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대한내과학회> The Korean Journal of Internal Medicine> Omics-based biomarkers for diagnosis and prediction of kidney allograft rejection

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Omics-based biomarkers for diagnosis and prediction of kidney allograft rejection

Jeong-hoon Lim , Byung Ha Chung , Sang-ho Lee , Hee-yeon Jung , Ji-young Choi , Jang-hee Cho , Sun-hee Park , Yong-lim Kim , Chan-duck Kim
  • : 대한내과학회
  • : The Korean Journal of Internal Medicine 37권3호
  • : 연속간행물
  • : 2022년 05월
  • : 520-533(14pages)
The Korean Journal of Internal Medicine

DOI


목차

INTRODUCTION
OMICS TECHNOLOGIES
OMICS-BASED BIOMARKERS FOR ALLOGRAFT REJECTION IN KIDNEY TRANSPLANT RECIPIENTS
CONCLUSIONS
Conflict of interest
Acknowledgments
REFERENCES

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Kidney transplantation is the preferred treatment for patients with end-stage kidney disease, because it prolongs survival and improves quality of life. Allograft biopsy is the gold standard for diagnosing allograft rejection. However, it is invasive and reactive, and continuous monitoring is unrealistic. Various biomarkers for diagnosing allograft rejection have been developed over the last two decades based on omics technologies to overcome these limitations. Omics technologies are based on a holistic view of the molecules that constitute an individual. They include genomics, transcriptomics, proteomics, and metabolomics. The omics approach has dramatically accelerated biomarker discovery and enhanced our understanding of multifactorial biological processes in the field of transplantation. However, clinical application of omics-based biomarkers is limited by several issues. First, no large-scale prospective randomized controlled trial has been conducted to compare omics-based biomarkers with traditional biomarkers for rejection. Second, given the variety and complexity of injuries that a kidney allograft may experience, it is likely that no single omics approach will suffice to predict rejection or outcome. Therefore, integrated methods using multiomics technologies are needed. Herein, we introduce omics technologies and review the latest literature on omics biomarkers predictive of allograft rejection in kidney transplant recipients.

UCI(KEPA)

간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCOPUS
  • : 격월
  • : 1226-3303
  • : 2005-6648
  • : 학술지
  • : 연속간행물
  • : 1986-2022
  • : 2772


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1Musculoskeletal complications in patients with diabetes mellitus

저자 : Jong Han Choi , Hae-rim Kim , Kee-ho Song

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 6호 발행 연도 : 2022 페이지 : pp. 1099-1110 (12 pages)

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Musculoskeletal conditions are common in patients with diabetes. Several musculoskeletal disorders are viewed as chronic complications of diabetes because epidemiological studies have revealed high correlations between such complications and diabetes, but the pathophysiological links with diabetes remains unclear. Genetic predispositions, shared risk factors, microvascular impairments, progressive accumulation of advanced glycation end-products, and diabetic neuropathy may underlie the development of musculoskeletal disorders. Musculoskeletal complications of diabetics have received less attention than life-threatening microvascular or macrovascular complications. Here, we review several diabetic musculoskeletal complications with a focus on the clinical importance of early recognition and management, which would improve quality of life and physical function.

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2Minimizing radiation exposure in endoscopic retrograde cholangiopancreatography: a review for medical personnel

저자 : Chi Hyuk Oh , Byoung Kwan Son

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 6호 발행 연도 : 2022 페이지 : pp. 1111-1119 (9 pages)

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Fluoroscopy is used frequently during endoscopic procedures, such as endoscopic retrograde cholangiopancreatography (ERCP). However, exposure to radiation is an important health concern, primarily because of the potential increase in the lifetime risk of malignancy. This consideration is important for patients and staff exposed to radiation during ERCP. Thus, an understanding of how radiation doses are measured during ERCP and the potential risks of this radiation is important. Additionally, staff must be educated about methods used to minimize the radiation dose, such as the use of different imaging techniques, the general principles of fluoroscopy, and advances in hardware and software. The use of personal protective equipment is also essential to minimize occupational exposure. However, no comprehensive ERCP guideline on the use of X-ray systems in clinical settings or on radiation protection for operators has been established. This review focuses on the properties of fluoroscopy systems and methods of radiation protection for physicians and assistants participating in ERCP.

