Korean Journal of Internal Medicine最新文献

Korean College of Rheumatology treatment recommendations for patients with axial spondyloarthritis: 2026 update. 韩国风湿病学院对轴性脊柱炎患者的治疗建议：2026年更新。

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-10-01 DOI: 10.3904/kjim.2026.354

Hong Ki Min, Mi Ryoung Seo, Sang-Hoon Lee, Yeon-Ah Lee, Jennifer Jooha Lee, Seong-Ryul Kwon, Tae-Hwan Kim, Min-Chan Park, Kichul Shin, Ji Hyeon Ju, Yong-Gil Kim, Bon San Koo, Eun Young Lee, Hoon-Suk Cha, Seung Cheol Shim, Ji Hui Shin, Tae-Jong Kim

{"title":"Korean College of Rheumatology treatment recommendations for patients with axial spondyloarthritis: 2026 update.","authors":"Hong Ki Min, Mi Ryoung Seo, Sang-Hoon Lee, Yeon-Ah Lee, Jennifer Jooha Lee, Seong-Ryul Kwon, Tae-Hwan Kim, Min-Chan Park, Kichul Shin, Ji Hyeon Ju, Yong-Gil Kim, Bon San Koo, Eun Young Lee, Hoon-Suk Cha, Seung Cheol Shim, Ji Hui Shin, Tae-Jong Kim","doi":"10.3904/kjim.2026.354","DOIUrl":"https://doi.org/10.3904/kjim.2026.354","url":null,"abstract":"We aimed to develop updated evidence-based recommendations for the management of adult patients with axial spondyloarthritis (axSpA) in Korea. The Korean College of Rheumatology convened a multidisciplinary panel to update the 2023 axSpA guideline. Twenty key clinical questions were formulated using the PICO framework. Systematic literature searches were conducted in PubMed, Embase, and the Cochrane Library for studies published between February 2021 and December 2024. Evidence was appraised using the GRADE methodology, and recommendations were finalized through a modified Delphi consensus process. Twenty recommendations were developed covering disease activity monitoring, non-pharmacological interventions, pharmacological treatment, treatment sequencing, tapering strategies, comorbidity management, surgical interventions, and safety monitoring. Key recommendations include implementation of a treat-to-target strategy, use of Axial Spondyloarthritis Disease Activity Score for disease assessment, smoking cessation and exercise, nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line therapy, and the use of tumor necrosis factor inhibitors, interleukin-17 inhibitors, or Janus kinase inhibitors in patients with active disease refractory to NSAIDs. Recommendations were also provided for treatment selection according to extra-musculoskeletal manifestations and for monitoring treatment-related adverse events. These updated recommendations provide evidence-based guidance for the comprehensive management of axSpA in Korea and aim to improve clinical outcomes, quality of life, and standardization of care.","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Blocked premature atrial contractions mimicking severe sinus bradycardia. 阻断过早心房收缩模拟严重窦性心动过缓。

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-09-01 DOI: 10.3904/kjim.2026.083

Chang Hee Kwon

引用次数: 0

Obesity hypoventilation syndrome in the Korean intensive care unit: rare disease or simply overlooked? 韩国重症监护室肥胖低通气综合征：罕见病还是被忽视？

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-09-01 DOI: 10.3904/kjim.2026.412

Bora Lee, Sang Haak Lee

引用次数: 0

Prognostic implications of functional significance, high-risk plaque and vessel characteristics in patients with diabetes mellitus. 糖尿病患者的功能意义、高危斑块和血管特征对预后的影响

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-09-01 DOI: 10.3904/kjim.2026.005

Jin-Eun Song, Seokhun Yang, Masahiro Hoshino, Taishi Yonetsu, Jinlong Zhang, Eun-Seok Shin, Joon-Hyung Doh, Chang-Wook Nam, Jianan Wang, Shaoliang Chen, Nobuhiro Tanaka, Hitoshi Matsuo, Takashi Kubo, Hyuk-Jae Chang, Tsunekazu Kakuta, Bon-Kwon Koo

