Korean Journal of Internal Medicine最新文献

Background/aims: To identify factors associated with achieving low disease activity (LDA) after 48 weeks of targeted therapy in patients with rheumatoid arthritis (RA) despite not meeting treat-to-target (T2T) criteria at week 24.

Methods: Data were collected from a multicenter, prospective observational cohort of Korea patients with RA receiving targeted therapy between April 2020 and July 2023. Patients who continued their initial targeted therapy despite not achieving LDA at week 24 were assigned to the LDA and non-LDA groups at week 48. Multivariable logistic regression was employed to identify factors associated with achieving delayed LDA at week 48.

Results: Among 456 patients with RA receiving targeted therapy, 213 were included in the analysis: 96 and 117 in the LDA and non-LDA groups, respectively. Patients with more comorbidities (HR 0.40, 95% CI 0.22-0.73) and those with seropositive RA (HR 0.15, 95% CI 0.03-0.70) were less likely to achieve LDA at week 48. Conversely, significant reductions in DAS28-ESR (HR 2.42, 95% CI 1.27-4.60) and HAQ-DI (HR 2.70, 95% CI 1.46-5.01) from enrolment to week 24, along with the absence of non-steroidal anti-inflammatory drug (NSAID) use at week 24 (HR 2.15, 95% CI 1.06-4.38), were associated with a greater likelihood of achieving delayed LDA at week 48.

Conclusion: Many patients with RA can achieve delayed LDA with continued targeted therapy without adhering to the T2T strategy. Key factors include fewer comorbidities, seronegative RA, substantial disease activity reduction in the first 24 weeks, and stopping NSAID at week 24.

Background/aims: To investigate the demographics, disease characteristics, and treatment modalities of patients with rheumatoid arthritis (RA) associated interstitial lung disease (ILD), focusing on ILD exacerbation and mortality.

Methods: This retrospective study included individuals aged ≥ 18 years diagnosed with RA-ILD at Ajou University Hospital from January 1999 to March 2022. Diagnosis was based on chest computed tomography (CT) scans; progression was monitored based on available follow-up pulmonary function tests (PFTs) and chest CTs. Logistic regression analysis identified factors associated with ILD progression and mortality.

Results: The study included participants with a mean age of 64.3 years, 48.3% of whom were male. Smoking status: 13.2% ex-smokers, 25.2% current smokers, 61.6% non-smokers. Mean RA and ILD duration were 134.0 and 87.5 months, respectively. Mean Disease Activity Score in 28 joints was 4.9. The usual interstitial pneumonia (UIP) pattern was seen in 60.3%. Baseline PFT showed a mean FVC of 81.9 L, diffusing capacity for carbon monoxide (DLco) of 58.7 mL/min/mm, and DLco corrected for alveolar volume of 83.4 mL/min. With a mean follow-up of 4 years, ILD progressed in 58.3% of patients, with a mortality rate of 21.2%. ILD progression and UIP pattern significantly influenced mortality. Methotrexate use did not impact progression or mortality.

Conclusion: RA-ILD patients showed diverse clinical profiles, with ILD duration and UIP pattern significantly affecting prognosis. Personalized management and vigilant monitoring are essential to improve outcomes for RA-ILD patients.

Background/aims: Transesophageal echocardiography (TEE) is a commonly used imaging modality for assessing embolic stroke of undetermined source (ESUS) in clinical practice. We aimed to develop an automatic plaque segmentation model based on U-net and evaluate its clinical usefulness in patients with ESUS.

Methods: We used two aorta image sets. TEE aortic images of 711 patients visiting two cardiovascular centers for various causes were randomly divided into training, validation, and test sets to automatically segment plaques and estimate the aortic plaque area (APA) and aortic plaque ratio (APR) using U-net. The model was tested in a clinical data set of patients with ESUS who attended three cardiovascular centers to determine whether it could predict a composite cardiovascular event in those patients.

Results: The mean intersection of over union to assess the accuracy of the U-net model was 0.997 ± 0.002 and 0.997 ± 0.001 for the model development and clinical application data sets, respectively. When using the U-net-based model, the APA and APR significantly differed between complex and simple aortic plaques (p < 0.001). However, unlike complex aortic plaques measured in clinical practice, APA or APR estimated by U-net models or manual segmentation did not show additional value in predicting major adverse cardiovascular and cerebrovascular events.

Conclusion: The estimation of APA and APR by the U-net model could be helpful in predicting complex aortic plaques. Additional comprehensive quantitative image analysis of plaque characteristics using artificial intelligence, such as movability and morphology, may be needed to predict prognosis.

Background/aims: Data on the interactions between clopidogrel and tegoprazan are limited. We compared the effects of tegoprazan and proton-pump inhibitors (PPIs) on platelet reactivity.

Methods: Using database data from March 2020 to January 2023, we retrospectively evaluated 262 patients who were taking either tegoprazan (n = 107) or PPIs (n = 155) combined with dual antiplatelet therapy, including aspirin and clopidogrel, after percutaneous coronary intervention. Platelet reactivity was assessed using VerifyNow P2Y12 assays.

Results: Platelet reaction unit (PRU) values at 3 (157 ± 8 vs. 162 ± 6, p = 0.659), 6 (167 ± 9 vs. 158 ± 7, p = 0.370), and 12 months (155 ± 10 vs. 164 ± 7, p = 0.448) were similar between groups. The prevalence of high on-treatment platelet reactivity, defined as ≥ 253 PRU, was also similar between the groups at 3 (10.3% vs. 10.2%, p = 0.976), 6 (7.0% vs. 8.2%, p = 1.000), and 12 months (4.3% vs. 9.0%, p = 0.503).

