Korean Journal of Internal Medicine最新文献

{"title":"Role of catheter ablation in patients with heart failure and atrial fibrillation.","authors":"Min-Su Jung, Hyoung-Seob Park","doi":"10.3904/kjim.2024.284","DOIUrl":"10.3904/kjim.2024.284","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"40 4","pages":"533-545"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601974","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}

{"title":"Beat-to-beat alternans.","authors":"Chan-Hee Lee, Melvin M Scheinman","doi":"10.3904/kjim.2024.372","DOIUrl":"10.3904/kjim.2024.372","url":null,"abstract":"","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":" ","pages":"687-688"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112481","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}

{"title":"Generalized edema with acute renal failure in a patient with diabetes.","authors":"Yujin Shin, Chang-Hoon Lee, Kyoung Min Kim, Yong Gon Cho, Kyung Pyo Kang","doi":"10.3904/kjim.2024.428","DOIUrl":"10.3904/kjim.2024.428","url":null,"abstract":"","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"40 4","pages":"689-690"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602042","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}

{"title":"Association between body mass index and survival after hematopoietic stem cell transplantation.","authors":"Han-Sang Baek, Jong Hyuk Lee, Joonyub Lee, Seung-Hwan Lee, Gi June Min, Sung-Soo Park, Silvia Park, Sung-Eun Lee, Byung-Sik Cho, Ki-Seong Eom, Yoo-Jin Kim, Seok Lee, Hee-Je Kim, Chang-Ki Min, Seok-Goo Cho, Jong Wook Lee, Jae-Ho Yoon","doi":"10.3904/kjim.2024.246","DOIUrl":"10.3904/kjim.2024.246","url":null,"abstract":"<p><strong>Background/aims: </strong>The unclear relationship between body mass index (BMI) and post-hematopoietic stem cell transplantation (HSCT) mortality was investigated, including the impact of metabolic diseases.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>Post-HSCT, obesity is not a prognostic factor for poor survival; however, certain metabolic diseases have diverse effects on mortality.</p>","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"40 4","pages":"645-656"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602023","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}

{"title":"Cytokine profiles associated with persisting symptoms of post-acute sequelae of COVID-19.","authors":"Ji-Soo Kwon, Euijin Chang, Hyeon Mu Jang, Ji Yeun Kim, Woori Kim, Ju Yeon Son, Junho Cha, Choi Young Jang, Seongman Bae, Jiwon Jung, Min Jae Kim, Yong Pil Chong, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, Sung-Han Kim","doi":"10.3904/kjim.2024.217","DOIUrl":"10.3904/kjim.2024.217","url":null,"abstract":"<p><strong>Background/aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"40 4","pages":"667-675"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602037","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}

{"title":"Decreased frequency and inflammatory change of FoxP3+ regulatory T cells in immunopathogenesis of human acute graft-versus-host disease.","authors":"Nayeon Seong, Cheongin Yang, Kunye Kwak, Ka-Won Kang, Yong Park, Byung Soo Kim, Seong Hyun Jeong, Joon Seong Park, Yoon Seok Choi","doi":"10.3904/kjim.2025.010","DOIUrl":"10.3904/kjim.2025.010","url":null,"abstract":"<p><strong>Background/aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"40 4","pages":"657-666"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602038","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}

{"title":"Detection rate by time period and predictors of serious arrhythmias in unexplained syncope: a multicenter implantable loop recorder registry study.","authors":"Juwon Kim, Il-Young Oh, Myung-Jin Cha, Jinhee Ahn, So-Ryoung Lee, Sung Ho Lee, Jae-Sun Uhm, Pil-Sung Yang, Jaemin Shim, Hyoung-Seob Park, Junbeom Park, Jun Hyung Kim, Ki-Hun Kim, Jumsuk Ko, Hong Euy Lim, Ju Youn Kim","doi":"10.3904/kjim.2024.364","DOIUrl":"10.3904/kjim.2024.364","url":null,"abstract":"<p><strong>Background/aims: </strong>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.</p><p><strong>Methods: </strong>We identified 394 patients who received ILR implantation for unexplained syncope enrolled in the Korean ILR registry.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"40 4","pages":"616-625"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602039","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}

{"title":"Efficacy and safety of first-line afatinib in older patients with advanced EGFR-mutated non-small cell lung cancer.","authors":"Mi-Hyun Kim, Hayoung Seong, Soo Han Kim, Min Ki Lee, Insu Kim, Kyung Soo Hong, June Hong Ahn, Jung Seop Eom","doi":"10.3904/kjim.2024.269","DOIUrl":"10.3904/kjim.2024.269","url":null,"abstract":"<p><strong>Background/aims: </strong>This study investigated the efficacy and safety of first-line afatinib treatment in older patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC).</p><p><strong>Methods: </strong>This retrospective, multicenter, observational cohort study included 103 patients aged ≥ 75 years who were treated with first-line afatinib for EGFR-mutated NSCLC. The primary outcome was time-on-treatment (TOT).</p><p><strong>Results: </strong>The median TOT of patients was 13.6 months (95% confidence interval 11.0-16.2). Ninety-two patients (89.3%) required dose modification. Dose reduction was significantly more frequent in the 40 mg starting dose group than in the 30 mg group (93.1% vs. 68.8%, p = 0.004). The most common grade 3 or worse adverse events (AEs) were diarrhea (n = 16, 54%), acneiform rash (n = 4, 14.3%), and stomatitis (n = 4, 14.3%). Grade 3 or worse AEs led to dose modification in 23 of 28 patients (82.1%) and permanent discontinuation of therapy in five of 28 patients (17.9%). On disease progression, tissue re-biopsy was performed in 18 of 74 patients (24.3%). Thirty-four patients (45.9%) received subsequent chemotherapy; of these, most patients (n = 21, 61.8%) received pemetrexed monotherapy.</p><p><strong>Conclusion: </strong>This study demonstrated the efficacy of first-line afatinib treatment for EGFR-mutant NSCLC in older patients. However, despite similar safety profiles and frequencies of AEs reported in previous studies, the frequency of dose modifications was higher in this population. A 30 mg starting dose of afatinib and a predefined dose adjustment may be suitable strategies for this population. Post-tyrosine kinase inhibitor management, such as tissue re-biopsy and platinum-based chemotherapy, tended to be underprescribed in this age group.</p>","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"40 4","pages":"626-633"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602041","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}

{"title":"Unraveling the immune responses in long COVID through cytokine profiling.","authors":"Oh-Hyun Cho","doi":"10.3904/kjim.2025.179","DOIUrl":"10.3904/kjim.2025.179","url":null,"abstract":"","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"40 4","pages":"531-532"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601977","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}

{"title":"Unexplained syncope: what time-to-diagnosis and risk profiles tell us.","authors":"Yoon Jung Park","doi":"10.3904/kjim.2025.180","DOIUrl":"10.3904/kjim.2025.180","url":null,"abstract":"","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"40 4","pages":"529-530"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601976","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}