SCI 발표논문

전체 4,588편

44382025

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

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Liquid metal-based stretchable bioelectronic fiber for electrical stimulation and drug delivery in minimally invasive cardiac therapy.
APL Bioeng. 2025;9(2):026118.

Abstract
Cardiovascular diseases, such as ventricular arrhythmias and heart failure, require timely and effective treatment to prevent disease progression and improve patient outcomes. Current therapeutics, including electrical shock and emergent cardiovascular medications, have significantly contributed to managing these conditions. However, due to their systemic side effects, there are ongoing demands for highly effective localized therapies. In this regard, a soft implantable device has been considered for cardiac applications, but invasiveness in their implantation procedure and difficulty in compact integration of multiple functions are unmet challenges. To address these issues, we develop a stretchable, multi-functional fiber designed for emergent cardiac intervention, offering electrogram recording, electrical modulation, and drug therapy directly at the epicardial surface. With temperature-dependent phase shifting properties of the liquid metal inside the fiber, the stiffened fiber can be implanted into the thoracic cavity without invasive surgery. Once implanted, the softened fiber provides multimodal therapies (e.g., chemotherapy and electrical therapy) tailored to the patient's condition. By tuning the delivery parameters based on continuous electrogram recording, effective and urgent cardiac interventions for severe arrhythmias are demonstrated in an in vivo rat model.
PubMed IF 4.9 순환기내과
44372025

제1저자 최진주, 곽윤진 · 교신저자 조수정

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Cancer-associated fibroblast-derived fibulin-5 promotes epithelial-mesenchymal transition in diffuse-type gastric cancer via cAMP response element-binding protein pathway, showing poor prognosis.
Exp Mol Med. 2025;57(5):1106-1119.

Abstract
Diffuse-type gastric cancer (DGC), characterized by poorly cohesive cells within fibrotic stroma, is associated with advanced disease and poor prognosis. Here, to identify distinct biomarkers for DGC compared with intestinal-type gastric cancer, we constructed a comprehensive large-scale signaling network using RNA-sequencing data from three genomic databases (The Cancer Genome Atlas, GSE62254 and GSE26253), developed a mathematical model and conducted simulation analyses. For validation, we used tissue microarray blocks of gastric cancers with immunohistochemical staining, single-cell RNA sequencing, primary cultures of cancer-associated fibroblasts (CAFs) and organoids, and a co-culture system involving CAFs and cancer cells. Signaling network analysis identified six differentially activated signaling components across the database, including BIRC5, TTK, NEK2, FHL1, NR2F1 and FBLN5. Among the differentially activated signaling components, high tumoral expression of fibulin-5 protein encoded by FBLN5 correlated with poor overall and disease-specific survival rates in patients with DGC, even after adjusting for the tumor, node, metastases (TNM) stage. Fibulin-5, derived from CAFs within DGC stroma, promoted organoid growth and epithelial-mesenchymal transition (EMT) in DGC cell lines via the cAMP response element-binding protein (CREB) pathway in a CAF co-culture system. FBLN5 knockdown in CAFs reduced the aggressive phenotype of co-cultured DGC cells, while CREB inhibitors reversed EMT. Furthermore, levels of secreted FBLN5 in patient blood samples correlated with its expression in primary tumors. In summary, fibulin-5 secreted by CAFs and interacted with DGC cells promotes EMT and is clinically associated with poor patient outcomes. These findings suggest fibulin-5 as a potential prognostic marker and therapeutic target in patients with DGC.
PubMed IF 17.5 소화기내과
44362025

제1저자 김중엽, 이찬미 · 교신저자 강창경, 이진우

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Cytomegalovirus reactivation in the lower respiratory tract as an independent risk factor for mortality in critically Ill patients.
Crit Care. 2025;29(1):177.

Abstract
BACKGROUND The clinical significance of cytomegalovirus reactivation in the lower respiratory tract (LRT) of critically ill patients remains unclear. We aimed to investigate the association between cytomegalovirus reactivation detected in LRT and intensive care unit (ICU) prognosis.
METHODS This study included critically ill patients admitted to a medical ICU at a tertiary referral center in South Korea between January 2021 and June 2023. Cytomegalovirus load in LRT samples collected via bronchoscopy was measured within 7 days of admission. Detection of cytomegalovirus DNA in LRT was defined as reactivation. Associations between cytomegalovirus reactivation and ICU, in-hospital, 30-day, and 90-day mortality were assessed using multivariable Fine-Gray model adjusted for major clinical factors.
RESULTS Of the 322 patients (median age 68 years, 66.8% male), 145 (45%) had cytomegalovirus reactivation in the LRT. Cytomegalovirus reactivation was independently associated with increased ICU (adjusted subdistribution hazard ratio [aSHR], 2.28; 95% confidence interval [CI], 1.46-3.56), in-hospital (aSHR, 2.00; 95% CI, 1.44-2.78), 30-day (aSHR, 2.11; 95% CI, 1.42-3.13), and 90-day mortality (aSHR, 2.05; 95% CI, 1.45-2.88). Anti-cytomegalovirus therapy was significantly associated with reduced ICU mortality in patients with radiologic findings suggestive of cytomegalovirus pneumonia (P for interaction = 0.001), but was linked to increased mortality in patients with positive bacterial cultures (P for interaction = 0.002).
CONCLUSION Cytomegalovirus reactivation in the LRT is associated with poor outcomes in critically ill patients. Anti-cytomegalovirus therapy was not associated with overall survival outcomes; however, the subgroup with radiologic findings of cytomegalovirus pneumonia suggested benefits, while the subgroup with bacterial co-infections suggested harmful effects. Randomized controlled trials are needed.
PubMed IF 11.4 호흡기내과
44352025

제1저자 문인기, 이지나 · 교신저자 윤연이

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Artificial Intelligence-Enhanced Analysis of Echocardiography-Based Radiomic Features for Myocardial Hypertrophy Detection and Etiology Differentiation.
Circ Cardiovasc Imaging. 2025;18(5):e017436.

Abstract
BACKGROUND While echocardiography is pivotal for detecting left ventricular hypertrophy (LVH), it struggles with etiology differentiation. To enhance LVH assessment, we aimed to develop an artificial intelligence algorithm using echocardiography-based radiomics. This algorithm is designed to detect LVH and differentiate its common etiologies, such as hypertrophic cardiomyopathy (HCM), cardiac amyloidosis (CA), and hypertensive heart disease (HHD), based on echocardiographic images.
METHODS The developmental data sets from multiple medical centers included 867 subjects, with an independent external test set from a single tertiary medical center containing 619 subjects. Radiomic feature analysis was conducted on 4 echocardiographic views, extracting both conventional and harmonization-driven myocardial textures along with myocardial geographic features. Then, we developed classification models for each condition. Variable contributions were evaluated using Shapley Additive Explanations analysis.
RESULTS The radiomics-based LightGBM model, selected from internal validation, maintained strong performance in the external test set (area under the curve of 0.96 for HCM, 0.89 for CA, and 0.86 for HHD). Compared with the logistic regression model using conventional echocardiographic parameters (left ventricular ejection fraction, left ventricular mass index, left atrial volume index, and E/e'), the final model demonstrated superior sensitivity (0.89 versus 0.80 for HCM, 0.80 versus 0.80 for CA, and 0.75 versus 0.33 for HHD) and F1-score (0.87 versus 0.57 for HCM, 0.84 versus 0.72 for CA, and 0.82 versus 0.50 for HHD). Feature analysis highlighted that harmonization-driven textures played a key role in differentiating HCM, while conventional textures and myocardial thickness were influential in differentiating CA and HHD.
CONCLUSIONS This study confirms that artificial intelligence-enhanced echocardiography-based radiomics effectively differentiate the etiology of LVH, highlighting the potential of artificial intelligence-driven texture and geographic analysis in LVH evaluation.
PubMed IF 9.1 순환기내과
44342025

제1저자 곽순구 · 교신저자 Marc R Dweck, 이승표

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Sex-Specific Association of Myocardial Fibrosis With Mortality in Patients With Aortic Stenosis.
JAMA Cardiol. 2025;10(5):446-455.

