatic stress disorder (PTSD) while 50% had depression during the treatment. Perceived stigma and history of psychiatric treatment affected PTSD symptom severity, consistent with previous emerging infectious diseases. Survivors also reported that they were concerned about infecting others and being discriminated and that they chose to avoid others after discharge. Further support and strategy to minimize their psychosocial difficulties after discharge should be considered.

    PubMed IF 3.2 감염내과
23. 32762020

    제1저자 기유정 · 교신저자 김효수

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

    Optimal Oversizing Index Depending on Valve Type and Leakage-Proof Function for Preventing Paravalvular Leakage after Transcatheter Aortic Valve Implantation.

    J Clin Med. 2020;9(12):jcm9123936.

    Abstract

    Paravalvular leak (PVL) is an important complication of transcatheter aortic valve implantation (TAVI) and is associated with poor prognosis. We aimed to identify the risk factors for PVL after TAVI including patient (calcium amount or location), device (leakage-proof or not), and procedural (oversizing index (OI)) factors. The primary outcome was mild or greater PVL at 1-month follow-up echocardiography. Overall, 238 patients who underwent TAVI using eight types of valves (Edwards Sapien, Sapien XT, Sapien 3, CoreValve, Evolut R, Evolut PRO, Lotus, and Lotus Edge) were included. The incidence of significant PVL (≥mild PVL) was 24.4%. Although patient factors (calcification of valve) were not predictors of PVL, valve without leakage-proof function (Edwards Sapien, Sapien XT, and CoreValve) was a significant predictor of PVL (adjusted odds ratio, 3.194, 95% CI, 1.620-6.299). Furthermore, OI has a significant protective role against PVL (PVL increased by 45% when OI decreased by 5%). The best cutoff value of OI to predict the absence of PVL was ≥17.6% for the Evolut system and ≥10.2% for the Sapien system. The predictors of PVL after TAVI included factors from the device (valve without leakage-proof function) and procedure (under-sizing). In patients with a high risk of PVL, the procedure should be optimized using valves with leakage-proof function and adequate OI.

    PubMed IF 3.3 순환기내과
24. 32752020

    제1저자 김학령, 구보경 · 교신저자 김원

    Kim HL^*, Koo BK^*, Joo SK, Kim W

    Association of arterial stiffness with the histological severity of nonalcoholic fatty liver disease.

    Hepatol Int. 2020;14(6):1048-1056.

    Abstract

    BACKGROUND Although arterial stiffness has been reported to be associated with nonalcoholic fatty liver disease (NAFLD), previous studies have relied only on noninvasive assessments for the diagnosis of NAFLD. This study attempted to investigate the association of arterial stiffness with the histological severity of NAFLD.

    METHODS We analyzed data from a biopsy-proven prospective NAFLD cohort. Augmentation index corrected for a heart rate of 75 bpm (AI@75) was obtained using applanation tonometry of the radial artery.

    RESULTS A total of 154 patients (mean age 55.2 years; females 55.8%) with biopsy-proven NAFLD were analyzed. Patients with higher AI@75 (≥ 76%) showed more severe grades of lobular and portal inflammation and hepatocellular ballooning, and more advanced stages of fibrosis compared to those with lower AI@75 (< 76%) (p < 0.05 for each). The presence of nonalcoholic steatohepatitis (NASH) (adjusted odds ratio [aOR] 2.48; 95% confidence interval [CI] 1.31-6.16; p = 0.008), lobular inflammation (aOR 2.03; 95% CI 1.09-3.78; p = 0.025) hepatocellular ballooning (aOR 2.82; 95% CI 1.23-6.43; p = 0.014), and significant fibrosis (≥ F2) (aOR 3.42; 95% CI 1.50-7.79; p = 0.003) were independently associated with higher AI@75 (≥ 76%) even after adjustment for confounders.

    CONCLUSION Arterial stiffness as indicated by higher AI@75 was associated with more severe NAFLD histology. This adds to the evidence for the association between increased arterial stiffness and NAFLD.

