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대한내과학회> The Korean Journal of Internal Medicine> Clinical outcomes of acute upper gastrointestinal bleeding according to the risk indicated by Glasgow-Blatchford risk score-computed tomography score in the emergency room

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

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
  • : 대한내과학회
  • : The Korean Journal of Internal Medicine 37권6호
  • : 연속간행물
  • : 2022년 11월
  • : 1176-1185(10pages)
The Korean Journal of Internal Medicine

DOI


목차

INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

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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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간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCOPUS
  • : 격월
  • : 1226-3303
  • : 2005-6648
  • : 학술지
  • : 연속간행물
  • : 1986-2023
  • : 2791


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1Deep appreciation to our reviewers in the past year

저자 : 대한내과학회

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 38권 1호 발행 연도 : 2023 페이지 : pp. 1-1 (1 pages)

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2Messages from new editor-in-chief

저자 : Hyoung-chul Oh

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 38권 1호 발행 연도 : 2023 페이지 : pp. 2-2 (1 pages)

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3Fecal microbiota transplantation is not a magical treatment, but better too early than too late

저자 : Jongbeom Shin

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 38권 1호 발행 연도 : 2023 페이지 : pp. 3-4 (2 pages)

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4Clinical and epidemiological implications of the data on the Korean clinical hypertension cohort

저자 : Jinho Shin

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 38권 1호 발행 연도 : 2023 페이지 : pp. 5-6 (2 pages)

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5Updated risk assessments for sudden cardiac death in hypertrophic cardiomyopathy patients with implantable cardioverter-defibrillator

저자 : Yae Min Park

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 38권 1호 발행 연도 : 2023 페이지 : pp. 7-15 (9 pages)

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Hypertrophic cardiomyopathy (HCM) is a genetic disease associated with a risk of malignant ventricular tachyarrhythmias and sudden cardiac death (SCD). Assessment of the SCD risk is crucial for its clinical management, and there has been considerable interest in developing risk stratification strategies. An implantable cardioverter-defibrillator (ICD) is a life-saving treatment for patients with HCM who are at a high-risk of ventricular tachyarrhythmias and SCD. However, a substantial number of ICD recipients experience adverse effects arising from inappropriate device therapy and implant-related complications. This has led to numerous investigations of the risk of SCD and the indications for ICD implantation. American guidelines were recently updated to include new risk markers, including left ventricular systolic dysfunction, apical aneurysm, and extensive late gadolinium enhancement, while European guidelines recommend individualized estimated 5-year SCD risk assessment models. Studies evaluating other risk factors for SCD in patients with HCM have also been published. Drawing on recent guidelines and publications on clinical risk factors, we focus this review on updated risk assessments for SCD with ICD therapy in patients with HCM.

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6Assessment and nonsurgical management of low back pain: a narrative review

저자 : Sung Cheol Park , Min-seok Kang , Jae Hyuk Yang , Tae-hoon Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 38권 1호 발행 연도 : 2023 페이지 : pp. 16-26 (11 pages)

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Low back pain (LBP) is a common condition that affects people of all ages and income levels worldwide. The etiology of LBP may be mechanical, neuropathic, systemic, referred visceral, or secondary to other causes. Despite numerous studies, the diagnosis and management of LBP remain challenging due to the complex biomechanics of the spine and confounding factors, such as trivial degenerative imaging findings irrelevant to symptoms and psychological and emotional factors. However, it is imperative to identify the crucial signs (“red flags”) indicating a serious underlying condition. While many recent guidelines emphasize non-pharmacologic management approaches, such as education, reassurance, and physical and psychological care, as the first option, LBP patients in many countries, including South Korea, are prescribed medications. Multidisciplinary rehabilitation combined with prudent use of medications is required in patients unresponsive to first-line therapy. The development of practical guidelines apposite for South Korea is needed with multidisciplinary discussion.

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7Analysis of the gut microbiome using extracellular vesicles in the urine of patients with colorectal cancer

저자 : Hyuk Yoon , Nam-eun Kim , Jihye Park , Cheol Min Shin , Nayoung Kim , Dong Ho Lee , Jae Yong Park , Chang Hwan Choi , Jae Gyu Kim , Young Soo Park

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 38권 1호 발행 연도 : 2023 페이지 : pp. 27-39 (13 pages)

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Background/Aims: We evaluated the gut microbiome using extracellular vesicles (EVs) in the urine of patients with colorectal cancer (CRC) to determine whether gut-microbe-derived EVs could be a potential biomarker for the diagnosis of CRC.
Methods: EVs were isolated from the urine of patients with CRC and healthy controls. DNA was extracted from the EVs, and the bacterial composition was analyzed using next-generation sequencing of the 16S rRNA.
Results: A total of 91 patients with CRC and 116 healthy controls were enrolled. We found some specific microbiomes that were more or less abundant in the CRC group than in the control group. The alpha-diversity of the gut microbiome was significantly lower in the CRC group than in the control group. A significant difference was observed in the beta-diversity between the groups. The alpha-diversity indices between patients with early- and late-stage CRC showed conflicting results; however, there was no significant difference in the beta-diversity according to the stage of CRC. There was no difference in the alpha- and beta-diversity of the gut microbiome corresponding to the location of CRC (proximal vs. distal).
Conclusions: A distinct gut microbiome is reflected in the urine EVs of patients with CRC compared with that in the healthy controls. Microbial signatures from EVs in urine could serve as potential biomarkers for the diagnosis of CRC.