Abstract
IMPORTANCE Myocardial fibrosis in aortic stenosis (AS) may exhibit sex differences. However, its prognostic significance in women with AS remains unclear.
OBJECTIVE To investigate sex differences in myocardial fibrosis assessed by cardiovascular magnetic resonance (CMR) and evaluate its prognostic value in women and men with AS.
DESIGN, SETTING, AND PARTICIPANTS Patients with severe AS who underwent CMR before aortic valve replacement (AVR) were prospectively enrolled from 13 international sites between March 2011 and September 2021. Myocardial fibrosis was evaluated using extracellular volume fraction (ECV%) and late gadolinium enhancement (LGE). The main analysis was conducted on patients without obstructive coronary artery disease (CAD), defined as those with no history of myocardial infarction and no concomitant coronary artery bypass grafting. Data were analyzed from December 2023 to February 2024.
EXPOSURES Surgical or transcatheter AVR.
MAIN OUTCOMES AND MEASURES The primary outcome was post-AVR all-cause mortality and the secondary outcome was cardiovascular mortality.
RESULTS Of 822 patients, 670 were without obstructive CAD (368 men [55%] and 302 women [45%]). Among these, women and men had a similar age (median, 72 years vs 71 years, respectively), comorbidities, and AS severity. ECV% was similar between sexes; however, women had less LGE (both infarct and noninfarct LGE). After a median follow-up of 3.7 (IQR, 2.1-4.7) years, there were 76 deaths (11.3%), including 29 adjudicated cardiovascular deaths, in patients without obstructive CAD. Increasing ECV% and LGE were associated with higher all-cause and cardiovascular mortality in both sexes. Cox analyses demonstrated that both ECV% and LGE were associated with higher all-cause mortality without significant interaction by sex (women: adjusted hazard ratio [HR], 1.08 per 1% ECV% increase; 95% CI, 1.04-1.12; P < .001; men: adjusted HR, 1.01; 95% CI, 0.96-1.06; P = .66; P for interaction by sex = .09 and women: adjusted HR, 2.49 for the presence of LGE; 95% CI, 1.07-5.80; P = .03; men: adjusted HR, 1.82; 95% CI, 1.00-3.32; P = .04; P for interaction by sex = .68). In the entire population (n = 822), both noninfarct and infarct-related LGE were associated with increased mortality without significant interaction by sex.
CONCLUSIONS AND RELEVANCE In this study, patients with severe AS who underwent AVR exhibited similar ECV% between sexes, while women had lower LGE. Increased myocardial fibrosis provided important prognostic value for both sexes.
PubMed IF 15.2 순환기내과
44332025

제1저자 윤민재 · 교신저자 최동주

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Self-Monitoring of Blood Pressure and Feedback via Mobile App in Treatment of Uncontrolled Hypertension: The SMART-BP Randomized Clinical Trial.
Mayo Clin Proc. 2025;100(5):840-853.

Abstract
OBJECTIVE To evaluate the effects of mobile apps with tailored recommendations on changes in blood pressure (BP) and drug adherence.
PATIENTS AND METHODS This study is a randomized, open-label, multicenter trial to evaluate the efficacy of self-monitoring of BP (SMBP) with a mobile application-based feedback algorithm (SMBP app with feedback) compared with SMBP alone. Patients with uncontrolled hypertension aged 19 years or older were randomly assigned. In the control group, the patients only measured their BP at home using the mobile app combined with a Bluetooth BP monitor and received standard care, whereas in the intervention group, the patients could also receive alerts for BP measurement and additional recommendations from the app using a feedback algorithm in response to the obtained BP value. The primary end point was the change in mean home systolic BP at 24 weeks.
RESULTS From September 1, 2019, through July 8, 2020, 184 patients were randomized into 2 groups: SMBP app with feedback (n=97) and SMBP alone (n=87). At 24 weeks, the mean ± SD home systolic BP reduction from baseline was significantly greater in the SMBP app with feedback group than in the SMBP alone group (-22.4±13.5 vs -17.2±13.3 mm Hg; P=.02). The SMBP app with feedback group had higher drug adherence and proportion of adherence of 95% or greater than the SMBP alone group.
CONCLUSION The SMBP app with feedback is superior to SMBP alone in terms of systolic BP reduction and improved drug adherence in patients with hypertension. Given the high cost of traditional interventions between patients and health care professionals, feedback through mobile apps could potentially be a useful tool in the management of hypertension.
TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT04470284.
PubMed IF 6.5 순환기내과
44322025

제1저자 조인래 · 교신저자 이상협

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Digital single-operator cholangioscopy for difficult anastomotic biliary strictures in living donor liver transplant recipients after failure of standard ERCP: SPYPASS-2 study (with videos).
Gastrointest Endosc. 2025;101(5):979-987.e3.

Abstract
BACKGROUND AND AIMS Liver transplantation (LT) is a curative treatment for end-stage liver disease. Anastomotic biliary strictures (ABSs) are more common in living donor LT (LDLT). However, the success rate of ERCP for ABSs remains unsatisfactory. In this study, we evaluated the efficacy of single-operator cholangioscopy (SOC) for ABS treatment in LDLT recipients where standard ERCP failed to access the stricture.
METHODS This prospective study included 40 LDLT patients undergoing ERCP with SOC (SpyGlass DS II; Boston Scientific Corp, Natick, Mass, USA) to treat ABSs when guidewire placement across the ABS was difficult during conventional ERCP (cannulation time >10 minutes) between October 2021 and May 2023. Our primary endpoint was technical success, defined as successful guidewire placement across the ABS and/or subsequent treatment. Secondary endpoints were rates of clinical success, adverse events, and reintervention.
RESULTS The mean patient age was 59.7 ± 7.2 years, and the mean time from LDLT to the occurrence of ABS was 212 ± 230 days. Technical and clinical success were achieved in 92.5% (37/40) and 82.5% (33/40) of patients, respectively. The rates of post-ERCP cholangitis, pancreatitis, and bleeding were 10.0%, 15.0%, and 2.5%, respectively. Intestinal perforation did not occur, and all adverse events were mild in severity. Early stent migration within 1 month occurred in 2 patients (5.4%), and 4 patients (10.8%) required reintervention within 1 month.
CONCLUSIONS This study shows the efficacy and safety of SOC-facilitated management for difficult ABSs in LDLT patients after failure of standard ERCP. (Clinical trial registration number: NCT05065125.).
PubMed IF 8 소화기내과
44312025

제1저자 권순일, 이소령 · 교신저자 최의근

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Benefits of Early Catheter Ablation in Patients With Atrial Fibrillation: A Nationwide Cohort Study.
JACC Clin Electrophysiol. 2025;11(5):956-965.

