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대한내과학회> The Korean Journal of Internal Medicine> Strategies for successful implementation and permanent maintenance of a rapid response system

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Strategies for successful implementation and permanent maintenance of a rapid response system

Myung Jin Song , Yeon Joo Lee
  • : 대한내과학회
  • : The Korean Journal of Internal Medicine 36권5호
  • : 연속간행물
  • : 2021년 09월
  • : 1031-1039(9pages)
The Korean Journal of Internal Medicine

DOI


목차

INTRODUCTION
KEY STRATEGIES IN THE AFFERENT LIMB: AN EFFECTIVE TRIGGERING SYSTEM AND A HOSPITAL CULTURE THAT EMBRACES THE RRS
KEY STRATEGIES FOR THE EFFERENT LIMB: QUALIFIED PRIMARY RESPONDERS AND DEDICATED PHYSICIANS
KEY STRATEGIES FOR IMPROVING QUALITY: REGULAR EVALUATION OF OUTCOMES AND FEEDBACK OF TEAM ACTIVITY
KEY STRATEGY FOR ADMINISTRATION: PROPER FUNDING SUPPORT
CONCLUSIONS
REFERENCES

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Rapid response systems (RRSs) have been introduced to intervene with patients experiencing non-code medical emergencies and operate widely around the world. An RRS has four components: an afferent limb, an efferent limb, quality improvement, and administration. A proper triggering system, a hospital culture that embraces the RRS from the afferent limb, experienced primary responders, and dedicated physicians from the efferent limb are key for successful implementation. After initial implementation, quality improvement through objective outcome measures and self-evaluation are crucial, which lead to a better outcome when this process is well performed. Furthermore, better outcomes lead to more investment, which is essential for effective development of the system. The RRS is successfully maintained when these four components are closely interconnected.

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간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCOPUS
  • : 격월
  • : 1226-3303
  • : 2005-6648
  • : 학술지
  • : 연속간행물
  • : 1986-2022
  • : 2654


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1Aerosolized antibiotics in the treatment of hospital-acquired pneumonia/ventilator-associated pneumonia

저자 : Yun Jung Jung , Eun Jin Kim , Young Hwa Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 1-12 (12 pages)

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Aerosolized antibiotics are being increasingly used to treat respiratory infections, especially those caused by drug-resistant pathogens. Their use in the treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in critically ill patients is especially significant. They are also used as an efficient alternative to overcome the issues caused by systemic administration of antibiotics, including the occurrence of drug-resistant strains, drug toxicity, and insufficient drug concentration at the target site. However, the rationale for the use of aerosolized antibiotics is limited owing to their insufficient efficacy and the potential for underestimated risks of developing side effects. Despite the lack of availability of high-quality evidence, the use of aerosolized antibiotics is considered as an attractive alternative treatment approach, especially in patients with multidrug-resistant pathogens. In this review, we have discussed the effectiveness and side effects of aerosolized antibiotics as well as the latest advancements in this field and usage in the Republic of Korea.

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2Metformin and its therapeutic applications in autoimmune inflammatory rheumatic disease

저자 : Ji-won Kim , Jung-yoon Choe , Sung-hwan Park

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 13-26 (14 pages)

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Metformin is a first-line therapeutic agent for type 2 diabetes. Apart from its glucose-lowering effect, metformin is attracting interest regarding possible therapeutic benefits in various other conditions. As metformin regulates cell metabolism, proliferation, growth, and autophagy, it may also modulate immune cell functions. Given that metformin acts on multiple intracellular signaling pathways, including adenosine monophosphate (AMP)-activated protein kinase (AMPK) activation, and that AMPK and its downstream intracellular signaling control the activation and differentiation of T and B cells and inflammatory responses, metformin may exert immunomodulatory and anti-inflammatory effects. The efficacy of metformin has been investigated in preclinical and clinical studies on rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, Sjögren's syndrome, scleroderma, ankylosing spondylitis, and gout. In this review, we discuss the potential mechanisms through which metformin exerts its therapeutic effects in these diseases, focusing particularly on rheumatoid arthritis and osteoarthritis.

