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대한내과학회> The Korean Journal of Internal Medicine

The Korean Journal of Internal Medicine update

  • : 대한내과학회
  • : 의약학분야  >  내과학
  • : KCI등재
  • : SCI,SCOPUS
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  • : 1226-3303
  • : 2005-6648
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수록범위 : 1권1호(1986)~36권4호(2021) |수록논문 수 : 2,569
The Korean Journal of Internal Medicine
36권4호(2021년 07월) 수록논문
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KCI등재 SCI SCOPUS

1The role of inflammation in diabetic kidney disease

저자 : Su Woong Jung , Ju-young Moon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 4호 발행 연도 : 2021 페이지 : pp. 753-766 (14 pages)

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Diabetic kidney disease (DKD) has been the leading cause of chronic kidney disease for over 20 years. Yet, over these two decades, the clinical approach to this condition has not much improved beyond the administration of glucose-lowering agents, renin-angiotensin-aldosterone system blockers for blood pressure control, and lipid-lowering agents. The proportion of diabetic patients who develop DKD and progress to end-stage renal disease has remained nearly the same. This unmet need for DKD treatment is caused by the complex pathophysiology of DKD, and the difficulty of translating treatment from bench to bed, which further adds to the growing argument that DKD is not a homogeneous disease. To better capture the full spectrum of DKD in our design of treatment regimens, we need improved diagnostic tools that can better distinguish the subgroups within the condition. For instance, DKD is typically placed in the broad category of a non-inflammatory kidney disease. However, genome-wide transcriptome analysis studies consistently indicate the inflammatory signaling pathway activation in DKD. This review will utilize human data in discussing the potential for redefining the role of inflammation in DKD. We also comment on the therapeutic potential of targeted anti-inflammatory therapy for DKD.

KCI등재 SCI SCOPUS

2Clinical and genetic characteristics of Korean autosomal dominant polycystic kidney disease patients

저자 : Yun Kyu Oh , Hayne Cho Park , Hyunjin Ryu , Yong-chul Kim , Kook-hwan Oh

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 4호 발행 연도 : 2021 페이지 : pp. 767-779 (13 pages)

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Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease. It is characterized by cyst growth in the kidneys, resulting in kidney enlargement and end-stage kidney disease. The polycystic kidney disease 1 (PKD1) and PKD2 have been identified as genes related to ADPKD and their significance in the molecular pathology of the disease has been studied. A disease-modifying drug has been approved; therefore, it has become important to identify patients at a high risk of kidney disease progression. Genetic tests, image analysis methods, and clinical factors for kidney disease progression prediction have been established. This review describes genetic and clinical characteristics, and discusses ongoing studies in Korean ADPKD patients.

KCI등재 SCI SCOPUS

3Blood pressure control in patients with chronic kidney disease

저자 : Jee Young Lee , Seung Hyeok Han

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 4호 발행 연도 : 2021 페이지 : pp. 780-794 (15 pages)

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Uncontrolled blood pressure (BP) in patients with chronic kidney disease (CKD) can lead to serious adverse outcomes. To prevent the occurrence of cardiovascular events (CVEs), and end-stage kidney disease, achieving an optimal BP level is important. Recently, there has been a paradigm shift in the management of BP largely as a result of the Systolic Blood Pressure Intervention Trial (SPRINT), which showed a reduction in CVEs by lowering systolic BP to 120 mmHg. A lower systolic blood pressure (SBP) target has been accepted by the Kidney Disease: Improving Global Outcomes (KDIGO) 2021 guidelines. However, whether intensive control of SBP targeting < 120 mmHg is also effective in patients with CKD is controversial. Notably, this lower target SBP is associated with a higher risk of adverse kidney outcomes. Unfortunately, there have been no randomized controlled trials on this issue involving only patients with CKD, particularly those with advanced CKD. In this review, we discuss the optimal control of BP in patients with CKD in terms of reduction in death and CVEs as well as attenuation of CKD progression based on the evidence-based literature.