Abstract
BACKGROUND Although early rhythm control showed better clinical outcomes in patients with atrial fibrillation (AF), limited data exist on the relationship between the timing of atrial fibrillation catheter ablation (AFCA) and clinical outcomes.
OBJECTIVES This study investigated the impact of early vs late AFCA on clinical outcomes.
METHODS Using the Korean claims database, 944,710 AF patients without previous AFCA were investigated. These patients were categorized into 3 groups based on the duration from their AF diagnosis to AFCA: <1 year (early-AFCA), 1 to <3 years (intermediate-AFCA), and ≥3 years (late-AFCA). The study outcomes included ischemic stroke, heart failure (HF) hospitalization, myocardial infarction, major adverse cardiovascular events (comprising the aforementioned three), all-cause mortality, a composite outcome (encompassing all mentioned outcomes), and AF recurrence.
RESULTS A total of 57,804 AF patients (38,536 without AFCA and 19,268 with AFCA; mean age 57.8 years; 73.5% men) were followed up for an average of 2.6 ± 1.5 years. AFCA was associated with lower risks across all study outcomes (HRs: 0.26-0.41 for all outcomes; all P < 0.001). Compared with the early-AFCA group, the intermediate- and late-AFCA groups showed higher risks of HF hospitalization and all-cause mortality. Additionally, the late-AFCA group had higher risks of major adverse cardiovascular events, composite outcomes, and AF recurrence than those of the early- and intermediate-AFCA groups. After weighing the propensity scores, the results were largely consistent with the primary analysis.
CONCLUSIONS Early AFCA showed improved clinical outcomes, primarily caused by decreased risk of HF hospitalization and AF recurrence.
PubMed IF 7.2 순환기내과
44302025

제1저자 한정규, 이기환 · 교신저자 김효수, 신상훈

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Short-Term DAPT After Complex PCI With Third-Generation DES: A Post Hoc Analysis of the HOST-IDEA Trial.
Circ Cardiovasc Interv. 2025;18(5):e014623.

Abstract
BACKGROUND The optimal duration of dual antiplatelet therapy (DAPT) after complex percutaneous coronary intervention (PCI) remains unclear. We aim to investigate the efficacy and safety of 3 to 6 months of DAPT over 12 months after complex PCI.
METHODS A post hoc analysis of the HOST-IDEA (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Coronary Intervention With Next-Generation Drug-Eluting Stent Platforms and Abbreviated Dual Antiplatelet Therapy) randomized trial which enrolled patients undergoing PCI with third-generation drug-eluting stents was performed. Complex PCI was defined by any of the following: ≥3 stents implanted, ≥3 lesions treated, bifurcation PCI with 2-stenting, total stent length ≥60 mm, left main PCI, or heavy calcification. The major end points were target lesion failure, a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization for ischemic outcomes, and major bleeding, defined as BARC (Bleeding Academic Research Consortium) type 3 or 5, for bleeding outcomes at 12 months.
RESULTS Among 1992 patients, 624 underwent complex PCI. The complex PCI group had clinical features associated with high bleeding risk. A shortened DAPT duration did not increase the risk of target lesion failure, with hazard ratios of 0.818 (95% CI, 0.403-1.659) for the complex PCI group and 1.282 (95% CI, 0.506-3.249) for the noncomplex PCI group (P_interaction=0.451). Conversely, it decreased the risk of major bleeding in the complex PCI group (hazard ratio, 0.269 [95% CI, 0.075-0.965]), but not in the noncomplex PCI group (hazard ratio, 1.534 [95% CI, 0.627-3.754], showing a significant interaction; P_interaction=0.029).
CONCLUSIONS In patients undergoing complex PCI with a third-generation drug-eluting stent, a 3- to 6-month duration of DAPT was associated with a reduced risk of bleeding without an increased risk of ischemic events compared with 12-month DAPT.
REGISTRATION URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02601157.
PubMed IF 7.2 순환기내과
44292025

제1저자 김순찬, 감가혜 · 교신저자 임석아, 구자록

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Establishment and characterization of 24 breast cancer cell lines and 3 breast cancer organoids reveals molecular heterogeneity and drug response variability in malignant pleural effusion-derived models.
Breast Cancer Res. 2025;27(1):66.

Abstract
Intratumoral heterogeneity of breast cancer cells causes undesired drug resistance and predispose to disease recurrence. We investigate the molecular heterogeneity of breast cancer cells derived from malignant pleural effusions (MPE) to understand variations in drug resistance and cellular evolution. MPE provides a unique environment, with cells experiencing significant microenvironmental changes that promote intratumoral heterogeneity and therapeutic resistance. By establishing 24 cell lines and 3 organoids from MPE samples of breast cancer patients, we performed extensive genomic, transcriptomic, and drug sensitivity analyses. Our findings reveal substantial genetic and transcriptomic diversity among MPE-derived cell lines, highlighting dynamic alterations in driver mutations and signaling pathways that correlate with variable drug responses. Notably, temporal and spatial heterogeneity within patient-derived samples emphasized the adaptability of breast cancer cells in MPE, as different subclones displayed distinct drug sensitivities. This work underscores the critical role of molecular profiling in understanding treatment resistance in breast cancer, presenting MPE-derived cell lines as valuable preclinical models for exploring personalized therapies in aggressive cancer phenotypes.
PubMed IF 6.2 혈액종양내과
44282025

제1저자 Martin Haluzík · 교신저자 Martin Haluzík, 임수

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Efficacy and safety of switching to iGlarLixi from premixed insulins in people with type 2 diabetes: The Soli-SWITCH study.
Diabetes Obes Metab. 2025;27(5):2730-2739.

Abstract
AIMS To assess the efficacy and safety of switching from premixed insulin to a once-daily, fixed-ratio combination of insulin glargine 100 U/mL + lixisenatide (iGlarLixi) in people with type 2 diabetes (T2D).
METHODS In this phase 4, 24-week, single-arm study, participants switched from once-daily or twice-daily premixed insulin to iGlarLixi (EudraCT number 2021-003711-25). Key inclusion criteria: ≥18 years; premixed insulin therapy for ≥3 months and < 10 years; ± 1-2 oral antidiabetic drugs (OADs); HbA1c ≥7.5% to ≤10.0%. The primary endpoint was the change in HbA1c from baseline to Week 24. Secondary endpoints included: participants achieving HbA1c <7% and change in body weight at Week 24, and safety.
RESULTS Overall, 162 participants switched to iGlarLixi (89.5% from twice-daily premixed insulin); mean duration of diabetes was 15.7 (standard deviation [SD]: 8.3) years. Mean baseline HbA1c (8.5%) reduced by least squares (LS) mean of 1.2% (95% confidence interval [CI]: -1.4, -1.1) at Week 24, and 37.6% of participants had achieved an HbA1c target of <7% (95% CI: 30.0, 45.7). LS mean body weight change from baseline to Week 24 was -1.0 kg (95% CI: -1.6, -0.5). Fasting and post-prandial plasma glucose decreased from baseline to Week 24 by 45.6 mg/dL (SD ± 52.4) and 67.6 mg/dL (SD ± 65.1), respectively. Confirmed symptomatic hypoglycaemia occurred in 38.3% of participants (ADA level 1: 35.8%; level 2: 15.4%; level 3: 0.0%).
CONCLUSIONS iGlarLixi initiation was associated with improved glycaemic control, without body weight gain or increased hypoglycaemia over 24 weeks.
PubMed IF 6.1 내분비대사내과
44272025

제1저자 박민정 · 교신저자 김정희, 이승훈

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Phenotype of pheochromocytoma and paraganglioma by germline mutation: a Korean multicenter study.
Endocr Relat Cancer. 2025;32(5):e240269.