    PubMed IF 7.8 소화기내과
25. 32742020

    제1저자 이현정 · 교신저자 박성지, 이승표

    Lee HJ, Lee H, Kim SM, Park JB, Kim EK, Chang SA, Park E, Kim HK, Lee W, Kim YJ, Lee SC, Park SW, Sohn DW, Oh JK, Park SJ, Lee SP

    Diffuse Myocardial Fibrosis and Diastolic Function in Aortic Stenosis.

    JACC Cardiovasc Imaging. 2020;13(12):2561-2572.

    Abstract

    OBJECTIVES The aim of this study was to investigate the relationship between extracellular volume fraction (ECV), a noninvasive parameter that quantifies the degree of diffuse myocardial fibrosis on cardiac magnetic resonance (CMR), and left ventricular diastolic dysfunction (LVDD) in patients with aortic stenosis (AS).

    BACKGROUND Myocardial fibrosis on invasive myocardial biopsy is associated with LVDD. However, there is a paucity of data on the association between noninvasively quantified diffuse myocardial fibrosis and the degree of LVDD and how these are related to symptoms and long-term prognosis in patients with AS.

    METHODS Patients with moderate or severe AS (n = 191; mean age 68.4 years) and 30 control subjects without cardiovascular risk factors underwent CMR. LVDD grade was evaluated using echocardiography according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Clinical outcomes were defined as a composite of all-cause mortality or hospitalization for heart failure aggravation.

    RESULTS Patients in higher ECV quintiles had a significantly higher prevalence of LVDD. Higher ECV was particularly associated with decreased myocardial relaxation (septal e' <7 cm/s) and increased LV filling pressure (E/e' ratio ≥15). Although both impaired diastolic function and higher ECV were significantly associated with a worse degree of dyspnea, patients with higher ECV showed greater dyspnea within the same grade of LVDD. During a median follow-up period of 5.6 years, 37 clinical events occurred. Increased ECV, as well as lower septal e' and higher E/septal e' ratio, were independent predictors of clinical events, irrespective of age, AS severity, aortic valve replacement, and left ventricular (LV) ejection fraction. ECV provided incremental prognostic value on top of clinical factors and LV systolic and diastolic function.

    CONCLUSIONS Diffuse myocardial fibrosis, assessed using ECV on CMR, was associated with LVDD in patients with AS, but both ECV and LV diastolic function parameters provided a complementary explanation for dyspnea and clinical outcomes. Concomitant assessment of both LVDD and diffuse myocardial fibrosis may further identify patients with AS with greater symptoms and worse prognosis.

    PubMed IF 19 순환기내과
26. 32732020

    제1저자 박지현, 전상훈 · 교신저자 김범석, 김성배

    Park JH^*, Chun SH, Lee YG, Chang H, Lee KW, Kim HR, Shin SH, An HJ, Lee KE, Hwang IG, Ahn MJ, Kim SB^*, Keam B^*

    Hyperprogressive disease and its clinical impact in patients with recurrent and/or metastatic head and neck squamous cell carcinoma treated with immune-checkpoint inhibitors: Korean cancer study group HN 18-12.

    J Cancer Res Clin Oncol. 2020;146(12):3359-3369.

    Abstract

    PURPOSE Although immune-checkpoint inhibitors (ICIs) have emerged as therapeutic options for recurrent and/or metastatic head and neck squamous cell carcinoma (R/M-HNSCC), concerns have been raised on exceptional acceleration of tumor growth during treatment with ICIs, a condition described as hyperprogressive disease (HPD). This study examined the incidence, potential predictors, and clinical impact of HPD in R/M-HNSCC.

    METHODS We retrospectively collected data of patients with R/M-HNSCC treated with ICIs between January 2013 and June 2018 from 11 medical centers in Korea. HPD was defined as tumor growth kinetics ratio (TGKr) > 2, which was calculated by comparing TGK on ICIs with that before treatment with ICIs.

    RESULTS Of 125 patients, 68 (54.4%) obtained progressive disease as their best responses (progressors). HPD was identified in 18 (26.5% of progressors, 14.4% of total) patients. Relatively younger age, primary tumor of oral cavity, and previous locoregional irradiation were significant predictors of HPD according to multivariable analysis (p = 0.040, 0.027, and 0.015, respectively). Compared to patients without HPD, patients with HPD had significantly shorter median progression-free survival (PFS) (1.2 vs. 3.4 months, p < 0.001) and overall survival (OS) (3.4 vs. 10.7 months, p = 0.047). However, interestingly, HPD did not significantly affect the therapeutic benefit of post-ICIs chemotherapy.

