SCI 발표논문

1. 25782018

   제1저자 박상신 · 교신저자 이창훈

   Park S, Choi NK, Kim S, Lee CH

   The relationship between metabolic syndrome and asthma in the elderly.

   Sci Rep. 2018;8(1):9378.

   Abstract

   The burden of asthma in the elderly is increasing, but the etiology of asthma in the elderly is not clearly understood. Recent studies have reported the epidemiological link between metabolic syndrome (MS) and asthma, but it has rarely been studied in the elderly. This study investigated the association between MS and asthma and the contribution of insulin resistance (IR) and systemic inflammation to this MS-asthma association in the elderly. Our study analyzed 4,060 elderly participants (≥65 years old) from a cross-sectional survey, the Korean National Health and Nutritional Examination Survey 2007-2012. Mediation analyses were performed to examine whether IR and systemic inflammation mediates the MS-asthma association. Participants with MS had significantly higher prevalence of asthma (adjusted odds ratio = 1.34; 95% confidence interval = 1.09-1.64), and those who had greater waist circumference and lower HDL-C were especially likely to have asthma. Participants with IR and systemic inflammation were associated with higher prevalence of asthma. Prevalence of IR and systemic inflammation were higher in participants with MS or with each MS component. The MS-asthma association was substantially mediated by IR and systemic inflammation. Our study showed a significant association between MS and asthma in the elderly. MS might affect asthma through both IR and systemic inflammation.

   PubMed IF 4.9 호흡기내과
2. 25772018

   제1저자 이주명 · 교신저자 구본권

   Lee JM, Rhee TM, Hwang D, Park J, Kim CH, Choi KH, Shin ES, Nam CW, Doh JH, Koo BK

   Prognostic implication of thermodilution coronary flow reserve in patients with indeterminate pressure-bounded coronary flow reserve.

   Int J Cardiol. 2018;261:24-27.

   Abstract

   BACKGROUND Recently, the concept of pressure-bounded coronary flow reserve (PB-CFR) has been introduced. However, using pressure-only data, a substantial proportion of patients could not be classified into high or low PB-CFR and remained as indeterminate PB-CFR. The current study evaluated the prognostic implication of thermodilution-based CFR (thermo-CFR) in patients with indeterminate PB-CFR.

   METHODS Among 199 patients (211 lesions) with indeterminate PB-CFR, 170 patients (179 lesions) with deferral of revascularization were analyzed for the current study. The rates of patient-oriented composite outcomes (POCO, a composite of all-cause mortality, any myocardial infarction, and any ischemia-driven revascularization) were compared according to thermo-CFR. All patients underwent fractional flow reserve (FFR) and thermo-CFR measurements. Thermo-CFR ≤ 2.0 was classified as low thermo-CFR. The median follow-up duration was 1350.0 (Q1-Q3 1252.0-1468.0) days.

   RESULTS Mean angiographic percent diameter stenosis, FFR, and thermo-CFR were 42.3 ± 13.9, 0.84 ± 0.06, and 3.10 ± 1.15, respectively. Among 170 patients, 36 patients (21.2%) showed low thermo-CFR. Patients with low thermo-CFR showed significantly higher rate of POCO compared to those with high thermo-CFR (30.6% vs. 3.0%, HR 12.117, 95% CI 3.854-38.091, p < 0.001). Adding thermo-CFR to a prediction model with FFR significantly increased discrimination and reclassification index for the risk of POCO (c-index 0.545 vs. 0.766, p = 0.002, category-free net reclassification index 1.169, p < 0.001, relative integrated discrimination index 31.828, p < 0.001).

   CONCLUSIONS Patients with low thermo-CFR showed a significantly higher risk of POCO compared to those with high thermo-CFR among patients with indeterminate PB-CFR. Thermo-CFR showed additional prognostic implication, in addition to FFR, in patients with indeterminate PB-CFR.

   PubMed IF 3.3 순환기내과
3. 25762018

   제1저자 이은영 · 교신저자 송경호

   Lee E, Song KH, Bae JY, Yoon D, Hwang JH, Choe PG, Park WB, Bang JH, Kim ES, Park SW, Kim NJ, Oh MD, Kim HB

   Risk factors for poor outcome in community-onset Clostridium difficile infection.

   Antimicrob Resist Infect Control. 2018;7:75.

   Abstract

   BACKGROUND A substantial portion of Clostridium difficile infection (CDI) cases occur in communities, and community-onset CDI (CO-CDI) can lead to serious complications including mortality. This study aimed to identify the risk factors for a poor outcome in CO-CDI.

   METHODS We performed a retrospective review of all inpatients with CDI, in a 1300-bed tertiary-care hospital in Korea, from 2008 through 2015. CO-CDI was defined as CDI occurring within 48 h of admission. Poor outcome was defined as follows: 1) all-cause 30-day mortality, 2) in-hospital mortality, or 3) surgery due to CDI.

   RESULTS Of a total 1256 CDIs occurring over 8 years, 152 (12.1%) cases were classified as CO-CDI and 23 (15.1%) had a poor outcome, including 22 (14.5%) cases of mortality and 2 (1.3%) cases of surgery. Patients with a poor outcome had a higher mean age than those without a poor outcome (75.8 vs. 69.6 years, p = 0.03). The proportion of men and prior proton pump inhibitor (PPI) use were significantly higher in the poor outcome group (65.2% vs. 41.9%, p = 0.04; 39.1% vs. 17.6%, p = 0.02, respectively). Multivariate binary logistic model showed that PPI use and anemia (hemoglobin < 10 g/dL) at presentation were significantly associated with a poor outcome (adjusted odds ratio [aOR], 3.76; 95% confidence interval [95CI], 1.26-11.21, aOR, 4.67; 95CI, 1.52-14.34, respectively).

   CONCLUSIONS Clinicians should not only be aware of the possibility of CDI in the community setting but also pay more attention to PPI-using elderly patients with anemia in consideration of a poor outcome.

   PubMed IF 5.2 감염내과
4. 25752018

   제1저자 이세영 · 교신저자 임수

   Lee SY, Ahn S, Kim YJ, Ji MJ, Kim KM, Choi SH, Jang HC, Lim S

   Comparison between Dual-Energy X-ray Absorptiometry and Bioelectrical Impedance Analyses for Accuracy in Measuring Whole Body Muscle Mass and Appendicular Skeletal Muscle Mass.

   Nutrients. 2018;10(6):nu10060738.

   Abstract

   We evaluate the accuracy of whole body muscle mass (WBMM) and appendicular skeletal muscle mass (ASMM) assessed by bioelectrical impedance analysis (BIA) using an InBody770 machine (InBody, Seoul, Korea) referenced to dual-energy X-ray absorptiometry (DXA) in 507 people (mean age 63.7 ± 10.8 years, body mass index (BMI) 25.2 ± 3.5 kg/m²). Mean WBMMs measured by BIA and DXA were 49.3 ± 6.6 kg and 46.8 ± 6.5 kg in men and 36.1 ± 4.7 kg and 34.0 ± 4.8 kg in women, respectively. The respective effect sizes and 95% confidence intervals (CIs) for the difference were 2.49 (2.22⁻2.76) for men, and 2.12 (1.91⁻2.33) for women. Mean ASMMs measured by BIA and DXA were 22.1 ± 3.3 kg and 19.9 ± 3.2 kg in men, and 15.3 ± 2.5 kg and 13.5 ± 2.2 kg in women, respectively. The respective effect sizes and 95% CIs for the difference were 2.26 (2.10⁻2.41) for men and 1.75 (1.65⁻1.87) for women. The BIA clearly overestimated WBMM by 2.28 kg and ASMM by 1.97 kg compared with DXA. Using BMI, gender, and fat percentage, we derive equations that improved the residuals to.