Abstract
Recent advances in genetic testing have challenged the traditional genotype-phenotype correlation in pheochromocytomas and paragangliomas (PPGL). We aimed to characterize the genotype-phenotype correlations in PPGL in a large Korean cohort and compare our findings with those from other countries. We retrospectively analyzed 627 patients with PPGL from two centers who underwent genetic testing for germline pathogenic variants (PVs) from 2000 to 2023 to examine the prevalence of clusters and their correlation with specific phenotypes. Moreover, we systematically reviewed 44 studies that investigated the frequency of germline PVs based on geographical differences. Germline PVs were identified in 29.7% of patients (n = 186). The prevalence of cluster 1A, 1B and 2 PVs was 10.6% (n = 67), 8.0% (n = 50) and 11.1% (n = 69), respectively. Cluster 1 patients were presented with more aggressive features, including younger age at diagnosis (39 years), higher rates of extra-adrenal (44.4%), and metastatic (27.8%) tumors, than did the wild-type and cluster 2 groups (P < 0.001). Cluster 1A patients had significantly higher metastasis rates than cluster 1B patients (38.8 vs 12.5%; P < 0.001). The cluster 2 group showed a high recurrence risk but rarely developed metastases. The cluster 1-to-cluster 2 ratio among Koreans (1.7) was lower than that among Europeans (2.9) and North Americans (3.3). This study underscores the genetic and clinical heterogeneity of PPGL among Korean patients based on genetic clusters and highlights geographic variations in PVs. These findings have significant implications for risk stratification, surveillance and management strategies for patients with PPGL.
PubMed IF 4.4 내분비대사내과
44262025

제1저자 강지훈 · 교신저자 박경우

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Long-Term Aspirin vs Clopidogrel After Coronary Stenting by Bleeding Risk and Procedural Complexity.
JAMA Cardiol. 2025;10(5):427-436.

Abstract
IMPORTANCE Antiplatelet monotherapy in the chronic maintenance period for patients with high bleeding risk (HBR) and those who have undergone complex percutaneous coronary intervention (PCI) has not yet been explored.
OBJECTIVE To compare clopidogrel vs aspirin monotherapy in patients with HBR and/or PCI complexity.
DESIGN, SETTING, AND PARTICIPANTS This post hoc analysis of the multicenter HOST-EXAM Extended study, an open-label trial conducted across 37 sites in South Korea, enrolled patients from 2014 to 2018 with up to 5.9 years of follow-up. The analysis was conducted from February to November 2023. Patients who maintained dual antiplatelet therapy (DAPT) event-free for 6 to 18 months following PCI were included.
INTERVENTIONS Patients were randomized to receive either clopidogrel or aspirin in a 1:1 ratio. Those with sufficient data to assess HBR or complex PCI were analyzed.
MAIN OUTCOMES AND MEASURES Coprimary end points were thrombotic composite end point (cardiovascular death, nonfatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and definite/probable stent thrombosis) and any bleeding (Bleeding Academic Research Consortium type 2 to 5).
RESULTS Of 3974 patients included (mean [SD] age, 63.4 [10.7] years; 2976 male [74.9%]), 866 had HBR (21.8%), and 849 underwent complex PCI (21.4%). Clopidogrel as compared with aspirin was associated with lower rates of thrombotic and bleeding events regardless of HBR and/or PCI complexity. For the thrombotic composite end point, the hazard ratio (HR) was 0.75 (95% CI, 0.53-1.04) among HBR vs 0.62 (95% CI, 0.48-0.80) among patients without HBR (P for interaction = 0.38) and 0.49 (95% CI, 0.32-0.77) among patients with complex PCI vs 0.74 (95% CI, 0.59-0.92) among patients with noncomplex PCI (P for interaction = 0.12). The reduction in bleeding by clopidogrel compared with aspirin was consistent among both patients with HBR (HR, 0.82; 95% CI, 0.56-1.21) and patients without HBR (HR, 0.58; 95% CI, 0.40-0.85; P for interaction = 0.20) and among patients undergoing complex PCI (HR, 0.79; 95% CI, 0.47-1.33) vs noncomplex PCI (HR, 0.68; 95% CI, 0.50-0.93; P for interaction = 0.62).
CONCLUSIONS AND RELEVANCE In this study, in patients who experienced PCI and were event-free during 6 to 18 months of DAPT, the beneficial impact of clopidogrel monotherapy over aspirin monotherapy was consistent, regardless of bleeding risk and/or PCI complexity.
TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02044250.
PubMed IF 15.2
44252025

제1저자 박세훈, 정수민 · 교신저자 김광수, 이하정

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A deep-learning algorithm using real-time collected intraoperative vital sign signals for predicting acute kidney injury after major non-cardiac surgeries: A modelling study.
PLoS Med. 2025;22(4):e1004566.

Abstract
BACKGROUND Postoperative acute kidney injury (PO-AKI) prediction models for non-cardiac major surgeries typically rely solely on preoperative clinical characteristics.
METHODS AND FINDINGS In this study, we developed and externally validated a deep-learning-based model that integrates preoperative data with minute-scale intraoperative vital signs to predict PO-AKI. Using data from three hospitals, we constructed a convolutional neural network-based EfficientNet framework to analyze intraoperative data and created an ensemble model incorporating 103 baseline variables of demographics, medication use, comorbidities, and surgery-related characteristics. Model performance was compared with the conventional SPARK model from a previous study. Among 110,696 patients, 51,345 were included in the development cohort, and 59,351 in the external validation cohorts. The median age of the cohorts was 60, 61, and 66 years, respectively, with males comprising 54.9%, 50.8%, and 42.7% of each cohort. The intraoperative vital sign-based model demonstrated comparable predictive power (AUROC (Area Under the Receiver Operating Characteristic Curve): discovery cohort 0.707, validation cohort 0.637 and 0.607) to preoperative-only models (AUROC: discovery cohort 0.724, validation cohort 0.697 and 0.745). Adding 11 key clinical variables (e.g., age, sex, estimated glomerular filtration rate (eGFR), albuminuria, hyponatremia, hypoalbuminemia, anemia, diabetes, renin-angiotensin-aldosterone inhibitors, emergency surgery, and the estimated surgery time) improved the model's performance (AUROC: discovery cohort 0.765, validation cohort 0.716 and 0.761). The ensembled deep-learning model integrating both preoperative and intraoperative data achieved the highest predictive accuracy (AUROC: discovery cohort 0.795, validation cohort 0.762 and 0.786), outperforming the conventional SPARK model. The retrospective design in a single-nation cohort with non-inclusion of some potential AKI-associated variables is the main limitation of this study.
CONCLUSIONS This deep-learning-based PO-AKI risk prediction model provides a comprehensive approach to evaluating PO-AKI risk prediction by combining preoperative clinical data with real-time intraoperative vital sign information, offering enhanced predictive performance for better clinical decision-making.
PubMed IF 9.9 신장내과
44242025