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3Korean Society of Nephrology 2022 recommendations on controversial issues in diagnosis and management of hyponatremia

저자 : Yeonhee Lee , Kyung Don Yoo , Seon Ha Baek , Yang Gyun Kim , Hyo Jin Kim , Ji Young Ryu , Jin Hyuk Paek , Sang Heon Suh , Se Won Oh , Jeonghwan Lee , Jong Hyun Jhee , Jin-soon Suh , Eun Mi Yang , Young

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 6호 발행 연도 : 2022 페이지 : pp. 1120-1137 (18 pages)

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The Korean Society for Electrolyte and Blood Pressure Research, in collaboration with the Korean Society of Nephrology, has published a clinical practice guideline (CPG) document for hyponatremia treatment. The document is based on an extensive evidence-based review of the diagnosis, evaluation, and treatment of hyponatremia with the multidisciplinary participation of representative experts in hyponatremia with methodologist support for guideline development. This CPG consists of 12 recommendations (two for diagnosis, eight for treatment, and two for special situations) based on eight detailed topics and nine key questions. Each recommendation begins with statements graded by the strength of the recommendations and the quality of the evidence. Each statement is followed by rationale supporting the recommendations. The committee issued conditional recommendations in favor of rapid intermittent bolus administration of hypertonic saline in severe hyponatremia, the use of vasopressin receptor antagonists in heart failure with hypervolemic hyponatremia, and syndrome of inappropriate antidiuresis with moderate to severe hyponatremia, the individualization of desmopressin use, and strong recommendation on the administration of isotonic fluids as maintenance fluid therapy in hospitalized pediatric patients. We hope that this CPG will provide useful recommendations in practice, with the aim of providing clinical support for shared decision-making to improve patient outcomes.

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4Seeking a better risk-prediction model for upper gastrointestinal bleeding

저자 : Sun Gyo Lim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 6호 발행 연도 : 2022 페이지 : pp. 1138-1139 (2 pages)

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5Oral beclomethasone dipropionate as an add-on therapy and response prediction in Korean patients with ulcerative colitis

저자 : Kyuwon Kim , Hee Seung Hong , Kyunghwan Oh , Jae Yong Lee , Seung Wook Hong , Jin Hwa Park , Sung Wook Hwang , Dong-hoon Yang , Jeong-sik Byeon , Seung-jae Myung , Suk-kyun Yang , Byong Duk Ye , Sang Hyoung

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 6호 발행 연도 : 2022 페이지 : pp. 1140-1154 (15 pages)

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Background/Aims: We aimed to investigate the oral beclomethasone dipropionate's (BDP) efficacy as an add-on therapy and to clarify the predictive factor for response to oral BDP in Korean ulcerative colitis (UC) patients.
Methods: Patients with a stable concomitant drug regimen with exposure to oral BDP (5 mg/day) within 30 days before BDP initiation were included. Partial Mayo score (pMS) was used to evaluate response to oral BDP. Clinical remission (CREM) was defined as a post-treatment pMS ≤ 1 point. Clinical response (CRES) was defined as an at least 2-point decrease in post-treatment pMS and an at least 30% decrease from baseline pMS. Patients without CREM or CRES were considered nonresponders (NRs).
Results: Of all, 37 showed CREM, 19 showed CRES, and 44 were NRs. The CREM group included more patients with mild disease activity (75.7% vs. 43.2%, p = 0.011) than NRs. In contrast to NRs, CREM and CRES patients showed significant improvement of post-treatment erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (ESR with p = 0.001, CRP with p = 0.004, respectively). Moreover, the initial rectal bleeding subscore (RBS) was significantly different between CREM and CRES, or NR (both with p < 0.001). In multivariate analyses, initial stool frequency subscore (SFS) of 0 and RBS of 0 were predictive factors for CREM (odds ratio [OR], 15.359; 95% confidence interval [CI], 1.085 to 217.499; p = 0.043 for SFS, and OR, 11.434; 95% CI, 1.682 to 77.710; p = 0.013 for RBS).
Conclusions: Oral BDP is an efficacious add-on therapy in Korean UC patients. Patients with initial SFS or RBS of 0 may be particularly good candidates for oral BDP.

