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대한내과학회> The Korean Journal of Internal Medicine

The Korean Journal of Internal Medicine update

  • : 대한내과학회
  • : 의약학분야  >  내과학
  • : KCI등재
  • : SCI
  • : 연속간행물
  • : 격월
  • : 1226-3303
  • : 2005-6648
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수록범위 : 1권1호(1986)~35권1호(2020) |수록논문 수 : 2,266
The Korean Journal of Internal Medicine
35권1호(2020년 01월) 수록논문
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KCI등재 SCI

1Recent insights regarding the molecular basis of myeloproliferative neoplasms

저자 : Mi-ae Jang , Chul Won Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 1호 발행 연도 : 2020 페이지 : pp. 1-11 (11 pages)

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Myeloproliferative neoplasms (MPNs) are a heterogeneous group of clonal disorders characterized by the overproduction of mature blood cells that have an increased risk of thrombosis and progression to acute myeloid leukemia. Next-generation sequencing studies have provided key insights regarding the molecular mechanisms of MPNs. MPN driver mutations in genes associated with the JAK-STAT pathway include JAK2 V617F, JAK2 exon 12 mutations and mutations in MPL, CALR, and CSF3R. Cooperating driver genes are also frequently detected and also mutated in other myeloid neoplasms; these driver genes are involved in epigenetic methylation, messenger RNA splicing, transcription regulation, and signal transduction. In addition, other genetic factors such as germline predisposition, order of mutation acquisition, and variant allele frequency also influence disease initiation and progression. This review summarizes the current understanding of the genetic basis of MPN, and demonstrates how molecular pathophysiology can improve both our understanding of MPN heterogeneity and clinical practice.

KCI등재 SCI

2Roles of mast cells in rheumatoid arthritis

저자 : Hong Ki Min , Kyoung-woon Kim , Sang-heon Lee , Hae-rim Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 1호 발행 연도 : 2020 페이지 : pp. 12-24 (13 pages)

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Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory arthritis, and the complex interaction and activation of innate and adaptive immune cells are involved in RA pathogenesis. Mast cells (MCs) are one of the tissue-resident innate immune cells, and they contribute to RA pathogenesis. In the present review, the evidence of the pathologic role of MC in RA is discussed based on human and animal data. In addition, the potential role of MC in RA pathogenesis and the research area that should be focused on in the future are suggested.

KCI등재 SCI

3Consensus regarding diagnosis and management of atypical hemolytic uremic syndrome

저자 : Hajeong Lee , Eunjeong Kang , Hee Gyung Kang , Young Hoon Kim , Jin Seok Kim , Hee-jin Kim , Kyung Chul Moon , Tae Hyun Ban , Se Won Oh , Sang Kyung Jo , Heeyeon Cho , Bum Soon Choi , Junshik Hong , Hae

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 1호 발행 연도 : 2020 페이지 : pp. 25-40 (16 pages)

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Thrombotic microangiopathy (TMA) is defined by specific clinical characteristics, including microangiopathic hemolytic anemia, thrombocytopenia, and pathologic evidence of endothelial cell damage, as well as the resulting ischemic end-organ injuries. A variety of clinical scenarios have features of TMA, including infection, pregnancy, malignancy, autoimmune disease, and medications. These overlapping manifestations hamper differential diagnosis of the underlying pathogenesis, despite recent advances in understanding the mechanisms of several types of TMA syndrome. Atypical hemolytic uremic syndrome (aHUS) is caused by a genetic or acquired defect in regulation of the alternative complement pathway. It is important to consider the possibility of aHUS in all patients who exhibit TMA with triggering conditions because of the incomplete genetic penetrance of aHUS. Therapeutic strategies for aHUS are based on functional restoration of the complement system. Eculizumab, a monoclonal antibody against the terminal complement component 5 inhibitor, yields good outcomes that include prevention of organ damage and premature death. However, there remain unresolved challenges in terms of treatment duration, cost, and infectious complications. A consensus regarding diagnosis and management of TMA syndrome would enhance understanding of the disease and enable treatment decision-making.

KCI등재 SCI

4The use of biological disease-modifying antirheumatic drugs for inflammatory arthritis in Korea: results of a Korean Expert Consensus

저자 : Eun-jung Park , Hyungjin Kim , Seung Min Jung , Yoon-kyoung Sung , Han Joo Baek , Jisoo Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 1호 발행 연도 : 2020 페이지 : pp. 41-59 (19 pages)

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Biological disease-modifying antirheumatic drugs (bDMARDs) are highly effective agents for the treatment of inf lammatory arthritis; however, they also possess a potential risk for serious infection. Recently, with the rapid expansion of the bDMARDs market in Korea, reports of serious adverse events related to the agents have also increased, necessitating guidance for the use of bDMARDs. Current work entitled, “Expert consensus for the use of bDMARDs drugs for inflammatory arthritis in Korea,” is the first to describe the appropriate use of bDMARDs in the management of inflammatory arthritis in Korea, with an aim to provide guidance for the local medical community to improve the quality of clinical care. Twelve consensus statements regarding the use of bDMARDs for the management of rheumatoid arthritis and ankylosing spondylitis were generated. In this review, we provide detailed guidance on bDMARDs use based on expert consensus, including who should prescribe, the role of education, indications for use, and monitoring strategies for safety.