   PubMed IF 5.8 내분비대사내과
5. 25742018

   제1저자 박현경 · 교신저자 윤성수

   Park H, Kim JW, Youk J, Koh Y, Lee JO, Kim KH, Bang SM, Kim I, Park S, Yoon SS

   Serum Free Light Chain Difference and β2 Microglobulin Levels Are Risk Factors for Thromboembolic Events in Patients With AL Amyloidosis.

   Clin Lymphoma Myeloma Leuk. 2018;18(6):408-414.

   Abstract

   BACKGROUND AL amyloidosis might increase the risk of thromboembolism and other plasma cell dyscrasias; however, only a few reports have described the clinical features of thromboembolism. The present study aimed to elucidate the clinical features of thromboembolic events and to identify the risk factors for these events.

   MATERIALS AND METHODS The medical records were retrospectively reviewed to define the clinically significant thromboembolic events.

   RESULTS A total of 106 patients with biopsy-proven AL amyloidosis were included. During a median follow-up of 18.1 months (range, 0.4-166.9 months), 13 thromboembolism events were identified in 13 patients. Of the 13 patients, 9 (8.5%) experienced acute cerebral infarction, 2 (1.9%) experienced pulmonary embolism, and 2 (1.9%) experienced deep vein thrombosis. Patients with a higher serum free light chain (FLC) difference (≥ 172.4 mg/L) or β₂-microglobulin (β2MG) levels (≥ 2.78 mg/L) experienced significantly more thromboembolic events compared with those with a lower value according to multivariable analysis (for FLC difference: hazard ratio, 4.309; 95% confidence interval, 1.158-16.032; P = .029; for β2MG: hazard ratio, 9.739; 95% confidence interval, 1.127-84.174; P = .039). Most thromboembolic events (11 of 13; 84.6%) occurred within the first year after the AL amyloidosis diagnosis.

   CONCLUSION The incidence of thromboembolism was substantial in those with AL amyloidosis. A greater FLC difference and for β2MG levels were risk factors for thromboembolic events.

   PubMed IF 4.1 혈액종양내과
6. 25732018

   제1저자 김경진 · 교신저자 김형관

   Kim KJ, Kim HK, Park JB, Hwang HY, Yoon YE, Kim YJ, Cho GY, Kim KH, Sohn DW, Ahn H

   Transthoracic Echocardiographic Findings of Mitral Regurgitation Caused by Commissural Prolapse.

   JACC Cardiovasc Imaging. 2018;11(6):925-926.

   PubMed IF 19 순환기내과
7. 25722018

   제1저자 김종빈 · 교신저자 김윤준

   Kim JB, Lee S, Kim HR, Park SY, Lee M, Yoon JH, Kim YJ

   Transforming growth factor-β decreases side population cells in hepatocellular carcinoma in vitro.

   Oncol Lett. 2018;15(6):8723-8728.

   Abstract

   Hepatocellular carcinoma (HCC) can result from hepatitis B or C infection, fibrosis or cirrhosis. Transforming growth factor-β (TGF-β) is one of the main growth factors associated with fibrosis or cirrhosis progression in the liver, but its role is controversial in hepatocarcinogenesis. In the present study, the effect of TGF-β on the HCC Huh-7 and Huh-Bat cell lines was evaluated. To study the effect of TGF-β, Huh-7 and Huh-Bat cells were treated with TGF-β and a TGF-β receptor inhibitor (SB431542). Cell survival, cell cycle, numbers of side population (SP) cells and expression of the cancer stem cell marker cluster of differentiation (CD)133, epithelial-mesenchymal transition markers (E-cadherin, α-smooth muscle actin and vimentin) and TGF-β-regulated proteins [phospho-c-Jun N-terminal kinase (p-JNK), p-c-Jun and p-smad2] were investigated. TGF-β treatment resulted in decreased cell survival with a targeted effect on SP cells. Expression of CD133 and vimentin was upregulated by treatment with the TGF-β receptor antagonist SB431542, but not with TGF-β. By contrast, TGF-β induced accumulation of cells at G0/G1, and upregulated expression of p-JNK, p-c-Jun and p-smad2. However, these effects were blocked when cells were treated with TGF-β plus SB431542, indicating the specificity of the TGF-β effect. The present results indicated that TGF-β has anticancer effects mediated by survival inhibition of cancer stem cells, which may be developed as a novel therapy for HCC.

   PubMed IF 2.1 소화기내과
8. 25712018

   제1저자 전원경 · 교신저자 김학령

   Jeon WK, Kim MA, Kim HL, Ki YJ, Rhee TM, Lim WH, Seo JB, Kim SH, Zo JH

   Association between aortic knob width and invasively measured aortic pulse pressure.

   Blood Press Monit. 2018;23(3):121-126.

   Abstract

   BACKGROUND Aortic knob width (AKW), which can be measured easily in simple radiography, is associated with the degree of dilatation and tortuosity of the aortic arch. Pulsatile stress influences aortic geometry. This study was carried out to investigate whether AKW can represent invasively measured aortic pulse pressure (APP).

   METHODS A total of 252 patients who underwent invasive coronary angiography (ICA) for the evaluation of coronary artery disease were enrolled. AKW was defined as the perpendicular length from the lateral margin of the main bronchus to the most prominent edge of the aortic knob on chest radiography. APP was measured at the ascending aorta using a pigtail catheter immediately before ICA.

   RESULTS When patients were divided into two groups according to the median value of APP (69 mmHg), AKW was significantly greater in patients with higher APP (≥69 mmHg) than in those with lower APP (<69 mmHg) (40.6±4.9 vs. 38.1±4.2 mm, P<0.001). There was a positive linear correlation between APP and AKW (r=0.207, P<0.001). In multiple linear regression analysis, the significant association between APP and AKW remained even after controlling for the confounding factors, including age, sex, height, heart rate, smoking status, left ventricular ejection fraction, and left ventricular end-diastolic dimension (β=0.131, P=0.031).

   CONCLUSION Greater AKW on chest radiography was independently predictive of increased APP in patients undergoing elective ICA. The results of this study suggest that AKW can be useful as a simple surrogate marker of APP.

   PubMed IF 1 순환기내과
9. 25702018

   제1저자 서현정,박완범 · 교신저자 김의석

   Suh HJ, Park WB, Jung SI, Song KH, Kwak YG, Kim KH, Hwang JH, Yun NR, Jang HC, Kim YK, Kim NH, Park KH, Kang SJ, Lee S, Kim ES, Kim HB

   A Risk-Scoring System for Predicting Methicillin Resistance in Community-Onset Staphylococcus aureus Bacteremia in Korea.

