SCI 발표논문

전체 4,588편

44682025

제1저자 오규철 · 교신저자 이해영, 송은영

, , , , , , , , , , , ,
Utility of Non-HLA Autoantibodies in Predicting Graft Survival After Heart Transplantation.
Transplantation. 2025;109(8):1449-1457.

Abstract
BACKGROUND The presence of antibodies to donor-specific HLAs is a well-known risk factor associated with heart transplantation (HTx) outcomes. Recently, non-HLA antibodies were reported to be associated with HTx outcomes.
METHODS We evaluated the association between the presence of non-HLA antibodies with early (≤1 y) and long-term graft failure in 192 patients undergoing HTx in 4 large transplant centers in Korea.
RESULTS Antibodies to vimentin (AVA) and type II collagen (ACA) were associated with a lower rate of 1-y graft survival (78.6% versus 92.6%, log-rank P = 0.006 for AVA + ; 72.2% versus 91.1%, log-rank P = 0.015 for ACA + ). AVA + stratified 1-y graft survival in patients with donor-specific antibodies (DSAs + ; 45.5% versus 94.1%, log-rank P = 0.002). AVA + also improved the prediction models based on conventional risk factors derived from Cox regression analysis (integrated discrimination improvement, 9%; P < 0.001; net reclassification index, 24%; P = 0.047). Compared with AVA - /ACA - patients, AVA + /ACA + patients had poor graft survival both in the early and late periods (all log-rank P < 0.001).
CONCLUSIONS In conclusion, the presence of non-HLA antibodies to vimentin and type II collagen was associated with poor graft outcomes in patients undergoing HTx. These findings highlight the need to consider non-HLA antibodies in assessing transplant recipients and tailoring immune modulation strategies.
PubMed IF 4.9 순환기내과
44672025

제1저자 이근욱, 장대영, 김형돈 · 교신저자 류민희, 김학균

, , , , , , ,
Multicenter phase Ib/II study of second-line durvalumab and tremelimumab in combination with paclitaxel in patients with biomarker-selected metastatic gastric cancer.
Br J Cancer. 2025;133(2):208-215.

Abstract
BACKGROUND This multicenter phase Ib/II trial aimed to evaluate the safety and efficacy of combining durvalumab, tremelimumab, and paclitaxel as second-line treatment for biomarker-selected patients with metastatic gastric cancer.
METHODS In phase Ib, the standard 3 + 3 dose escalation method was used. Durvalumab and tremelimumab were administered every 4 weeks for 13 and 4 cycles, respectively, combining paclitaxel 80 mg/m² (dose level 2) or 60 mg/m² (dose level 1) on days 1, 8, and 15. The primary outcome for phase II was the objective response rate (ORR).
RESULTS In phase Ib (n = 7), dose level-1 was selected as the recommended phase II dose. In phase II, 48 patients were enrolled: microsatellite instability-high or deficient mismatch repair protein tumors (n = 16); EBV-positive tumors (n = 15); high tumor mutation burden ( ≥ 5/Mb) (n = 11); CD274 amplification (n = 5); and POLD1 mutation (n = 1). The ORR was 52.1%, meeting the primary endpoint. The median progression-free survival and overall survival were 5.3 and 13.1 months, respectively. The most common any-grade and grade 3-4 adverse events were anemia (41.7%) and neutropenia (10.4%), respectively.
CONCLUSIONS Durvalumab-tremelimumab with paclitaxel was tolerable and efficacious in biomarker-selected gastric cancer patients as a second-line treatment, highlighting the importance of biomarker-based approaches for immunotherapy in gastric cancer.
CLINICAL TRIAL REGISTRATION NCT03751761.
PubMed IF 7.8 혈액종양내과
44662025

제1저자 김윤준 · 교신저자 김윤준

, , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
Regorafenib for Hepatocellular Carcinoma in Real-World Practice (REFINE): A Prospective, Observational Study.
Liver Cancer. 2025;14(4):391-407.

Abstract
INTRODUCTION In the phase 3 RESORCE trial, regorafenib prolonged overall survival (OS) in patients with unresectable hepatocellular carcinoma (uHCC) whose disease progressed on prior sorafenib. The prospective, observational REFINE study aimed to evaluate the safety and effectiveness of regorafenib in a broader population of patients in real-world clinical practice, including patients with Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2, Child-Pugh B liver status, and sorafenib intolerance.
METHODS This international, prospective, multicenter study (NCT03289273) enrolled patients with uHCC for whom the decision to treat with regorafenib was made by their physician before enrollment, according to the local health authority-approved label. The primary aim was to evaluate the safety of regorafenib, including the incidence of treatment-emergent adverse events (TEAEs) and dose modifications due to TEAEs.
RESULTS Of the 1,028 patients enrolled, 1,005 initiated regorafenib and were eligible for analysis. Median age was 66 years (range 21-94); most patients were male (83%), Child-Pugh A (61%), and had an ECOG PS of 0 or 1 (82%) at study entry. Overall, 47%, 11%, and 40% of patients initiated regorafenib at 160, 120, and 80 mg/day, respectively. Median treatment duration was 3.7 months (range 1 day to 38.9 months). Dose modifications and permanent discontinuation of regorafenib due to TEAEs occurred in 45% and 31% of patients, respectively. The most common drug-related TEAEs were hand-foot skin reaction (31%), diarrhea (26%), and fatigue (15%). Median OS was 13.2 months (95% confidence interval 11.6, 14.8).
CONCLUSION The results of the real-world REFINE study confirmed the safety and effectiveness of regorafenib in a broad population of patients with uHCC. Of patients who received standard regorafenib dosing in REFINE, safety and efficacy findings were consistent with those reported in the RESORCE trial.
PubMed IF 10.5 소화기내과
44652025

제1저자 박지석, 김지연 · 교신저자 윤연이, 전재익

, , , , , , , , , ,
Deep Learning-Based Detection and Severity Assessment of Bicuspid Aortic Valve Stenosis.
J Am Soc Echocardiogr. 2025;38(8):723-725.

PubMed IF 8.3 순환기내과
44642025

제1저자 정재훈 · 교신저자 김학령

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Incremental prognostic value of combined information of arterial stiffness and the result of treadmill exercise test in patients with suspected coronary artery disease.
J Hum Hypertens. 2025;39(8):566-571.