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6The effect of rebamipide on non-steroidal antiinflammatory drug-induced gastro-enteropathy: a multi-center, randomized pilot study

저자 : Dong Jun Oh , Hyuk Yoon , Hyun Soo Kim , Yoon Jin Choi , Cheol Min Shin , Young Soo Park , Nayoung Kim , Dong Ho Lee , You-jung Ha , Eun Ha Kang , Yun Jong Lee , Nayoung Kim , Ki-jeoung Kim , Fei Liu

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 6호 발행 연도 : 2022 페이지 : pp. 1153-1166 (14 pages)

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Background/Aims: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly-used medications, and ailments such as arthritis or heart disease, require long-term use of these drugs, which can induce gastroenteropathy with bleeding and ulcers. This study investigated the associations between efficacy, safety, and gastrointestinal symptoms linked to rebamipide and proton pump inhibitor administration in patients requiring long-term NSAID use.
Methods: This study was a multi-center, randomized, open-labeled, pilot design.
Results: Thirty-three patients were included. Of these, 15 were included in the study group and 18 were in the control group. NSAID-induced gastric ulcers, which were the primary outcome of this study, did not occur in either the study or control group. Changes in the number of small bowel erosions and ulcers were -0.6 ± 3.06 in the study group and 1.33 ± 4.71 in the control group. The number of subjects with mucosal breaks (defined as multiple erosions and/or ulcers) was three (20%) in the study group and six (40%) in the control group (p = 0.427). No serious adverse events occurred in either group. However, dyspepsia and skin rashes occurred in six patients (31.58%) in the study group and 13 (65%) in the control group (p = 0.036).
Conclusions: Although statistically significant differences were not generated, possibly as a result of the small sample size, mucosal breaks observed via capsule endoscopy revealed that rebamipide was likely to be more effective than lansoprazole in preventing small intestine damage caused by NSAIDs. Furthermore, fewer side-effects emerged with rebamipide.

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7Real-life experience of ledipasvir and sofosbuvir for HCV infected Korean patients: a multicenter cohort study

저자 : Soon Kyu Lee , Sung Won Lee , Hae Lim Lee , Hee Yeon Kim , Chang Wook Kim , Do Seon Song , U Im Chang , Jin Mo Yang , Sun Hong Yoo , Jung Hyun Kwon , Soon Woo Nam , Seok-hwan Kim , Myeong Jun Song , Jae

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 6호 발행 연도 : 2022 페이지 : pp. 1167-1176 (10 pages)