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

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

Abstract
BACKGROUND Revascularisation decisions based on angiography-derived fractional flow reserve (FFR) or optimisation of stent implantation with intravascular ultrasound yield superior clinical outcomes compared with percutaneous coronary intervention (PCI) guided by angiography alone. However, the differences in outcomes when a single approach is used for both purposes remain unclear. We aimed to assess the non-inferiority of angiography-derived FFR versus intravascular ultrasound guidance in terms of clinical outcomes at 12 months in patients with angiographically significant stenosis.
METHODS This investigator-initiated, open-label, multicentre, randomised, non-inferiority trial, which was done in 22 centres in China, enrolled patients aged 18 years or older with suspected ischaemic heart disease and with at least 50% stenosis in epicardial coronary arteries measuring at least 2·5 mm by visual estimation on coronary angiography. Patients were randomly assigned (1:1) to undergo PCI guided by either angiography-derived FFR or intravascular ultrasound, including revascularisation decisions and optimisation of the stent implantations based on prespecified PCI criteria and optimal PCI goals. Use of both modalities simultaneously was not permitted. Randomisation as performed using a web-based program and stratified based on the trial centre and the presence or absence of diabetes. The primary outcome was a composite of death, myocardial infarction, or revascularisation at 12 months in the intention-to-treat population, and the non-inferiority margin was 2·5 percentage points. This trial is registered with ClinicalTrials.gov, NCT04397211; long-term follow-up is ongoing.
FINDINGS Between May 29, 2020, and Sept 20, 2023, 1872 patients were enrolled. After 33 patients withdrew, 923 patients were randomly assigned to the angiography-derived FFR group and 916 to the intravascular ultrasound group. Median age of the study population was 66·0 years (IQR 58·0-72·0), and 1248 (67·9%) patients were male and 591 (32·1%) were female. Revascularisation was performed in 688 (69·5%) of 990 target vessels in the angiography-derived FFR group and 797 (81·0%) of 984 target vessels in the intravascular ultrasound group. At a median follow-up of 12 months (IQR 12-12), the primary outcome event occurred in 56 patients in the angiography-derived FFR group and 54 patients in the intravascular ultrasound group (6·3% vs 6·0%, absolute difference 0·2 percentage points [upper boundary of one-sided 97·5% CI 2·4], p_{non-inferiority}=0·022; hazard ratio 1·04 [95% CI 0·71 to 1·51]). Mortality did not differ between the two groups (1·8% in the angiography-derived FFR group vs 1·3% in the intravascular ultrasound group, absolute difference 0·4 percentage points [95% CI -0·7 to 1·6]; hazard ratio 1·34 [0·63 to 2·83], p=0·45). The incidence of recurrent angina was low in both groups: 26 (2·8%) of 923 patients in the angiography-derived FFR group and 35 (3·8%) of 916 patients in the intravascular ultrasound group.
INTERPRETATION The angiography-derived FFR-guided comprehensive PCI strategy, encompassing revascularisation decision making and stent optimisation, was non-inferior to intravascular ultrasound guidance. This finding might have implications for future guidelines on its role and application.
FUNDING National Natural Science Foundation of China, The Key R & D Projects of Zhejiang Province, and the RCT Program from The Second Affiliated Hospital of Zhejiang University School of Medicine.
PubMed IF 109 순환기내과
44232025

제1저자 이병주 · 교신저자 박인규, 임수, 이대식

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

Abstract
The increasing prevalence of obesity and metabolic disorders has created a significant demand for personalized devices that can effectively monitor fat metabolism. In this study, we developed an advanced breath analyzer system designed to provide real-time monitoring of exercise-induced fat burning by analyzing volatile organic compounds (VOCs) present in both oral and alveolar breath. Acetone in exhaled breath and β-hydroxybutyric acid (BOHB) in the blood are both biomarkers closely linked to the metabolic fat burning process occurring in the liver, particularly after exercise. The breath analyzer utilizes a sensor array to detect VOC patterns, with the data analyzed using a one-dimensional convolutional neural network (1D CNN) for an accurate prediction of BOHB levels in the blood. We collected and analyzed 30 exhaled breath samples with our analyzer and blood samples for BOHB from participants before and after exercise. The results showed a strong correlation between sensor responses and BOHB levels, with Pearson correlation coefficients of 0.99 across different postexercise time points. The 1D CNN model effectively estimated BOHB concentrations, achieving Pearson coefficients of 0.96 for the training data set and 0.86 for the test data set. Additionally, our findings confirm that alveolar air samples, which contain metabolic byproducts from deeper in the lungs, offer more reliable data for fat burning analysis than oral air samples. This noninvasive, real-time breath monitoring tool offers a promising solution for individuals demanding to optimize their exercise routines and track metabolic health with high precision and accuracy.
PubMed IF 10.9 내분비대사내과
44222025

제1저자 권주성, 안형범 · 교신저자 서정원

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

Abstract
BACKGROUND Considering that most patients with low or no significant risk factors can safely undergo noncardiac surgery without additional cardiac evaluation, and given the excessive evaluations often performed in patients undergoing intermediate or higher risk noncardiac surgeries, practical preoperative risk assessment tools are essential to reduce unnecessary delays for urgent outpatient services and manage medical costs more efficiently.
OBJECTIVE This study aimed to use the Observational Medical Outcomes Partnership Common Data Model to develop a predictive model by applying machine learning algorithms that can effectively predict major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing noncardiac surgery.
METHODS This retrospective observational network study collected data by converting electronic health records into a standardized Observational Medical Outcomes Partnership Common Data Model format. The study was conducted in 2 tertiary hospitals. Data included demographic information, diagnoses, laboratory results, medications, surgical types, and clinical outcomes. A total of 46,225 patients were recruited from Seoul National University Bundang Hospital and 396,424 from Asan Medical Center. We selected patients aged 65 years and older undergoing noncardiac surgeries, excluding cardiac or emergency surgeries, and those with less than 30 days of observation. Using these observational health care data, we developed machine learning-based prediction models using the observational health data sciences and informatics open-source patient-level prediction package in R (version 4.1.0; R Foundation for Statistical Computing). A total of 5 machine learning algorithms, including random forest, were developed and validated internally and externally, with performance assessed through the area under the receiver operating characteristic curve (AUROC), the area under the precision-recall curve, and calibration plots.
RESULTS All machine learning prediction models surpassed the Revised Cardiac Risk Index in MACCE prediction performance (AUROC=0.704). Random forest showed the best results, achieving AUROC values of 0.897 (95% CI 0.883-0.911) internally and 0.817 (95% CI 0.815-0.819) externally, with an area under the precision-recall curve of 0.095. Among 46,225 patients of the Seoul National University Bundang Hospital, MACCE occurred in 4.9% (2256/46,225), including myocardial infarction (907/46,225, 2%) and stroke (799/46,225, 1.7%), while in-hospital mortality was 0.9% (419/46,225). For Asan Medical Center, 6.3% (24,861/396,424) of patients experienced MACCE, with 1.5% (6017/396,424) stroke and 3% (11,875/396,424) in-hospital mortality. Furthermore, the significance of predictors linked to previous diagnoses and laboratory measurements underscored their critical role in effectively predicting perioperative risk.
CONCLUSIONS Our prediction models outperformed the widely used Revised Cardiac Risk Index in predicting MACCE within 30 days after noncardiac surgery, demonstrating superior calibration and generalizability across institutions. Its use can optimize preoperative evaluations, minimize unnecessary testing, and streamline perioperative care, significantly improving patient outcomes and resource use. We anticipate that applying this model to actual electronic health records will benefit clinical practice.
PubMed IF 8.2 순환기내과
44212025

