Korean Journal of Internal Medicine最新文献

Atrial fibrillation (AF) is the most common sustained tachyarrhythmia and its increasing prevalence has resulted in a growing healthcare burden. Catheter ablation is indicated for patients with AF who are either refractory or intolerant to antiarrhythmic drugs or who exhibit decreased left ventricular systolic function. Catheter ablation can be categorized based on the energy source used, including radiofrequency ablation (RFA), cryoablation, laser ablation, and the recently emerging pulsed field ablation (PFA). PFA is anticipated to be promising owing to its tissue specificity, resulting in less collateral damage than thermal energy catheter ablations, such as RFA and cryoablation. In this review, we summarize the biophysical principles and clinical applications of PFA, highlighting its safety and efficacy profile compared to that with conventional thermal ablation.

Background/aims: This study aims to evaluate the global burden of adverse effects of medical treatment (AEMT) using data from the Global Burden of Disease Study (GBD) 2021.

Methods: Data were extracted from the GBD 2021, covering 204 countries/territories from 1990 to 2021. AEMT was defined using ICD-9 and ICD-10 codes, encompassing complications from medical procedures, treatments, or healthcare exposures. Estimates were categorized into fatal and non-fatal outcomes and stratified by age, sex, year, and covariates, including the Socio-demographic Index (SDI). Mortality-incidence ratios (MIRs), defined as the ratio of mortality calculated by dividing the number of deaths by the total incident cases, were analyzed.

Results: In 2021, the global age-standardized prevalence, incidence, disability-adjusted life years (DALYs), and mortality rates of AEMT were 11.48 (95% uncertainty interval [UI], 8.86-14.13), 150.44 (131.19-171.81), 64.19 (51.06-73.11), and 1.53 (1.29-1.68) per 100,000 population, respectively. DALY rates were highest in the early neonatal group (4,789.47 per 100,000 population [95% UI, 3,682.00-5,963.30]), while mortality rates followed a U-shaped pattern across age groups. In 2021, MIRs were highest at both ends of the age range: the early neonatal group (0.58 [95% UI, 0.55-0.58]) and the 95+ age group (0.05 [0.04-0.06]). This pattern was consistent across all SDI quintiles, with higher MIRs observed in lower SDI quintiles.

Conclusion: The significantly higher prevalence and incidence rates of AEMT among the older population in high SDI quintiles, compared to lower SDI quintiles, could be attributed to the healthcare overutilization, highlighting the need for policy adjustments.

This review provides a comprehensive examination of the recent research findings concerning the pathophysiology and clinical implications of adipose tissue fibrosis in obesity and metabolic diseases. Recent large-scale studies, including a longitudinal study spanning 24 years (Swedish Obese Subjects), have demonstrated that weight loss in obese patients is directly correlated with reduced metabolic complications and mortality. Nonetheless, instances of weight regain and subsequent loss of metabolic improvements have been observed in some patients, with adipose tissue dysfunction and fibrosis identified as significant contributing factors. Adipose tissue fibrosis is increasingly recognized as a critical pathological mechanism that influences weight loss responsiveness and long-term prognosis, extending beyond the previously predominant focus on inflammatory responses. Recent advancements in spatial transcriptomics and single-cell omics have elucidated the interactions and molecular networks among various cell types (e.g., fibroblasts and macrophages), revealing the involvement of miRNAs, among other factors, in metabolic plasticity and weight maintenance. Anti-diabetic therapies (such as GLP-1 receptor agonists, SGLT2 inhibitors, and thiazolidinediones) and bariatric surgery have been shown to contribute to tissue remodeling and the mitigation of fibrosis. However, the issue of weight regain upon drug discontinuation persists, underscoring the necessity for integrated strategies that simultaneously target adipose tissue set-point regulation and fibrosis improvement. In conclusion, adipose tissue fibrosis is proposed as a novel predictive and therapeutic target for metabolic health prognosis and treatment selection in patients with obesity. This study is anticipated to lay the groundwork for personalized management from a precision medicine perspective.

Background/aims: The clinical characteristics of Clostridioides difficile infection (CDI) in patients within the Asia-Pacific region who test positive on the nucleic acid amplification test (NAAT) and negative on the toxin enzyme immunoassay (EIA, hereafter referred to as "Toxin") are unclear. We evaluated the clinical significance and associated factors of NAAT+/Toxinpatients whose diagnosis of CDI was confirmed by toxigenic C. difficile culture.

Methods: This retrospective cohort study enrolled adult patients admitted to Seoul St. Mary's Hospital between January 2015 and December 2015 with a diagnosis of active CDI.

Results: In total, 3,311 stool samples were subjected to C. difficile culture, NAAT, and toxin EIA. Among them, 298 culture- positive patients fulfilled the criteria for CDI, and 3 NAAT-/Toxin- patients were excluded. The risk factors for a negative EIA and positive NAAT and culture results were evaluated in 295 patients. Among them, 128 patients were Toxin- and 167 were Toxin+. No clinical or laboratory parameters (fever, white blood cell count of < 1,000/mm3, eosinophils, C-reactive protein, creatinine, or albumin) differed significantly between NAAT+/Toxin+ and NAAT+/Toxin- patients. In addition, the clinical outcomes did not differ between the two groups. In the multivariable analysis, previous use of antibiotics was inversely associated with negative EIA results, whereas high-dose corticosteroid use was positively associated.