Abstract
The effectiveness of diagnostic tools can be enhanced by their combination. This study aimed to investigate whether total arterial stiffness data, obtained by brachial-ankle pulse wave velocity (baPWV) measurement, could improve prognostic value to exercise treadmill test (ETT) to predict future cardiovascular events. A total of 1 610 consecutive subjects (mean age 56.3 ± 9.8 years, 59.4% men) with suspected of having coronary artery disease (CAD), who underwent ETT and baPWV on the same day were prospectively recruited. The study outcome was major adverse cardiovascular event (MACE), a composite of cardiac death, non-fatal myocardial infarction, and coronary revascularization. During a mean follow-up period of 938 days (interquartile range, 125-2 252 days), there were 61 cases of MACE (3.8%). The elevated baPWV (≥1 526 cm/s) (hazard ratio [HR] 2.99, 95% confidence interval [CI] 1.64-5.46, P < 0.001) and positive ETT result (HR 4.18, 95% CI 2.48-7.06, P < 0.001) were associated with MACE even after adjustment for potential confounders. The combination of baPWV to traditional risk factors and ETT result further stratified the subjects' risk (low baPWV and negative ETT result vs high baPWV and positive ETT result; HR 14.11, 95% CI 5.74-34.69, P < 0.001). Total arterial stiffness, assessed by baPWV, had incremental prognostic value to ETT result in patients with suspected of CAD. Combined information of baPWV and ETT result can serve as a useful clinical tool for risk stratification in this high-risk patient population.
PubMed IF 3.3 순환기내과
44632025

제1저자 김선조 · 교신저자 조은주, 권성원

, , , , , , ,
Metabolic phenotyping combined with transcriptomics metadata fortifies the diagnosis of early-stage Hepatocellular carcinoma.
J Adv Res. 2025;74:153-163.

Abstract
INTRODUCTION The low sensitivity of alpha-fetoprotein (AFP) renders it unsuitable as a stand-alone marker for early hepatocellular carcinoma (eHCC) surveillance. Therefore, additional blood-based biomarkers with enhanced sensitivities are required.
OBJECTIVES In light of the metabolic changes that are distinctive to eHCC development, the current study presents a panel of serum metabolites that may serve as noninvasive diagnostic indicators for patients with eHCC.
METHODS Serum samples obtained from normal control (NC), cirrhosis, and eHCC patients were analyzed by four different metabolomic platforms. A meta-analysis of very early-stage HCC transcriptomic datasets retrieved from public sources supports the integrated interpretation with metabolic changes.
RESULTS A total of 94 metabolites were significantly correlated with a progressive disease status. Integrated analysis of the significant metabolites and differentially expressed genes from meta-analysis emphasized metabolic pathways including bile acid biosynthesis, phenylalanine and tyrosine metabolism, and butanoate metabolism. The 11 metabolites associated with these pathways were compiled into a metabolite panel for use as diagnostic signatures. With an accuracy of 81.8%, compared with 45.4% for a model trained solely on AFP, the model enhanced its ability to differentiate between the three groups by incorporating a metabolite panel and AFP. Upon examining the trained models using receiver operating characteristic curves, the AFP and metabolite panel combined model exhibited greater area under the curve values in comparisons between NC and eHCC (1.000 versus 0.810) and cirrhosis and eHCC (0.926 versus 0.556). The result was consistent in an independent validation cohort.
CONCLUSION This study emphasizes the role of circulating metabolite markers in the diagnosis of eHCC.
PubMed IF 17.1 소화기내과
44622025

제1저자 Zorc R, Redmond C, Sylvester M · 교신저자 박진균, Gadina M, Grayson PC

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A coding single nucleotide polymorphism in the interleukin-6 receptor enhances IL-6 signalling in CD4 T cells and predicts treatment response to tocilizumab in giant cell arteritis.
Ann Rheum Dis. 2025;84(8):1401-1411.

Abstract
OBJECTIVES The study objective was to determine if a common single nucleotide polymorphism in the interleukin 6 (IL-6) receptor (rs2228145, p.Asp358Ala) predicted treatment response to tocilizumab in giant cell arteritis (GCA).
METHODS Genetic sequencing of the rs2228145 locus was performed in 2 independent cohorts of patients with GCA. Peripheral blood mononuclear cells (PBMCs) from patients and controls were evaluated for expression of the interleukin 6 receptor (IL-6R) and its coreceptor, gp130, using flow cytometry. The same PBMCs were stimulated with IL-6 and evaluated for downstream targets of IL-6: STAT3 phosphorylation (pSTAT3) and IL-17A expression.
RESULTS In total, 100 patients with GCA were included (derivation cohort n = 58; validation cohort n = 42). The rs2228145 variant predicted tocilizumab response in each cohort. In the derivation cohort, a gene dose-dependent response was observed with a 36% response rate in the homozygous patients and 95% response rate in patients without the variant (P = .003). In the validation cohort, tocilizumab response rates were 50% for homozygotes and 85% for patients without the variant (P = .04). pSTAT3 levels were significantly increased in response to IL-6 stimulation in a gene dose-dependent manner in CD4 T cells from patients with GCA but not controls. CD4 T cells from patients with GCA had significantly higher membrane expression of gp130 than healthy controls, and response to IL-6 correlated with gp130 expression. IL-17 producing CD4 T cells were increased in a gene dose-dependent response to IL-6 (P < .01).
CONCLUSIONS The rs2228145 variant is associated with decreased treatment response to tocilizumab and worse outcomes in GCA by enhancing CD4 T cell response to IL-6.
PubMed IF 24 류마티스내과
44612025

제1저자 박승신, 노종성, 김진희 · 교신저자 최만호, 김정희

, , , , , , , ,
Machine learning-based classification of adrenal tumors using clinical, hormonal, and body composition data.
Eur J Endocrinol. 2025;193(2):204-215.

Abstract
OBJECTIVE Accurate diagnosis of adrenal tumors, including mild autonomous cortisol secretion (MACS), adrenal Cushing's syndrome (ACS), primary aldosteronism (PA), pheochromocytoma (PCC), and nonfunctioning adrenal adenomas (NFAs), is crucial but challenging. We aimed to develop a machine learning (ML)-based single-step diagnostic method for differentiating adrenal tumors by integrating clinical data, serum adrenal hormone profiles (SAPs), and body composition data.
METHODS A total of 641 patients with adrenal tumors (MACS = 141, ACS = 64, PA = 265, PCC = 78, and NFA = 93), excluding adrenal metastases and adrenocortical carcinoma, were enrolled from Seoul National University Hospital. Patients were randomly divided into training and test cohorts at a 4:1 ratio. The ML models were developed to differentiate adrenal tumors using 32 clinical data points, 49 SAP markers, and 15 body composition data points.
RESULTS The best-performing ML model for differentiating all 5 adrenal tumors achieved a balanced accuracy of 0.78, sensitivity of 0.77, specificity of 0.93, and area under the curve (AUC) of 0.89. To distinguish MACS, ACS, PA, and PCC from NFA, the accuracies were 0.85, 0.94, 0.78, and 0.86, with AUCs of 0.96, 0.99, 0.90, and 0.94, respectively. The ML model differentiating between NFA and the other functioning adrenal tumors exhibited an accuracy of 0.75 and an AUC of 0.79. The SAP features were identified as the most critical for differentiation, whereas body composition data contributed only minimally.
CONCLUSIONS The ML model demonstrates high diagnostic accuracy in differentiating adrenal tumor subtypes by integrating clinical data, body composition, and SAP, potentially reducing the need for invasive procedures and aiding clinical decision-making.
PubMed IF 6.7 내분비대사내과
44602025

제1저자 이민영 · 교신저자 임석아, 이경훈

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Cyclin dependent kinase 9 inhibitor induces transcription-replication conflicts and DNA damage accumulation in breast cancer.
Cancer Cell Int. 2025;25(1):282.