   Microb Drug Resist. 2018;24(5):556-562.

   Abstract

   AIMS We aimed to develop a simple scoring system to predict risk for methicillin resistance in community-onset Staphylococcus aureus bacteremia (CO-SAB) by identifying the clinical and epidemiological risk factors for community-onset methicillin-resistant S. aureus (MRSA).

   METHODS We retrospectively analyzed data from three multicenter cohort studies in Korea in which patient information was prospectively collected and risk factors for methicillin resistance in CO-SAB were identified. We then developed and validated a risk-scoring system.

   RESULTS To analyze the 1,802 cases of CO-SAB, we included the four most powerful predictors of methicillin resistance that we identified in the scoring system: underlying hematologic disease (-1 point), endovascular infection as the primary site of infection (-1 point), history of hospitalization or surgery in ≤1 year (+0.5 points), and previous isolation of MRSA in ≤6 months (+1.5 points). With this scoring system, cases were classified into low (less than -0.5), intermediate (-0.5-1.5), and high (≥1.5) risk groups. The proportions of MRSA cases in each group were 24.7% (22/89), 39.0% (607/1,557), and 78.8% (123/156), respectively, and 16.7% (1/6), 33.8% (112/331), and 76.9% (10/13) in a validation set.

   CONCLUSIONS This risk-scoring system for methicillin resistance in CO-SAB may help physicians select appropriate empirical antibiotics more quickly.

   PubMed IF 1.8 감염내과
10. 25692018

    제1저자 남은영,양수진 · 교신저자 김의석

    Nam EY, Yang SJ, Kim ES, Cho JE, Park KH, Jung SI, Yoon N, Kim DM, Lee CS, Jang HC, Park Y, Lee KS, Kwak YG, Lee JH, Park SY, Hwang JH, Kim M, Song KH, Kim HB

    Emergence of Daptomycin-Nonsusceptible Methicillin-Resistant Staphylococcus aureus Clinical Isolates Among Daptomycin-Naive Patients in Korea.

    Microb Drug Resist. 2018;24(5):534-541.

    Abstract

    This study was conducted to assess emergence of daptomycin-nonsusceptible (DAP-NS) phenotype in DAP-naive patients with invasive Staphylococcus aureus (ISA) infections in Korea. A total of 208 S. aureus clinical isolates were selected from a previous prospective study on ISA infections and evaluated for DAP-NS. Although DAP has never been introduced in Korea, five DAP-NS S. aureus strains (2.4%) were identified among 208 S. aureus strains collected from ISA infections. The DAP-NS phenotype was observed only in methicillin-resistant S. aureus (MRSA) strains, but not in methicillin-susceptible S. aureus strains. One DAP-NS MRSA strain belonged to sequence type 72 (ST72) and four were ST5 MRSA strains, three of which were heteroresistant vancomycin (VAN)-intermediate S. aureus. All these five DAP-NS MRSA strains were from healthcare-associated infections without prior exposure to VAN within 30 days. While the ST72 MRSA strain exhibited DAP-NS phenotype via charge repulsion mechanism, four ST5 DAP-NS S. aureus strains had charge-independent DAP-NS mechanism. None of the five DAP-NS strains displayed significant increase in cell wall thickness, indicating that altered cell wall thickness was not associated with the observed DAP-NS phenotype.

    PubMed IF 1.8 감염내과
11. 25682018

    제1저자 조혜기, 안홍근 · 교신저자 이정훈, 정용진

    Cho H, Ahn H, Lee DH, Lee JH, Jung YJ, Chang Y, Nam JY, Cho YY, Lee DH, Cho EJ, Yu SJ, Lee JM, Kim YJ, Yoon JH

    Entecavir and tenofovir reduce hepatitis B virus-related hepatocellular carcinoma recurrence more effectively than other antivirals.

    J Viral Hepat. 2018;25(6):707-717.

    Abstract

    Nucleos(t)ide analogues (NAs) have been shown to decrease the risk of hepatocellular carcinoma (HCC) recurrence. This study evaluated whether high-potency NAs (entecavir and tenofovir disoproxil fumarate [TDF]) reduce the risk of tumour recurrence more potently than low-potency NAs after curative treatment of hepatitis B virus (HBV)-related HCC. This study included 607 consecutive HBV-related HCC patients treated with surgical resection or radiofrequency ablation. The patients were categorized into three groups according to antiviral treatment: group A (no antiviral; n = 261), group B (low-potency NA; n = 90) and group C (high-potency NA; n = 256). The primary end-point was recurrence-free survival (RFS). During the duration of follow-up, the median RFS was 29.4, 25.1, and 88.2 months in groups A, B and C, respectively (P < .001, log-rank test). The multivariate Cox analysis indicated that group C had a significantly longer RFS than both group A (adjusted hazard ratio [HR] = 0.39, P < .001) and group B (adjusted HR = 0.47, P < .001). When baseline characteristics were balanced using inverse probability weighting, group C still had a significantly longer RFS than group A (adjusted HR = 0.46, P < .001) and group B (adjusted HR = 0.59, P = .007). Group C had significantly lower risk of viral breakthrough than group B (HR = 0.19, P < .001). Viral breakthrough was an independent risk factor for shorter RFS among groups B and C (adjusted HR = 2.03, P = .007, time-dependent Cox analysis). Antiviral agents with high genetic barrier to resistance (entecavir and TDF) reduced the risk of HCC recurrence compared with other antivirals and no antiviral treatment, especially in patients with high baseline viral load.

    PubMed IF 2.3 소화기내과
12. 25672018

    제1저자 구보경, 주세경 · 교신저자 김원

    Koo BK, Joo SK, Kim D, Bae JM, Park JH, Kim JH, Kim W

    Additive effects of PNPLA3 and TM6SF2 on the histological severity of non-alcoholic fatty liver disease.

    J Gastroenterol Hepatol. 2018;33(6):1277-1285.

    Abstract

    BACKGROUND AND AIM We investigated the effects of PNPLA3 rs738409, TM6SF2 rs58542926, and MBOAT7-TMC4 rs641738 variants on metabolic phenotypes and their combined effects on the histological severity of non-alcoholic fatty liver disease (NAFLD).

    METHODS We genotyped rs738409, rs58542926, and rs641738 in biopsy-proven NAFLD patients (n = 416) and healthy controls (n = 109). Homeostasis model assessment of insulin resistance and adipose tissue insulin resistance were calculated.

    RESULTS The rs738409 and rs58542926 variants, but not rs641738, were associated not only with non-alcoholic steatohepatitis (NASH) (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.46-2.73 and OR, 1.91; 95% CI, 1.04-3.51) but also with significant fibrosis (≥ F2) (OR, 1.53; 95% CI, 1.11-2.11 and OR, 1.88; 95% CI, 1.02-3.46) in NAFLD, even after adjustment for metabolic risk factors. Of both variants, only rs738409 was associated with homeostasis model assessment of insulin resistance and adipose tissue insulin resistance even in healthy controls (P = 0.046 and 0.002, respectively) as well as in the entire study cohort (P = 0.016 and 0.048, respectively). PNPLA3 and TM6SF2 risk variants additively increased the risk of NASH and significant fibrosis (OR per risk allele, 2.03; 95% CI, 1.50-2.73 and 1.61; 95% CI, 1.19-2.17). Even in subjects with low insulin resistance, the risk of NASH or significant fibrosis increased as the number of risk alleles increased (P = 0.008 and 0.020, respectively).

