Korean Journal of Internal Medicine最新文献

Background/aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with various metabolic disorders; however, its relationship with thyroid cancer remains unclear. This study investigated the association between MASLD and the risk of thyroid cancer.

Methods: This retrospective cohort study used data from the Korean National Health Insurance Service database on individuals who underwent three or more health examinations between January 2002 and December 2015. MASLD was diagnosed using the Hepatic Steatosis Index. Participants were followed up until December 31, 2019, to assess the incidence of newly diagnosed thyroid cancer.

Results: A total of 121,479 individuals were included in this study. In the age- and sex-adjusted analysis, the risk of thyroid cancer was significantly higher in the MASLD group than in the normal group (HR 1.19, 95% CI 1.11-1.29, p < 0.001). Age was a significant effect modifier of the relationship between MASLD and thyroid cancer (p for interaction < 0.05). Among individuals aged 65 years or older, the risk of thyroid cancer was higher in the MASLD group than in the normal group (HR 1.31, 95% CI 1.00-1.72, p = 0.05), whereas in individuals younger than 65 years, MASLD was not associated with thyroid cancer (HR 0.97, 95% CI 0.89-1.04, p = 0.37).

Conclusion: This study suggests an association between MASLD and an increased risk of thyroid cancer in older adults. However, further research is needed to determine whether lifestyle modifications, such as weight management, influence thyroid cancer risk in this population.

Background/aims: This study aimed to evaluate the feasibility and outcomes of mini-probe endoscopic ultrasound (mEUS) followed by submucosal saline injection (SSI-mEUS) for assessing the endoscopic resectability of colorectal subepithelial lesions (SELs).

Methods: From January 2020 to December 2023, the medical records of 391 SELs (364 patients) were retrospectively reviewed and categorized into no EUS, mEUS-only, and SSI-mEUS groups according to the procedure used. To compare variables between the SSI-mEUS and other groups, the no EUS and mEUS-only groups were combined into the non-SSI-mEUS group. In the SSI-mEUS group, submucosal cushion thickness was endosonographically measured after the saline injection. Treatment outcomes and histological diagnosis were retrospectively reviewed.

Results: A total of 210 lesions in the no EUS group, 23 in the mEUS-only group, and 125 in the SSI-mEUS group were endoscopically resected. The mean SEL size was larger in the SSI-mEUS than in the non-SSI-mEUS group (6.8 ± 2.6 mm vs. 4.9 ± 2.6 mm, p < 0.001). R0 resection was achieved in 107 of 110 neoplastic lesions (97.3%) in the SSI-mEUS group vs. 159 of 176 neoplastic lesions (90.3%) in the non-SSI-mEUS group (p = 0.046). Not using SSI-mEUS was the only factor associated with indeterminate or positive deep resection margins (odds ratio 3.45, 95% confidence interval 1.19-13.40, p = 0.021).

Conclusion: For colorectal SELs, including those that appear insufficiently elevated during conventional endoscopy, SSI-mEUS enables an objective assessment of the feasibility of endoscopic resection and can predict a high likelihood of achieving a safe and complete resection.

Atrial fibrillation (AF) and heart failure (HF) frequently coexist with other cardiovascular conditions and adversely affect each other. Over the past few decades, there have been therapeutic advances in AF and HF; however, whether rate-control or rhythm-control is the superior approach for these patients remains controversial. Additionally, there is debate regarding whether antiarrhythmic drug therapy or ablation is the optimal strategy for rhythm-control. The outcomes of AF ablation have improved, and several studies have assessed the potential benefits of AF ablation in patients with HF. The positive impact of catheter ablation in patients with AF and impaired left ventricular (LV) systolic function extends beyond rhythmic outcomes and may result in LV function improvement. This review provides a brief overview of this topic and summarizes several prospective randomized trials that have shown important clinical outcomes comparing AF ablation and non-ablation treatment options in patients with AF and HF so as to provide improved treatment guidance.

Background/aims: The impact of body mass index (BMI) on the clinical outcomes of intestinal Behçet's disease (BD) remains unclear. This study assessed the association between BMI and disease progression.