Abstract
BACKGROUND Cyclin-dependent kinase 9 (CDK9) is a crucial regulator of transcriptional progression of RNA polymerase-II (RNAP2). RNA polymerases trapped in DNA can be a source of transcription-replication conflict (T-R conflict), which is a common source of replication stress. AZD4573, a highly selective CDK9 inhibitor, has been shown to induce apoptosis in leukemia cell lines, while its anti-tumor potential in breast cancer has yet to be elucidated.
METHODS To evaluate the cytotoxicity of AZD4573 in vitro, MTT assays were performed. The expression of signal transduction molecules was determined using Western blotting, immunoprecipitation, and immunofluorescence. Apoptotic cell death was verified by the annexin-V assay. DNA strand breaks and repair efficacy were evaluated through the alkaline comet assay. The siRNA knock-down system was used to confirm the action mechanism.
RESULTS AZD4573 induced T-R conflicts during S-phase, increasing replication stress and DNA strand breaks, resulting in apoptosis by induction of caspase-3. Furthermore, we identified Dead-box 25 (DDX25) helicase as a key mediator in resolving the T-R conflicts. Nuclear translocation of DDX25 correlated with reduced sensitivity to AZD4573 by the resolution of T-R conflicts.
CONCLUSIONS Inhibition of CDK9 by AZD4573 induces the accumulation of DNA damage through T-R conflicts. DDX25 helicases were identified as a key mediator in resolving T-R conflicts and the reduced sensitivity to AZD4573.
PubMed IF 7 혈액종양내과
44592025

제1저자 이근욱 · 교신저자 이근욱, Samuel J. Klempner

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DKN-01 and tislelizumab as second-line therapy in DKK1-high gastroesophageal adenocarcinoma: DisTinGuish trial part B.
Nat Commun. 2025;16(1):6393.

Abstract
Biomarker-enriched, chemotherapy-free treatments for patients with advanced gastric and gastroesophageal junction cancer have not been widely explored. In this multicenter, phase 2 trial (NCT04363801), we evaluated the efficacy and safety of second-line doublet immunotherapy, combining DKN-01, an immunomodulating antibody targeting Dickkopf-related protein 1 (DKK1), with the anti-programmed cell death-1 (PD1) antibody, tislelizumab in patients with advanced gastric/gastroesophageal junction cancer and elevated tumor DKK1 expression, a putative predictive biomarker for DKN-01. Here we report part B (second line cohort) of the larger DisTinGuish trial. The primary endpoint was safety and tolerability, with secondary endpoints including objective response rate (ORR), overall survival (OS), progression free survival (PFS), and disease control rate (DCR). The trial met the prespecified primary endpoint. In the safety population (n = 52), 21 (40.4%) patients reported at least 1 DKN-01-related adverse event, most of which were low-grade, with fatigue (15.4%) and nausea (9.6%) being most common. The ORR was 21.7% in the overall population (n = 46) and 31.8% in the programmed death-ligand 1 (PD-L1) ≥ 5% population. The median OS was 8.2 months, median PFS 1.4 months, and DCR rate 34.8% in the overall population. Although exploratory, the results of this trial compare favorably against second-line benchmarks of Keynote-061 and RAINBOW and support the safety and tolerability of DKN-01 combined with tislelizumab.
PubMed IF 18.1 혈액종양내과
44582025

제1저자 김경아, 권준현, 손우정 · 교신저자 박현선, 고성준

, , , , , , , ,
Association between food diversity in the infant period and the risk of inflammatory bowel disease: a nationwide cohort study in South Korea.
J Crohns Colitis. 2025;19(7):8159173.

Abstract
BACKGROUND Emerging evidence suggests that diet plays a significant role in the development of inflammatory bowel diseases. This study aimed to assess the association between early-life food diversity and the incidence of inflammatory bowel diseases from a nationwide retrospective cohort study in South Korea.
METHODS This study incorporated 1 242 295 South Korean infants who participated in the National Health Insurance Service. Food diversity was categorized as "high" or "low" based on vegetables, fruits, grains, meats, fish, and eggs consumed during weaning. The association between food diversity and inflammatory bowel disease incidence was examined and subgroup analysis was conducted according to food diversity groups. The Cox proportional hazards model was used to estimate the risk of inflammatory bowel disease, with hazard ratios adjusted for demographic factors. Propensity score matching was employed for evaluating the general characteristics of the study population.
RESULTS Among the infants evaluated, 71.3% of those who developed ulcerative colitis and 66.0% of those who developed Crohn's disease did not consume high-diversity food. Individually, food diversity, solid food intake frequency, antibiotic usage, and breastfeeding status were not significantly associated with inflammatory bowel disease incidence. However, the combination of high food diversity and frequent solid food intake (≥3 times/day) was associated with a lower risk of ulcerative colitis by 48% (adjusted hazard ratio: 0.52, CI 0.28-0.98, P = .0426).
CONCLUSIONS Food diversity, combined with the frequency of solid food intake, during infancy is associated with the incidence of ulcerative colitis. Promoting a diverse diet during infancy may be important in preventing the development of IBD.
PubMed IF 10.3 소화기내과
44572025

제1저자 윤동환 · 교신저자 한승석, Afkarian M

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Complement Proteins Identify Rapidly Progressive Diabetic Kidney Disease.
Kidney Int Rep. 2025;10(7):2296-2310.

