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대한내과학회> The Korean Journal of Internal Medicine> Off-hour presentation and outcomes for percutaneous coronary intervention in acute myocardial infarction with Killip Ⅲ-Ⅳ

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

Seok Oh , Ju Han Kim , Kyung Hoon Cho , Min Chul Kim , Doo Sun Sim , Young Joon Hong , Youngkeun Ahn , Myung Ho Jeong
  • : 대한내과학회
  • : The Korean Journal of Internal Medicine 37권3호
  • : 연속간행물
  • : 2022년 05월
  • : 591-610(20pages)
The Korean Journal of Internal Medicine

DOI


목차

INTRODUCTION
METHODS
RESULTS
DISCUSSION
Conflict of interest
Acknowledgments
REFERENCES
Supplementary Table 1. Short-term clinical outcomes during index hospitalization, from 1,464 acute myocardial infarction patients with advanced Killip class III-IV treated by percutaneous coronary intervention procedure
Supplementary Table 2. Clinical outcomes during post-discharge 6-month follow-up, from 1,435 acute myocardial infarction survivors with advanced Killip class III-IV treated by percutaneous coronary intervention procedure
Supplementary Table 3. Baseline characteristics of the patients who did not receive PCI or coronary artery bypass graft, or received failed PCI
Supplementary Table 4. Baseline characteristics of the patients who did not receive PCI or coronary artery bypass graft, or received failed PCI
Supplementary Table 5. Baseline characteristics of 316 patients who were deceased during the index hospitalization
Supplementary Table 6. Detailed information about patients who received thrombolysis during the index hospitalization

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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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간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCOPUS
  • : 격월
  • : 1226-3303
  • : 2005-6648
  • : 학술지
  • : 연속간행물
  • : 1986-2022
  • : 2726


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1Executive summary of the Korean Society of Nephrology 2021 clinical practice guideline for optimal hemodialysis treatment

저자 : Ji Yong Jung , Kyung Don Yoo , Eunjeong Kang , Hee Gyung Kang , Su Hyun Kim , Hyoungnae Kim , Hyo Jin Kim , Tae-jin Park , Sang Heon Suh , Jong Cheol Jeong , Ji-young Choi , Young-hwan Hwang , Miyoung Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 701-718 (18 pages)

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The Korean Society of Nephrology (KSN) has published a clinical practice guideline (CPG) document for maintenance hemodialysis (HD). The document, 2021 Clinical Practice Guideline on Optimal HD Treatment, is based on an extensive evidence-oriented review of the benefits of preparation, initiation, and maintenance therapy for HD, with the participation of representative experts from the KSN under the methodologists' support for guideline development. It was intended to help clinicians participating in HD treatment make safer and more effective clinical decisions by providing user-friendly guidelines. We hope that this CPG will be meaningful as a recommendation in practice, but not on a regulatory rule basis, as different approaches and treatments may be used by health care providers depending on the individual patient's condition. This CPG consists of eight sections and 15 key questions. Each begins with statements that are graded by the strength of recommendations and quality of the evidence. Each statement is followed by a summary of the evidence supporting the recommendations. There are also a link to full-text documents and lists of the most important reports so that the readers can read further (most of this is available online).

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2Current state and prospects of gout treatment in Korea

저자 : Eun Hye Park , Sang Tae Choi , Jung Soo Song

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 719-731 (13 pages)

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Effective management of gout includes the following: appropriate control of gout flares; lifestyle modifications; management of comorbidities; and long-term urate-lowering therapy (ULT) to prevent subsequent gout flares, structural joint damage, and shortening of life expectancy. In addition to traditional treatments for gout, novel therapies have been introduced in recent years. Indeed, new recommendations for the management of gout have been proposed by various international societies. Although effective and safe medications to treat gout have been available, management of the disease has continued to be suboptimal, with poor patient adherence to ULT and failure to reach serum urate target. This review outlines recent progress in gout management, mainly based on the latest published guidelines, and specifically provides an update on efficient strategies for implementing treatment, efficacy and safety of specific medications for gout, and cardiovascular outcomes of ULT. In particular, we reviewed gout management approaches that can be applied to a Korean population.

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3Perioperative and anesthetic management of patients with rheumatoid arthritis

저자 : Hae-rim Kim , Seong-hyop Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 732-739 (8 pages)

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Our understanding and management of rheumatoid arthritis (RA) have greatly improved, but perioperative and anesthetic management remain challenging. RA is not limited to joints; systemic evaluation is thus required when planning perioperative management. Especially, careful airway evaluation is needed; management of airway-related arthritis is challenging. A multidisciplinary approach is essential to prevent complications without exacerbating RA disease activity. Guidelines published in 2017 are available for perioperative management of anti-rheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty. However, the guidelines focus only on anti-rheumatic medications, and do not consider all aspects of perioperative management (including anesthesia). Here, we discuss the perioperative and anesthetic management of patients with RA.