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8Effect of age on the prognosis of intrahepatic cholangiocarcinoma

저자 : Jung Hun Kim , Young Koog Cheon , Tae Yoon Lee , Sang Hoon Lee , Hyunji Chung

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 38권 1호 발행 연도 : 2023 페이지 : pp. 39-47 (9 pages)

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Background/Aims: Intrahepatic cholangiocarcinoma (iCCA) is a subgroup of cholangiocarcinoma and is the second- most-common primary hepatic tumor. Several predictive and prognostic factors have been analyzed; however, in this study we focused on the influence of age. Our aim was to use real-world results to determine the influence of age in iCCA patients.
Methods: A retrospective analysis of patients treated between 2005 and 2016 at Konkuk University Medical Center. In total, 133 patients with iCCA were identified. The mass-forming, periductal-infiltrating, and intraductal-growth types were included; patients with extrahepatic or hilar-type cholangiocarcinoma were excluded. We defined two groups: a younger group, age < 65 years, and an older group, age ≥ 65 years. Statistical analyses using univariate and multivariate Cox regression analyses, including the Kaplan-Meier method, were conducted.
Results: In total, 114 patients were enrolled. The two groups differed with regard to treatment options such as surgery with adjuvant chemotherapy or palliative chemotherapy (p = 0.012, p < 0.001). The younger group had significantly longer survival than the older group (p = 0.017). In the younger group, patients who received therapy had longer survival than those who did not (hazard ratio, 3.942; 95% confidence interval, 2.053 to 7.569; p < 0.001). Multivariate analysis indicated that younger age, lower bilirubin, low CA 19-9, and no lymph-node involvement were independent factors for improved survival.
Conclusions: Younger patients and those who underwent surgery with adjuvant chemotherapy had longer survival. The younger the patient, the more treatments received, including palliative chemotherapy.

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9Recognition and attitudes of Korean physicians toward fecal microbiota transplantation: a survey study

저자 : Tae-geun Gweon , Yoo Jin Lee , Sung Kyun Yim , Seung Yong Kim , Chang Hwan Choi , Young-seok Cho

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 38권 1호 발행 연도 : 2023 페이지 : pp. 48-58 (11 pages)

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Background/Aims: Fecal microbiota transplantation (FMT) represents a treatment option for recurrent Clostridioides difficile infection (CDI). Recently, FMT has been investigated in various clinical settings other than CDI. This study examined Korean physicians' recognition of FMT and their attitudes toward this procedure
Methods: An online questionnaire included questions on indications for FMT, the FMT process, physicians' attitudes toward FMT for the treatment of CDI and non-CDI diseases, and possible concerns.
Results: Finally, 107 physicians responded to this survey: 66 (61.7%) had experience of performing FMT, and 86 (80.4%) replied that they were willing to perform FMT for CDI. Two-thirds of physicians (63.6%, n = 68) would perform FMT for recurrent CDI on patients who had at least three recurrences. The most common obstacle to performing FMT for the treatment of CDI was the lack of regulations or guidelines (55.1%, n = 59). Seventy-seven (72.0%) physicians would consider FMT for non- CDI diseases when conventional treatment had failed. The most common obstacle for FMT for the treatment of non-CDI diseases was low treatment efficacy (57.0%, n = 61).
Conclusions: Two-thirds of Korean physicians had experience of performing FMT, and many performed FMT for recurrent CDI. The results of this study will prove useful to researchers and practitioners in FMT in Korea.

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10Long-term cardiovascular events in hypertensive patients: full report of the Korean Hypertension Cohort

저자 : Jin Young Lee , Jean Kyung Bak , Mina Kim , Ho-gyun Shin , Kyun-ik Park , Seung-pyo Lee , Hee-sun Lee , Ju-yeun Lee , Kwang-il Kim , Si-hyuck Kang , Jang Hoon Lee , Se Yong Jang , Ju-hee Lee , Kye Hun K

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 38권 1호 발행 연도 : 2023 페이지 : pp. 56-79 (24 pages)

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Background/Aims: This study evaluated the long-term cardiovascular complications among Korean patients with hypertension and compared them with that of controls without hypertension.
Methods: The Korean Hypertension Cohort (KHC) enrolled 11,043 patients with hypertension and followed them for more than 10 years. Age- and sex-matched controls without hypertension were enrolled at a 1:10 ratio. We compared the incidence of cardiovascular events and death among patients and controls without hypertension.
Results: The mean age was 59 years, and 34.8% and 16.5% of the patients belonged to the high and moderate cardiovascular risk groups, respectively. During the 10-year follow-up, 1,591 cardiovascular events (14.4%) with 588 deaths (5.3%) occurred among patients with hypertension and 7,635 cardiovascular events (6.9%) with 4,826 deaths (4.4%) occurred among controls. Even the low-risk population with hypertension showed a higher cardiovascular event rate than the population without hypertension. Although blood pressure measurements in the clinic showed remarkable inaccuracy compared with those measured in the national health examinations, systolic blood pressure (SBP) ≥ 150 mmHg was significantly associated with a higher risk of cardiovascular events.
Conclusions: This long-term follow-up study confirmed the cardiovascular event rates among Korean hypertensive patients were substantial, reaching 15% in 10 years. SBP levels ≥ 150 mmHg were highly associated with occurrence of cardiovascular event rates.

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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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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).
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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).
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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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