    CONCLUSIONS PNPLA3 and TM6SF2 determine the risk of NASH and significant fibrosis, even after adjustment for insulin resistance, and exert an additive effect on NASH and significant fibrosis.

    PubMed IF 3.5 소화기내과
13. 25662018

    제1저자 강창경, 곽이경 · 교신저자 김홍빈

    Kang CK, Kwak YG, Park Y, Song KH, Kim ES, Jung SI, Park KH, Park WB, Kim NJ, Kim YK, Jang HC, Lee S, Jeon JH, Kwon KT, Kim CJ, Kim YS, Kim HB, Korea INfectious Diseases (KIND) study group

    Gender affects prognosis of methicillin-resistant Staphylococcus aureus bacteremia differently depending on the severity of underlying disease.

    Eur J Clin Microbiol Infect Dis. 2018;37(6):1119-1123.

    Abstract

    We aimed to elucidate the potential impact of gender on prognosis of Staphylococcus aureus bacteremia (SAB). We analyzed SAB cases prospectively collected over an 8-year period at 11 hospitals in Korea. SAB-related mortality was pre-defined as a death within 30 days from the onset of SAB without other apparent cause of death. The effect of gender on SAB-related mortality was examined in the entire cohort and in subgroups stratified according to methicillin resistance and Charlson's comorbidity-weighted index (CCWI) score. Those factors independently associated to SAB-related mortality were explored. Among 1974 eligible cases, SAB-related mortality rates in male and female were 21.2% (259/1224) and 21.9% (164/750), respectively (P = 0.786). The SAB-related mortality rate was independently higher in male than that in female in CCWI score ≤ 3 methicillin-resistant SAB (MRSAB) group (15.9 vs. 6.2%; aOR 3.65, 95% CI 1.46-9.13; P = 0.006) while the association tended to be inverse when CCWI score rises. Interaction between CCWI score and gender to MRSAB-related mortality was significant in multivariate analysis (aOR 0.85, 95% CI 0.74-0.96; P = 0.011). There was no significant interaction between gender and CCWI in entire SAB or methicillin-susceptible SAB cohorts. Gender may affect clinical outcomes of MRSAB differently depending on the severity of underlying disease.

    PubMed IF 3.2 감염내과
14. 25652018

    제1저자 김나영, 강민정 · 교신저자 이상협

    Kim N, Kang MJ, Lee SH, Son JH, Lee JE, Paik WH, Ryu JK, Kim YT

    Fisetin Enhances the Cytotoxicity of Gemcitabine by Down-regulating ERK-MYC in MiaPaca-2 Human Pancreatic Cancer Cells.

    Anticancer Res. 2018;38(6):3527-3533.

    Abstract

    BACKGROUND Pancreatic cancer is a highly lethal malignancy with a poor prognosis. This study was set up to investigate the combined effect of gemcitabine and fisetin, a natural flavonoid from plants, on human pancreatic cancer cells. Meterials and Methods: Cytotoxic effect of fisetin in combination with gemcitabine on MiaPaca-2 cells was evaluated by the MTT assay, caspase 3/7 assay and propidium iodide/Annexin V. Extracellular signal-regulated kinase (ERK)-v-myc avian myelocytomatosis viral oncogene homolog (MYC) pathway was investigated by western blotting and quantitative real-time polymerase chain reaction.

    RESULTS Combination treatment with fisetin and gemcitabine inhibited the proliferation of pancreatic cancer cells within 72 h and induced apoptosis, as indicated by activation of caspase 3/7. Fisetin down-regulated ERK at the protein and mRNA levels, and reduced ERK-induced MYC instability at the protein level.

    CONCLUSION Fisetin sensitized human pancreatic cancer cells to gemcitabine-induced cytotoxicity through inhibition of ERK-MYC signaling. These results suggest that the combination of fisetin and gemcitabine could be developed as a novel potent therapeutic.

    PubMed IF 1.8 소화기내과
15. 25642018

    제1저자 김휘영,남준열 · 교신저자 이정훈

    Kim HY, Nam JY, Lee JH, Lee HA, Chang Y, Lee HY, Cho H, Lee DH, Cho YY, Cho EJ, Yu SJ, Lee JM, Kim YJ, Yoon JH

    Intensity of surveillance for hepatocellular carcinoma determines survival in patients at risk in a hepatitis B-endemic area.

    Aliment Pharmacol Ther. 2018;47(11):1490-1501.

    Abstract

    BACKGROUND Data are insufficient regarding the survival benefit of surveillance for hepatocellular carcinoma (HCC).

    AIM To investigate the effectiveness of HCC surveillance in a hepatitis B-endemic population.

    METHODS This retrospective cohort study included 1402 consecutive patients who were newly diagnosed with HCC between 2005 and 2012 at a single tertiary hospital in Korea. The primary endpoint was overall survival. Lead-time and length-time biases were adjusted (sojourn time = 140 days) and sensitivity analyses were performed.

    RESULTS The most common aetiology was hepatitis B (80.4%). Cirrhosis was present in 78.2%. HCC was diagnosed during regular surveillance (defined as mean interval of ultrasonography <8 months, n = 834), irregular surveillance (n = 104) or nonsurveillance (n = 464). Patients in the regular surveillance group were diagnosed at earlier stages ([very] early stage, 64.4%) than the irregular surveillance (40.4%) or nonsurveillance (26.9%) groups and had more chance for curative treatments (52.4%) than the irregular surveillance (39.4%) or nonsurveillance (23.3%) groups (all P < 0.001). Mortality risk was significantly lower in the regular surveillance group (adjusted hazard ratio [aHR], 0.69; 95% [CI], 0.57-0.83) but not in the irregular surveillance group (aHR, 0.94; 95% CI, 0.69-1.28) compared with the nonsurveillance group after adjusting for confounding factors and lead-time. When the subjects were restricted to cirrhotic patients or Child-Pugh class A/B patients, similar results were obtained for mortality risk reduction between groups.

    CONCLUSIONS HCC surveillance was associated with longer survival owing to earlier diagnosis and curative treatment. Survival advantage was significant with regular surveillance but not with irregular surveillance.

    PubMed IF 6.8 소화기내과
16. 25632018

    제1저자 황인창, 김주영 · 교신저자 김효수

    Hwang IC, Kim JY, Kim JH, Lee JE, Seo JY, Lee JW, Park J, Yang HM, Kim SH, Cho HJ, Kim HS

    Therapeutic Potential of a Novel Necrosis Inhibitor, 7-Amino-Indole, in Myocardial Ischemia-Reperfusion Injury.

    Hypertension. 2018;71(6):1143-1155.