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3Current status of the diagnosis of chronic pancreatitis by ultrasonographic elastography

저자 : Kazunori Nakaoka , Senju Hashimoto , Ryoji Miyahara , Hiroki Kawashima , Eizaburo Ohno , Takuya Ishikawa , Takamichi Kuwahara , Hiroyuki Tanaka , Yoshiki Hirooka

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 27-36 (10 pages)

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Chronic pancreatitis (CP) is pathologically characterized by the loss of exocrine pancreatic parenchyma, irregular fibrosis, cellular infiltration, and ductal abnormalities. Diagnosing CP objectively is difficult because standard diagnostic criteria are insufficient. The change of parenchymal hardness is the key factor for the diagnosis and understanding of the severity of CP. The ultrasonography (US) or endoscopic ultrasonography (EUS) elastography have been used to diagnose pancreatic diseases. Both strain elastography (SE) and shear wave elastography are specific diagnostic techniques for measuring tissue hardness. Most previous studies were conducted with SE. There are three methods of interpreting SE; the method of recognizing the patterns in SE distribution images in the region of interest, the method of using strain ratio to compare the hardness of adipose tissue or connective tissue with that of the lesion, and the method of evaluating the hardness distribution of a target by histogram analysis. These former two methods have been used primarily for neoplastic diseases, and histograms analysis has been used to assess hardness distribution in the evaluation of CP. Since the hardness of the pancreas increases with aging, it is necessary to consider the age in the diagnosis of pancreatic disorders using US or EUS elastography.

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4Is there sufficient evidence to justify changes in dietary habits in heart failure patients? A systematic review

저자 : Alejandra García-garcía , Luis A. Alvarez-sala-walther , Hae-young Lee , Cristina Sierra , Domingo Pascual-figal , Miguel Camafort

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 37-47 (11 pages)

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The incidence and prevalence of heart failure (HF) is increasing worldwide, leading to high morbidity and mortality. The global management of HF involves lifestyle changes in addition to pharmacological treatments. Changes include exercise and dietary recommendations, mainly salt and fluid restriction, but without any clear evidence. We conducted a systematic review to analyse the degree of evidence for these dietary recommendations in HF. Only randomized controlled trials (RCT), and observational studies in humans were selected. Studies were considered eligible if they included participants with HF and sodium and/or fluid restriction. Publications in languages other than English or Spanish were excluded. We included 15 studies related to sodium or fluid restriction. Nine RCT and six observational studies showed some improvements in symptoms and quality of life and a degree of reduction in new hospitalizations, but the results are based on limited population groups, applying different methodologies, and with different restriction goals. We found a lack of clear evidence of the benefits of sodium/fluid restriction in chronic HF. The evidence is limited to few studies with conflicting results. Randomized clinical trials are needed to fill this gap in our knowledge.

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5Challenges to be addressed in management of patients with sinusoidal obstruction syndrome after hematopoietic cell transplantation

저자 : Seong Kyu Park , Young Sok Ji , Se Hyung Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 48-50 (3 pages)

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6Efficacy of hydroxychloroquine for knee osteoarthritis

저자 : Young Ho Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 51-52 (2 pages)

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7Anti-fibrotic effects of branched-chain amino acids on hepatic stellate cells

저자 : Hae Lim Lee , Jungmin Lee , Jung Hoon Cha , Sungwoo Cho , Pil Soo Sung , Wonhee Hur , Seung Kew Yoon , Si Hyun Bae

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 53-62 (10 pages)