KCI등재 SCI

5It is time to focus on pre-hospital delays in patients with ST-segment elevation myocardial infarction

저자 : Hack-lyoung Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 1호 발행 연도 : 2020 페이지 : pp. 60-61 (2 pages)

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KCI등재 SCI

6Does normouricemic status in acute gouty arthritis really reflect a normal status? Consider confounders of serum levels of urate

저자 : Hong Ki Min , Hae-rim Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 1호 발행 연도 : 2020 페이지 : pp. 62-64 (3 pages)

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KCI등재 SCI

7Potential etiology, prevalence of cirrhosis, and mode of detection among patients with non-B non-C hepatocellular carcinoma in Korea

저자 : Jihye Kim , Wonseok Kang , Dong Hyun Sinn , Geum-youn Gwak , Yong-han Paik , Moon Seok Choi , Joon Hyeok Lee , Kwang Cheol Koh , Seung Woon Paik

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 1호 발행 연도 : 2020 페이지 : pp. 65-81 (17 pages)

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Background/Aims: We systematically evaluated the clinical characteristics, prevalence of cirrhosis, and mode of detection in virus-unrelated (non-B non-C, NBNC) hepatocellular carcinoma (HCC) patients in Korea.
Methods: A total of 447 consecutive treatment-naïve NBNC-HCC adult patients who were registered at the Samsung Medical Center HCC registry in Korea from 2010 to 2013 were analyzed. NBNC was defined as negative hepatitis B surface antigen and negative anti-hepatitis C virus antibody. Presence of cirrhosis was determined based on histological, radiological, endoscopic, and serologic results. Mode of detection was classified as either under surveillance, incidental, or symptomatic.
Results: Heavy alcohol use was the most common potential etiology in NBNC-HCC (NBNC-A, alcohol) (59.7%). Ten patients had other identif iable causes (NBNC-O, other identifiable cause) such as autoimmune hepatitis. The rest (38.0%) had no-identifiable cause (NBNC-NA-NO, non-alcohol, no-other identifiable cause). In NBNC-NA-NO group, 83.5% (96/115) of patients with available hepatitis B core immunoglobulin G antibody (HBcIgG) showed HBcIgG positivity, and 80.6% (137/170) had metabolic risk factors (diabetes, obesity, hypertension, and/ or dyslipidemia). Cirrhosis was present in 90.0%, 70.4%, and 60.0% of NBNC-O, NBNC-A, and NBNC-NA-NO patients, respectively. The proportion of patients diagnosed under surveillance was 25.5% across all patients, with specific proportions being 80.0%, 27.7%, and 18.8% for NBNC-O, NBNC-A, and NBNC-NA-NO, respectively.
Conclusions: Among NBNC-HCC patients, heavy alcohol use or any other identifiable cause was not found in 38.0%. These NBNC-NA-NO HCC patients showed a high prevalence of HBcIgG positivity and metabolic risk factors, suggesting that prior hepatitis B virus infection and metabolic risk factors may be major contributing factors in the hepatocarcinogenesis in NBNC-NA-NO patients.

KCI등재 SCI

8Association between clinical risk factors and severity of dysphagia after extubation based on a videofluoroscopic swallowing study

저자 : Won-jong Yang , Eunhee Park , Yu-sun Min , Jae-won Huh , Ae Ryoung Kim , Hyun-min Oh , Tae-woo Nam , Tae-du Jung

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 1호 발행 연도 : 2020 페이지 : pp. 79-89 (11 pages)