    CONCLUSIONS Younger patients with oral cavity cancer or prior treatment with locoregional radiotherapy could be regarded potential risk groups for HPD in patients with R/M-HNSCC treated with ICIs. Although HPD could consistently predict poorer survival outcomes, patients who experienced HPD with ICIs should not be excluded from the subsequent salvage chemotherapy treatments.

    PubMed IF 3.3 혈액종양내과
27. 32722020

    제1저자 차명진 · 교신저자 오세일

    Cha MJ, Oh GC, Lee H, Park HE, Choi SY, Oh S

    Alcohol consumption and risk of atrial fibrillation in asymptomatic healthy adults.

    Heart Rhythm. 2020;17(12):2086-2092.

    Abstract

    BACKGROUND Excessive alcohol consumption is related to atrial fibrillation (AF) development in the general population.

    OBJECTIVE The purpose of this study was to investigate the effect of alcohol consumption on new-onset AF development in asymptomatic healthy individuals.

    METHODS Asymptomatic healthy adults (age <75 years; body mass index <30 kg/m²) undergoing routine health examinations from 2007 to 2015 were screened. Those with sinus rhythm and without any previously diagnosed medical or surgical illness were recruited for analysis. The primary outcome was new-onset AF. Secondary outcomes were a composite of non-AF cardiac events, including clinically significant tachy- or bradyarrhythmias, acute myocardial infarction, heart failure, or cardiac death.

    RESULTS Among 19,634 individuals (50% male; age 19-74 years), 199 cardiac events were recorded, including new-onset AF (n = 160), acute myocardial infarction (n = 30), and clinically significant tachy- or bradyarrhythmia (n =19), during mean follow-up of 7.0 ± 2.8 years. The incidence of new-onset AF was higher in drinkers (hazard ratio [HR] 2.21; 95% confidence interval [CI] 1.55-3.14; P <.001), whereas composite non-AF cardiac events were not correlated to alcohol. There was a dose-dependent increase in the risk of AF according to the amount of alcohol consumed, and the risk increased more abruptly in men than in women. The risk of AF was highest in frequent binge drinkers (HR 3.15; 95% CI 1.98-4.99; P <.001), compared to infrequent light drinkers.

    CONCLUSION In the asymptomatic healthy population, drinking increases the risk of new-onset AF in a dose-dependent manner, regardless of sex. Frequent binge drinking should be avoided.

    PubMed IF 7 순환기내과
28. 32712020

    제1저자 송진희 · 교신저자 김나영

    Song CH, Kim N, Hee Nam R, In Choi S, Hee Son J, Eun Yu J, Shin E, Lee HN, Kim DH, Surh YJ

    17β-Estradiol strongly inhibits azoxymethane/dextran sulfate sodium-induced colorectal cancer development in Nrf2 knockout male mice.

    Biochem Pharmacol. 2020;182:114279.

    Abstract

    Nuclear factor erythroid 2-related factor 2 (Nrf2) has dual effects on inflammation and cancer progression depending on the microenvironment. Estrogens have a protective effect on colorectal cancer (CRC) development. The aim of this study was to investigate CRC development in Nrf2 knockout (KO) mice. Azoxymethane (AOM) and dextran sulfate sodium (DSS)-treated wild-type (WT) and Nrf2 KO male mice were sacrificed at weeks 2 and 16 after AOM injection with/without 17β-estradiol (E2) treatment during week 1. Disease activity index and colon tissue damage at week 2 showed strong attenuation following E2 administration in WT mice but to a lesser extent in Nrf2 KO male mice. At week 16, E2 significantly diminished AOM/DSS-induced adenoma/cancer incidence at distal colon in the Nrf2 KO group, but not in the WT. Furthermore, mRNA or protein levels of NF-κB-related mediators (i.e., iNOS, TNF-α, and IL-1β) and Nrf2-related antioxidants (i.e., NQO1 and HO-1) were significantly lower in the Nrf2 KO group regardless of E2 treatment compared to the WT. The expression of estrogen receptor beta (ERβ) was higher in the Nrf2 KO group than in the WT. In conclusion, estrogen further inhibits CRC by upregulating ERβ-related alternate pathways in the absence of Nrf2.