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Background/Aims: Patients with liver cirrhosis (LC) have low levels of branched-chain amino acids (BCAAs). There is accumulating evidence that BCAAs have anti-fibrotic effects in cirrhosis. This study is aimed to evaluate the effect of BCAAs on the function and phenotype of activated hepatic stellate cells (HSCs).
Methods: LX-2, an immortalized human stellate cell line, was used in in vitro experiments. LX-2 cells were exposed to transforming growth factor β1 (TGF-β1) and BCAAs or to valine, leucine, and isoleucine, which are components of BCAAs. Activation of the TGF-β signaling pathway in LX-2 cells was observed using real-time quantitative polymerase chain reaction and Western blotting.
Results: The increased expression of snail family transcriptional repressor 1 (SNAI1) was observed in LX-2 cells activated by TGF-β1. After BCAA treatment, its expression was significantly decreased at the mRNA level. The increased expression of Col1α1 and TIMP2 at the mRNA level and alpha smooth muscle actin at the protein level in activated LX-2 cells decreased after BCAA treatment. Among the BCAA components, leucine and valine significantly abrogated TGF-β-induced activation of LX-2 cells. BCAA treatment led to the decreased phosphorylation of Smad2 and p38 proteins, which are markers for Smad and Smad-independent p38 mitogen-activated protein kinase signaling pathways, respectively.
Conclusions: BCAA treatment can improve hepatic fibrosis by directly affecting the activated state of hepatic stellate cells through inhibition of the TGF-β signaling pathway. Among BCAA components, leucine and valine mainly abrogated TGF-β- induced activation of HSCs. Our results suggest that BCAA may be used to attenuate the progression of liver fibrosis.

KCI등재 SCOPUS

8Current trends in the management of pancreatic cystic neoplasms in Korea: a national survey

저자 : Hyung Ku Chon , Sung Hoon Moon , Sang Wook Park , Woo Hyun Paik , Chang Nyol Paik , Byoung Kwan Son , Tae Jun Song , Dong Won Ahn , Eaum Seok Lee , Yun Nah Lee , Yoon Suk Lee , Jae Min Lee , Tae Joo Jeon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 63-76 (14 pages)

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Background/Aims: The study aimed to investigate the current practice patterns in the management of pancreatic cystic neoplasms in Korea.
Methods: An electronic survey was systematically distributed by email to members of the Korean Pancreatobiliary Association from December 2019 to February 2020.
Results: In total, 115 (110 gastroenterologists, five surgeons) completed the survey, 72.2% of whom worked in a tertiary/ academic medical center. Most (65.2%) followed the 2012/2017 International Association of Pancreatology guidelines for the management of pancreatic cystic neoplasms. A gadolinium-enhanced magnetic resonance imaging/magnetic resonance cholangiopancreatography was the most common first-line diagnostic modality (42.1%), but a contrast-enhanced computed tomography scan was preferred as a subsequent surveillance tool (58.3%). Seventy-four percent of respondents routinely performed endoscopic ultrasound-guided fine needle aspiration for pancreatic cystic neoplasms with suspicious mural nodules. Endoscopic ultrasound-guided fine needle aspiration cytology (94.8%) and cystic fluid carcinoembryonic antigen (95.7%) were used for cystic fluid analysis. Most (94%) typically recommended surgery in patients with high-risk stigmata, but 18.3% also considered proceeding with surgery in patients with worrisome features. Most (96.5%) would continue surveillance of pancreatic cystic neoplasms for more than 5 years.
Conclusions: According to this survey, there was variability in the management of pancreatic cystic neoplasms among the respondents. These results suggest that the development of evidence-based guidelines for pancreatic cystic neoplasms that fit the Korean practice is needed to create an optimal approach to the management of pancreatic cystic neoplasms.

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9Seroprevalence of viral infectious diseases and associated factors in Korean patients with inflammatory bowel diseases

저자 : Hee Seung Hong , Jiwon Jung , Sang Hyoung Park , Hwa Jung Kim , Sung Wook Hwang , Dong-hoon Yang , Jeong-sik Byeon , Seung-jae Myung , Suk-kyun Yang , Byong Duk Ye

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 73-87 (15 pages)

