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대한내과학회> The Korean Journal of Internal Medicine

The Korean Journal of Internal Medicine update

  • : 대한내과학회
  • : 의약학분야  >  내과학
  • : KCI등재
  • : SCI
  • : 연속간행물
  • : 격월
  • : 1226-3303
  • : 2005-6648
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수록범위 : 1권1호(1986)~35권5호(2020) |수록논문 수 : 2,390
The Korean Journal of Internal Medicine
35권5호(2020년 09월) 수록논문
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KCI등재 SCI

1The proposed algorithm for emergency endoscopy during the coronavirus disease 2019 outbreak

저자 : Sung Bum Kim , Kook Hyun Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 5호 발행 연도 : 2020 페이지 : pp. 1027-1030 (4 pages)

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Following the coronavirus disease 2019 outbreak in China, more than 10,765 pa-tients tested positive for severe acute respiratory syndrome coronavirus 2 from February 18, 2020 to April 30, 2020 in South Korea. Performing emergency en-doscopy is extremely challenging from the clinicians' viewpoint during the viral outbreak. There are no available guidelines for emergency endoscopy in tertiary hospitals during this pandemic. We set up an algorithm as a guide for emergency endoscopy in patients presenting to the emergency room with bleeding, foreign body, or impending cholangitis. From February 18, 2020 to April 30, 2020 of outbreak, 130 patients underwent emergency endoscopy in our center. Owing to the simple and streamlined algorithm for performing emergency endoscopy, no endoscopy-related infection to other patients or medical workers was reported in our center.

KCI등재 SCI

2Squamous cell carcinoma of head and neck: what internists should know

저자 : Kyungsuk Jung , Manpreet Narwal , Seon Young Min , Bhumsuk Keam , Hyunseok Kang

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 5호 발행 연도 : 2020 페이지 : pp. 1031-1044 (14 pages)

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Squamous cell carcinoma of head and neck (SCCHN) is a group of cancer arising from mucosal surfaces of the head and neck. Optimal management of SCCHN requires a multidisciplinary team of surgical oncologists, radiation oncologists, medical oncologists, nutritionist, and speech-language pathologists, due to the complexity of anatomical structure and importance of functional outcome. Human papilloma virus (HPV)-related SCCHN represents a distinct subset from HPV negative SCCHN which is associated with carcinogen exposure such as cigarette smoking, betel nut use and alcohol. HPV related SCCHN responds better to concurrent chemoradiation and has better overall prognosis, compared to HPV negative SCCHN. Radiation therapy has been introduced to the treatment of SCCHN, administered concurrently with systemic chemotherapy for locoregional SCCHN, as well as a palliative measure for recurrent and/or metastatic (R/M) SCCHN. Recently, immune checkpoint inhibitors have been shown to improve overall survival in R/M-SCCHN and have been incorporated into the standard of care. Combination approaches with immune therapy and targeted therapy for biomarker enriched population based on genomics are being actively investigated and will shape the future of SCCHN treatment.

KCI등재 SCI

3Proprotein convertase subtilisin/kexin type 9 inhibition in cardiovascular disease: current status and future perspectives

저자 : Kyung Hoon Cho , Young Joon Hong

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 5호 발행 연도 : 2020 페이지 : pp. 1045-1058 (14 pages)

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Proprotein convertase subtilisin/kexin type 9 (PCSK9) targets the degradation of low-density lipoprotein (LDL) receptors; it has been proved that its inhibition improves cardiovascular outcomes in patients with established atherosclerotic cardiovascular disease (ASCVD). Herein, we review the current status of PCSK9 inhibitors in clinical practice and the future scope of PCSK9 inhibition. The results of two recent large clinical trials reveal that two PCSK9 monoclonal antibodies evolocumab and alirocumab reduce the risk of a cardiovascular event on top of background statin therapy in patients with stable ASCVD and those with recent acute coronary syndrome, respectively. However, there are several ongoing concerns regarding the efficacy in reducing mortality, cost-effectiveness, and long-term safety of extremely low LDL cholesterol levels with PCSK9 inhibition. The results of ongoing cardiovascular outcomes trials with PCSK9 monoclonal antibodies for primary prevention and with small interfering RNA to PCSK9 for secondary prevention may help to shape the use of this new therapeutic class.