{"title":"Prognostic implications of functional significance, high-risk plaque and vessel characteristics in patients with diabetes mellitus.","authors":"Jin-Eun Song, Seokhun Yang, Masahiro Hoshino, Taishi Yonetsu, Jinlong Zhang, Eun-Seok Shin, Joon-Hyung Doh, Chang-Wook Nam, Jianan Wang, Shaoliang Chen, Nobuhiro Tanaka, Hitoshi Matsuo, Takashi Kubo, Hyuk-Jae Chang, Tsunekazu Kakuta, Bon-Kwon Koo","doi":"10.3904/kjim.2026.005","DOIUrl":"10.3904/kjim.2026.005","url":null,"abstract":"Background/aims: We investigated the prognostic value of high-risk plaque (HRP) and high-risk vessel (HRV) characteristics on coronary computed tomography angiography (CCTA) alongside fractional flow reserve (FFR) in patients with diabetes mellitus (DM).Methods: We analyzed 307 vessels from 184 diabetic patients who underwent both CCTA and invasive FFR. HRP was defined as the presence of ≥ 3 high-risk features (minimal lumen area < 4 mm2, plaque burden ≥ 70%, low-attenuation plaque, positive remodeling, spotty calcification, or napkin-ring sign). HRV was defined as the presence of ≥ 1 quantitative volumetric parameter above the optimal cutoff. The primary endpoint was target vessel failure (TVF). HRs were adjusted for FFR, HRP, HRV, and the number of clinical risk factors.Results: Functional significance (FFR ≤ 0.80; adjusted HR 2.56; 95% CI 1.07-6.12; p = 0.034), HRP (adjusted HR 2.29; 95% CI 1.10-4.77; p = 0.028), and HRV (adjusted HR 2.37; 95% CI 1.12-5.01; p = 0.025) were independent predictors of TVF. Notably, deferred vessels with FFR > 0.80 harboring HRP and/or HRV had a significantly higher risk of TVF compared to the deferred low-risk group (HR 4.78; 95% CI 1.68-13.57; p = 0.003), and their prognosis was comparable to that of deferred vessels with functional significance (FFR ≤ 0.80; HR 5.57; 95% CI 1.70-18.24; p = 0.005).Conclusion: In patients with DM, both lesion-level (HRP) and vessel-level (HRV) characteristics provided incremental prognostic value beyond FFR. Integrating these anatomical risk features may refine risk stratification for diabetic patients, particularly for those with functionally insignificant lesions.","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 5","pages":"873-883"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mortality risk associated with permanent central venous catheter use in the oldest-old population: a nationwide cohort study. 在最高龄人群中使用永久性中心静脉导管的死亡率风险：一项全国性队列研究。

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-09-01 DOI: 10.3904/kjim.2025.343

Joo Un Park, Chang Min Park, Do Hyoung Kim, Hyangkyoung Kim, Byung Ha Chung, Hyung Seok Lee, Sang Jun Park, Min-Ho Kim, Hoon Suk Park

{"title":"Mortality risk associated with permanent central venous catheter use in the oldest-old population: a nationwide cohort study.","authors":"Joo Un Park, Chang Min Park, Do Hyoung Kim, Hyangkyoung Kim, Byung Ha Chung, Hyung Seok Lee, Sang Jun Park, Min-Ho Kim, Hoon Suk Park","doi":"10.3904/kjim.2025.343","DOIUrl":"10.3904/kjim.2025.343","url":null,"abstract":"Background/aims: Owing to aging-related factors, arteriovenous access (AV) is difficult to establish in older patients; central venous catheter (CVC) access is used instead. However, evidence on long-term outcomes of permanent vascular access types in the oldest-old adults (≥ 80 yr) is lacking. We aimed to compare mortality by vascular access type in older Korean patients undergoing hemodialysis.Methods: This nationwide retrospective cohort study included 79,286 adult patients who initiated maintenance hemodialysis between 2012 and 2021, identified from the Korean National Health Insurance Service database. Patients were categorized by permanent vascular access type (AV fistula [AVF], AV graft [AVG], or CVC). Kaplan-Meier survival analysis and Cox proportional hazards models were used to assess mortality across vascular access types. Analyses were stratified by age group.Results: CVC access was associated with the highest mortality. Compared with AVF use, CVC use was associated with more than a threefold increase in mortality risk (aHR 3.54; 95% CI, 3.43-3.65). Though attenuated, the CVC use-associated mortality risk remained significantly elevated in octogenarians and nonagenarians (aHR 3.30; 95% CI, 3.14-3.47 and aHR 3.18; 95% CI, 2.65-3.82, respectively). Compared with AVG use, CVC use remained consistently associated with elevated mortality risk across age groups.Conclusion: CVC use as permanent access was associated with increased mortality, even among the oldest-old. Advanced age should be regarded as a clinical consideration rather than a definitive contraindication to AV access. Our findings support the need for individualized clinical decision-making, even in the oldest-old population.","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 5","pages":"927-939"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diabetes progression and severe hypoglycemia: a nationwide cohort study of 2,475,605 adults with type 2 diabetes mellitus. 糖尿病进展和严重低血糖：一项2475605名成人2型糖尿病患者的全国性队列研究

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-09-01 DOI: 10.3904/kjim.2026.084