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Background/Aims: Data on the immunoprotective status against measles, mumps, rubella, varicella zoster virus (VZV), hepatitis A virus (HAV), and Epstein-Barr virus (EBV) infection in patients with inflammatory bowel disease (IBD) are still lacking. Therefore, we investigated the seropositivity rates for viral infectious diseases and the associated factors in Korean patients with IBD.
Methods: In this retrospective cohort study, serum immunoglobulin G antibody positivity rates against measles virus, mumps virus, rubella virus, VZV, HAV, and EBV viral capsid antigen (VCA) were measured in patients with Crohn's disease or ulcerative colitis (UC) who first visited the IBD clinic. Seropositivity rates and their associated factors were analyzed.
Results: Between January 2016 and December 2018, 263 patients were enrolled (male, 167 [67.3%]; UC, 134 [50.9%]). The median age at serological test was 30 years (interquartile range, 22 to 46). The seropositivity rates were 84.0%, 85.2%, 66.5%, 87.4%, 50.0%, and 93.7% for measles, mumps, rubella, VZV, HAV, and EBV, respectively. Younger age at serological test was associated with seronegative status for measles (adjusted odds ratio [aOR], 0.92; 95% confidence interval [CI], 0.88 to 0.96), VZV (aOR, 0.83; 95% CI, 0.74 to 0.93), and HAV (aOR, 0.93; 95% CI, 0.91 to 0.95). Furthermore, IBD type-UC was associated with seronegative status against VZV (aOR, 0.33; 95% CI, 0.11 to 0.99).
Conclusions: Seropositivity rates for common viral infectious diseases in Korean patients with IBD were similar to those of the general population. In the younger age group, protective immunity against measles, VZV, and HAV is required, with proper vaccination, as necessary.

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10Extracellular vesicles derived from small intestinal lamina propria reduce antigen-specific immune response

저자 : Tae-seop Shin , Jae Yong Park , Yoon-keun Kim , Jae Gyu Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 85-97 (13 pages)

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Background/Aims: Extracellular vesicles (EVs) are secreted from various types of cells and have specific functions related to their origin. EVs are observed in the small intestinal lamina propria (lpEVs), but their function remains unclear. This study aimed to investigate the role of lpEVs.
Methods: LpEVs were isolated from antigen (ovalbumin [OVA])-fed mice (lpEVs/OVA), and administrated to the naïve mice for 5 days before induction of lung inflammation. Afterwards, the mice were sensitized and challenged with OVA to evaluate the role of lpEVs/OVA in the regulation of immune tolerance.
Results: The isolated lpEVs/OVA were sphere-shaped, bi-layered vesicles of approximately 50 to 100 nm in size. The vesicles expressed CD81, A33 antigen, and major histocompatibility complex (MHC) class II on the surface. When administrated to naïve mice, the lpEVs/OVA migrated to the spleen. Intraperitoneal lpEVs/OVA administration to naïve mice decreased the immune response against sensitized antigen in a CD4+FoxP3+T cell-dependent manner.
Conclusions: EVs are actively secreted from small intestinal epithelial cells to deliver information about orally administered antigens to immune cells, which will facilitate the modulation of the immune response by acting as an intercellular communicasome.

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1Strategies for successful implementation and permanent maintenance of a rapid response system

저자 : Myung Jin Song , Yeon Joo Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1031-1039 (9 pages)

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Rapid response systems (RRSs) have been introduced to intervene with patients experiencing non-code medical emergencies and operate widely around the world. An RRS has four components: an afferent limb, an efferent limb, quality improvement, and administration. A proper triggering system, a hospital culture that embraces the RRS from the afferent limb, experienced primary responders, and dedicated physicians from the efferent limb are key for successful implementation. After initial implementation, quality improvement through objective outcome measures and self-evaluation are crucial, which lead to a better outcome when this process is well performed. Furthermore, better outcomes lead to more investment, which is essential for effective development of the system. The RRS is successfully maintained when these four components are closely interconnected.