    Abstract

    Opening of mitochondrial permeability transition pore and Ca²⁺ overload are main contributors to myocardial ischemia-reperfusion injury, which paradoxically causes a wide variety of myocardial damage. We investigated the protective role of a novel necrosis inhibitor (NecroX-7; NecX) against myocardial ischemia-reperfusion injury using in vitro and in vivo models. H9C2 rat cardiomyoblasts and neonatal cardiomyocytes were exposed to hypoxia-reoxygenation stress after pre-treatment with NecX, vitamin C, a combination of vitamin C and E, N-acetylcysteine, an apoptosis inhibitor (Z-VAD-fmk), or cyclosporine A. The main mechanism of cell death after hypoxia-reoxygenation stress was not apoptosis but necrosis, which was prevented by NecX. Protective effect of NecX was based on its potent reactive oxygen species scavenging activity, especially on mitochondrial reactive oxygen species. NecX preserved mitochondrial membrane potential through prevention of Ca²⁺ influx and inhibition of mitochondrial permeability transition pore opening, which was more potent than that by cyclosporine A. Using Sprague-Dawley rats exposed to myocardial ischemia for 45 minutes followed by reperfusion, we compared therapeutic efficacies of NecX with cyclosporine A, vitamin C, a combination of vitamin C and E, and 5% dextrose, each administered 5 minutes before reperfusion. NecX markedly inhibited myocardial necrosis and reduced fibrotic area to a greater extent than did cyclosporine A and other treated groups. In addition, NecX preserved systolic function and prevented pathological dilatory remodeling of left ventricle. The novel necrosis inhibitor has a significant protective effect against myocardial ischemia-reperfusion injury through inhibition of mitochondrial permeability transition pore opening, indicating that it is a promising candidate for cardioprotective adjunctive measure on top of reperfusion therapy.

    PubMed IF 9.8 순환기내과
17. 25622018

    제1저자 박진균 · 교신저자 이은봉

    Park JK, Lee YJ, Shin K, Ha YJ, Lee EY, Song YW, Choi Y, Winthrop KL, Lee EB

    Impact of temporary methotrexate discontinuation for 2 weeks on immunogenicity of seasonal influenza vaccination in patients with rheumatoid arthritis: a randomised clinical trial.

    Ann Rheum Dis. 2018;77(6):898-904.

    Abstract

    OBJECTIVE To determine whether a 2-week methotrexate (MTX) discontinuation after vaccination improves the efficacy of seasonal influenza vaccination in patients with rheumatoid arthritis (RA).

    METHODS In this prospective randomised parallel-group multicentre study, patients with RA on stable dose of MTX were randomly assigned at a ratio of 1:1 to continue MTX or to hold MTX for 2 weeks after 2016-2017 quadrivalent seasonal influenza vaccine containing H1N1, H3N2, B-Yamagata and B-Victoria. The primary outcome was frequency of satisfactory vaccine response, defined as greater than or equal to fourfold increase of haemagglutination inhibition (HI) antibody titre at 4 weeks after vaccination against ≥2 of four vaccine strains. Secondary endpoints included seroprotection (ie, HI titre ≥1:40) rate, fold change in antibody titres.

    RESULTS The modified intention-to-treat population included 156 patients in the MTX-continue group and 160 patients in the MTX-hold group. More patients in MTX-hold group achieved satisfactory vaccine response than the MTX-continue group (75.5% vs 54.5%, p<0.001). Seroprotection rate was higher in the MTX-hold group than the MTX-continue group for all four antigens (H1N1: difference 10.7%, 95% CI 2.0% to 19.3%; H3N2: difference 15.9%, 95% CI 5.9% to 26.0%; B-Yamagata: difference13.7%, 95% CI 5.2% to 22.4%; B-Victoria: difference 14.7%, 95% CI 4.5% to 25.0%). The MTX-hold group showed higher fold increase in their antibody titres against all four influenza antigens (all p<0.05). Change in disease activity was similar between groups.

    CONCLUSIONS A temporary MTX discontinuation for 2 weeks after vaccination improves the immunogenicity of seasonal influenza vaccination in patients with RA without increasing RA disease activity.

    TRIAL REGISTRATION NCT02897011.

    PubMed IF 24 류마티스내과
18. 25612018

    제1저자 이태민, 이주명 · 교신저자 김효수

    Rhee TM, Lee JM, Shin ES, Hwang D, Park J, Jeon KH, Kim HL, Yang HM, Han JK, Park KW, Hahn JY, Koo BK, Kim SH, Kim HS

    Impact of Optimized Procedure-Related Factors in Drug-Eluting Balloon Angioplasty for Treatment of In-Stent Restenosis.

    JACC Cardiovasc Interv. 2018;11(10):969-978.

    Abstract

    OBJECTIVES The aim of this study was to investigate the impact of optimizing procedure-related factors during drug-eluting balloon (DEB) angioplasty on clinical outcomes of drug-eluting stent in-stent restenosis (ISR).

    BACKGROUND Although DEB angioplasty is recommended as a reasonable option for ISR, recurrent target lesion failure (TLF) still occurs in many patients after DEB angioplasty.

    METHODS Consecutive patients with drug-eluting stent ISR treated with DEB (SeQuent Please) were collected from 4 centers in Korea. The primary outcome was 2-year TLF. Procedure-related modifiable independent predictors for TLF and their best cutoff values were determined.

    RESULTS In a total of 256 patients (309 lesions), TLF occurred in 52 patients (20.3%). Modifiable independent predictors of TLF among procedure-related factors were residual diameter stenosis after lesion preparation (residual percentage diameter stenosis [%DS]), DEB-to-stent ratio (BSR), and DEB inflation time (T_inflation), whose best cutoff values were 20%, 0.91, and 60 s, respectively. TLF rates were significantly higher in groups with residual %DS ≥20% (34.7% vs. 12.5%; adjusted hazard ratio: 2.15; 95% confidence interval: 1.86 to 2.48; p < 0.001), BSR ≤0.91 (46.4% vs. 21.9%; adjusted hazard ratio: 2.02; 95% confidence interval: 1.75 to 2.34; p < 0.001), and T_inflation ≤60 s (26.2% vs. 14.0%; adjusted hazard ratio: 1.82; 95% confidence interval: 1.36 to 2.45; p < 0.001). When classifying ISR lesions by combination of procedure-related factors, TLF occurred in 8.3% in the fully optimized procedure group (residual %DS <20%, BSR >0.91, and T_inflation >60 s) and 66.7% in the nonoptimized group (residual %DS ≥20%, BSR ≤0.91, and T_inflation ≤60 s) (p < 0.001).

    CONCLUSIONS Residual %DS after lesion preparation, BSR, and T_inflation were the only modifiable procedure-related factors in DEB angioplasty. Fully optimized DEB angioplasty with optimal lesion preparation, prolonged inflation, and sufficient dilation may play an important role in reducing TLF after DEB angioplasty.

    PubMed IF 12.7 순환기내과
19. 25602018

    제1저자 박경우, 이태민 · 교신저자 김효수

    Park KW, Rhee TM, Kang HJ, Koo BK, Gwon HC, Yoon JH, Lim DS, Chae IH, Han KR, Ahn T, Jeong MH, Jeon DW, Jang YS, Kim HS

    Randomized Prospective Comparison of Everolimus-Eluting vs. Sirolimus-Eluting Stents in Patients Undergoing Percutaneous Coronary Intervention - 3-Year Clinical Outcomes of the EXCELLENT Randomized Trial.