Methods: A retrospective analysis of 760 patients with intestinal BD was conducted. Patients were classified by BMI as underweight (< 18.5 kg/m2), normal (18.5-22.9), overweight (23.0-24.9), or obese (≥ 25.0). The association between BMI and clinical outcomes-biologics, surgery, hospitalization, and emergency visits-was examined.

Results: Among 760 patients, 130 (17.1%) were underweight, 384 (50.5%) normal, 152 (20.0%) overweight, and 94 (12.4%) obese. Higher BMI linked to lower cumulative rates of biologics use (p trend = 0.002), surgery (p trend = 0.004), hospitalization (p trend = 0.004), and emergency visits (p trend = 0.008). Compared with the underweight group, the normal (HR 0.667, 95% CI 0.483-0.922, p = 0.014), overweight (HR 0.589, 95% CI 0.394-0.879, p = 0.010), and obese groups (HR 0.515, 95% CI 0.321-0.828, p = 0.006) had lower hospitalization risks. The overweight (HR 0.490, 95% CI 0.241-0.996, p = 0.049) and obese (HR 0.312, 95% CI 0.116-0.840, p = 0.021) groups were negatively associated with future biologics use. The normal (HR 0.705, 95% CI 0.480-1.036, p = 0.075) and obese (HR 0.510, 95% CI 0.272-0.953, p = 0.035) groups were negatively associated with future surgery in multivariable analysis.

Conclusion: Lower BMI was linked to poorer clinical outcomes in intestinal BD, emphasizing the need to optimize nutritional status.

Background/aims: The unclear relationship between body mass index (BMI) and post-hematopoietic stem cell transplantation (HSCT) mortality was investigated, including the impact of metabolic diseases.

Methods: This retrospective study conducted at a Korean tertiary hospital (2009-2021) included patients who underwent HSCT. Patients were categorized as underweight (BMI < 18.5 kg/m2, n = 106), normal (BMI 18.5-22.9 kg/m2, n = 1,345), overweight (BMI 23.0-24.9 kg/m2, n = 980), or obese (BMI ≥ 25.0 kg/m2, n = 1,471). Diabetes mellitus (DM), hypertension, and dyslipidemia were identified by disease codes or medication prescriptions. A Cox proportional hazards model was used to analyze mortality risks.

Results: Over 108 months, 29.8% (1,164/3,902) of the participants died. Patients with underweight had significantly higher mortality (adjusted HR 1.76, 95% CI 1.29-2.40, p < 0.001) than in those with normal BMI. Patients with overweight and obesity did not show increased mortality. Post-HSCT, DM significantly raised mortality risk (HR 3.36, 95% CI 2.86-3.94, p < 0.001), whereas newly diagnosed dyslipidemia was associated with lower mortality (HR 0.27, 95% CI 0.23-0.33, p < 0.001). Post-transplant hypertension had no significant impact on mortality (HR 1.10, 95% CI 0.95-1.28, p = 0.184).

Conclusion: Post-HSCT, obesity is not a prognostic factor for poor survival; however, certain metabolic diseases have diverse effects on mortality.

Background/aims: Post-acute sequelae of COVID-19 (PASC) are highly heterogeneous; therefore, the pathophysiological mechanisms for PASC remain unclear. In this study, we aimed to examine the immunologic aspects of various PASC symptoms.

Methods: We prospectively enrolled adults aged ≥ 18 years who were diagnosed with COVID-19 between August 2022 and September 2023. Blood samples were collected from all participants, who were interviewed using a questionnaire for PASC symptoms at least once between 1 and 6 months after the COVID-19 diagnosis. For immunological evaluation, plasma concentrations of SARS-CoV-2 spike subunit 1-specific IgG and 33 cytokines were measured using enzyme-linked immunosorbent assays and multiplex-based immunoassay, respectively.