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Background/Aims: This study aimed to evaluate the correlation between clinical risk factors of post-extubation dysphagia (PED) and the severity of impaired pharyngeal swallowing function assessed via videofluoroscopic swallowing studies (VFSSs).
Methods: This study was a retrospective review of medical records. Of 116 patients who were admitted to the intensive care unit and underwent VFSS, 32 who had non-neurologic disorders and experienced prolonged intubation (for more than 48 hours) were diagnosed with PED. The severity of PED was evaluated by using a functional dysphagia scale (FDS) and a penetration aspiration scale (PAS), on the basis of VFSS.
Results: The Simplified Acute Physiology Score 3 and total FDS score were positively correlated (r = 0.40, p = 0.02). Intubation duration was positively correlated with total PAS and FDS scores (r = 0.62, p < 0.001; r = 0.65, p < 0.001, respectively). The amounts of residue in the valleculae (RV) and pyriform sinuses (RP) were associated with intubation duration (r = 0.58, p < 0.001; r = 0.57, p < 0.001, respectively). Multivariate regression analysis revealed that intubation duration was significantly associated with the total FDS score, RV and RP subscales of the FDS, and total PAS score.
Conclusions: The severity of impaired swallowing function, particularly the amount of residue in the pharyngeal recesses assessed via VFSS, was strongly associated with both severity of medical illness and intubation duration. Intubation duration could be a prognostic factor for assessing impaired swallowing function on the basis of VFSS.

KCI등재 SCI

9Combined effect of hepatic venous pressure gradient and liver stiffness on long-term mortality in patients with cirrhosis

저자 : Jae Gon Lee , Joo Hyun Sohn , Jae Yoon Jeong , Tae Yeob Kim , Sun Min Kim , Young Seo Cho , Yongsoo Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 1호 발행 연도 : 2020 페이지 : pp. 88-99 (12 pages)

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Background/Aims: Both hepatic venous pressure gradient (HVPG) and liver stiffness (LS) are useful tools for predicting mortality in patients with cirrhosis. We investigated the combined effect of HVPG and LS on long-term mortality in patients with cirrhosis.
Methods: We retrospectively collected data from 103 patients with cirrhosis, whose HVPG and LS were measured between November 2009 and September 2013. The patients were divided into four groups according to the results of the HVPG and LS measurements. Long-term mortality and the risk factors for mortality were analyzed.
Results: Of the 103 patients, 35 were in group 1 (low HVPG and low LS), 16 in group 2 (high HVPG and low LS), 24 in group 3 (low HVPG and high LS), and 28 in group 4 (high HVPG and high LS). Over a median follow-up of 47.3 months, 18 patients died. The mortality rate of patients in group 4 was significantly higher than in the other three groups (vs. group 1, p = 0.005; vs. group 2, p = 0.049; vs. group 3, p = 0.004), but there were no significant differences in survival between groups 1, 2, and 3. In multivariable analyses, both HVPG and LS were identified as independent risk factors for mortality (hazard ratio [HR], 1.127, p = 0.018; and HR, 1.062, p = 0.009, respectively).
Conclusions: In patients with cirrhosis, those with concurrent elevation of HVPG and LS had the highest long-term mortality rates. However, when either HVPG or LS alone was elevated, mortality did not increase significantly.

KCI등재 SCI

10A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF)

저자 : Hyeongsoo Kim , Young Soo Lee , Tae-hoon Kim , Myung-jin Cha , Jung Myung Lee , Junbeom Park , Jin-kyu Park , Ki-woon Kang , Jaemin Shim , Jae-sun Uhm , Hyung Wook Park , Eue-keun Choi , Jin-bae Kim , C

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 1호 발행 연도 : 2020 페이지 : pp. 99-112 (14 pages)

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Background/Aims: Efforts to reduce stroke in patients with atrial fibrillation (AF) have focused on increasing physician adherence to oral anticoagulant (OAC) guidelines; however, the high early discontinuation rate of vitamin K antagonists (VKAs) is a limitation. Although non-VKA OACs (NOACs) are more convenient to administer than warfarin, their lack of monitoring may predispose patients to nonpersistence. We compared the persistence of NOAC and VKA treatment for AF in real-world practice.
Methods: In a prospective observational registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF] registry), 7,013 patients with nonvalvular AF (mean age 67.2 ± 10.9 years, women 36.4%) were consecutively enrolled between June 2016 and June 2017 from 10 tertiary hospitals in Korea. This study included 3,381 patients who started OAC 30 days before enrollment (maintenance group) and 572 patients who newly started OAC (new-starter group). The persistence rate of OAC was evaluated.
Results: In the maintenance group, persistence to OAC declined during 6 months, to 88.3% for VKA and 95.5% for NOAC (p < 0.0001). However, the persistence rate was not different among NOACs. In the new-starter group, persistence to OAC declined during 6 months, to 78.9% for VKA and 92.1% for NOAC (p < 0.0001). The persistence rate was lower for rivaroxaban (83.7%) than apixaban (94.6%) and edoxaban (94.1%, p < 0.001). In the new-starter group, diabetes, valve disease, and cancer were related to nonpersistence of OAC.
Conclusions: Nonpersistence was significantly lower with NOAC than VKA in both the maintenance and new-starter groups. In only the new-starter group, apixaban or edoxaban showed higher persistence rates than rivaroxaban.

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