Conclusion: There was no significant difference in platelet reactivity between the tegoprazan and PPI groups in patients undergoing PCI and receiving dual antiplatelet therapy with clopidogrel.

Background/aims: This study evaluated the non-inferiority of HL-301 to erdosteine in terms of symptom relief and the anti- inflammatory effects in acute bronchitis patients not treated with antibiotics.

Methods: In a double-blind, non-inferiority trial, patients were randomized 1:1 to receive either HL-301 (300 mg twice daily) or erdosteine (300 mg three times daily) for seven days. The primary endpoint was change in total Bronchitis Severity Score (BSS) from baseline to day 7. The non-inferiority margin was set at -0.99 for the difference in BSS change. The secondary endpoints were changes in specific symptoms, overall improvement, patient satisfaction, and inflammatory markers.

Results: Mean BSS reduction at day 7 was -4.43 in the HL-301 group (n = 53) and -4.33 in the erdosteine group (n = 52). The difference in mean BSS change between the groups was 0.11, with the lower limit of the 97.5% one-sided confidence interval at -0.42, confirming non-inferiority. The improvement in specific symptoms, overall improvement, and patient satisfaction were high in both groups; however, there were no significant differences between the groups. Additionally, the changes in C-reactive protein, tumor necrosis factor-alpha, interleukin (IL)-1β, and IL-6 were similar between the groups, with no significant differences observed. The incidence of adverse events was higher in the HL-301 group compared to the erdosteine group, including gastrointestinal disorder, periodontitis, and increased blood cholesterol, although this difference was not statistically significant.

Conclusion: HL-301 was non-inferior to erdosteine, confirming its positive effect on symptom relief in acute bronchitis patients managed with conservative care.

Evidence supporting antibiotic administration within 3 hours in sepsis without shock is limited. Therefore, we conducted a systematic review and meta-analysis to determine whether the timing of antibiotic initiation influences mortality in patients with sepsis or septic shock. We comprehensively searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and the Korean Medical Database from inception to November, 2022, using the keywords "sepsis," "septic shock," "anti-bacterial agents," "time to treatment," and "time factors." Two reviewers independently performed eligibility screening and full-text review. Thirteen studies including 79,246 patients were analyzed: five prospective, seven retrospective, and one retrospective case-control study. In overall sepsis cases, mortality did not differ significantly between patients who received antibiotics within 1 hour and those in the delayed group but was significantly lower in those who received antibiotics within 3 hours than in those in the delayed group. In patients with septic shock, mortality was significantly lower in groups that received antibiotics within both 1 and 3 hours than in the delayed group. In septic shock, administration of antibiotics within 1 hour of diagnosis reduces mortality. In patients with sepsis, antibiotic administration within 3 hours, but not necessarily within 1 hour, was associated with reduced mortality.

Lung cancer remains a leading cause of cancer-related mortality worldwide and is often diagnosed at an advanced stage, with poor survival outcomes. Early detection and appropriate management of incidental pulmonary nodules, frequently identified through low-dose computed tomography screening, are critical for improving prognosis and reducing lung cancer mortality. Established guidelines, including those of the Fleischner Society and American College of Radiology, provide structured recommendations for risk assessment, surveillance, and intervention. Recent advancements in diagnostic modalities, such as positron emission tomography, endobronchial ultrasound, electromagnetic navigation bronchoscopy, and robot-assisted bronchoscopy, have enhanced the diagnostic accuracy while minimizing procedural risks. A multidisciplinary approach that incorporates these technologies is essential for optimizing patient care. This review summarizes the current strategies for evaluating and managing solitary pulmonary nodules, including risk stratification models, imaging features, and biopsy techniques, thereby providing a comprehensive overview for clinicians.

Background/aims: Herpes zoster (HZ) vaccination is primarily administered to prevent shingles, yet its systemic immunomodulatory effects may offer protection against other organ-related diseases, including hepatobiliary and pancreatic diseases. Therefore, this emulated target trial aimed to evaluate whether live HZ vaccination reduces the long-term risk of hepatobiliary diseases in older adults.

Methods: We conducted a nationwide, population-based cohort study in South Korea (n = 2,207,784 individuals aged ≥ 50 years) from January 1, 2012, to December 31, 2021, with follow-up until January 31, 2024. This cohort was built by merging health insurance (Korea Health Insurance Review and Assessment Service), national health screening (Korean National Health Insurance Service), and vaccination records (Korea Disease Control and Prevention Agency). To assess the risk of any hepatobiliary diseases and eight subcategories following HZ vaccination, we performed 1:1 exposure-driven propensity score matching and estimated adjusted hazard ratios (aHRs) using Cox proportional hazards models.

Results: After matching, 1,462,070 individuals were included (mean age, 61.57 years; 56.26% females). HZ vaccination was associated with a 14% lower risk of developing any hepatobiliary events (aHR 0.86, 95% CI 0.85-0.87). Risk reductions were consistent across all subcategories, notably for hepatic failure (aHR 0.71, 95% CI 0.63-0.78) and liver cirrhosis (aHR 0.74, 95% CI 0.70-0.77). Protective associations were more pronounced in males, younger individuals (< 60 years), and smokers. The benefit persisted for eight years, peaking within the first four years.

Conclusion: HZ vaccination was associated with significantly reducing hepatobiliary and pancreatic diseases, supporting potential broader health benefits beyond shingles prevention in older adults.