Abstract
INTRODUCTION Mechanisms underlying diabetic kidney disease (DKD) progression remain incompletely understood. This study used untargeted and targeted mass spectrometry-based proteomics in 2 independent cohorts to capture rapidly progressive DKD.
METHODS We conducted untargeted and targeted mass spectrometry on urine samples from Korean patients with type 2 diabetes and biopsy-confirmed diabetic nephropathy (SNUH-DN cohort; n = 64) and a DKD subgroup of the Chronic Renal Insufficiency Cohort (CRIC-T2D; n = 282), respectively. Urine proteins associated with kidney disease progression (doubling of serum creatinine, ≥ 50% decrease in estimated glomerular filtration rates [eGFRs], or progression to end-stage kidney disease[ESKD]) were identified after adjusting for eGFR, proteinuria, and other clinical variables.
RESULTS In the SNUH-DN patients, urine proteins clustered into 2 groups, with cluster 1 exhibiting a 4.6-fold higher hazard of disease progression (95% confidence interval [CI]: 1.9-11.5) than cluster 0. Proteins in cluster 1 mapped to 10 pathways, 4 of the top 5 being complement-related. A high complement score, derived from urine complement protein abundance, correlated with histopathologic features of DKD and conferred a 2.4-fold greater hazard of disease progression (95% CI: 1.0-5.4) than a low complement score. In CRIC-T2D, targeted mass spectrometry similarly confirmed that complement score stratified patients into rapid and slow DKD progression groups. In both cohorts, complement score exhibited a linear association with disease progression.
CONCLUSION The strong association between complement activation and rapid DKD progression highlights the need to explore complement inhibition as a potential therapeutic strategy for DKD.
PubMed IF 6.2 신장내과
44562025

제1저자 한석문, 이소령 · 교신저자 최의근

, , , , , , , , , ,
Early Rhythm Control of Atrial Fibrillation in Cancer Survivors: A Nationwide Population-Based Study.
J Am Heart Assoc. 2025;14(13):e040908.

Abstract
BACKGROUND Although early rhythm control (ERC) is effective in reducing stroke in patients with atrial fibrillation (AF), its benefits have not been well elucidated in cancer survivors. This study aimed to compare the risk of ischemic stroke between ERC and usual care in cancer survivors with AF.
METHODS This nationwide observational study was conducted using the Korean National Health Insurance Service database. Patients aged ≥20 years with newly diagnosed AF between 2009 and 2018 were included. Patients who received rhythm control therapy within 1 year of AF diagnosis were defined as the ERC group, while the remaining patients were defined as usual care group. The risk of ischemic stroke in the ERC group was compared with those of the usual care group in cancer survivors (cancer diagnosis ≥5 years) and the noncancer group.
RESULTS A total of 591 692 patients were included in the study (18 747 patients [3.2%] with cancer; mean age, 65.7±14.6 years; 53.7% men). During a mean 4-year follow-up, stroke occurred in 52 500 patients (1338 cancer survivors and 51 182 noncancer survivors). The ERC group showed a lower risk of stroke than the usual care group, regardless of the presence of a cancer history (adjusted hazard ratio, 0.67 [95% CI, 0.58-0.76] in cancer survivors versus 0.76 [95% CI, 0.74-0.78] in the noncancer group).
CONCLUSIONS ERC is associated with a lower risk of ischemic stroke among cancer survivors. An integrated approach that incorporates appropriate rhythm control strategies should be considered for cancer survivors with newly diagnosed AF.
PubMed IF 6 순환기내과
44552025

제1저자 송우길, 이은영, 박승완 · 교신저자 정인경, 이정석, 이은영

, , , , , , , , , , , , , ,
Type 1 interferon signature and allograft inflammatory factor-1 contribute to refractoriness to TNF inhibition in ankylosing spondylitis.
Nat Commun. 2025;16(1):5531.

Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory arthritis that primarily affects the enthesis and may culminate in bony ankylosis of the spine. Despite TNF inhibitor (TNFi) being foundational in managing active inflammation, 30-40% of patients with AS remain non-responsive. Through longitudinal and multi-omics profiling of peripheral blood mononuclear cells from TNFi-receiving patients with AS, here we reveal that elevated type I IFN signatures at baseline are associated with poor TNFi response, leading to a paradoxical enhancement of IFN signatures and Th17 responses following TNFi therapy. Among type I IFN-related genes, we identify and validate AIF-1 as a predictive biomarker reflecting the inherent IFN signature that differentiates responders from non-responders. AIF-1 also contributes to an inflammatory cycle by increasing IFNα receptor expression and Th17 responses. In summary, our findings advocate for a personalized approach to managing AS by considering individual variations in AIF-1 levels and IFN signatures.
PubMed IF 18.1 류마티스내과
44542025

제1저자 양경모, 김규래 · 교신저자 김원, 정원일

, , , , , , , , , , , , , , , , , , , , ,
Binge drinking triggers VGLUT3-mediated glutamate secretion and subsequent hepatic inflammation by activating mGluR5/NOX2 in Kupffer cells.
Nat Commun. 2025;16(1):5546.

Abstract
Glutamate, a crucial player in hepatic amino acid metabolism, has been relatively unexplored in immune cell activation. We show in a study with male mice that hepatic glutamate accumulates in vesicles of perivenous hepatocytes through vesicular glutamate transporter 3 (VGLUT3), regulated by the aryl hydrocarbon receptor upon chronic alcohol intake. Additional binge drinking triggers the exocytosis of glutamate by altering the intracellular Ca²⁺ level, stimulating metabotropic glutamate receptor 5 (mGluR5) and subsequent NADPH oxidase 2 (NOX2)-mediated ROS production in Kupffer cells (KCs). This interaction between hepatocytes and KCs is facilitated by pseudosynapse formation, arising from alcohol-induced ballooning of perivenous hepatocytes. Genetic or pharmacological interference of mGluR5 or NOX2 in KCs alleviates alcohol-related steatohepatitis (ASH). Analysis of patient samples confirmed some of the findings from mice, showing that plasma glutamate concentration and VGLUT3 levels correlate with ASH development. Conclusively, our findings highlight glutamate storage and release in mediating ASH, particularly through the pseudosynapse between hepatocytes and KCs.
PubMed IF 18.1 소화기내과
44532025

제1저자 양석훈 · 교신저자 구본권

, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
Prognostic Time Frame of Plaque and Hemodynamic Characteristics and Integrative Risk Prediction for Acute Coronary Syndrome.
JACC Cardiovasc Imaging. 2025;18(7):784-795.