KCI등재SCOUPUS

2Improving the care of inflammatory bowel disease (IBD) patients: perspectives and strategies for IBD center management

저자 : Jihye Park , Sinyoung Park , Shin Ae Lee , Soo Jung Park , Jae Hee Cheon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1040-1048 (9 pages)

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The incidence and prevalence rates of inflammatory bowel disease (IBD) have been increasing in East Asian countries over the past few decades. Accordingly, the general understanding and awareness of IBD among healthcare professionals has increased considerably in this region. This increase is ultimately associated with the evolving focus of IBD clinicians devoted to comprehensive patient care, especially in establishing IBD clinics/centers capable of providing multi-disciplinary counseling. Comprehensive IBD care at IBD clinics/centers usually includes surgical and medication decision-making, transition from pediatric to adult clinics, care of extraintestinal manifestations, care of infectious diseases in patients undergoing immunomodulatory or biologic therapies, and nutritional, psychosocial, socioeconomic, and pharmacological care. Team members com-prise specialists from various departments related to IBD and can be divided into core and ad hoc members. Usually, the scope of work in IBD clinics/centers involves patient care, patient outreach, and system management. Considering the environmental changes in IBD treatment, it is necessary to perform comprehensive IBD patient care in the form of a program based on competencies, rather than simply following the organization of previous IBD centers. The present review summarizes recent trends in IBD patient care and offers perspectives regarding IBD center management.

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3Young-onset type 2 diabetes in South Korea: a review of the current status and unmet need

저자 : Ye Seul Yang , Kyungdo Han , Tae Seo Sohn , Nam Hoon Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1049-1058 (10 pages)

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The prevalence of young-onset (diagnosis at age < 40 years) type 2 diabetes mellitus (T2DM) is increasing globally. Young-onset T2DM has a common pathophysiology of glucose dysregulation as in late-onset T2DM. However, it presents a greater association with obesity and a more rapid decline in β-cell function than late-onset T2DM. Accumulating evidence indicates that disease progression in young-onset T2DM is rapid, resulting in early and frequent development of microvascular and macrovascular complications, as well as premature death. Improper management and low adherence to medical therapy are important issues in young-onset T2DM. This review discusses the epidemiology, disease entity, and clinical issues associated with young-onset T2DM. We also present the prevalence and clinical characteristics of patients with young-onset T2DM in South Korea.

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4Development of a Korean-specific cardiovascular risk model in a cohort at high-risk of hypertension

저자 : Il Suk Sohn

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1059-1060 (2 pages)

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5Nosocomial exposure to tuberculosis: a snapshot of South Korea

저자 : Hayoung Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1061-1062 (2 pages)

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6Second-look endoscopy findings after endoscopic submucosal dissection for colorectal epithelial neoplasms

저자 : Soo-kyung Park , Hyeon Jeong Goong , Bong Min Ko , Haewon Kim , Hyo Sun Seok , Moon Sung Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1063-1074 (12 pages)

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Background/Aims: Although second-look endoscopy (SLE) is frequently performed after gastric endoscopic submucosal dissection (ESD) to prevent bleeding, no studies have reported SLE findings after colorectal ESD. This study aimed to investigate SLE findings and their role in preventing delayed bleeding after colorectal ESD.
Methods: Post-ESD ulcer appearances were divided into coagulation (with or without remnant minor vessels) and clip closure groups. SLE findings were categorized according to the Forrest classification (high-risk ulcer stigma [type I and IIa] and low-risk ulcer stigma [type IIb, IIc, III, or clip closure]), and risk factors for high-risk ulcer stigma were analyzed.
Results: Among the 375 cases investigated, SLEs were performed in 171 (45.6%) patients. The incidences of high-risk ulcer stigma and low-risk stigma were 5.3% (9/171) and 94.7% (162/171), respectively. During SLE, endoscopic hemostasis was performed more frequently in the high-risk ulcer stigma group than in the low- risk ulcer stigma group (44.4% [4/9] vs. 1.9% [3/162], respectively; p < 0.001), but most of the endoscopic hemostasis in the high-risk ulcer stigma group (3/4, 75.0%) were prophylactic hemostasis. Post-ESD delayed bleeding occurred in three (0.8%) patients belonging to the SLE group, of which, one patient was from the high-risk stigma group and two were from the low-risk stigma group.
Conclusions: The incidence of high-risk ulcer stigma during SLE was low, and delayed bleeding occurred in, both, high-risk and low-risk groups of SLE. SLEs performed after colorectal ESD may not be effective in preventing delayed bleeding, and further prospective studies are needed to evaluate the efficacy of SLE in post-colorectal ESD.