    Circ J. 2018;82(6):1566-1574.

    Abstract

    BACKGROUND Everolimus-eluting stents (EES) have equivalent short-term angiographic and clinical outcomes to sirolimus-eluting stents (SES), but EES may be superior to SES with regard to long-term clinical safety. We report the 3-year clinical outcomes of EES and SES from the prospective EXCELLENT Randomized Trial (NCT00698607).

    METHODS AND RESULTS We randomly assigned 1,443 patients undergoing percutaneous coronary intervention 3:1 to receive EES and SES, respectively. We investigated endpoints including target lesion failure (TLF) and individual clinical outcomes including stent thrombosis (ST) at 3 years. For EES and SES, the TLF rate was 4.82% and 4.12% (risk ratio [RR], 1.16, 95% CI: 0.65-2.06, P=0.62), respectively. Results were similar in other efficacy endpoints including target lesion revascularization. For safety endpoints, rate of all-cause death was significantly lower for EES (1.67%) than SES (3.57%; RR, 0.46; 95% CI: 0.23-0.94, P=0.03), while the incidence of cardiac death or myocardial infarction was numerically lower in EES. On 1-year landmark analysis, rates of all-cause death and major adverse cardiovascular events were significantly lower for EES than SES. Definite or probable ST was numerically 3-fold higher for SES (1.37%) compared with EES (0.46%).

    CONCLUSIONS EES and SES had similar efficacy with regard to 3-year outcomes in the EXCELLENT trial, while delayed safety events all trended to favor EES.

    PubMed IF 5.8 순환기내과
20. 25592018

    제1저자 최윤진 · 교신저자 이동호

    Choi YJ, Lee DH, Han KD, Kim HS, Yoon H, Shin CM, Park YS, Kim N

    Correction: The relationship between drinking alcohol and esophageal, gastric or colorectal cancer: A nationwide population-based cohort study of South Korea.

    PLoS One. 2018;13(5):e0197765.

    Abstract

    [This corrects the article DOI: 10.1371/journal.pone.0185778.].

    PubMed IF 2.8 소화기내과
21. 25582018

    제1저자 박준빈, 황인창 · 교신저자 김효수, 이활

    Park JB, Hwang IC, Lee W, Han JK, Kim CH, Lee SP, Yang HM, Park EA, Kim HK, Chiam PTL, Kim YJ, Koo BK, Sohn DW, Ahn H, Kang JW, Park SJ, Kim HS

    Quantified degree of eccentricity of aortic valve calcification predicts risk of paravalvular regurgitation and response to balloon post-dilation after self-expandable transcatheter aortic valve replacement.

    Int J Cardiol. 2018;259:60-68.

    Abstract

    BACKGROUND Limited data exist regarding the impact of aortic valve calcification (AVC) eccentricity on the risk of paravalvular regurgitation (PVR) and response to balloon post-dilation (BPD) after transcatheter aortic valve replacement (TAVR). We investigated the prognostic value of AVC eccentricity in predicting the risk of PVR and response to BPD in patients undergoing TAVR.

    METHODS We analyzed 85 patients with severe aortic stenosis who underwent self-expandable TAVR (43 women; 77.2±7.1years). AVC was quantified as the total amount of calcification (total AVC load) and as the eccentricity of calcium (EoC) using calcium volume scoring with contrast computed tomography angiography (CTA). The EoC was defined as the maximum absolute difference in calcium volume scores between 2 adjacent sectors (bi-partition method) or between sectors based on leaflets (leaflet-based method).

    RESULTS Total AVC load and bi-partition EoC, but not leaflet-based EoC, were significant predictors for the occurrence of ≥moderate PVR, and bi-partition EoC had a better predictive value than total AVC load (area under the curve [AUC]=0.863 versus 0.760, p for difference=0.006). In multivariate analysis, bi-partition EoC was an independent predictor for the risk of ≥moderate PVR regardless of perimeter oversizing index. The greater bi-partition EoC was the only significant parameter to predict poor response to BPD (AUC=0.775, p=0.004).

    CONCLUSION Pre-procedural assessment of AVC eccentricity using CTA as "bi-partition EoC" provides useful predictive information on the risk of significant PVR and response to BPD in patients undergoing TAVR with self-expandable valves.

    PubMed IF 3.3 순환기내과
22. 25572018

    제1저자 박영식 · 교신저자 이창훈

    Park YS, Lee CH, Kim YI, Ahn CM, Kim JO, Park JH, Lee SH, Kim JY, Chun EM, Jung TH, Yoo KH

    Association between secondhand smoke exposure and hypertension in never smokers: a cross-sectional survey using data from Korean National Health and Nutritional Examination Survey V, 2010-2012.

    BMJ Open. 2018;8(5):e021217.

    Abstract

    OBJECTIVES Secondhand smoke (SHS) exposure is associated with cardiovascular disease. This study aims to determine the association between SHS exposure estimated by questionnaire and hypertension in Korean never smokers.

    SETTING Korean National Health and Nutrition Examination Survey (KNHANES) V was conducted from 2010 to 2012.

    PARTICIPANTS We selected the never smokers aged over 20 years who answered the question about the SHS exposure.

    PRIMARY AND SECONDARY MEASURES SHS exposure in both the home and work place was estimated using a self-reporting questionnaire. We investigated the association between SHS exposure and hypertension by using multivariate analysis. And we evaluated the mean systolic and diastolic blood pressure values according to SHS exposure after adjusting for possible confounding factors. All analyses were stratified by women and men.

    RESULTS There were 10 532 (women 8987 and men 1545) never smokers. We divided the subjects into three groups according to the amount of SHS exposure: none-group I, <2 hour/day-group II and ≥2 hour/day-group III. Using multivariate analysis, hypertension was more commonly associated with group III than group I in women (adjusted OR 1.50, 95% CI 1.00 to 2.04, p=0.011). Adjusted mean systolic and diastolic blood pressure values in women who were not taking antihypertensive medication were significantly elevated in group III by 2.3 and 1.7 mm Hg, respectively.

    CONCLUSION SHS exposure is significantly associated with hypertension in women never smokers.

    PubMed IF 2.5 호흡기내과
23. 25562018

    제1저자 김민주,문신제 · 교신저자 박영주

    Kim MJ, Moon S, Oh BC, Jung D, Ji K, Choi K, Park YJ

    Association between perfluoroalkyl substances exposure and thyroid function in adults: A meta-analysis.

    PLoS One. 2018;13(5):e0197244.

    Abstract

    OBJECTIVE Many people are exposed to perfluoroalkyl substances (PFASs) because these substances are widely used as industrial products. Although epidemiological studies suggest that PFASs can disrupt thyroid hormones, the association between PFAS exposure and thyroid function remains inconclusive. Therefore, we performed a comprehensive meta-analysis to investigate the association between PFASs exposure and thyroid hormones.

    METHODS We searched medical literature databases for articles on the association between PFASs-perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorohexane sulfonic acid (PFHxS)-and thyroid hormone levels in adults. Twelve articles were included in the meta-analysis, and the pooled z values were calculated with correlation or regression coefficients.