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Background/Aims: To evaluate the efficacy and safety of ledipasvir/sofosbuvir (LDV/SOF) therapy in hepatitis C virus (HCV)-infected Korean patients in a real clinical setting.
Methods: A total of 273 patients who received LDV/SOF therapy between May 2016 and February 2021 were consecutively enrolled and analyzed. A per-protocol analysis was performed to evaluate the virologic response.
Results: Seventy-five percent were infected with genotype 1, and 25% were infected with genotype 2. A hundred eightyone (66.3%) patients had chronic hepatitis, 74 (27.1%) had compensated cirrhosis, eight (2.9%) had decompensated cirrhosis, and 10 (3.7%) had undergone liver transplantation. Undetectable HCV RNA at week 4 was achieved in 90.2% (231/256) of patients, 99.2% (250/252) achieved the end of treatment response, and 98.1% (202/206) achieved sustained virologic response at 12 weeks post-treatment (SVR12). According to liver function, the SVR12 rates were 99.3% (135/136) in chronic hepatitis, 96.4% (53/55) in compensated cirrhosis, and 100% (6/6) in decompensated cirrhosis. The SVR12 rates according to the genotype were 98.2% (167/170) for genotype 1 and 97.2% (35/36) for genotype 2. An 8-week LDV/SOF treatment in treatment-naive chronic hepatitis patients with HCV RNA < 6,000,000 IU/mL at baseline resulted in 100% (23/23) SVR12 rates. Overall, LDV/SOF was tolerated well, with a 0.7% (2/273) discontinuation rate due to adverse events that were unrelated to LDV/SOF.
Conclusions: LDV/SOF is effective and safe for treating HCV-infected Korean patients with high SVR12 rates.

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8Clinical outcomes of acute upper gastrointestinal bleeding according to the risk indicated by Glasgow-Blatchford risk score-computed tomography score in the emergency room

저자 : Hyun Ae Lee , Hye-kyung Jung , Tae Oh Kim , Ju-ran Byeon , Eui-sun Jeong , Hyun-ji Cho , Chung Hyun Tae , Chang Mo Moon , Seong-eun Kim , Ki-nam Shim , Sung-ae Jung

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 6호 발행 연도 : 2022 페이지 : pp. 1176-1185 (10 pages)

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Background/Aims: Acute upper gastrointestinal (UGI) bleeding is a significant emergency situation with a mortality rate of 2% to 10%. Therefore, initial risk stratification is important for proper management. We aimed to evaluate the role of contrast- enhanced multidetector computed tomography (MDCT) for risk stratification in patients with acute UGI bleeding in the emergency room (ER).
Methods: This retrospective study included patients with UGI bleeding in the ER. Glasgow-Blatchford risk score-computed tomography (GBS-CT) was assessed using a combination of GBS and the MDCT scan scoring system.
Results: Of the 297 patients with UGI bleeding, 124 (41.8%) underwent abdominal MDCT. Among them, 90.3% were classified as high-risk by GBS, and five patients died (4.0%). Rebleeding occurred in nine patients (7.3%). The high-risk GBS-CT group had significantly higher in-hospital mortality (10.5% in high-risk vs. 1.4% in moderate risk vs. 0% in low-risk, p = 0.049), transfusion amount (p < 0.001), and endoscopic hemostasis (p < 0.001) compared to the moderate- and low-risk groups.
Conclusions: Adding MDCT scans to the existing validated prognosis model when predicting the risk of UGI bleeding in patients in the ER plays a significant role in determining in-hospital mortality, transfusions, and the need for endoscopic hemostasis.

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9Neuromuscular blocking agents and opioids are major risk factors for developing pressure injuries in patients in the intensive care unit

저자 : Su Yeon Lee , Dong Kyu Oh , Sang-bum Hong , Chae-man Lim , Jin Won Huh

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 6호 발행 연도 : 2022 페이지 : pp. 1186-1197 (12 pages)

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Background/Aims: Patients in the intensive care unit (ICU) are at high risk for developing pressure injuries, which can cause severe complications and even increase the mortality risk. Therefore, prevention of pressure injuries is most important. In this study, we investigated the risk factors of pressure injury development in patients admitted to the ICU.
Methods: We retrospectively analyzed patients ages > 18 years admitted to the medical ICU in a tertiary hospital between January and December 2019. We collected patient baseline characteristics, medications received, mechanical ventilation or hemodialysis use, laboratory findings, and date of pressure injury onset and characteristics.
Results: We analyzed 666 patients who did not have pressure injuries at ICU admission. Pressure injuries developed in 102 patients (15%). The risk of pressure injury development increased as the administration days for neuromuscular blocking agents (NMBAs; odds ratio [OR], 1.138; p = 0.019) and opioids (OR, 1.084; p = 0.028) increased, and if the patient had problem with friction and shear (OR, 2.203; p = 0.011).
Conclusions: The prolonged use of NMBAs and opioids can increase the risk of pressure injury development. Because these medications are associated with immobilization, using both should be minimized and patient early mobilization should be promoted. Among the Braden subscales, “friction and shear” was associated with the development of pressure injuries in ICU patients.