    PubMed IF 6.5 소화기내과
29. 32702020

    제1저자 강진우 · 교신저자 이상협

    Kang J, Lee SH, Choi JH, Paik WH, Ahn DW, Jeong JB, Ryu JK, Kim YT

    Folfirinox chemotherapy prolongs stent patency in patients with malignant biliary obstruction due to unresectable pancreatic cancer.

    Hepatobiliary Pancreat Dis Int. 2020;19(6):590-595.

    Abstract

    BACKGROUND Stent insertion for biliary decompression to relieve jaundice and subsequent biliary infection is necessary for patients with biliary obstruction caused by pancreatic cancer, and it is important to keep the stent patent as long as possible. However, few studies have compared stent patency in terms of chemotherapy in patients with pancreatic cancer. This study aimed to evaluate the differences in stent patency in terms of recently evolving chemotherapy.

    METHODS Between January 2015 and May 2017, 161 patients with pancreatic cancer who had undergone biliary stent insertion with a metal stent were retrospectively analyzed. The relationship between chemotherapy and stent patency was assessed. Additionally, overall survival according to the treatment, risk factors for stent patency, and long-term adverse events were evaluated.

    RESULTS Median stent patency was 42 days for patients with the best supportive care and 217 days for patients with chemotherapy (conventional gemcitabine-based chemotherapy and folfirinox) (P < 0.001). Furthermore, the folfirinox group showed the longest median stent patency and overall survival, with 283 days and 466 days, respectively (P < 0.001) despite higher adverse events rate. Patients who underwent folfirinox chemotherapy after stent insertion had better stent patency in multivariate analysis (HR = 0.26; 95% CI: 0.12-0.60; P = 0.001).

    CONCLUSIONS Compared with patients who received best supportive care only, patients who underwent chemotherapy after stent insertion had better stent patency. More prolonged stent patency can be expected for patients with folfirinox than conventional gemcitabine-based chemotherapy.

    PubMed IF 3.9 소화기내과
30. 32692020

    제1저자 황인창 · 교신저자 조구영

    Hwang IC, Cho GY, Choi HM, Yoon YE, Park JJ, Park JB, Park JH, Lee SP, Kim HK, Kim YJ, Sohn DW

    Derivation and validation of a mortality risk prediction model using global longitudinal strain in patients with acute heart failure.

    Eur Heart J Cardiovasc Imaging. 2020;21(12):1412-1420.

    Abstract

    AIMS To develop a mortality risk prediction model in patients with acute heart failure (AHF), using left ventricular (LV) function parameters with clinical factors.

    METHODS AND RESULTS In total, 4312 patients admitted for AHF were retrospectively identified from three tertiary centres, and echocardiographic parameters including LV ejection fraction (LV-EF) and LV global longitudinal strain (LV-GLS) were measured in a core laboratory. The full set of risk factors was available in 3248 patients. Using Cox proportional hazards model, we developed a mortality risk prediction model in 1859 patients from two centres (derivation cohort) and validated the model in 1389 patients from one centre (validation cohort). During 32 (interquartile range 13-54) months of follow-up, 1285 patients (39.6%) died. Significant predictors for mortality were age, diabetes, diastolic blood pressure, body mass index, natriuretic peptide, glomerular filtration rate, failure to prescribe beta-blockers, failure to prescribe renin-angiotensin system blockers, and LV-GLS; however, LV-EF was not a significant predictor. Final model including these predictors to estimate individual probabilities of mortality had C-statistics of 0.75 [95% confidence interval (CI) 0.73-0.78; P < 0.001] in the derivation cohort and 0.78 (95% CI 0.75-0.80; P < 0.001) in the validation cohort. The prediction model had good performance in both heart failure (HF) with reduced EF, HF with mid-range EF, and HF with preserved EF.

    CONCLUSION We developed a mortality risk prediction model for patients with AHF incorporating LV-GLS as the LV function parameter, and other clinical factors. Our model provides an accurate prediction of mortality and may provide reliable risk stratification in AHF patients.

    PubMed IF 6.1 순환기내과

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