Abstract
BACKGROUND The relevant time frame for predicting future acute coronary syndrome (ACS) based on coronary lesion characteristics remains uncertain.
OBJECTIVES The aim of this study was to investigate the association of lesion characteristics with test-to-event time and their prognostic impact on ACS.
METHODS The EMERALD II (Exploring the Mechanism of Plaque Rupture in Acute Coronary Syndrome Using Coronary CT Angiography and Computational Fluid Dynamics II) study analyzed 351 patients who underwent coronary computed tomography angiography (CTA) and experienced ACS between 1 month and 3 years of follow-up. Lesions identified on coronary CTA were classified as culprit (n = 363) or nonculprit (n = 2,088) on the basis of invasive coronary angiography findings at the time of ACS. Core laboratory coronary CTA analyses assessed 4 domains: degree of stenosis, plaque burden, number of adverse plaque characteristics (APC) (low-attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign), and changes in coronary CTA-derived fractional flow reserve across the lesion (ΔFFR_CT). Patients were categorized into short (<1 year), mid (1-2 years), and long (2-3 years) test-to-event time groups.
RESULTS Patient characteristics, including cardiovascular risk factors, did not differ across short, mid, and long test-to-event groups (P > 0.05 for all), and the proportion of ACS culprit lesions was similar (P = 0.552). Among culprit lesions, shorter test-to-event time was associated with higher luminal stenosis, plaque burden, and ΔFFR_CT (P for trend < 0.001 for all). The predictability for ACS culprit lesions based on the combined 4 characteristics tended to decrease over time and significantly reduced beyond 2 years (AUC: 0.851 vs 0.741; P = 0.006). In predicting ACS risk within test-to-event time <2 years using obstructive lesions (stenosis ≥ 50%), APC ≥2, plaque burden ≥70%, and ΔFFR_CT ≥0.10, the risk was elevated compared to the average proportion of lesions becoming ACS culprit (12.1%) in the following subsets: lesions with 4 characteristics (proportion of lesions becoming ACS culprit: 49.3%; P < 0.001), lesions with 3 characteristics (obstructive lesions with plaque burden ≥70% and either ΔFFR_CT ≥0.10 [proportion of lesions becoming ACS culprit: 33.0%; P < 0.001] or APC ≥2 [proportion of lesions becoming ACS culprit: 31.2%; P < 0.001]), and lesions with 2 characteristics (plaque burden ≥70% and ΔFFR_CT ≥0.10; proportion of lesions becoming ACS culprit: 21.5%; P = 0.016).
CONCLUSIONS Increased luminal stenosis, plaque burden, and ΔFFR_CT were associated with shorter test-to-ACS event time. The prognostic impact of lumen, plaque, and local hemodynamic characteristics was most relevant to ACS risk within a 2-year period, with higher risk observed when specific combinations of them were present. (Exploring the Mechanism of Plaque Rupture in Acute Coronary Syndrome Using Coronary CT Angiography and Computational Fluid Dynamics II [EMERALD II] Study; NCT03591328).
PubMed IF 19 순환기내과
44522025

제1저자 김연욱 · 교신저자 김연욱

, , , , , , , , , , , , , , , , , ,
Diagnostic Yield and Synergistic Impact of Needle Aspiration and Forceps Biopsy With Electromagnetic Navigation Bronchoscopy for Peripheral Pulmonary Lesions: A Randomized Controlled Trial.
Chest. 2025;168(1):236-247.

Abstract
BACKGROUND Electromagnetic navigation bronchoscopy (ENB) is an advanced imaging-guided technique used to diagnose peripheral pulmonary lesions. However, the optimal strategy for selecting biopsy devices remains unclear.
RESEARCH QUESTION Does the combination of needle aspiration and forceps biopsy improve diagnostic yield compared with using a single device alone?
STUDY DESIGN AND METHODS We conducted a randomized crossover study during ENB performed under moderate sedation. This trial recruited participants with peripheral pulmonary lesions requiring biopsy who were eligible for elective ENB. ENB-guided needle aspiration and forceps biopsy were sequentially performed in a randomized order. The primary outcome was diagnostic yield, defined as the percentage of patients for whom the biopsy provided a specific diagnosis able to inform patient management. The diagnostic yield achieved by each biopsy modality individually and in combination was evaluated.
RESULTS Between December 1, 2021, and November 13, 2023, 142 participants were enrolled and underwent the study procedures. Complete follow-up data were obtained for 140 participants. Diagnostic yield was 44.4% (63 of 142) for forceps biopsy, 51.4% (73 of 142) for needle aspiration (P = .221 vs forceps), and 66.9% (95 of 142) for the combination (P < .001 vs forceps alone, P < .001 vs needle alone). Sensitivities for malignancy were 47.5% (57 of 120) for forceps biopsy and 58.3% (70 of 120) for needle aspiration (P = .074). The combination of the 2 modalities resulted in a significantly improved sensitivity of 71.7% (86 of 120) compared with either individual modality (P < .001 vs forceps alone and needle alone). Pneumothorax occurred in 3.5% (5 of 142) of patients, and 1.4% (2 of 142) developed pneumothorax requiring tube drainage.
INTERPRETATION Our results show that when performing ENB under moderate sedation, the combination of needle aspiration and forceps biopsy significantly improves the diagnostic yield and sensitivity for malignancy compared with each modality alone, with a favorable safety profile. These results indicate that a multimodal approach using needles and forceps is a valid diagnostic strategy for ENB.
CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT05110131; URL: www.
CLINICALTRIALS gov.
PubMed IF 9.8 호흡기내과
44512025

제1저자 김지원, 경동수 · 교신저자 이근욱

, , , , , , , , , , , , , , ,
Pairwise analysis of plasma cell-free DNA before and after palliative second-line paclitaxel plus ramucirumab treatment in patients with metastatic gastric cancer.
Gastric Cancer. 2025;28(4):620-630.

Abstract
BACKGROUND This study compared plasma cell-free DNA (cfDNA) and tumor tissue DNA (ttDNA) to explore the clinical applicability of cfDNA in patients with metastatic gastric cancer (mGC) receiving palliative second-line paclitaxel + ramucirumab treatment.
METHODS Targeted sequencing of 106 genes was conducted using germline DNA and cfDNA at baseline (baseline-cfDNA) and progressive disease (PD-cfDNA). The results were compared with those of ttDNA-based cancer panel data.
RESULTS Of 76 consecutive patients, 46 (27 males; median age 57.5 [range, 32-73] years) who had all three samples were included. Combined analysis of ttDNA and baseline-cfDNA revealed that TP53 (58.7%) was the most frequently mutated gene, followed by CDH1 (26.1%), KRAS (21.7%), and APC (13.0%). For these genes, the sensitivity and positive predictive value of baseline-cfDNA over ttDNA were 71.8% and 51.9%, respectively. When baseline-cfDNA and PD-cfDNA results were combined, 34 patients (73.9%) were found to have additional mutations compared with ttDNA results alone. PD-cfDNA analysis revealed 14 novel pathogenic mutations in ten patients (21.7%). At baseline, patients with a high circulating tumor DNA fraction concentration showed a significantly shorter progression-free survival (PFS) (P = 0.016) in univariable and multivariable analyses. High maximal variant allele frequency (VAF) (P = 0.022), high sum of VAF (P = 0.028), and high TP53 VAF (P = 0.022) were associated with worse PFS in univariable analysis.
CONCLUSIONS Although cfDNA alone cannot replace ttDNA entirely, cfDNA analysis revealed additional mutations. Notably, PD-cfDNA analysis revealed novel pathogenic mutations that emerged during treatment. Moreover, the baseline circulating tumor DNA fraction concentration and VAF values were associated with longer PFS.
PubMed IF 6.1 소화기내과
44502025

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

, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
Fibrosis-4plus score: a novel machine learning-based tool for screening high-risk varices in compensated cirrhosis (CHESS2004): an international multicenter study.
Clin Mol Hepatol. 2025;31(3):881-898.