KCI등재 SCI

4Clinical spectrum and diagnosis of diabetic neuropathies

저자 : Jeeyoung Oh

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 5호 발행 연도 : 2020 페이지 : pp. 1059-1069 (11 pages)

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Neuropathy is the most prevalent microvascular complication of diabetes mel-litus; it encompasses distal symmetric polyneuropathy, autonomic neuropathy, radiculoplexus neuropathy, mononeuropathy, and treatment-induced neuropathy. The prevalence rate of diabetic neuropathy in Korea was reported to be approx-imately 43%, which is similar to rates in other countries. However, the precise pathogenic mechanism underlying diabetic neuropathy is still obscure, and many clinical trials have failed to develop methods to prevent or reduce the progression of diabetic neuropathy. Nevertheless, early diagnosis and proper management of diabetic neuropathy are essential to alleviate disabling symptoms and to improve the quality of life of patients. This review discusses clinical manifestations and classification of diabetic neuropathies, bedside neurological examination, and electrophysiological tests.

KCI등재 SCI

5What does left atrial structural remodeling mean in cardiac resynchronization therapy?

저자 : Sung-hee Shin

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 5호 발행 연도 : 2020 페이지 : pp. 1070-1071 (2 pages)

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KCI등재 SCI

6Chest X-rays in culture-negative pulmonary tuberculosis: early determination is superior to late determination

저자 : Yong-soo Kwon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 5호 발행 연도 : 2020 페이지 : pp. 1072-1073 (2 pages)

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KCI등재 SCI

7Effects of vitamin D supplements in patients with chronic hepatitis C: a randomized, multi-center, open label study

저자 : Jae Yoon Jeong , Dae Won Jun , Sol Ji Park , Joo Hyun Sohn , Sang Gyune Kim , Se Whan Lee , Soung Won Jeong , Moon Young Kim , Won Kim , Jae-jun Shim , Hyoung Su Kim , Ki Tae Suk , Sang Bong Ahn

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 5호 발행 연도 : 2020 페이지 : pp. 1074-1083 (10 pages)

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Background/Aims: We aimed to assess the role of vitamin D supplementation in the response to pegylated interferon-α (PEG-IFN-α) plus ribavirin (RBV) treatment in patients with chronic hepatitis C (CHC).
Methods: Our study was a multi-center, randomized controlled trial in 11 hospitals. CHC patients were randomly assigned (1:1) to two groups namely, PEG-IFN-α plus RBV (control group) or PEG-IFN-α plus RBV + vitamin D (800 IU daily) (vitamin D group). The primary end-point was the rate of sustained virologic response (SVR).
Results: One hundred forty eight CHC patients were randomly assigned to two groups. Seventy-one patients received the PEG-IFN-α plus RBV and 77 patients received the PEG-IFN-α plus RBV + vitamin D. A total of 105 patients completed the study (control group, 47 vs. vitamin D group, 58). Baseline characteristics were mostly similar in both the groups. There was a modest but non-significant increase in SVR in the vitamin D group compared to the control group with the intention to treat analysis (64.0% vs. 49.3 %, p = 0.071) as well as in the per protocol analysis (control group vs. vitamin D group: 74.5% vs. 84.5%, p = 0.202). Fifty-two patients (73.2%) in the control group and 63 patients (81.8%) in the vitamin D group experienced at least one adverse event. The drop-out rate due to adverse effects was not different between both groups (control group vs. vitamin D group: 19.7% vs. 10.4%, p = 0.111).
Conclusions: Vitamin D supplement did not increase SVR in treatment naïve patients with CHC irrespective of genotype.

KCI등재 SCI

8Proton pump inhibitor use is associated with hip fracture development: a nationwide population-based cohort study

저자 : Yang Won Min , Yeong Chan Lee , Kyunga Kim , Seungho Ryu , Kyoung Sub Hong , Han Ho Jeon , Yong Sung Kim , Jong Heon Park , Hee Jung Son , Poong-lyul Rhee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 5호 발행 연도 : 2020 페이지 : pp. 1084-1093 (10 pages)