Kyu-Na Lee, Bongseong Kim, Mee Kyoung Kim, Sukil Kim

{"title":"Diabetes progression and severe hypoglycemia: a nationwide cohort study of 2,475,605 adults with type 2 diabetes mellitus.","authors":"Kyu-Na Lee, Bongseong Kim, Mee Kyoung Kim, Sukil Kim","doi":"10.3904/kjim.2026.084","DOIUrl":"10.3904/kjim.2026.084","url":null,"abstract":"Background/aims: Severe hypoglycemia (SH) is a major concern in type 2 diabetes mellitus (T2DM). We evaluated whether a composite diabetes progression score could predict incident SH.Methods: Using the Korean National Health Insurance Service database, we identified 2,475,605 adults with T2DM who underwent health examinations in 2015-2016. Incident SH was defined by ICD-10 codes plus emergency department visit or hospitalization. The progression score (range, 0-6) comprised six indicators: longer diabetes duration, use of ≥ 3 oral glucose-lowering drug classes, insulin use, chronic kidney disease (CKD), cardiovascular disease, and diabetic retinopathy.Results: During 1 year of follow-up, 1,186 SH events occurred. Each component of diabetes progression was independently insuassociated with SH risk hazard ratios (HRs) from 1.19-3.27, with insulin use and CKD showing the largest effects. SH risk increased stepwise with higher progression scores. Compared with a score of 0, the adjusted HRs (95% confidence intervals) were 3.35 (2.63-4.27), 7.74 (6.15-9.74), 12.61 (9.97-15.95), 22.39 (17.44-28.75) for scores 1, 2, 3, and ≥ 4, respectively.Conclusion: A concise diabetes progression score strongly stratified short-term SH risk in this nationwide cohort, and may help target proactive prevention and early intervention.","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 5","pages":"916-926"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparative efficacy and safety of warfarin and direct oral anticoagulants in patients with end-stage kidney disease and atrial fibrillation. 华法林与直接口服抗凝剂在终末期肾病合并心房颤动患者中的疗效和安全性比较

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-09-01 DOI: 10.3904/kjim.2025.052.e1

Yujin Yang, Sun Hwa Lee, Wonmook Hwang, Ji Hoon Jung, Jae-Hyeong Park

引用次数: 0

Probable obesity hypoventilation syndrome in a Korean medical intensive care unit: clinical characteristics and outcomes. 韩国重症监护病房中可能的肥胖低通气综合征：临床特征和结果

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-09-01 DOI: 10.3904/kjim.2026.085

Kyu Jin Lee, Hong Yeul Lee, Jinwoo Lee, Sang-Min Lee, Jaeyoung Cho

{"title":"Probable obesity hypoventilation syndrome in a Korean medical intensive care unit: clinical characteristics and outcomes.","authors":"Kyu Jin Lee, Hong Yeul Lee, Jinwoo Lee, Sang-Min Lee, Jaeyoung Cho","doi":"10.3904/kjim.2026.085","DOIUrl":"10.3904/kjim.2026.085","url":null,"abstract":"Background/aims: Obesity hypoventilation syndrome (OHS) is associated with morbidity and intensive care unit (ICU) utilization. However, data from Asian ICUs are limited. We evaluated the proportion, characteristics, and outcomes of probable OHS among obese patients admitted to a medical ICU (MICU) in Korea.Methods: We analyzed obese adults (body mass index [BMI] ≥ 27 kg/m²) admitted to the MICU at Seoul National University Hospital between 2016 and 2023. Probable OHS was defined as obesity with chronic hypercapnia (PaCO₂ ≥ 45 mmHg and bicarbonate ≥ 27 mmol/L) without alternative causes. Clinical characteristics and outcomes were compared between the probable OHS and obese non-probable OHS groups. Mortality was evaluated using inverse probability of treatment weighting (IPTW).Results: Among 3,660 MICU admissions, 531 patients (14.5%) were obese. The proportion of probable OHS was 0.4% (16/3,660) overall, 3.0% (16/531) among obese patients, and 6.5% (12/186) at BMI ≥ 30 kg/m². Obstructive airway disease was more prevalent in the probable OHS group. Most patients meeting probable OHS criteria went unrecognized during their stay in the MICU. Patients with probable OHS tended to have longer hospital stays (40 vs. 24 days, p = 0.083), despite lower illness severity at admission. Although unadjusted mortality was lower in the probable OHS group, IPTW-adjusted analyses showed no significant differences in in-hospital or 90-day mortality.Conclusion: This single-center study found that 3% of obese MICU patients had probable OHS. These findings suggest that underlying OHS may be overlooked in the ICU, highlighting the need for improved recognition and diagnostic strategies.","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 5","pages":"894-904"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Epidemiological and clinical trends of malignant small-bowel tumors in Asia. 亚洲恶性小肠肿瘤的流行病学和临床趋势。