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10The efficacy and safety of DW1601 in patients with acute bronchitis: a multi-center, randomized, double-blind, phase III clinical trial

저자 : Young Seok Lee , Seong Yong Lim , Kyung Hoon Min , Do Jin Kim , Kwang Ha Yoo , Tae-bum Kim , Hak-ryul Kim , Jae Jeong Shim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 6호 발행 연도 : 2022 페이지 : pp. 1195-1209 (15 pages)

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Background/Aims: DW1601, an oral fixed dose combination syrup composed of DW16011 and Pelargonium sidoides, was developed to enhance the symptom relief effect in patients with acute bronchitis. We evaluated the efficacy and safety of DW1601 compared to DW16011 or P. sidoides for treatment of acute bronchitis using a randomized, double-blind, placebocontrolled, multi-centre trial design.
Methods: A total of 204 patients with acute bronchitis was randomized 1:1:1 to receive DW1601 (n = 67), DW16011 (n = 70), or P. sidoides (n = 64) for 7 days. The primary outcome was efficacy of DW1601 compared to DW16011 or P. sidoides in reducing the total bronchitis severity score (BSS) at day 4 of treatment. Secondary endpoints were changes in total and symptomspecific BSS, response rate and patient satisfaction rate. Safety analysis was assessed at day 7.
Results: At 4 days after medication, decrease of total BSS from baseline was significantly greater in the DW1601 group than in the DW16011 group (-3.51 ± 0.18 vs. -2.65 ± 0.18, p = 0.001) or P. sidoides group (-3.56 ± 0.18 vs. -2.64 ± 0.19, p < 0.001). In addition, the BSS total score at day 7 and the BSS cough and sputum component scores at days 4 and 7 were significantly more improved with DW1601 treatment compared with the DW16011 group or P. sidoides group. Participants treated with DW1601 showed higher rates of response and satisfaction than control groups (response rate, DW1601, 100% vs. DW16011, 85.7% vs. P. sidoides, 85.9%; satisfaction rate, DW1601, 92.6% vs. DW16011, 82.9% vs. P. sidoides, 81.2%). Significant adverse events were not observed in the DW1601 group.
Conclusions: DW1601 is superior to DW16011 or P. sidoides in improving symptoms of acute bronchitis.

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1Emotional and cognitive changes in chronic kidney disease

저자 : Duk-soo Kim , Seong-wook Kim , Hyo-wook Gil

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 489-501 (13 pages)

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Chronic kidney disease (CKD) leads to cognitive impairment and emotional changes. However, the precise mechanism underlying the crosstalk between the kidneys and the nervous system is not fully understood. Inflammation and cerebrovascular disease can influence the development of depression in CKD. CKD is one of the strongest risk factors for cognitive impairment. Moreover, cognitive impairment occurs in CKD as patients experience the dysregulation of several brain functional domains due to damage caused to multiple cortical regions and to subcortical modulatory neurons. The differences in structural brain changes between CKD and non-CKD dementia may be attributable to the different mechanisms that occur in CKD. The kidney and brain have similar anatomical vascular systems, which may be susceptible to traditional risk factors. Vascular factors are assumed to be involved in the development of cognitive impairment in patients with CKD. Vascular injury induces white matter lesions, silent infarction, and microbleeds. Uremic toxins may also be directly related to cognitive impairment in CKD. Many uremic toxins, such as indoxyl sulfate, are likely to have an impact on the central nervous system. Further studies are required to identify therapeutic targets to prevent changes in the brain in patients with CKD.