    RESULTS The blood PFOS concentration was positively correlated with free T4. The pooled z value was 0.05 (95% confidence interval (CI): 0.03, 0.08). PFOS was negatively correlated with total T4 and total T3 when excluding outlier studies. In a subgroup analysis stratified by mean PFOS concentration, PFOS was observed to be positively associated with free T4 and TSH and negatively associated with total T3 in the intermediate concentration group (8-16 ng/mL). PFOA concentration was negatively correlated with total T4 (z value, -0.06; 95% CI: -0.09, -0.03) after omitting one outlier study. PFHxS also showed a negative correlation with total T4 (z value, -0.04; 95% CI: -0.07, -0.01). A subgroup analysis of pregnant women showed that there was no association between PFASs and thyroid hormones.

    CONCLUSIONS Our meta-analysis suggests that PFASs are negatively associated with total T4, and their effect can be different depending on the PFAS concentration.

    PubMed IF 2.8 내분비대사내과
24. 25552018

    제1저자 박진주 · 교신저자 조구영

    Park JJ, Park JB, Park JH, Cho GY

    Global Longitudinal Strain to Predict Mortality in Patients With Acute Heart Failure.

    J Am Coll Cardiol. 2018;71(18):1947-1957.

    Abstract

    BACKGROUND Heart failure (HF) is currently classified according to left ventricular ejection fraction (LVEF); however, the prognostic value of LVEF is controversial. Myocardial strain is a prognostic factor independently of LVEF.

    OBJECTIVES The authors sought to evaluate the prognostic value of global longitudinal strain (GLS) in patients with HF.

    METHODS GLS was measured in 4,172 consecutive patients with acute HF. Patients were categorized as either HF with reduced (LVEF <40%), midrange (LVEF 40% to 49%), or preserved ejection fraction (LVEF ≥50%) and were also classified as having mildly (GLS >12.6%), moderately (8.1% < GLS <12.5%), or severely (GLS ≤8.0%) reduced strain. The primary endpoint was 5-year all-cause mortality.

    RESULTS Mean GLS was 10.8%, and mean LVEF was 40%. Overall, 1,740 (40.4%) patients had died at 5 years. Patients with reduced ejection fraction had slightly higher mortality than those with midrange or preserved ejection fraction (41%, 38%, and 39%, respectively; log-rank p = 0.031), whereas patients with reduced strain had significantly higher mortality (severely reduced GLS, 49%; moderately reduced GLS, 38%; mildly reduced GLS, 34%; log-rank p < 0.001). In multivariable analysis, each 1% increase in GLS was associated with a 5% decreased risk for mortality (p < 0.001). Patients with moderate (hazard ratio: 1.31; 95% confidence interval: 1.13 to 1.53) and severe GLS reductions (hazard ratio: 1.61; 95% confidence interval: 1.36 to 1.91) had higher mortality, but LVEF was not associated with mortality.

    CONCLUSIONS In patients with acute HF, GLS has greater prognostic value than LVEF. Therefore, the authors suggest that GLS should be considered as the standard measurement in all patients with HF. This new concept needs validation in further studies.

    PubMed IF 22.3 순환기내과
25. 25542018

    제1저자 김민주 · 교신저자 조선욱

    Kim MJ, Cho SW, Choi S, Ju DL, Park DJ, Park YJ

    Changes in Body Compositions and Basal Metabolic Rates during Treatment of Graves' Disease.

    Int J Endocrinol. 2018;2018:9863050.

    Abstract

    OBJECTIVES Because thyroid hormone is an important determinant of body weight and basal metabolic rate, we investigated the changes in the basal metabolic rate and body composition sequentially after treatment for Graves' disease.

    METHODS A prospective cohort study was performed with six women newly diagnosed with Graves' disease. During a 52-week treatment of methimazole, body composition, resting respiratory expenditure (REE), and handgrip strength were measured consecutively.

    RESULTS After methimazole treatment, body weight was initially increased (0-8 weeks), subsequently plateaued (8-24 weeks), and gradually decreased in the later period (24-52 weeks) despite the decreased food intake. The measured REE was 40% higher than the predicted REE at baseline, and it gradually decreased after treatment. REE positively correlated with thyroid hormone levels, peripheral deiodinase activity, and thyroid's secretory capacity. Body compositional analyses showed that the fat mass increased during an earlier period (4-12 weeks), while the lean mass increased significantly during the later period (26-52 weeks). Consistent with the lean mass changes, muscle strength also significantly increased during the later period.

    CONCLUSIONS Treatment of Graves' disease increased body weight and fat mass transiently with decreased REE. However, long-term compositional changes moved in a beneficial direction increasing lean mass and reinforcing muscle strength, following decreasing fat percentages.

    PubMed IF 2.5 내분비대사내과
26. 25532018

    제1저자 정영애, 조영진 · 교신저자 최의근, 황금숙

    Jung Y, Cho Y, Kim N, Oh IY, Kang SW, Choi EK, Hwang GS

    Lipidomic profiling reveals free fatty acid alterations in plasma from patients with atrial fibrillation.

    PLoS One. 2018;13(5):e0196709.

    Abstract

    Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its incidence is increasing worldwide. One method used to restore sinus rhythm is direct current cardioversion (DCCV). Despite the high success rate of DCCV, AF typically recurs within the first 2 weeks. However, our understanding of the pathophysiology of AF recurrence, incidence, and progression are highly limited. Lipidomic profiling was applied to identify altered lipids in plasma from patients with AF using ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry coupled with multivariate statistical analysis. Partial least-squares discriminant analysis revealed a clear separation between AF patients and healthy controls. The levels of several lipid species, including fatty acids and phospholipids, were different between AF patients and healthy controls, indicating that oxidative stress and inflammation are associated with the pathogenesis of AF. Similar patterns were also detected between recurrent and non-recurrent AF patients. These results suggest that the elevated saturated fatty acid and reduced polyunsaturated fatty acid levels in AF patients may be associated with enhanced inflammation and that free fatty acid levels may play a crucial role in the development and progression of AF.

    PubMed IF 2.8 순환기내과
27. 25522018

    제1저자 김진원 · 교신저자 김지현

    Kim JW, Lee YG, Hwang IG, Song HS, Koh SJ, Ko YH, Shin SH, Woo IS, Hong S, Kim TY, Kim SY, Nam BH, Kim HJ, Kim HJ, Lee MA, Kwon JH, Hong YS, Bae SH, Koo DH, Kim KI, Kim JH

    Predicting cumulative incidence of adverse events in older patients with cancer undergoing first-line palliative chemotherapy: Korean Cancer Study Group (KCSG) multicentre prospective study.

    Br J Cancer. 2018;118(9):1169-1175.

    Abstract

    BACKGROUND Older patients have increased risk of toxicity from chemotherapy. Current prediction tools do not provide information on cumulative risk.

    METHODS Patients aged ≥ 70 years with solid cancer were prospectively enrolled. A prediction model was developed for adverse events (AEs) ≥ Grade 3 (G3), based on geriatric assessment (GA), laboratory, and clinical variables.