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7Risk stratification of patients with gastric lesions indefinite for dysplasia

저자 : Young Sin Cho , Il-kwun Chung , Yunho Jung , Su Jung Han , Jae Kook Yang , Tae Hoon Lee , Sang-heum Park , Sun-joo Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1074-1082 (9 pages)

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Background/Aims: There are no definite guidelines for the management of gastric lesions diagnosed as indefinite for dysplasia (IND) by endoscopic forceps biopsy (EFB). Therefore, this study aimed to evaluate the clinical outcomes of gastric IND and predictive factors for gastric neoplasm.
Methods: This study included 457 patients with a first diagnosis of gastric IND by EFB between January 2005 and December 2013. Patient characteristics and endoscopic and pathological data were reviewed and compared.
Results: Of the 457 gastric IND patients, 128 (28%) were diagnosed with invasive carcinoma, 21 (4.6%) with high-grade dysplasia, 31 (6.8%) with low-grade dysplasia, and 277 (60.6%) as negative for dysplasia. Of lesions observed, 180 (39.4%) showed upgraded histology. Multivariate analysis revealed that surface erythema (odds ratio [OR], 2.804; 95% confidence interval [CI], 1.741 to 4.516), spontaneous bleeding (OR, 2.618; 95% CI, 1.298 to 5.279), lesion size ≥ 1 cm (OR, 5.762; 95% CI, 3.459 to 9.597), and depressed morphology (OR, 2.183; 95% CI, 1.155 to 4.124) were significant risk factors for high-grade dysplasia or adenocarcinoma. The ORs associated with 2 and ≥ 3 risk factors were 7.131 and 34.86, respectively.
Conclusions: Precautions should be taken in the management of gastric IND patients, especially when risk factors, including surface erythema, spontaneous bleeding, lesion size ≥ 1 cm, and depressed morphology are present. Considering the combined effect of the presence of multiple risk factors on the incidence of high-grade dysplasia or adenocarcinoma, endoscopic resection should be recommended if a gastric IND patient has at two or more of these factors.

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8Risk of colorectal cancer in patients with positive results of fecal immunochemical test performed within 5 years since the last colonoscopy

저자 : Yoon Suk Jung , Jinhee Lee , Chang Mo Moon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1083-1091 (9 pages)

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Background/Aims: Annual fecal immunochemical tests (FITs) are often repeated within the recommended colonoscopy surveillance intervals. However, it remains unclear whether interval FITs are useful. To answer this question, we assessed the risk of colorectal cancer (CRC) according to the interval from the last colonoscopy to an FIT.
Methods: Using the Korean National Cancer Screening Program database, we collected data on patients who underwent FITs in 2011. Patients with positive FIT results were classified into three groups according to their previous colonoscopy interval: 0.5 to 5 years (group 1), 5 to 10 years (group 2), and ≥ 10 years or no colonoscopy (group 3). CRC incidence was defined as CRC diagnosed within 1 year after an FIT.
Results: Among 177,660 patients with positive FIT results, the incidence of CRC in groups 1, 2, and 3 was 0.72% (n = 214/29,575), 1.28% (n = 116/9,083), and 3.88% (n = 5,387/139,002), respectively. The age- and sex-adjusted risk for CRC was higher in groups 2 (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.43 to 2.25) and 3 (OR, 5.56; 95% CI, 4.85 to 6.38) than in group 1. Among patients who did and did not undergo a polypectomy during the previous colonoscopy, those in group 2 had a higher rate of CRC than those in group 1 (without polypectomy: 1.15% vs. 0.63%; OR, 1.79; 95% CI, 1.37 to 2.34) (with polypectomy: 2.37% vs. 0.93 %; OR, 2.30; 95% CI, 1.44 to 3.69).
Conclusion: In patients with positive FIT results who had undergone a colonoscopy within the past 5 years, the risk of CRC is very low, regardless of whether a polypectomy was performed, suggesting that interval FITs are not useful.