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-09-01 Epub Date: 2026-08-26 DOI: 10.3904/kjim.2025.422

Jung Rock Moon, Seong Ran Jeon

{"title":"Epidemiological and clinical trends of malignant small-bowel tumors in Asia.","authors":"Jung Rock Moon, Seong Ran Jeon","doi":"10.3904/kjim.2025.422","DOIUrl":"10.3904/kjim.2025.422","url":null,"abstract":"Malignant small-bowel tumors are uncommon, accounting for < 5% of all gastrointestinal cancers, yet their incidence has exhibited a steady rise in both Western and Asian populations. This increase is attributed to expanded use of advanced diagnostic modalities and improved registry completeness. Malignant small-bowel tumors encompass a heterogeneous group-adenocarcinoma, neuroendocrine tumors, gastrointestinal stromal tumors, and lymphoma-each with distinct anatomic predilections, molecular characteristics, and clinical behavior. In Asia, sporadic adenocarcinoma remains the predominant subtype, whereas Crohn's disease-associated lesions and small-bowel neuroendocrine tumors are relatively less common than in Western cohorts. Early detection continues to be limited by diagnostic delays caused by nonspecific symptoms and the anatomic inaccessibility of the small-bowel. Prognosis varies substantially across subtypes, with adenocarcinoma demonstrating the poorest survival rate despite advances in systemic therapy. Recent nationwide and multicenter studies from Asian countries have highlighted evolving temporal trends, improvements in diagnostic performance, and emerging regional differences in etiology, stage distribution, and outcomes. A clearer understanding of the epidemiologic patterns and clinical charimacteristics of malignant small-bowel tumors in Asia is essential for developing region-specific diagnostic strategies, optimizing treatment pathways, and prioritizing areas for future collaborative research.","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":" ","pages":"799-807"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prognostic significance of artificial intelligence-quantified late gadolinium enhancement on cardiac magnetic resonance in hypertrophic cardiomyopathy. 人工智能量化心脏磁共振晚期钆增强对肥厚性心肌病的预后意义。

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-09-01 DOI: 10.3904/kjim.2026.065

Young-Sang Jeong, Jong-Il Park, Kang-Un Choi, Jong-Ho Nam, Chan-Hee Lee, Jang-Won Son, Ung Kim, Jong-Seon Park, Eunjung Kong

{"title":"Prognostic significance of artificial intelligence-quantified late gadolinium enhancement on cardiac magnetic resonance in hypertrophic cardiomyopathy.","authors":"Young-Sang Jeong, Jong-Il Park, Kang-Un Choi, Jong-Ho Nam, Chan-Hee Lee, Jang-Won Son, Ung Kim, Jong-Seon Park, Eunjung Kong","doi":"10.3904/kjim.2026.065","DOIUrl":"10.3904/kjim.2026.065","url":null,"abstract":"Background/aims: This study aimed to evaluate the prognostic value of artificial intelligence (AI)-based late gadolinium enhancement (LGE) quantification using cardiovascular magnetic resonance (CMR) in patients with hypertrophic cardiomyopathy (HCM).Methods: We retrospectively analyzed 142 patients with HCM (mean age 58.5 ± 13.7 yr; 72.5% men) who underwent CMR at Yeungnam University Medical Center between 2015 and 2023. LGE was quantified using an AI-based segmentation algorithm with a 6-standard deviation method. Patients were stratified into a high LGE group (≥ 15%) and a low LGE group (< 15%). The primary outcome was a composite of cardiovascular death, including sudden cardiac death (SCD) and SCD-equivalent events.Results: Over a median follow-up of 59 months, the high LGE group experienced a higher incidence of the primary outcome compared with the low LGE group (21.2% vs. 4.6%, p = 0.0067). After adjustment for age and left ventricular ejection fraction, a high AI-quantified LGE burden (≥ 15%) remained independently associated with the primary outcome (adjusted hazard ratio 4.67, 95% confidence interval 1.43-15.30, p = 0.011). Receiver operating characteristic analysis determined an optimal LGE cutoff of 8% for predicting the primary outcome (area under the curve 0.821). Patients with LGE ≥ 8% exhibited markedly increased rates of the primary outcome (18.2% vs. 0%, p < 0.001) and SCD/SCD-equivalent events (13.6% vs. 0%, p = 0.00074).Conclusion: AI-based quantitative assessment of LGE is an independent predictor of adverse cardiovascular outcomes in patients with HCM and may represent a clinically meaningful imaging biomarker for risk stratification.","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 5","pages":"884-893"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0