KCI등재 SCI SCOPUS

4How important is dietary management in chronic kidney disease progression? A role for low protein diets

저자 : Gang-jee Ko , Kamyar Kalantar-zadeh

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 4호 발행 연도 : 2021 페이지 : pp. 795-806 (12 pages)

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High dietary protein intake may lead to increased intraglomerular pressure and glomerular hyperfiltration, which in the long-term can lead to de novo or aggravating preexisting chronic kidney disease (CKD). Hence, a low protein diet (LPD, 0.6 to 0.8 g/kg/day) is recommended for the management of CKD. There are evidences that dietary protein restriction mitigate progression of CKD and retard the initiation of dialysis or facilitate incremental dialysis. LPD is also helpful to control metabolic derangements in CKD such as metabolic acidosis and hyperphosphatemia. Recently, a growing body of evidence has emerged on the benefits of plant-dominant low-protein diet (PLADO), which composed of > 50% plant-based sources. PLADO is considered to be helpful for relieving uremic burden and metabolic complications in CKD compared to animal protein dominant consumption. It may also lead to favorable alterations in the gut microbiome, which can modulate uremic toxin generation along with reducing cardiovascular risk. Alleviation of constipation in PLADO may minimize the risk of hyperkalemia. A balanced and individualized dietary approach for good adherence to LPD utilizing various plant-based sources as patients' preference should be elaborated for the optimal care in CKD. Periodic nutritional assessment under supervision of trained dietitians should be warranted to avoid protein-energy wasting.

KCI등재 SCI SCOPUS

5Evidence based guidelines for the treatment of Helicobacter pylori infection in Korea 2020

저자 : Hye-kyung Jung , Seung Joo Kang , Yong Chan Lee , Hyo-joon Yang , Seon-young Park , Cheol Min Shin , Sung Eun Kim , Hyun Chul Lim , Jie-hyun Kim , Su Youn Nam , Woon Geon Shin , Jae Myung Park , Il Ju Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 4호 발행 연도 : 2021 페이지 : pp. 807-862 (56 pages)

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Helicobacter pylori infection is one of the most common infectious diseases worldwide. H. pylori is responsible for substantial gastrointestinal morbidity with a high disease burden. Since the revision of the H. pylori Clinical Practice Guidelines in 2013 in Korea, the eradication rate of H. pylori has gradually decreased with the use of a clarithromycin based triple therapy. According to a nationwide randomized controlled study by the Korean College of Helicobacter and Upper Gastrointestinal Research released in 2018, the intention-to-treat eradication rate was only 63.9%, which was mostly due to increased antimicrobial resistance to clarithromycin. The clinical practice guidelines for treatment of H. pylori were updated based on evidence-based medicine from a meta-analysis conducted on a target group receiving the latest level of eradication therapy. The draft recommendations developed based on the meta-analysis were finalized after expert consensus on three recommendations regarding the indication for treatment and eight recommendations on the treatment itself. These guidelines were designed to provide clinical evidence for the treatment of H. pylori to patients, nurses, medical school students, policymakers, and clinicians. These may differ from current medical insurance standards, and will be revised if more evidence emerges in the future.

KCI등재 SCI SCOPUS

6Risk-stratified colorectal cancer screening for optimal use of colonoscopy resources

저자 : Dong-hoon Yang

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 4호 발행 연도 : 2021 페이지 : pp. 839-841 (3 pages)

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KCI등재 SCI SCOPUS

7Rivaroxaban: striking two birds with one stone

저자 : Yae Min Park

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 4호 발행 연도 : 2021 페이지 : pp. 842-844 (3 pages)

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KCI등재 SCI SCOPUS

8Application of deep learning to predict advanced neoplasia using big clinical data in colorectal cancer screening of asymptomatic adults

저자 : Hyo-joon Yang , Chang Woo Cho , Jongha Jang , Sang Soo Kim , Kwang-sung Ahn , Soo-kyung Park , Dong Il Park

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 4호 발행 연도 : 2021 페이지 : pp. 845-861 (17 pages)

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Background/Aims: We aimed to develop a deep learning model for the prediction of the risk of advanced colorectal neoplasia (ACRN) in asymptomatic adults, based on which colorectal cancer screening could be customized.
Methods: We collected data on 26 clinical and laboratory parameters, including age, sex, smoking status, body mass index, complete blood count, blood chemistry, and tumor marker, from 70,336 first-time colonoscopy screening recipients. For reference, we used a logistic regression (LR) model with nine variables manually selected from the 26 variables. A deep neural network (DNN) model was developed using all 26 variables. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of the models were compared in a randomly split validation group.
Results: In comparison with the LR model (AUC, 0.724; 95% confidence interval [CI], 0.684 to 0.765), the DNN model (AUC, 0.760; 95% CI, 0.724 to 0.795) demonstrated significantly improved performance with respect to the prediction of ACRN (p < 0.001). At a sensitivity of 90%, the specificity significantly increased with the application of the DNN model (41.0%) in comparison with the LR model (26.5%) (p < 0.001), indicating that the colonoscopy workload required to detect the same number of ACRNs could be reduced by 20%.
Conclusions: The application of DNN to big clinical data could significantly improve the prediction of ACRNs in comparison with the LR model, potentially realizing further customization by utilizing large quantities and various types of biomedical information.