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4Predictors of recurrent acute myocardial infarction despite initially successful percutaneous coronary intervention: back to the basic

저자 : Seonghoon Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 740-741 (2 pages)

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5Call for evidence mapping in accordance with the changing features of invasive pulmonary aspergillosis during the coronavirus disease 2019 pandemic

저자 : Young Kyung Yoon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 742-744 (3 pages)

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6Improved anti-fibrotic effects by combined treatments of simvastatin and NS-398 in experimental liver fibrosis models

저자 : Seong Hee Kang , Hyung Joon Yim , Ji-won Hwang , Mi-jung Kim , Young-sun Lee , Young Kul Jung , Hyungshin Yim , Baek-hui Kim , Hae-chul Park , Yeon Seok Seo , Ji Hoon Kim , Jong Eun Yeon , Soon Ho Um ,

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 745-762 (18 pages)

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Background/Aims: Efficient anti-fibrotic therapies are required for the treatment of liver cirrhosis. Hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) and cyclooxygenase-2 (COX-2) inhibitors have been reported to have anti-fibrotic effects. Here, we investigated whether combined treatment with a statin and a COX-2 inhibitor has synergistic anti-fibrotic effects.
Methods: The effects of treatment strategies incorporating both simvastatin and a COX-2 inhibitor, NS-398, were investigated using an immortalized human hepatic stellate cell line (LX-2) and a hepatic fibrosis mouse model developed using thioacetamide (TAA) in drinking water. Cellular proliferation was investigated via 5-bromo-2-deoxyuridine uptake. Pro- and anti-apoptotic factors were investigated through Western blotting and real-time polymerase chain reaction analysis.
Results: The evaluation of the anti-proliferative effects on LX-2 cells showed that the observed effects were more pronounced with combination therapy than with single-drug therapy. Moreover, hepatic fibrosis and collagen deposition decreased significantly in TAA-treated mice in response to the combined treatment strategy. The mechanisms underlying the anti-fibrotic effects of the combination therapy were investigated. The effects of the combination therapy were correlated with increased expression levels of extracellular signal-regulated kinase 1/2 signaling molecules, upregulation of the Bax/Bcl- 2 signaling pathway, inhibition of the transforming growth factor-β signaling pathway, and inhibition of tissue inhibitor of matrix metalloproteinases 1 and 2.
Conclusions: The combination of simvastatin and NS-398 resulted in a synergistic anti-fibrotic effect through multiple pathways. These findings offer a theoretical insight into the possible clinical application of this strategy for the treatment of advanced liver diseases with hepatic fibrosis.

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7Effect of L-carnitine on quality of life in covert hepatic encephalopathy: a randomized, double-blind, placebo-controlled study

저자 : Eileen L. Yoon , Sang Bong Ahn , Dae Won Jun , Yong Kyun Cho , Do Seon Song , Jae Yoon Jeong , Hee Yeon Kim , Young Kul Jung , Myeong Jun Song , Sung Eun Kim , Hyoung Su Kim , Soung Won Jeong , Sang Gyune K

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 757-770 (14 pages)

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Background/Aims: L-carnitine is potentially beneficial in patients with hepatic encephalopathy (HE). We aimed to evaluate the impact of L-carnitine on the quality of life and liver function in patients with liver cirrhosis and covert HE.
Methods: We conducted an investigator-initiated, prospective, multi-center, double-blind, randomized phase III trial in patients with covert HE. A total of 150 patients were randomized 1:1 to L-carnitine (2 g/day) or placebo for 24 weeks. Changes in quality of life and liver function were assessed at 6 months. The model for end-stage liver disease (MELD), the 36-Item Short Form Survey (SF-36), the psychometric hepatic encephalopathy score (PHES), and the Stroop Test were evaluated in all patients.
Results: The total SF-36 score significantly improved in the L-carnitine group after 24 weeks (difference: median, 2; interquartile range, 0 to 11; p < 0.001); however, these values were comparable between the two groups. Furthermore, there was a significant ordinal improvement in PHES scores among patients with minimal HE who were in the L-carnitine group (p = 0.007). Changes in the total carnitine level also positively correlated with improvements in the Stroop test in the L-carnitine group (color test, r = 0.3; word test, r = 0.4; inhibition test, r = 0.5; inhibition/switching test, r = 0.3; all p < 0.05). Nevertheless, the MELD scores at week 24 did not differ between the groups.
Conclusions: Twenty-four weeks of L-carnitine supplementation was safe but ineffective in improving quality of life and liver function.