제1저자 류호인, 김성렬 · 교신저자 남영희, 강혜련

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

Abstract
BACKGROUND Drug hypersensitivity reaction (DHR) poses significant challenges in clinical practice, with some patients experiencing more severe reactions upon re-exposure. Understanding the factors contributing to escalation into more severe reactions is crucial for improving patient safety. This study aimed to investigate the clinical characteristics and risk factors associated with the progression from non-severe DHR to anaphylaxis.
METHODS A multicenter retrospective study was conducted using data from a drug-induced anaphylaxis registry across 10 university hospitals in Korea. Clinical data, including information on culprit drugs, DHR history, and the severity of reactions, were assessed.
RESULTS Among 494 cases of drug-induced anaphylaxis, 417 cases (84.4%) occurred without prior DHR, while 77 cases (15.6%) had a history of non-severe DHR. Of these, 43 cases had a previous DHR to a drug of the same class, and 34 cases involved DHR to drugs of different classes. In the group with prior DHR to a drug of the same class, anaphylaxis occurring in daily life was significantly more common compared to those reacting to a different class of drug or those with no prior DHR (48.8% vs. 23.5% or 22.5%, p = 0.008 and < 0.001, respectively). Non-steroidal anti-inflammatory drugs (NSAIDs), H2 blockers, and penicillins were identified as risk factors for anaphylaxis evolving from non-severe DHR.
CONCLUSION Enhanced vigilance is required for patients with a history of non-severe DHR to NSAIDs, H2 blockers, and penicillins as re-exposure may lead to the progress to anaphylaxis.
PubMed IF 4.2 알레르기내과
44202025

제1저자 고지원, 김진영 · 교신저자 임석아

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

Abstract
PURPOSE Considering the high disease burden and unique features of Asian patients with breast cancer (BC), it is essential to have a comprehensive view of genetic characteristics in this population. An institutional targeted sequencing platform was developed through the Korea Research-Driven Hospitals project and was incorporated into clinical practice. This study explores the use of targeted next-generation sequencing (NGS) and its outcomes in patients with advanced/metastatic BC in the real world.
MATERIALS AND METHODS We reviewed the results of NGS tests administered to BC patients using a customized sequencing platform-FiRST Cancer Panel (FCP)-over 7 years. We systematically described clinical translation of FCP for precise diagnostics, personalized therapeutic strategies, and unraveling disease pathogenesis.
RESULTS NGS tests were conducted on 548 samples from 522 patients with BC. Ninety-seven point six percentage of tested samples harbored at least one pathogenic alteration. The common alterations included mutations in TP53 (56.2%), PIK3CA (31.2%), GATA3 (13.8%), BRCA2 (10.2%), and amplifications of CCND1 (10.8%), FGF19 (10.0%), and ERBB2 (9.5%). NGS analysis of ERBB2 amplification correlated well with human epidermal growth factor receptor 2 immunohistochemistry and in situ hybridization. RNA panel analyses found potentially actionable and prognostic fusion genes. FCP effectively screened for potentially germline pathogenic/likely pathogenic mutation. Ten point three percent of BC patients received matched therapy guided by NGS, resulting in a significant overall survival advantage (p=0.022), especially for metastatic BCs.
CONCLUSION Clinical NGS provided multifaceted benefits, deepening our understanding of the disease, improving diagnostic precision, and paving the way for targeted therapies. The concrete advantages of FCP highlight the importance of multi-gene testing for BC, especially for metastatic conditions.
PubMed IF 4.2 혈액종양내과
44192025

제1저자 김정연 · 교신저자 김천형, 이은영

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

Abstract
OBJECTIVES This study aimed to investigate the efficacy of mitochondrial transplantation as a therapeutic intervention for idiopathic inflammatory myopathy (IIM). This study used a comprehensive approach, incorporating both in vitro and in vivo IIM models, and conducted a first-in-human clinical trial to assess the effectiveness and safety of mitochondria isolated from human umbilical cord mesenchymal stem cells (PN-101).
METHODS Mitochondria isolated from umbilical cord mesenchymal stem cells were designated as PN-101. The efficacy of PN-101 was assessed using myoblasts derived from patients with IIM and C2C12 mouse perforin/granzyme B-treated myoblasts as an in vitro IIM model. PN-101's effect on IIM was examined using C protein-induced myositis (CIM) mice as an in vivo model. The efficacy and safety of PN-101 were evaluated in a phase 1/2a clinical trial involving 9 adult patients with refractory polymyositis or dermatomyositis.
RESULTS The myoblasts derived from patients with IIM exhibited defects in mitochondrial function and myogenesis. PN-101 transplantation enhances muscle differentiation and mitochondrial function in IIM myoblasts. PN-101 also enhanced intracellular adenosine triphosphate content, cell viability, and myogenesis in C2C12 perforin/granzyme B-treated myoblasts. In an in vivo model, PN-101 reduced myositis severity by exhibiting anti-inflammatory effects and restoring the CIM-induced metabolic shift. In a phase 1/2a prospective clinical trial involving adult patients with refractory IIM, PN-101 demonstrated no severe adverse drug reactions and showed at least minimal improvement in the International Myositis Assessment and Clinical Studies Group (IMACS)-Total Improvement Scores (TISs) compared with baseline.
CONCLUSIONS PN-101 transplantation could serve as a novel treatment for IIM by enhancing mitochondrial repair and reducing inflammation in muscle tissues.
PubMed IF 24 류마티스내과
44182025

제1저자 장윤영 · 교신저자 강은정, 이하정

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

Abstract
RATIONALE & OBJECTIVE Recipients of kidney allografts are at risk of osteoporotic fractures (OF), but the association of OF with transplant patient outcomes remains uncertain due to common coexisting risks and complex medical conditions. This study sought to assess whether the overall incidences of OF among recipients of kidney allografts compared to that of patients receiving maintenance dialysis for kidney failure.
STUDY DESIGN A national retrospective cohort study.
SETTING & PARTICIPANTS 145,090 Korean patients newly diagnosed with kidney failure between 2009 and 2019.
EXPOSURE Kidney transplantation versus dialysis resulting in OF, and OF increasing risk of death.
OUTCOME Incident OF overall and by site (hip, spine, forearm, and humerus); death.
ANALYTICAL APPROACH Comparison of patients receiving maintenance dialysis with recipients of kidney allografts matched by age, sex, year of new index date, duration of dialysis, and presence of hypertension and diabetes mellitus. Cause-specific Cox proportional hazards regression models estimated the association between modality of kidney replacement therapy and OF. Cox models incorporating OF as a time-updated covariate were used to estimate the association of OF and mortality.
RESULTS A total of 11,413 pairs were matched. Over the entire study period, 541 (4.7%) OFs in allograft recipients and 657 (5.8%) in matched dialysis comparators occurred, respectively. After 5.5 years of follow-up evaluation, the risk of incident OF was lower in kidney transplant recipients compared with matched dialysis comparators (adjusted hazard ratio[AHR], 0.73 [95% CI, 0.64-0.84], P<0.001). The differences in fracture rates were primarily driven by differences in hip fractures. Incident OF was associated with increased mortality risk (AHR, 2.18 [95% CI, 1.57-3.02], P<0.001) and death-censored allograft failure (AHR, 1.42 [95% CI, 1.02-1.97], P=0.040).
LIMITATIONS Use of claims data, and no data on bone mineral density or hyperparathyroidism; the definition of OF that was used encompassed traumatic fractures.
CONCLUSIONS Kidney allograft recipients have a lower rate of incident OF compared with dialysis patients, but when OF occurs it is associated with a higher rate of death and allograft loss.
PubMed IF 9.4 신장내과
44172025