Conclusion: Clinical outcomes related to CDI are not different between NAAT+/Toxin+ and NAAT+/Toxin- patients, emphasizing the need for individual clinical evaluation.

Inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn's disease, are distinct chronic immune-mediated intestinal inflammatory disorders. The pathogenesis of IBD is complex and involves a combination of genetic and environmental factors, the gut microbiome, and the host immune system. Despite significant progress in identifying the genetic factors of IBD, the increasing IBD incidence in recent decades, along with findings from immigrant and twin studies, suggest the involvement of environmental factors on IBD susceptibility. In this review, we summarize various up-to-date environmental factors, including early-life influences; diet, food, and nutritional exposures; urbanization and air pollution; smoking; appendectomy; medications; psychological stress; sleep; and latitude and geography.

Background/aims: This matched case-control study investigated the impact of HFE gene mutations on sustained virological response (SVR) in Egyptian patients with chronic hepatitis C (CHC) treated with daclatasvir and sofosbuvir.

Methods: A total of 150 CHC patients were enrolled (75 responders and 75 non-responders) based on HCV RNA levels 12 weeks post-treatment. HFE gene mutations (C282Y, H63D, S65C) were detected by PCR-restriction fragment length polymorphism. Liver function and iron parameters were assessed.

Results: Among responders, 86.67% had wild-type HFE alleles, compared to 72.00% of non-responders (p = 0.027). Heterozygous mutant alleles were more common in non-responders (28.00%) than in responders (13.33%). Wild-type carriers had 2.59 times higher odds of achieving SVR (OR, 2.59; 95% CI, 1.10-5.83). HFE mutations were significantly associated with elevated serum iron (p = 0.031) and ferritin (p = 0.044) levels, the with C282Y mutation linked to increased iron. However, after multivariate adjustment using principal component analysis, only iron overload remained a significant predictor of non-response (p < 0.001), while the association with HFE mutations was no longer significant (p = 0.647).

Conclusion: HFE mutations are associated with lower SVR rates and iron overload, but their impact appears mediated through disrupted iron metabolism. Iron overload emerged as the key independent predictor of treatment failure. These findings underscore the importance of evaluating iron status in conjunction with genetic factors to more accurately predict treatment outcomes in CHC patients receiving direct-acting antivirals.

Background/aims: To explore the biological implications of positron emission tomography/computed tomography (PET/CT) findings in multiple myeloma (MM), we investigated the mutational characteristics relevant to PET/CT findings using targeted DNA sequencing.

Methods: Fourteen newly diagnosed patients with MM who underwent 18F-fluorodeoxyglucose (FDG) PET/CT at diagnosis were retrospectively reviewed. Targeted sequencing was performed on their bone marrow samples using a customized panel covering 80 genes relevant to MM biology. In seven patients, serial PET/CT and sequencing were also conducted after firstline treatment.

Results: The most frequently identified mutant gene was ATM, followed by HUWE1, PABPC1, and TP53. Patients with high diffuse FDG uptake (high DU) in their bone marrow showed a higher tumor burden than those with low diffuse uptake (low DU), and they were likely to have an inferior overall survival. Mutations detected in high DU were associated with various oncogenic pathways relevant to the disease progression of MM. Notably, pathways involving epigenetic regulators were predominantly enriched in patients with high DU. In serial follow-ups, a patient with residual PET/CT findings showed the emergence of new mutations; however, those with complete resolution of PET/CT abnormalities demonstrated improved mutational characteristics.

Conclusion: Patients with high DU showed diverse mutational characteristics, which may reflect the heterogeneous nature of MM and contribute to inferior survival outcomes.

Background/aims: Previously developed fracture risk prediction models primarily estimate long-term risk and are limited in their ability to predict imminent fractures. We developed a simplified and practical model to predict the short-term fracture risk (1- to 3-year risk) in elderly Korean women.

Methods: We included 1,440,988 women who underwent a national life-transition health examination at age 66 between 2011 and 2017. The participants were followed-up for 3 years to identify major osteoporotic fractures (MOFs) and hip fractures. Clinical risk factors such as body mass index, bone mineral density, fall history within 6 months, prior fractures within 3 years, recent fractures within 1 year, and recurrent fractures were analyzed. Multivariate logistic regression was used to estimate the odds ratios (ORs) for these risk factors. Each OR was converted into a risk score, and the total scores were stratified into five groups: 0-4, 5-7, 8-10, 11-14, and 15-18 points.

Results: Higher scores were associated with a significantly increased risk of fractures. At 3 years, the incidences of MOF were 3.4%, 5.8%, 12.0%, 21.3%, and 36.6%, and the hip fracture incidences were 0.13%, 0.26%, 0.59%, 0.73%, and 1.82% across the five groups, respectively.

Conclusion: This simplified scoring model is a practical tool for predicting the 1- to 3-year fracture risk in elderly Korean women. By stratifying patients into risk groups based on routine clinical data, it enables the early identification of high-risk individuals and facilitates timely preventive care.