Abstract
BACKGROUND/AIMS A large percentage of patients undergoing esophagogastroduodenoscopy (EGD) screening do not have esophageal varices (EV) or have only small EV. We evaluated a large, international, multicenter cohort to develop a novel score, termed FIB-4plus, by combining the fibrosis-4 (FIB-4) score, liver stiffness measurement (LSM), and spleen stiffness measurement (SSM) to identify high-risk EV (HRV) in compensated cirrhosis.
METHODS This international cohort study involved patients with compensated cirrhosis from 17 Chinese hospitals and one Croatian institution (NCT04546360). Two-dimensional shear wave elastography-derived LSM and SSM values, and components of the FIB-4 score (i.e., age, aspartate aminotransferase, alanine aminotransferase, and platelet count [PLT]) were combined using machine learning algorithms (logistic regression [LR] and extreme gradient boosting [XGBoost]) to develop the LR-FIB-4plus and XGBoost-FIB-4plus models, respectively. Shapley Additive exPlanations method was used to interpret the model predictions.
RESULTS We analyzed data from 502 patients with compensated cirrhosis who underwent EGD screening. The XGBoost-FIB-4plus score demonstrated superior predictive performance for HRV, with an area under the receiver operating characteristic curve (AUROC) of 0.927 (95% confidence interval [CI] 0.897-0.957) in the training cohort (n=268), and 0.919 (95% CI 0.843-0.995) and 0.902 (95% CI 0.820-0.984) in the first (n=118) and second (n=82) external validation cohorts, respectively. Additionally, the XGBoost-FIB-4plus score exhibited high AUROC values for predicting EV across all cohorts. The FIB-4plus score outperformed the individual parameters (LSM, SSM, PLT, and FIB-4).
CONCLUSION The FIB-4plus score effectively predicted EV and HRV in patients with compensated cirrhosis, providing clinicians with a valuable tool for optimizing patient management and outcomes.
PubMed IF 21.7 소화기내과
44492025

제1저자 임수, 남가은 · 교신저자 Arya M Sharma

, ,
Differences between Type 2 Diabetes Mellitus and Obesity Management: Medical, Social, and Public Health Perspectives.
Diabetes Metab J. 2025;49(4):565-579.

Abstract
Obesity and type 2 diabetes mellitus (T2DM) are among the most urgent global public health challenges, yet differ markedly in recognition and management across medical, social, infrastructure, and policy domains. T2DM is supported by clear diagnostic criteria, defined treatment targets, and broad acceptance as a chronic disease. In contrast, obesity is assessed using imprecise metrics like body mass index, lacks standardized treatment goals, and is often misunderstood as a lifestyle issue rather than a chronic, relapsing disease. This misconception contributes to stigma, discrimination, and unrealistic patient expectations. T2DM receives substantial research funding, comprehensive clinical guidelines, and structured medical education, with strong support from large professional societies and multidisciplinary care models. Obesity care remains underfunded, inconsistently delivered, and underrepresented in medical training. Public health and policy efforts strongly favor T2DM, providing coordinated programs, insurance coverage, and regulatory oversight. Conversely, obesity is marginalized, with limited policy influence and a largely unregulated commercial weight-loss industry. Bridging these disparities requires adopting lessons from T2DM management-such as evidence-based guidelines, improved provider training, expanded insurance coverage, and public health strategies-to enhance obesity care and recognize it as a chronic disease requiring long-term, structured management.
PubMed IF 8.2 내분비대사내과
44482025

제1저자 김선미, 한경도 · 교신저자 최수연

, , , , , , , ,
Pregravid Weight Gain Is Associated with an Increased Risk of Gestational Diabetes.
Diabetes Metab J. 2025;49(4):826-836.

Abstract
BACKGRUOUND Studies have reported a significant association between pregravid weight gain and the subsequent development of gestational diabetes mellitus (GDM) in various populations. The current study aims to investigate this relationship using data from the Korean National Health Insurance Service database.
METHODS We conducted a retrospective nationwide population-based cohort study, involving 159,798 women who gave birth between 2015 and 2017 and had undergone two national health screening examinations: 1 year (index checkup) and 3 years before (baseline checkup) their respective estimated conception date. Participants were categorized into five groups based on the extent of weight change between the two examinations: more than 10%, 5% to 10%, -5% to 5% (reference group), -10% to -5%, and more than -10%. The study assessed the association between pregravid weight change and GDM risk.
RESULTS Among the 146,363 women analyzed, 11,012 (7.52%) were diagnosed with GDM. Multiple regression analysis revealed that women who gained 5% to 10% of their weight had a 12% increased risk of GDM (adjusted odds ratio [aOR], 1.12; 95% confidence interval [CI], 1.06 to 1.17), while those who gained ≥10% had a 34% higher risk (aOR, 1.34; 95% CI, 1.26 to 1.43). Notably, pregravid weight gain was particularly associated with GDM risk in non-obese or non-metabolic syndrome groups at index checkup.
CONCLUSION Pregravid weight gain showed a dose-dependent association with a higher risk of GDM. This association was more pronounced in non-obese individuals emphasizing the importance of minimizing pregravid weight gain for GDM prevention, even in non-obese women.
PubMed IF 8.2 순환기내과
44472025

제1저자 홍성은 · 교신저자 김원, 최무림

, , , , , , , ,
Single-cell eQTL analysis identifies genetic variation underlying metabolic dysfunction-associated steatohepatitis.
Nat Genet. 2025;57(7):1638-1648.

Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized for its medical and socioeconomic impacts, driven by diverse genetic and environmental factors. Here, to address the urgent need for individually tailored therapies, we show results from single-cell expression quantitative trait locus (sc-eQTL) analysis on liver biopsies from 25 patients with MASLD and 23 controls. This approach identified over 3,500 sc-eQTLs across major liver cell types and cell-state-interacting eQTLs (ieQTLs) with significant enrichment for disease heritability (for MASLD trait, ieQTL enrichment odds ratio 10.27). We integrated transcription factors as upstream regulators of ieQTLs, revealing 601 functional units ('quartets') composed of transcription factors, cell states, SNP components of ieQTL (ieSNPs) and Gene component of ieQTL (ieGenes). From these results, we pinpoint the loss of an eQTL in EFHD1 during hepatocyte maladaptation associated with genotype-specific regulation by FOXO1, further contributing to the risk of MASLD. Our approach underscores the role of eQTL analysis in capturing crucial genetic variations that influence gene expression and clinical outcomes in complex diseases.
PubMed IF 25.5 소화기내과
44462025

제1저자 전유경 · 교신저자 안소연, 윤혁

, , , , , , ,
Impact of early aggressive treatment on long-term biochemical marker patterns in inflammatory bowel disease.
J Gastroenterol. 2025;60(7):854-865.