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9Impact of liver cirrhosis on the clinical outcomes of patients with COVID-19: a nationwide cohort study of Korea

저자 : Dongsub Jeon , Minkook Son , Jonggi Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1092-1104 (13 pages)

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Background/Aims: The impact of liver cirrhosis (LC) on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) remains elusive. This study evaluated the association between LC and the development of severe complications from COVID-19.
Methods: We used the National Health Insurance claims data of Korea. We included 234,427 patients older than 19 years who tested for severe acute respiratory syndrome coronavirus 2. Patients with LC who were infected with COVID-19 (n = 67, LC+ COVID+) were matched with those with cirrhosis only (n = 332, LC+ COVID-) and those with COVID-19 only (n = 333, LC- COVID+) using a propensity score in a 1:5 ratio. The primary outcome was the development of severe complications.
Results: Of the matched patients, the mean age was 60 years and 59.7% were male. Severe complications occurred in 18, 54, and 60 patients in the LC+ COVID+, LC+ COVID-, and LC- COVID+ groups, respectively. After adjusting for comorbidities, there was no significant difference in the risk of developing severe complications from COVID-19 between the LC+ COVID+ and LC- COVID+ groups but significant difference exists between the LC+ COVID+ and LC+ COVID-. Older age, hypertension, cancer, chronic obstructive pulmonary disease, and a higher Charlson comorbidity index were associated with a higher risk of severe complications in patients with cirrhosis and COVID-19.
Conclusions: Our study suggests that LC was not independently associated with the development of severe complications, including mortality, in patients with COVID-19. Our results need to be evaluated through a large, prospective study.

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10Clinical features and predictors of masked uncon-trolled hypertension from the Korean Ambulatory Blood Pressure Monitoring Registry

저자 : Hyun-jin Kim , Jeong-hun Shin , Yonggu Lee , Ju Han Kim , Sun Ho Hwang , Woo Shik Kim , Sungha Park , Sang Jae Rhee , Eun Mi Lee , Sang Hyun Ihm , Wook Bum Pyun , Jinho Shin

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1102-1119 (18 pages)

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Background/Aims: The clinical characteristics of patients with masked uncontrolled hypertension (MUCH) have been poorly defined, and few studies have investigated the clinical predictors of MUCH. We investigated the demographic, clinical, and blood pressure (BP) characteristics of patients with MUCH and pro-posed a prediction model for MUCH in patients with hypertension.
Methods: We analyzed 1,986 subjects who were enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) Registry and taking antihypertensive drugs, and classified them into the controlled hypertension (n = 465) and MUCH (n = 389) groups. MUCH was defined as the presence of a 24-hour ambulatory mean systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg in patients treated with antihypertensive drugs, having normal office BP.
Results: Patients in the MUCH group had significantly worse metabolic profiles and higher office BP, and took significantly fewer antihypertensive drugs com-pared to those in the controlled hypertension group. Multivariate logistic regression analyses identified high office systolic BP and diastolic BP, prior stroke, dyslipidemia, left ventricular hypertrophy (LVH, ≥ 116 g/㎡ for men, and ≥ 96 g/㎡ for women), high heart rate (≥ 75 beats/min), and single antihypertensive drug use as independent predictors of MUCH. A prediction model using these predictors showed a high diagnostic accuracy (C-index of 0.839) and goodness-of-fit for the presence of MUCH.
Conclusions: MUCH is associated with a high-normal increase in office BP and underuse of antihypertensive drugs, as well as dyslipidemia, prior stroke, and LVH, which could underscore achieving optimal BP control. The proposed model accurately predicts MUCH in patients with controlled office BP.

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