Results: In total, 156 pairs of blood samples and symptom reports from 79 participants were eligible for analysis. The most frequent symptom was fatigue, followed by post exertional malaise, chronic cough, thirst, and brain fog. Gastrointestinal symptoms, chest pain, post exertional malaise, smell/taste change, fatigue, brain fog, abnormal movement, and palpitation were accompanied by significant increases in IL-10, VEGF, and inflammatory cytokines like MIP-1α, IL-1β, IL-6, IL-8, MIG, granzyme A, and CX3CL1 levels, while chronic cough, dizziness, dyspnea, and hair loss were not accompanied by significant differences in cytokine levels.

Conclusion: Symptoms classified into different categories based on the dysfunctional organs may share a common pathophysiology regarding elevation of certain cytokines. Although PASC symptoms are heterogeneous, our findings suggest that T-cell recruitment, thrombosis, and increased vascular permeability might contribute to various symptom clusters sharing common pathophysiological mechanisms.

Background/aims: Acute graft-versus-host disease (GvHD) is a severe complication of allogeneic stem cell transplantation, characterized by immune-mediated tissue damage primarily affecting the skin, liver, and gastrointestinal tract. Regulatory T (Treg) cells play a critical role in maintaining immune homeostasis. However, the pathogenic roles of changes in Treg cell number and function on acute GvHD remain poorly understood. This study aimed to investigate the quantitative and qualitative changes in Treg cells and their clinical and pathogenic implication of acute GvHD.

Methods: A total of 62 patients who underwent allogeneic stem cell transplantation at a tertiary institution from 2019 to 2024 were enrolled. Peripheral blood mononuclear cells were isolated and analyzed by multicolor flow cytometry. Treg cell subsets and cytokine production were assessed after T-cell receptor stimulation. Serum levels of inflammatory cytokines were measured using cytometric bead array, and Treg cell suppressive function was evaluated through co-culture experiments.

Results: Patients with acute GvHD showed a decreased frequency of circulating Treg cells, with a notable increase in the CD45RA-FoxP3lo pro-inflammatory subset. Treg cells produced inflammatory cytokines including TNF-α upon stimulation and exhibited reduced suppressive activity. The frequency of TNF-α+ Treg cells correlated with the clinical severity of acute GvHD. Elevated serum levels of IL-6 and IL-21 were associated with the inflammatory conversion of Treg cells.

Conclusion: During human acute GvHD, frequencies of circulating Treg cells are significantly decreased. Inflammatory change of Treg cells, represented by TNF-α production and reduced suppressive capacity, contributes to the immunopathogenesis of acute GvHD.

Background/aims: Although an implantable loop recorder (ILR) is a valuable tool for investigation of unexplained syncope, there are limited data regarding time course to diagnosis and predictors of serious arrhythmias as a cause of unexplained syncope. We sought to investigate diagnosis rate by time period after ILR implantation and identify predictors of serious arrhythmias in patients with unexplained syncope.

Methods: We identified 394 patients who received ILR implantation for unexplained syncope enrolled in the Korean ILR registry.

Results: Serious arrhythmias were documented in 205 patients (52.0%). One hundred seventy-two patients (43.7%) had sick sinus-node syndrome (SSS), 24 (6.1%) had atrioventricular block, and nine (2.3%) had ventricular arrhythmia. Of these, 48 (23.4%) and 77 (37.6%) were diagnosed within two weeks and one month after ILR implantation, respectively. Median time to diagnosis was 62 days. In multivariable analysis, left atrial volume index (LAVI) ≥ 34 mL/m2 (hazard ratio [HR] 1.582), hypertension (HR 1.788), sinus bradycardia with a heartrate less than 60 beats per minute (HR 1.762), and LAVI ≥ 34 mL/m2 combined with sinus bradycardia (HR 1.911) were independent predictors of SSS. Cumulative detection rate of SSS was significantly higher in patients with LAVI ≥ 34 mL/m2 than those with LAVI < 34 mL/m2 (p < 0.001).

Conclusion: More than half of patients with unexplained syncope had serious arrhythmias, and more than one-third of these arrhythmias were diagnosed within one month after ILR implantation. LAVI combined with sinus bradycardia may be a useful predictor of SSS as a cause of unexplained syncope.