    RESULTS 301 patients were enrolled (median age, 75 years). Median number of chemotherapy cycles was 4. During first-line chemotherapy, 53.8% of patients experienced AEs ≥ G3. Serum protein < 6.7 g/dL, initial full-dose chemotherapy, psychological stress or acute disease in the past 3 months, water consumption < 3 cups/day, unable to obey a simple command, and self-perception of poor health were significantly related with AEs ≥ G3. A predicting model with these six variables ranging 0-8 points was selected with the highest discriminatory ability (c-statistic= 0.646), which could classify patients into four risk groups. Predicted cumulative incidence of AEs ≥ G3 was discriminated according to risk groups.

    CONCLUSIONS This prediction tool could identify the risk of AEs ≥ G3 after chemotherapy and provide information on the cumulative incidence of AEs in each cycle.

    CLINICAL TRIAL ID WHO ICTRP number, KCT0001071.

    PubMed IF 7.8 혈액종양내과
28. 25512018

    제1저자 강지훈 · 교신저자 구본권, Wang Jianan

    Kang J, Koo BK, Hu X, Lee JM, Hahn JY, Yang HM, Shin ES, Nam CW, Doh JH, Lee BK, Ahn C, Wang J, Tahk SJ

    Comparison of Fractional FLow Reserve And Intravascular ultrasound-guided Intervention Strategy for Clinical OUtcomes in Patients with InteRmediate Stenosis (FLAVOUR): Rationale and design of a randomized clinical trial.

    Am Heart J. 2018;199:7-12.

    Abstract

    BACKGROUND Coronary angiography has limitations in defining the ischemia-causing stenotic lesion, especially in cases with intermediate coronary stenosis. Fractional flow reserve (FFR) is a current standard method to define the presence of ischemia, and intravascular ultrasound (IVUS) is the most commonly used invasive imaging tool that can provide the lesion geometry and can provide the information on plaque vulnerability. The primary aim of this study is to compare the safety and efficacy of FFR-guided and IVUS-guided percutaneous coronary intervention (PCI) strategies in patients with intermediate coronary stenosis.

    TRIAL DESIGN Comparison of Fractional FLow Reserve And Intravascular ultrasound-guided Intervention Strategy for Clinical OUtcomes in Patients with InteRmediate Stenosis (FLAVOUR) trial is an international, multicenter, prospective, randomized clinical trial. A total of 1,700 consecutive patients with intermediate stenosis (40%-70% by visual estimation) in a major epicardial coronary artery will be randomized 1:1 to receive either FFR-guided or IVUS-guided PCI strategy. Patients will be treated with PCI according to the predefined criteria for revascularization; FFR ≤ 0.80 in the FFR-guided group and Minimal Lumen Area (MLA) ≤3 mm² (or 3 mm²<MLA ≤4 mm² and plaque burden >70%) in the IVUS-guided group. The primary end point is the patient-oriented composite outcome, which is a composite of all-cause death, myocardial infarction, and any repeat revascularization at 24months after randomization. We will test noninferiority of current standard FFR-guided PCI strategy compared with IVUS-guided decision for PCI and stent optimization strategy.

    CONCLUSION The FLAVOUR trial will compare the safety and efficacy of FFR- and IVUS-guided PCI strategies in patients with intermediate coronary stenosis. This study will provide an insight on optimal evaluation and treatment strategy for patients with intermediate coronary stenosis.

    PubMed IF 3.4 순환기내과
29. 25502018

    제1저자 남준열 · 교신저자 김윤준

    Nam JY, Chang Y, Cho H, Kang SH, Cho YY, Cho EJ, Lee JH, Yu SJ, Yoon JH, Kim YJ

    Delayed viral suppression during antiviral therapy is associated with increased hepatocellular carcinoma rates in HBeAg-positive high viral load chronic hepatitis B.

    J Viral Hepat. 2018;25(5):552-560.

    Abstract

    The treatment option in chronic hepatitis B (CHB) patients with persistent low-level viremia despite entecavir or tenofovir monotherapy is unclear. This study investigated the development of hepatocellular carcinoma (HCC) or cirrhosis in hepatitis B e antigen (HBeAg)-positive high viral load CHB patients, according to the time needed to achieve complete viral suppression. A total of 325 HBeAg-positive CHB patients with high viral load who were recently started on antiviral therapy with entecavir or tenofovir were included. The enrolled patients were divided into 2 groups with 4 separate criteria based on the time needed to achieve complete viral suppression: within 1, 2, 3 or 4 years of therapy initiation. The outcomes were development of HCC and cirrhosis. The cumulative incidence of HCC was significantly higher in patients failing complete viral suppression within 1 year (hazard ratio (HR), 4.54; 95% confidence interval (CI), 1.03-19.93; P = .045) or 2 years (HR, 3.38; 95% CI, 1.24-9.23; P = .018), than patients who achieved complete viral suppression within 1 or 2 years, respectively. Cumulative incidence of cirrhosis was also significantly higher in patients failing suppression within 1 year (HR, 1.95; 95% CI, 1.04-3.66; P = .037) or 2 years (HR, 2.44; 95% CI, 1.41-4.22; P = .001). When the time for achieving viral suppression exceeded 2 years, the cumulative incidence of HCC or cirrhosis was not different regardless of viral suppression. Complete hepatitis B virus suppression within 2 years of antiviral therapy initiation is associated with risk reduction in HCC or cirrhosis development.

    PubMed IF 2.3 소화기내과
30. 25492018

    제1저자 임수 · 교신저자 고광곤

    Lim S, Eckel RH, Koh KK

    Clinical implications of current cardiovascular outcome trials with sodium glucose cotransporter-2 (SGLT2) inhibitors.

    Atherosclerosis. 2018;272:33-40.

    Abstract

    The final goal in the management of patients with type 2 diabetes (T2D) is reduction in cardiovascular (CV) complications and total mortality. Various factors including hyperglycemia contribute to these complications and mortality directly and indirectly. In recent years, large-scale CV outcome trials with new antidiabetic medications, such as dipeptidyl peptidase-4 (DPP4) inhibitors, glucagon-like peptide-1 (GLP1) receptor agonists, and sodium glucose cotransporter-2 (SGLT2) inhibitors, have been completed. Most clinical trials with DPP4 inhibitors have shown no inferiority compared with placebo treatments in terms of CV safety. However, they did not show benefits in terms of adverse CV events or mortality. CV outcome trials with GLP1 receptor agonists showed inconsistent results: lixisenatide did not show benefits in preventing major adverse CV events. In contrast, liraglutide and semaglutide (longer acting GLP1 receptor agonists) proved to be superior in terms of alleviating CV morbidity and mortality. Two large-scale CV outcome trials with SGLT2 inhibitors showed significant results: empagliflozin proved to be superior in preventing CV and all-cause mortality, and canagliflozin proved to be superior in preventing CV mortality but not all-cause mortality. So far, controlling cardiometabolic risk factors such as hemodynamic changes and weight loss by SGLT2 inhibitors are suggested to be the main mechanisms for these results. However, the risk-benefit profile for these new drugs will need further elucidation, and more studies are warranted to reveal the possible mechanisms. It will also be important to confirm these results from other ongoing trials with SGLT2 inhibitors.

    PubMed IF 7.1 내분비대사내과

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