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2Glomerular filtration rate as a kidney outcome of diabetic kidney disease: a focus on new antidiabetic drugs

저자 : Hyo Jin Kim , Sang Soo Kim , Sang Heon Song

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 502-519 (18 pages)

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Diabetes has reached epidemic proportions, both in Korea and worldwide and is associated with an increased risk of chronic kidney disease and kidney failure (KF). The natural course of kidney function among people with diabetes (especially type 2 diabetes) may be complex in real-world situations. Strong evidence from observational data and clinical trials has demonstrated a consistent association between decreased estimated glomerular filtration rate (eGFR) and subsequent development of hard renal endpoints (such as KF or renal death). The disadvantage of hard renal endpoints is that they require a long follow-up duration. In addition, there are many patients with diabetes whose renal function declines without the appearance of albuminuria, measurement of the eGFR is emphasized. Many studies have used GFR-related parameters, such as its change, decline, or slope, as clinical endpoints for kidney disease progression. In this respect, understanding the trends in GFR changes could be crucial for developing clinical management strategies for the prevention of diabetic complications. This review focuses on the clinical implication of the eGFR-related parameters that have been used so far in diabetic kidney disease. We also discuss the use of recently developed new antidiabetic drugs for kidney protection, with a focus on the GFR as clinical endpoints.

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3Omics-based biomarkers for diagnosis and prediction of kidney allograft rejection

저자 : Jeong-hoon Lim , Byung Ha Chung , Sang-ho Lee , Hee-yeon Jung , Ji-young Choi , Jang-hee Cho , Sun-hee Park , Yong-lim Kim , Chan-duck Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 520-533 (14 pages)

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Kidney transplantation is the preferred treatment for patients with end-stage kidney disease, because it prolongs survival and improves quality of life. Allograft biopsy is the gold standard for diagnosing allograft rejection. However, it is invasive and reactive, and continuous monitoring is unrealistic. Various biomarkers for diagnosing allograft rejection have been developed over the last two decades based on omics technologies to overcome these limitations. Omics technologies are based on a holistic view of the molecules that constitute an individual. They include genomics, transcriptomics, proteomics, and metabolomics. The omics approach has dramatically accelerated biomarker discovery and enhanced our understanding of multifactorial biological processes in the field of transplantation. However, clinical application of omics-based biomarkers is limited by several issues. First, no large-scale prospective randomized controlled trial has been conducted to compare omics-based biomarkers with traditional biomarkers for rejection. Second, given the variety and complexity of injuries that a kidney allograft may experience, it is likely that no single omics approach will suffice to predict rejection or outcome. Therefore, integrated methods using multiomics technologies are needed. Herein, we introduce omics technologies and review the latest literature on omics biomarkers predictive of allograft rejection in kidney transplant recipients.

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4Role of T cells in ischemic acute kidney injury and repair

저자 : Kyungho Lee , Hye Ryoun Jang

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 534-550 (17 pages)

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Ischemic acute kidney injury (AKI) is a common medical problem with significant mortality and morbidity, affecting a large number of patients globally. Ischemic AKI is associated with intrarenal inflammation as well as systemic inflammation; thus, the innate and adaptive immune systems are implicated in the pathogenesis of ischemic AKI. Among various intrarenal immune cells, T cells play major roles in the injury process and in the repair mechanism affecting AKI to chronic kidney disease transition. Importantly, T cells also participate in distant organ crosstalk during AKI, which affects the overall outcomes. Therefore, targeting T cell-mediated pathways and T cell-based therapies have therapeutic promise for ischemic AKI. Here, we review the major populations of kidney T cells and their roles in ischemic AKI.