제1저자 정영애, 이승미 · 교신저자 황금숙, 박중신, 김원

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

Abstract
BACKGROUND This study aims to identify early metabolomic biomarkers of gestational diabetes mellitus (GDM) and evaluate their association with hepatic steatosis.
METHODS We compared maternal serum metabolomic profiles between women who developed GDM (n = 118) and matched controls (n = 118) during the first (10-14 gestational weeks) and second (24-28 gestational weeks) trimesters using ultra-performance liquid chromatography coupled with mass spectrometry. Mediation analysis was performed to evaluate the mediating role of metabolic dysfunction-associated steatotic liver disease (MASLD) in the relationship between metabolites and subsequent development of GDM. A refined prediction model was developed to predict GDM using established clinical factors and selected metabolites.
RESULTS Significant alterations in circulating metabolites, including amino acids, bile acids, and phospholipids, were observed in the GDM group compared to controls during early pregnancy. Mediation analysis revealed that several metabolites, including glycocholic acid (proportion mediated (PM) = 31.9%), butanoyl carnitine (PM = 25.7%), and uric acid (PM = 22.4%), had significant indirect effects on GDM incidence mediated by hepatic steatosis. The refined prediction model composed of clinical factors and selected metabolites in the first trimester demonstrated higher performance in predicting GDM development than the established prediction model composed solely of clinical factors (AUC, 0.85 vs. 0.63, p < 0.001).
CONCLUSIONS Women who developed GDM exhibited altered metabolomic profiles from early pregnancy, which showed a significant correlation with GDM, with MASLD as a mediator. Selected metabolomic biomarkers may serve as predictive markers and potential targets for early risk assessment and intervention in GDM.
RESEARCH INSIGHTS WHAT IS CURRENTLY KNOWN ABOUT THIS TOPIC?: Gestational diabetes mellitus (GDM) is a common pregnancy complication with significant health risks. Early identification of women at high risk for GDM is crucial for timely intervention and improved outcomes. WHAT IS THE KEY RESEARCH QUESTION?: What alterations in circulating metabolites during early pregnancy are associated with subsequent GDM development? Does metabolic dysfunction-associated steatotic liver disease (MASLD) mediate the association between specific metabolites and GDM risk? WHAT IS NEW?: Significant alterations in bile acids, amino acids, phosphatidylethanolamines, and phosphatidylinositols were observed in early pregnancy sera of women who later developed GDM. MASLD significantly mediated the effects of several metabolites on GDM risk, with mediation proportions ranging from 9.7 to 31.9%. A refined prediction model composed of clinical factors and metabolites significantly improved the performance in predicting GDM development. HOW MIGHT THIS STUDY INFLUENCE CLINICAL PRACTICE?: These results provide new insights into early metabolic alterations associated with GDM development and highlight the potential mediating role of MASLD. This comprehensive metabolomic approach may contribute to the development of improved risk prediction models and targeted interventions for GDM prevention.
PubMed IF 15.6 소화기내과
44162025

제1저자 김중엽, 황현택 · 교신저자 임재준

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

Abstract
BACKGROUND Mycobacterium avium complex pulmonary disease (MAC-PD) is a chronic lung condition with rapidly increasing prevalence worldwide. Macrolides like azithromycin and clarithromycin are the backbone of long-term antibiotic therapy for progressive MAC-PD. The impact of minimum inhibitory concentrations (MICs), especially within the susceptible range, for macrolides on treatment responses remains unclear.
METHODS We analyzed adult patients who started treatment for MAC-PD between 1 March 2009 and 1 March 2022 at Seoul National University Hospital. Patients were categorized into 4 groups according to the clarithromycin MICs of their causative strains at treatment initiation. Logistic regression was employed to evaluate the impact of clarithromycin MICs on the likelihood of microbiological cure. Companion drugs and their MICs, alongside clinical characteristics like age, sex, body mass index, cavity presence, acid-fast bacilli smear positivity, causative species, and erythrocyte sedimentation rate were adjusted in multivariable analysis.
RESULTS Four-hundred thirty-six patients (median age, 65 years; 34% men) were included. Microbiological cure rates were 51.8%, 51.9%, 50.0%, and 18.2% for patients with clarithromycin MICs ≤0.5, 1-2, 4-8, and ≥32 µg/mL, respectively (P = .181). No significant differences in microbiological cure rates were observed across varying levels of clarithromycin MICs within the susceptible range (≤8 µg/mL). Relative to patients with clarithromycin-susceptible strains, patients with MICs ≥32 µg/mL had an odds ratio of 0.25 for achieving microbiological cure (95% confidence interval [CI]: 0.06-1.07; P = .06).
CONCLUSIONS Treatment responses were comparable among patients with strains having clarithromycin MICs within the susceptible range but were likely to be worse for patients with strains having MICs ≥32 µg/mL.
PubMed IF 8.3 순환기내과
44152025

제1저자 곽순구 · 교신저자 이승표, 김대희

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

Abstract
IMPORTANCE The association between left ventricular (LV) systolic dysfunction and adverse outcomes in patients with severe degenerative mitral regurgitation (MR) may vary by sex.
OBJECTIVE To investigate the sex-specific association of LV systolic function with mortality in patients with severe degenerative MR.
DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included consecutive patients who underwent surgery for severe degenerative MR at 2 tertiary hospitals in South Korea from 2006 to 2020. Preoperative LV ejection fraction (LVEF) and LV global longitudinal strain (LV-GLS) were measured, with absolute LV-GLS values reported. Patients were stratified by LVEF (≤55%, >55% to ≤60%, and >60%) and LV-GLS (<19.9%, ≥19.9% to <23.4%, and ≥23.4%) tertiles. Mortality status was verified through December 2023, with a median (IQR) follow-up duration of 8.2 (5.3-12.2) years. Data analysis was conducted in March 2024.
EXPOSURES Surgical MV repair or replacement.
MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality after MV surgery. Restricted cubic spline (RCS) curves visualized the association between LVEF, LV-GLS, and mortality for each sex.
RESULTS Among 1686 patients, 1088 (64.5%) were men and 598 (35.5%) were women. Women were older than men (median [IQR] age, 62 [51-70] vs 54 [45-63] years) and had higher LVEF and LV-GLS than men did. During the follow-up, 220 (13.0%) deaths occurred (117 men [10.8%]; 103 women [17.2%]). In Kaplan-Meier curves, mortality in men increased in the lowest LVEF (≤55%) and LV-GLS (<19.9%) groups, whereas women exhibited an earlier increase in mortality at higher LVEF (55%-60%) and LV-GLS (19.9%-23.4%) levels. Multivariable Cox analyses showed a higher mortality risk associated with LVEF less than or equal to 55% (adjusted hazard ratio [HR], 3.48; 95% CI, 1.84-6.58; P < .001) and 55% to 60% (adjusted HR, 2.21; 95% CI, 1.36-3.58; P = .001) compared with LVEF greater than 60% in women, but not in men (P for interaction by sex = .02). RCS curves showed an earlier increase in mortality risk at higher LVEF and LV-GLS levels in women. Similar trends were observed in asymptomatic patients.
CONCLUSIONS AND RELEVANCE In this cohort study of patients with severe degenerative MR, women had an earlier increase in mortality risk associated with LV systolic dysfunction, suggesting the need to consider sex-specific criteria for early surgery in asymptomatic patients.
PubMed IF 11.7 순환기내과
44142025