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8Clinical outcomes of metachronous recurrence of gastric epithelial neoplasia based on Helicobacter pylori infection status and microsatellite stability

저자 : Yeon-ji Kim , Jaeyoung Kim , Woo Chul Chung

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 768-776 (9 pages)

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Background/Aims: Helicobacter pylori eradication may prevent the recurrence of gastric epithelial neoplasia after endoscopic treatment. However, H. pylori eradication therapy is unlikely to prevent gastric cancer. This study determined the long-term results and clinical outcomes of patients with gastric epithelial neoplasia based on H. pylori infection status and microsatellite stability (MSS).
Methods: Patients diagnosed with gastric epithelial neoplasia who underwent an endoscopic mucosal resection or submucosal dissection between 2004 and 2010 were included in this retrospective study. During the follow-up period (range, 4 to 14 years), disease recurrence was monitored, and tissue examinations were conducted for seven sets of microsatellite loci initially linked to the tumour suppressor gene locus. When H. pylori infection was identified, patients underwent eradication therapy.
Results: The patients (n = 120) were divided into three groups: H. pylori-negative with MSS, H. pylori-positive with MSS, and microsatellite instability (MSI). After H. pylori eradication, the rate of metachronous recurrence was significantly different in the MSI (28.2%) and MSS groups (3.7%, p < 0.01). The mean duration of recurrence was 77 months (range, 24 to 139) in the MSI group. There was no recurrence after eradication therapy in patients who were positive for H. pylori in the MSS group.
Conclusion: H. pylori eradication could help prevent gastric cancer recurrence in patients with stable microsatellite loci. Careful, long-term monitoring is required in patients with unstable microsatellite loci.

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9Predictors of recurrent acute myocardial infarction despite successful percutaneous coronary intervention

저자 : Sang Hun Lee , Myung Ho Jeong , Joon Ho Ahn , Dae Young Hyun , Kyung Hoon Cho , Min Chul Kim , Doo Sun Sim , Young Joon Hong , Ju Han Kim , Youngkeun Ahn , Jin Yong Hwang , Weon Kim , Jong Seon Park , C

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 777-790 (14 pages)

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Background/Aims: Recurrent acute myocardial infarction (AMI) is an adverse cardiac event in patients with a first AMI. The predictors of recurrent AMI after the first AMI in patients who underwent successful percutaneous coronary intervention (PCI) have not been elucidated.
Methods: We analyzed the data collected from 9,869 patients (63.2 ± 12.4 years, men:women = 7,446:2,423) who were enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health between November 2011 and October 2015, had suffered their first AMI and had received successful PCI during the index hospitalization. Multivariable logistic regression analysis was performed to identify the independent predictors of recurrent AMI following the first AMI.
Results: The cumulative incidence of recurrent AMI after successful PCI was 3.6% (359/9,869). According to the multivariable logistic regression analysis, the significant predictive factors for recurrent AMI were diabetes mellitus, renal dysfunction, atypical chest pain, and multivessel disease.
Conclusions: In this Korean prospective cohort study, the independent predictors of recurrent AMI after successful PCI for the first AMI were diabetes mellitus, renal dysfunction, atypical chest pain, and multivessel disease.

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10Treatment delay and outcomes of ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention during the COVID-19 era in South Korea

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

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 786-799 (14 pages)

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Background/Aims: Little is known about the clinical characteristics and treatment outcomes of ST-segment elevation myocardial infarction (STEMI) in Korea during the coronavirus disease 2019 (COVID-19) era. We aimed to evaluate the clinical characteristics and treatment outcomes of patients with STEMI in the COVID-19 era.
Methods: A total of 588 consecutive patients with STEMI who underwent primary percutaneous coronary intervention were included in this study. The patients were categorized into the COVID-19 (from January 20, 2020 to December 31, 2020) and control groups (from January 20, 2019 to December 31, 2019).
Results: The COVID-19 group showed pre-hospital and in-hospital delays than the control group. The control group underwent more thrombus aspiration and had a higher proportion of left main coronary artery diseases, while the COVID-19 group had a higher proportion of multivessel diseases with a marked increase in the number and total length of stents than the control group. As for the prescribed medications, the COVID-19 group was administered more beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins than the control group. The clinical outcomes were comparable between the groups, except for higher incidences of atrioventricular block and temporary pacemaker implantation in the COVID-19 group.
Conclusions: Reperfusion after STEMI treatment during the COVID-19 period was delayed; therefore, efforts should be made to improve on reperfusion.

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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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7Radiology 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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8Is 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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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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