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5Changes in practice for mechanically ventilated patients: effect of the pain, agitation, and delirium guidelines

저자 : Jin Won Huh

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 553-554 (2 pages)

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6Safety of direct oral anticoagulants compared to warfarin in cirrhotic patients with atrial fibrillation

저자 : Seo Yeon Yoo , Eunju Kim , Gi-byoung Nam , Danbi Lee , Ju Hyun Shim , Kang Mo Kim , Young-suk Lim , Han Chu Lee , Young-hwa Chung , Yung Sang Lee , Jonggi Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 555-566 (12 pages)

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Background/Aims: The safety of direct oral anticoagulants (DOACs) compared with warfarin in patients with both nonvalvular atrial fibrillation (AF) and clinically confirmed liver cirrhosis (LC) has not been well studied. We compared the risk of a major bleeding event between DOAC and warfarin treatments in this patient population.
Methods: A total of 238 cirrhotic patients with AF were retrospectively analyzed. The major bleeding event risk was compared between DOAC- and warfarin-treated groups. The median follow-up duration was 5.6 years.
Results: Among the 238 study patients with LC and AF, 128 (53.8%) received DOACs and 110 (46.2%) received warfarin. The mean patient age was 68.8 years, and 78.2% were men. A major bleeding event occurred in 10 and 20 patients in the DOAC and warfarin groups, respectively, most commonly caused by gastrointestinal bleeding (70.0%). The cumulative risk of major bleeding did not differ between the groups by log-rank test (p = 0.12). This finding did not change when using 60 propensity score-matched pairs. A multivariable Cox regression model indicated that the concomitant use of antiplatelet agents (adjusted hazard ratio [aHR], 2.06; 95% confidence interval [CI], 1.00 to 4.30; p = 0.048) and presence of esophageal or gastric varices confirmed by endoscopic examination (aHR, 2.31; 95% CI, 1.03 to 5.17; p = 0.04) were associated with major bleeding in the entire cohort.
Conclusions: A major bleeding event risk is not increased by DOAC compared with warfarin treatment. Antiplatelet agent use and varices are independently associated with a higher risk of major bleeding during anticoagulation.

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7Is radiological healing alone enough? 'Can't take my eyes off' the mucosa

저자 : Su Hyun Park , Sang Hyoung Park

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 567-568 (2 pages)

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8Radiology plus ileocolonoscopy versus radiology alone in Crohn's disease: prognosis prediction and mutual agreement

저자 : Hye Kyung Hyun , Jongwook Yu , Eun Ae Kang , Jihye Park , Soo Jung Park , Jae Jun Park , Tae Il Kim , Won Ho Kim , Jae Hee Cheon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 567-579 (13 pages)

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Background/Aims: The optimal tools for monitoring Crohn's disease (CD) are controversial. We compared radiology plus ileocolonoscopy and radiology alone in terms of prognosis prediction and evaluated the agreement between radiologic and ileocolonoscopic findings in patients with CD.
Methods: Patients with CD who were followed up with computed tomography enterography (CTE) or magnetic resonance enterography (MRE) alone or CTE or MRE plus ileocolonoscopy were retrospectively recruited. Time to relapse was investigated to evaluate the difference in prognosis using the log-rank and Cox regression tests, and the agreement between radiologic and ileocolonoscopic findings was determined using a kappa value.
Results: A total of 501 patients with CD in clinical remission who underwent CTE or MRE and/or ileocolonoscopy were analyzed. Of these, 372 (74.3%) patients underwent CTE or MRE alone and 129 (25.7%) patients underwent CTE or MRE plus ileocolonoscopy. The cumulative maintenance rate of clinical remission between the two groups was not significantly different (p = 0.526, log-rank test). In multivariate analysis, age <40 years (hazard ratio [HR], 2.756; 95% confidence interval [CI], 1.263 to 6.013) and a history of steroid use (HR, 2.212; 95% CI, 1.258 to 3.577) were found to independently predict an increased risk for clinical relapse in patients with CD in clinical remission. Radiologic and ileocolonoscopic findings had a moderate degree of agreement (κ = 0.401, -0.094 to 0.142). The comparison of agreement between radiologic and ileocolonoscopic findings was the highest in the anastomotic site (κ = 0.749, -0.168 to 0.377).
Conclusions: Radiology plus ileocolonoscopy was not superior to radiology alone in predicting the prognosis of CD.