Abstract
BACKGROUNDS The disease course of inflammatory bowel disease (IBD) is highly variable; early and precise identification of patients with poor outcomes is crucial. We aimed to classify the long-term disease course of IBD using biochemical markers and evaluate the clinical factors associated with different disease courses.
METHODS A latent class mixed model was employed to identify distinct trajectories of C-reactive protein (CRP) and fecal calprotectin (FCP) levels in 256 and 635 patients with Crohn's disease (CD) and ulcerative colitis (UC), respectively, from a tertiary hospital cohort. Multinomial logistic regression was used to evaluate the relationships between various trajectories and clinical variables.
RESULTS Three trajectories were identified for CD and UC: class 1, early and sustained biochemical remission; class 2, delayed remission; and class 3, prolonged difficulty in achieving remission for > 5 years. For patients with CD, early immunomodulator initiation was associated with a high likelihood of belonging to class 1 in the CRP trajectory analysis, whereas early advanced therapy increased the probability of belonging to class 1 in the FCP trajectory analysis. CRP trajectory analysis showed no significant associations in patients with UC. Younger age at diagnosis and early immunomodulator initiation were associated with higher odds of being in class 2 or 3, whereas current smoking was associated with a high likelihood of being in class 1 in the FCP trajectory analysis.
CONCLUSIONS Early aggressive medical treatment for CD may lead to long-term biochemical remission, whereas no similar association was observed in UC.
PubMed IF 5.7 소화기내과
44452025

제1저자 윤영현, 정기영 · 교신저자 고성준, 최형진

, , , , , , , , , , , ,
AI-powered 3D pathology protocol enhances enteric nervous system visualization and quantification for clinical diagnostics.
Theranostics. 2025;15(15):7440-7453.

Abstract
Rationale: Accurate diagnosis and understanding of gastrointestinal (GI) diseases such as ulcerative colitis and Hirschsprung's disease remain challenging due to the limitations of traditional two-dimensional (2D) histopathology in capturing the intricate three-dimensional (3D) architecture and dynamic microenvironment of GI tissues. This study explores the potential of integrating 3D imaging techniques with artificial intelligence (AI)-based analysis to improve histological evaluation and diagnostic accuracy. Methods: Using advanced imaging and computational tools, we identified critical structural and functional details of the enteric nervous system and associated tissues that are often missed by 2D approaches. Results: The results showed that 3D imaging coupled with AI significantly improves diagnostic accuracy and provides new insights into disease mechanisms, enabling earlier and more precise detection of pathological changes. In addition, this approach enhances our understanding of the pathophysiology of GI diseases, bridging gaps in both clinical and basic research. Conclusions: These findings underscore the transformative potential of 3D imaging and AI to revolutionize diagnostic workflows and advance our knowledge of GI diseases, ultimately contributing to improved patient outcomes and innovative research methodologies.
PubMed IF 14.9 소화기내과
44442025

제1저자 류현호, 이소령 · 교신저자 최의근, 한경도

, , , , , , , , , , , , ,
Impact of steatotic liver diseases on diabetes mellitus risk in patients with atrial fibrillation: a nationwide population study.
Cardiovasc Diabetol. 2025;24(1):242.

Abstract
BACKGROUND Atrial fibrillation (AF) frequently coexists with diabetes mellitus (DM), leading to a worse prognosis if both are present. Steatotic liver disease (SLD) may also predispose to DM, but its impact among AF patients is unclear. We aimed to determine whether metabolic dysfunction-associated SLD (MASLD), MASLD with increased alcohol intake (MetALD), or alcohol-related liver disease (ALD) elevates DM risk in AF.
METHODS Non-diabetic individuals who developed AF between 2010 and 2018 from the Korean National Health Insurance Service database were included. Patients with a fatty liver index (FLI) < 30 were classified as non-SLD, whereas those with FLI ≥ 30 and at least one cardiometabolic risk factors were categorized as MASLD, MetALD, or ALD based on daily alcohol intake. Incident DM hazard ratios (HRs) were estimated with Cox regression models.
RESULTS Among 195,195 patients (mean age 64.4 ± 13.0 years, 57.5% male); 108,918 (55.8%) in non-SLD, 71,795 (36.8%) in MASLD, 7644 (3.9%) in MetALD, and 6838 (3.5%) in ALD, respectively. Over a mean follow-up of 6.0 ± 2.9 years, 25,632 (13.0%) developed DM. Compared with non-SLD, the adjusted HRs with 95% confidence intervals (CIs) for incident DM were 1.930 (1.879-1.983), 1.789 (1.682-1.904), and 1.932 (1.817-2.054) for MASLD, MetALD, and ALD, respectively. In the age 20-39 years group, adjusted HRs with 95% CIs were 5.844 (4.501-7.587), 5.354 (3.681-7.787), and 7.033 (4.660-10.615), respectively.
CONCLUSION SLD confers an increased risk of new-onset DM in AF patients, especially in younger adults. Implementing management strategies to prevent DM in AF patients with SLD might mitigate the risk of DM and its potential impact on AF-related outcomes.
PubMed IF 15.6 순환기내과
44432025

제1저자 이소령 · 교신저자 최의근

, , , , , , , , , , , , , ,
Reduction of AF Burden After Cryoballoon Ablation in Patients With Early Persistent AF: The COOL-PER Trial.
JACC Clin Electrophysiol. 2025;11(6):1234-1247.

Abstract
BACKGROUND Limited data exist on reducing the atrial fibrillation (AF) burden, the regression from persistent to paroxysmal AF, and symptom improvement after cryoablation in patients with persistent AF.
OBJECTIVES This study sought to evaluate the efficacy of cryoablation in reducing the AF burden, regression to paroxysmal AF, and symptom improvement in patients with early persistent AF.
METHODS This investigator-initiated, multicenter, and prospective cohort study enrolled the patients with early persistent AF (≤3 years). All patients were inserted an implantable loop recorder at the time of trial entry. AF burden (percentage of time in AF) and actual AF type were evaluated during pre-cryoablation and 12-month follow-up after cryoablation. AF-related symptoms and quality of life were assessed.
RESULTS A total of 130 patients were enrolled (median age 61 years [Q1-Q3: 54-67 years]; median duration of persistent AF 6 months [Q1-Q3: 4-10 months]). The mean AF burden before cryoablation was 77 ± 34% (25.4% of high-burden paroxysmal AF; 74.6% of implantable loop recorder-confirmed persistent AF), which was reduced to 9 ± 21% after 12-month follow-up (mean 68 ± 37% of AF burden reduction; P < 0.001). Of the total, 38.5% had no recurrence of AF, 43.1% had a recurrence of paroxysmal AF, and 18.5% had a recurrence of persistent AF. Among those with confirmed persistent AF at baseline, 76% of patients showed regression to paroxysmal AF or no recurrence. After cryoablation, 77% of patients improved AF-related symptoms and quality of life as assessed by 36-Item Short Form Survey questionnaires.
CONCLUSIONS In patients with early persistent AF, cryoablation significantly reduced AF burden and achieved regression of AF type followed by symptom improvement. (Cryoablation for Pulmonary Vein Isolation Alone in Patients with Early Persistent AF Assessed by Continuous Monitoring [COOL-PER]; NCT05507749).
PubMed IF 7.2 순환기내과
44422025