제1저자 장하영, 최보윤 · 교신저자 강혜련, 오정미

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

Abstract
BACKGROUND The development of hypersensitivity reactions (HSRs) to carboplatin can interrupt anticancer treatment and may shorten patient survival. Several studies have evaluated the risk factors for carboplatin HSRs, but the results have been inconclusive.
OBJECTIVE This systematic review and meta-analysis aimed to establish a consensus on the risk factors of HSRs to carboplatin in patients with cancer.
METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, relevant studies were searched across MEDLINE, Embase, and Korean Medical Database. Inclusion criteria focused on original articles of case-control or cohort studies that evaluated risk factors for carboplatin HSRs in patients with cancer. Exclusion criteria targeted articles with incomplete or overlapping data. The latest search and quality assessment of the included studies, using the Newcastle-Ottawa scale, was performed on February 1, 2023.
RESULTS Among 1,182 articles identified, 19 studies were included in the final systematic review and meta-analysis. The identified risk factors for carboplatin hypersensitivity included a history of allergy to medicines, food, or environmental factors (odds ratio [OR] = 1.76; 95% CI, 1.46-2.12), BRCA mutation (OR = 4.03; 95% CI, 2.00-8.13), carboplatin free interval of 12 months or more (OR = 4.93; 95% CI, 2.89-8.40), increased cumulative dose (standardized mean difference, 0.58; 95% CI, 0.41-0.75), relapse (OR = 2.26; 95% CI, 1.58-3.25), and younger age (standardized mean difference, -0.15; 95% CI, -0.26 to -0.03).
CONCLUSIONS To our knowledge, this meta-analysis provides the first comprehensive quantitative evaluation of risk factors for carboplatin HSRs in patients with cancer. These findings can guide the development of personalized risk assessment tools and preventive strategies, potentially improving patient safety and treatment outcomes in carboplatin-based chemotherapy.
PubMed IF 6.6 알레르기내과
44132025

제1저자 전중원 · 교신저자 이상협, 김윤희

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

Abstract
BACKGROUND Oxaliplatin is a commonly used platinum-based chemotherapy drug for patients with pancreatic cancer (PC). Drug resistance is a major challenge in PC treatment, underscoring the urgent need for new approaches. Targeting DNA damage repair, one of the factors responsible for platinum resistance, is an attractive strategy to overcome drug resistance. This study aimed to investigate the potential of the ATR inhibitor BAY 1895344 in improving the drug responsiveness of oxaliplatin-resistant PC.
METHODS Oxaliplatin-resistant PC cells (CFPAC-1 and Capan-2) were selected and treated with oxaliplatin, BAY 1895344, or a combination of both in vivo and in vitro. Their combinatorial effects on the DNA damage response (DDR) signaling pathway, apoptosis, and extent of DNA damage were evaluated using appropriate methods. Patient response was predicted using organoid models.
RESULTS Combination treatment with BAY 1895344 and oxaliplatin exhibited a synergistic effect on both PC cell lines, with the effect being more pronounced on Capan-2. Additionally, the combination treatment substantially suppressed phospho-Chk1, a coordinator of DDR and cell cycle checkpoints. Mechanistically, ATR inhibition augmented the DNA damage induced by oxaliplatin, leading to mitotic catastrophe and cell death. Furthermore, in an in vivo study using a tumor-bearing xenograft mouse model, the combination treatment markedly reduced tumor growth. This synergistic effect was confirmed in patient-derived organoids with poor response to oxaliplatin.
CONCLUSION ATR inhibition enhanced the anticancer effect of oxaliplatin, suggesting that this combination treatment could be an effective therapeutic strategy for overcoming platinum resistance in PC.
PubMed IF 5 소화기내과
44122025

제1저자 손민지 · 교신저자 임수

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

Abstract
AIMS This study evaluated the effects of choline alfoscerate on cognitive function and quality of life in T2DM patients with mild cognitive decrements.
MATERIALS AND METHODS In a double-blind, randomized, placebo-controlled trial, we recruited 36 individuals with T2DM and mild cognitive impairment which was assessed by the Mini-Mental State Examination (MMSE) score of 25-28, and randomly assigned them to receive either 1200 mg/day of choline alfoscerate or a placebo. Four additional questionnaires-the 36-Item Short Form Survey, the modified Informant Questionnaire on Cognitive Decline in the Elderly, the Korean version of Activities of Daily Living, and the Patient Health Questionnaire-were investigated at 6 and 12 months and analysed via mixed-effects models for repeated measures.
RESULTS The mean age of study participants was 71.8 ± 5.3 years and 69.4% women. Six-month treatment with choline alfoscerate resulted in a non-significant increase in the MMSE score from 26.2 ± 1.3 to 26.9 ± 2.0, whereas the placebo group showed a non-significant decline from 26.6 ± 1.3 to 25.9 ± 2.3, resulting in a mean difference of +1.4 between the two groups (p = 0.059). At 12 months, the mean difference increased to +1.7 with statistical significance (p < 0.001). Physical health, as measured by the SF-36 survey, was significantly better in the choline alfoscerate group than in the placebo group.
CONCLUSIONS Choline alfoscerate 1200 mg once daily treatment showed marginal improvement in cognitive function in T2DM patients with mild cognitive impairment at 6 months but leading to significance at 12 months compared to placebo, suggesting its potential as an adjunct therapy for managing early cognitive decline.
PubMed IF 6.1 내분비대사내과
44112025

제1저자 안창호, 김태우 · 교신저자 김정희

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

Abstract
Background The detection and classification of adrenal nodules are crucial for their management. Purpose To develop and test a deep learning model to automatically depict adrenal nodules on abdominal CT images and to simulate triaging performance in combination with human interpretation. Materials and Methods This retrospective study (January 2000-December 2020) used an internal dataset enriched with adrenal nodules for model training and testing and an external dataset reflecting real-world practice for further simulated testing in combination with human interpretation. The deep learning model had a two-stage architecture, a sequential detection and segmentation model, trained separately for the right and left adrenal glands. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) for nodule detection and intersection over union for nodule segmentation. Results Of a total of 995 patients in the internal dataset, the AUCs for detecting right and left adrenal nodules in internal test set 1 (n = 153) were 0.98 (95% CI: 0.96, 1.00; P < .001) and 0.93 (95% CI: 0.87, 0.98; P < .001), respectively. These values were 0.98 (95% CI: 0.97, 0.99; P < .001) and 0.97 (95% CI: 0.96, 0.97; P < .001) in the external test set (n = 12 080) and 0.90 (95% CI: 0.84, 0.95; P < .001) and 0.89 (95% CI: 0.85, 0.94; P < .001) in internal test set 2 (n = 1214). The median intersection over union was 0.64 (IQR, 0.43-0.71) and 0.53 (IQR, 0.40-0.64) for right and left adrenal nodules, respectively. Combining the model with human interpretation achieved high sensitivity (up to 100%) and specificity (up to 99%), with triaging performance from 0.77 to 0.98. Conclusion The deep learning model demonstrated high performance and has the potential to improve detection of incidental adrenal nodules. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Malayeri and Turkbey in this issue.
PubMed IF 17.6 내분비대사내과
44102025

제1저자 서경훈 · 교신저자 이승환, 임수

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

PubMed IF 8.2 내분비대사내과
44092025

제1저자 오도연 · 교신저자 오도연

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

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

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