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9Long-term effect of the eradication of Helicobacter pylori on the hemoglobin A1c in type 2 diabetes or prediabetes patients

저자 : Won Seok Kim , Yonghoon Choi , Nayoung Kim , Seon Hee Lim , Gitark Noh , Ki Wook Kim , Jaehyung Park , Hyeongho Jo , Hyuk Yoon , Cheol Min Shin , Young Soo Park , Dong Ho Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 579-596 (18 pages)

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Background/Aims: The long-term effect of Helicobacter pylori eradication on the metabolic syndrome or diabetes are unclear. The aim of this study was to evaluate the effect of H. pylori eradication on glycemic control in type 2 diabetes mellitus (T2DM) or prediabetes mellitus (preDM).
Methods: A total of 124 asymptomatic subjects with T2DM or preDM were divided into H. pylori-negative (n = 40), H. pylori-positive with non-eradicated (n = 34), and eradicated (n = 50) groups. We measured H. pylori status (culture, histology, and rapid urease test) and glycated hemoglobin A1c (A1C) levels and followed-up at the 1st year and the 5th year of follow-up.
Results: The A1C levels significantly decreased in the eradicated group compared to the negative group and the non-eradicated groups (at the 1st year, p = 0.024; at the 5th year, p = 0.009). The A1C levels decreased in male, and/or subjects < 65 years of age in subgroup analyses (in male subjects, p = 0.047 and p = 0.020 at the 1st and the 5th year; in subjects < 65 years of age, p = 0.028 and p = 0.006 at the 1st and the 5th year; in male subjects < 65 years of age, p = 0.039 and p = 0.032 at the 1st and the 5th year). The eradication of H. pylori was related to the decrease in A1C values throughout the follow-up period, compared to the non-eradicated group (p = 0.017).
Conclusions: H. pylori eradication was related to the decreasing of A1C levels in patients with T2DM or preDM over a long-term follow-up period, especially in male and subjects < 65 years of age.

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10Off-hour presentation and outcomes for percutaneous coronary intervention in acute myocardial infarction with Killip Ⅲ-Ⅳ

저자 : Seok Oh , Ju Han Kim , Kyung Hoon Cho , Min Chul Kim , Doo Sun Sim , Young Joon Hong , Youngkeun Ahn , Myung Ho Jeong

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 591-610 (20 pages)

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Background/Aims: Acute myocardial infarction (AMI) is conventionally recognized as an urgent medical condition requiring timely and effective reperfusion therapy. However, the results of studies on the clinical outcomes in AMI according to hospital visit timings are inconclusive. To explore the difference in long-term outcomes between off- and on-hour percutaneous coronary interventions (PCI) in patients with AMI of Killip functional classification III-IV (Killip III-IV AMI).
Methods: Data on the characteristics and clinical outcomes of 1,751 patients with Killip III-IV AMI between November 2011 and June 2015 from the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry were analyzed. All participants were allocated into two groups: off-hour (weekdays from 6:00 PM to 8:00 AM, weekends, and legal holidays) and on-hour (weekdays from 8:00 AM to 6:00 PM) groups. The incidence of major adverse cardiac and cerebrovascular events, defined as a composite of all-cause mortality, nonfatal myocardial infarction, any revascularization, cerebrovascular accident, and stent thrombosis, was the primary endpoint.
Results: Among the 1,751 patients, 572 (39.1%) underwent PCI during on-hours and 892 (60.9%) during off-hours. At the 3-year follow-up, no significant difference was found in the clinical outcomes between the two groups in both the unadjusted and propensity-score weighing-adjusted analyses.
Conclusions: The outcomes of patients with Killip III-IV AMI admitted during off- and on-hours were similar.

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