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Background/Aims: Effect of proton pump inhibitor (PPI) use on the risk of hip fracture is controversial. This study aimed to clarify the association between PPI use and hip fracture risk using a large cohort.
Methods: This study recruited participants from the nationwide cohort (n = 1,025,340). After exclusion of participants who had hip fractures or were aged less than 40 years during the baseline period (2002 to 2004), 371,806 participants were followed to 2013. Participants prescribed PPIs for more than 90 days during base-line period were defined as users. Fracture cases were defined when participants were hospitalized with claims of a hip fracture.
Results: During 4,159,343 person-years of follow-up, fractures developed more of-ten in PPI users than in nonusers (relative risk [RR], 1.787; 95% confidence interval [CI], 1.260 to 2.534; p = 0.002). The results persisted after adjusting for age, sex, and many drugs relevant to osteoporosis or influential in bone health. Furthermore, fracture risk associated with PPI use increased with duration of use (p trend < 0.001). The fully adjusted RRs of hip fracture development were 1.350 (95% CI, 1.203 to 1.515) for 1- to 90-day users, 1.487 (95% CI, 0.957 to 2.311) for 91- to 180-day users, and 1.771 (95% CI, 0.931 to 3.368) for > 180-day users. The positive association be-tween PPI use and fracture was also confirmed in a subgroup with health screen-ing data where further adjustment for body mass index, smoking status, alcohol consumption, and physical activity was available (adjusted RR, 2.025; 95% CI, 1.151 to 3.564, p = 0.014).
Conclusions: PPI use is associated with hip fracture development.

KCI등재 SCI

9Impact of previous metronidazole exposure on metronidazole-based second-line quadruple therapy for Helicobacter pylori infection

저자 : Gil Ho Lee , Kee Myung Lee , Sung Jae Shin , Joon Koo Kang , Choong-kyun Noh , Jin Hong Kim , Sun Gyo Lim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 5호 발행 연도 : 2020 페이지 : pp. 1094-1103 (10 pages)

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Background/Aims: The negative effects on the eradication success of Helicobacter pylori infection after previous exposure to macrolides, including clarithromycin on clarithromycin-based first-line therapy have been demonstrated. However, whether this is true for metronidazole-based second-line quadruple therapy remains unclear. We investigated the relationship between past administration of metronidazole and the failure of metronidazole-based second-line quadruple therapy in patients with H. pylori infection.
Methods: Patients over 20 years of age who were diagnosed with H. pylori infection between January 1998 and March 2016 were enrolled in this study. The relationship between the clinical parameters and the results of a C13-urea breath test after metronidazole-based second-line quadruple therapy was analyzed in patients for whom clarithromycin-based triple therapy failed to eradicate H. pylori.
Results: The H. pylori eradication failure rate was significantly higher in patients with a history of metronidazole use than in patients without a history of metronidazole use (p = 0.011). Multivariable analysis showed that the odds ratio of previous metronidazole use for eradication failure was 3.468 (95% confidence interval, 1.391 to 8.649; p = 0.008). In the subgroup analysis of patients with a history of metronidazole use, the duration of metronidazole use and interval between its use and eradication therapy did not significantly affect H. pylori eradication failure.
Conclusions: Previous exposure to metronidazole was a significant risk factor for treatment failure of metronidazole-based second-line quadruple therapy; therefore, this should be considered when establishing a treatment strategy for patients with H. pylori infection.

KCI등재 SCI

10Impact of early anti-TNF use on clinical outcomes in Crohn's disease: a nationwide population-based study

저자 : Yoon Suk Jung , Minkyung Han , Sohee Park , Jae Hee Cheon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 5호 발행 연도 : 2020 페이지 : pp. 1104-1114 (11 pages)

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Background/Aims: The optimal timing for initiation of anti-tumor necrosis factor (TNF) therapy in Crohn's disease (CD) is still debated. Little is known about the clinical outcomes of early versus late administration of anti-TNF agents, especially in Asian CD patients. We aimed to evaluate the impact of early anti-TNF therapy on clinical outcomes in Korean CD patients.
Methods: Using the Korean National Health Insurance Claims database, we collected data on patients diagnosed with CD who received anti-TNF therapy for more than 6 months between 2010 and 2016. Early initiation of anti-TNF therapy was defined as those starting infliximab or adalimumab therapy within 1 year of diagnosis. The following outcomes were assessed using a Cox proportional hazard model: abdominal surgery, CD-related emergency room (ER) visit, CD-related hospitalization, and new corticosteroid use.
Results: Among 1,207 patients, 609 were early initiators of anti-TNF. Late anti-TNF initiation (> 1 year after diagnosis) was associated with increased risk of surgery (adjusted hazard ratio [aHR], 1.64; 95% confidence interval [CI], 1.05 to 2.55) and tended to be associated with increased risk of ER visit (aHR, 1.38; 95% CI, 0.99 to 1.94). However, there were no significant differences in the risk of hospitalization and corticosteroid use between early and late initiators.
Conclusions: Early anti-TNF therapy among Korean CD patients within 1 year of diagnosis was associated with better clinical outcomes than late therapy, such as lower surgery and ER visit rates. Our results suggest that aggressive medical intervention in the early stages of CD may potentially change the course of this disease.

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