KCI등재 SCI SCOPUS

9Helicobacter pylori-derived outer membrane vesicles stimulate interleukin 8 secretion through nuclear factor kappa B activation

저자 : Mun Sun Choi , Eun Young Ze , Jae Yong Park , Tae-seop Shin , Jae Gyu Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 4호 발행 연도 : 2021 페이지 : pp. 857-867 (11 pages)

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Background/Aims: Bacteria-derived outer membrane vesicles (OMVs) are commonly associated with various biological activities and functions. Helicobacter pylori-derived OMVs are thought to contribute to pathogenesis. This study aimed to investigate the effects of H. pylori-derived OMVs.
Methods: H. pylori strains were isolated from patients with gastritis, gastric ulcer, or gastric cancer using endoscopic biopsy. The U-937, AGS, and MKN-45 cell lines were exposed to H. pylori and H. pylori-derived OMVs. The expression of interleukin 8 (IL-8) messenger RNA (mRNA) was assessed using reverse transcription-polymerase chain reaction (RT-PCR) and real-time RT-PCR, and IL-8 secretion was analyzed using enzyme-linked immunosorbent assay. Nuclear factor kappa B (NF-κB) activation was evaluated by Western blotting.
Results: H. pylori and H. pylori-derived OMVs induced the expression of IL-8 mRNA and protein. Importantly, the bacteria induced higher IL-8 mRNA and protein expression than the OMVs. IL-8 expression was induced to different levels in response to H. pylori-derived OMVs from hosts with different gastric diseases. Western blotting revealed the increased phosphorylation and reduced degradation of inhibitor of NF-κB alpha in cells exposed to OMVs.
Conclusions: H. pylori-derived OMVs may aid the development of various gastric diseases by inducing IL-8 production and NF-κB activation.

KCI등재 SCI SCOPUS

10Subclinical sacroiliitis detected by abdominopelvic computed tomography in Korean patients with Crohn's disease

저자 : You-jung Ha , Hyo Jin Kim , Eugene Lee , Ji Hye Park , Young Soo Park , Yun Jong Lee , Yusuhn Kang , Hyuk Yoon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 4호 발행 연도 : 2021 페이지 : pp. 868-877 (10 pages)

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Background/Aims: Sacroiliitis is a frequent extraintestinal manifestation of inflammatory bowel diseases (IBDs). This study aimed to assess the prevalence of sacroiliitis using a validated screening tool based on abdominopelvic computed tomography (APCT) in Korean patients with Crohn's disease (CD) and examine potential associations between clinical characteristics and sacroiliitis.
Methods: One hundred five patients with CD undergoing APCT for any indication at an IBD clinic were matched 1:1 for age and sex with 105 controls without underlying chronic illnesses. Using a validated APCT screening tool that defines sacroiliitis as either ankylosis or a total erosion score (TES) ≥ 3, all computed tomography scans were assessed by two independent, blinded radiologists. We compared the prevalence of sacroiliitis between CD patients and controls and clinical characteristics between CD patients with and without sacroiliitis.
Results: The prevalence of sacroiliitis was significantly higher in CD patients than in controls (13.3% vs. 4.8%, p = 0.030). All subjects with sacroiliitis had a TES ≥ 3, but no ankylosis. The assessment of sacroiliitis in APCT showed excellent interreader reliability (Cohen's kappa = 0.933 for presence of sacroiliitis). Sacroiliitis in CD patients was bilateral and asymptomatic. There were no significant associations between sacroiliitis and any demographic data or clinical characteristics in these patients.
Conclusions: The prevalence of APCT-detected sacroiliitis in CD patients was higher than that in controls, but the condition was asymptomatic. The clinical significance of asymptomatic sacroiliitis in Korean CD patients remains unclear.

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