제1저자 김경민 · 교신저자 임수

, , , , , , , , ,
Efficacy of phentermine/topiramate extended release in weight management and metabolic profiles: A multicentre study in South Korea.
Diabetes Obes Metab. 2025;27(6):3252-3261.

Abstract
AIMS Clinical trials have demonstrated the effectiveness of the phentermine and topiramate combination in weight management. This research evaluated the efficacy and safety of phentermine/topiramate extended release (ER) for weight management, focusing on alterations in body weight and metabolic parameters in routine clinical practice.
MATERIALS AND METHODS We retrospectively included people with obesity who initiated phentermine/topiramate ER between January 2020 and April 2023 at 10 tertiary hospitals in South Korea. The study assessed body weight changes at 5-6 months and for those who continued, at 12 months, along with metabolic parameters. Total body weight was measured using calibrated electronic scales with participants in light indoor clothing.
RESULTS The cohort included 1839 patients (540 men and 1299 women), with a 5-6-month continuation rate of 48%. At 5-6 months, the mean weight reduction was 7.9%, with sex-specific losses of 7.1% in men and 8.2% in women. Over 56% of participants achieved more than 5% weight loss, with 23% exceeding a 10% reduction. Younger participants, women and those with moderate to severe obesity exhibited more pronounced weight loss compared to older men and individuals with mild obesity, respectively. Concurrently, phentermine/topiramate ER treatment improved glucose regulation, lipid profiles and decreased blood pressure: the HbA1c decreased by 0.4 ± 0.9%, low-density lipoprotein (LDL) cholesterol by 10 ± 32 mg/dL and systolic blood pressure by 6 ± 15 mmHg (all p < 0.001). Treatment was well-tolerated, with a 15% incidence of mild adverse events like paresthesia, dry mouth and insomnia. At 12 months, patients who persisted in treatment (21%) experienced an average weight loss of 9.6%, with 65% surpassing a 5% weight loss.
CONCLUSION The study suggests phentermine/topiramate ER is an effective option for obesity management in a South Korean population, though long-term adherence remains a challenge.
PubMed IF 6.1 내분비대사내과
44412025

제1저자 이태승, 최진호 · 교신저자 이상협

, , , , , , , , , , , , , , , ,
A randomized non-inferiority trial investigating antibiotic adjustments based on blood culture in acute cholangitis.
Clin Microbiol Infect. 2025;31(6):987-994.

Abstract
OBJECTIVES This study evaluated the adequacy of using blood cultures alone for antibiotic therapy in mild-to-moderate acute cholangitis after adequate biliary drainage.
METHODS A prospective, multi-centre, non-inferiority, randomized trial was conducted from August 2015 to September 2023 across 12 tertiary hospitals in South Korea. Patients were randomly assigned 1:1 to groups. The control group was administered antibiotics based on blood and bile culture results, whereas the experimental group was treated based on blood culture results alone. The primary outcome was the rate of organ failure, assessed by the presence of shock, acute kidney injury, altered mental status, and acute respiratory distress. The secondary outcomes were all-cause mortality, frequency of re-interventions, antibiotic usage duration, and hospital stay. The non-inferiority margin was 10%.
RESULTS Patients in the control group (n = 215) and experimental group (n = 213) were analysed. Organ failure occurred in 28 (13.0%) in the control and 27 (12.7%) in the experimental group (difference: -0.350% [95% CI, -6.690% to 5.990%], p > 0.999). Mortality rates were 3.3% in the control (seven patients) and 2.3% in the experimental group (five patients) (-0.908% [-4.033% to 2.216%], p 0.782). The reintervention rates were 31 (14.9%) in the control and 26 (12.2%) in the experimental groups (-2.677% [-9.155% to 3.801%], p 0.504). The antibiotic therapy duration was different (-1.500 days [-2.840 to -0.160], p 0.037) between the control (12.8 ± 8.0 days) and the experimental groups (11.3 ± 6.5 days), and the hospital stay was different (-1.900 days [-0.380 to 0.000], p 0.046) between the control (14.1 ± 11.0 days) and the experimental groups (12.2 ± 9.0 days).
DISCUSSION This study confirms that relying on blood culture results alone for managing mild-to-moderate cholangitis is reasonable and may help reduce the unnecessary use of medical resources.
PubMed IF 8.7 소화기내과
44402025

제1저자 정광현 · 교신저자 이상협

,
Optimal tissue acquisition method for pancreatic mass.
Dig Endosc. 2025;37(6):629-637.

Abstract
Pancreatic masses pose a diagnostic difficulty due to the technical complexities related to tissue acquisition. Endoscopic ultrasound (EUS)-guided tissue acquisition has transformed the field by allowing access to pancreatic lesions through fine-needle and biopsy. However, diagnostic accuracy differs based on tumor characteristics and procedural factors. This narrative review explores the nuances of tissue acquisition methods for pancreatic tumors, including factors such as tumor location, size, histological characteristics, and needle selection. It assesses the efficacy of different needle designs and maneuvers, including suction techniques and needle passes. Moreover, the diverse tissue preparation methods, including cytological smear, cell block, and direct histology, are discussed, highlighting the importance of tailored approaches based on tumor characteristics. Additionally, the roles of macroscopic on-site evaluation and rapid on-site evaluation in optimizing specimen adequacy are investigated. Furthermore, percutaneous ultrasound-guided biopsy is considered an alternative approach, particularly in settings where EUS is impractical. Additionally, the review emphasizes the emerging trend of using tissue for genetic testing and molecular analysis, requiring high-quality sample acquisition. Future directions in tissue acquisition techniques and their integration into clinical practice are discussed, providing promising avenues for pancreatic disease diagnosis and treatment.
PubMed IF 3.6 소화기내과
44392025

제1저자 김미소 · 교신저자 박흥우, 류기연

, , , , ,
Association Between Prevalence of Anemia and Asthma Severity.
Allergy. 2025;80(6):1782-1784.

PubMed IF 11.3 알레르기내과

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