Korean Journal of Internal Medicine最新文献_第5页

Korean expert consensus on the management of thrombotic thrombocytopenic purpura. 韩国专家对血栓性血小板减少性紫癜治疗的共识。

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-07-01 DOI: 10.3904/kjim.2025.361

Seo-Yeon Ahn, Junshik Hong, Jin Seok Kim, Sung-Hyun Kim, Kyoung Ha Kim, Ho-Young Yhim, Yoo Jin Lee, Jaewoo Song, Soo-Mee Bang, Ji Hyun Lee, Seongsoo Jang, Sung Hwa Bae

{"title":"Korean expert consensus on the management of thrombotic thrombocytopenic purpura.","authors":"Seo-Yeon Ahn, Junshik Hong, Jin Seok Kim, Sung-Hyun Kim, Kyoung Ha Kim, Ho-Young Yhim, Yoo Jin Lee, Jaewoo Song, Soo-Mee Bang, Ji Hyun Lee, Seongsoo Jang, Sung Hwa Bae","doi":"10.3904/kjim.2025.361","DOIUrl":"10.3904/kjim.2025.361","url":null,"abstract":"Thrombotic thrombocytopenic purpura (TTP) is a rare but life-threatening thrombotic microangiopathy resulting from severe ADAMTS13 deficiency. Although effective treatments, such as therapeutic plasma exchange, immunosuppressive therapy with rituximab, and caplacizumab, have significantly improved survival, important challenges remain. These include limited diagnostic capacity, barriers to the early use of novel therapies, and long-term complications. In Korea, additional difficulties persist due to the restricted availability of ADAMTS13 antibody testing, reimbursement limitations for rituximab, and the absence of caplacizumab in clinical practice. To address these issues, the Korean Society of Hematology Thrombosis and Hemostasis Working Party convened an expert panel to develop consensus recommendations for the diagnosis and management of TTP. The panel reviewed current international guidelines, pivotal clinical studies, and real-world experiences and adapted them to the Korean clinical setting. This consensus statement provides updated recommendations for diagnostic approaches, initial and adjunctive therapies, management of refractory disease, ADAMTS13 monitoring, and long-term follow-up. By integrating international evidence with local circumstances, this document aims to provide Korean clinicians with practical, upto-date guidance to enhance the routine care of patients with TTP.","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 4","pages":"572-584"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431304","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

Serum uric acid and valvular heart disease: a new window into cardiometabolic risk stratification. 血清尿酸与瓣膜性心脏病：心脏代谢危险分层的新窗口

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-07-01 DOI: 10.3904/kjim.2026.282

Ki Won Moon

引用次数: 0

Not all prediabetes is the same in its effect for bone health. 并非所有的前驱糖尿病对骨骼健康的影响都是一样的。

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-05-01 DOI: 10.3904/kjim.2026.163

Jeonghoon Ha

引用次数: 0

Comparison between ligation-assisted and precutting endoscopic mucosal resection for small rectal neuroendocrine tumors: a CHASID study. 结扎辅助与预切内镜粘膜切除术治疗直肠小神经内分泌肿瘤的比较：一项CHASID研究。

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-05-01 DOI: 10.3904/kjim.2025.234

Sunghyeok Ryou, Yunho Jung, Dae Sung Kim, Hee Seok Moon, Hoon Sup Koo, Hyun Deok Shin, Ki Bae Bang, Kyu Chan Huh

{"title":"Comparison between ligation-assisted and precutting endoscopic mucosal resection for small rectal neuroendocrine tumors: a CHASID study.","authors":"Sunghyeok Ryou, Yunho Jung, Dae Sung Kim, Hee Seok Moon, Hoon Sup Koo, Hyun Deok Shin, Ki Bae Bang, Kyu Chan Huh","doi":"10.3904/kjim.2025.234","DOIUrl":"10.3904/kjim.2025.234","url":null,"abstract":"Background/aims: Few studies have compared modified endoscopic mucosal resection (EMR) techniques for small rectal neuroendocrine tumors (NETs). This study evaluated the clinical outcomes of ligation-assisted EMR (EMR-L) and precutting EMR (EMR-P) for the treatment of small rectal NETs.Methods: We retrospectively reviewed patients who underwent EMR-L or EMR-P for rectal NETs ≤ 10 mm at four university hospitals between January 2018 and December 2022. Primary outcomes were en bloc resection and complete resection rates; secondary outcomes included procedural time and complications.Results: Among a total of 195 rectal NETs, 143 were resected using EMR-L and 52 using EMR-P. Although the histopathologically measured lesion size (4.0 ± 1.7 mm vs. 5.2 ± 2.4 mm, p = 0.002) was larger in the EMR-P group, the presence of ulcer or depression and lesion location did not significantly differ between the two groups. The en bloc resection rate (100.0% vs. 96.2%, p = 0.070) and complete resection rate (95.8% vs. 90.4%, p = 0.140) also were not significantly different. However, EMR-L had a significantly shorter procedure time (3.9 ± 2.3 min vs. 9.8 ± 5.6 min, p < 0.001). No significant differences were observed in procedure-related bleeding, perforation, recurrence, or hospital stay between the groups.Conclusion: Both EMR-L and EMR-P achieved high en bloc and complete resection rates with favorable safety profiles. However, EMR-L was significantly faster, suggesting that it is a more time-efficient approach for small rectal NET resection.","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 3","pages":"432-440"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13172795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934965","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

Targeting immune dysregulation in chronic spontaneous urticaria: beyond antihistamines. 针对慢性自发性荨麻疹免疫失调：超越抗组胺药。

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-05-01 DOI: 10.3904/kjim.2025.374

Young-Min Ye

{"title":"Targeting immune dysregulation in chronic spontaneous urticaria: beyond antihistamines.","authors":"Young-Min Ye","doi":"10.3904/kjim.2025.374","DOIUrl":"10.3904/kjim.2025.374","url":null,"abstract":"Chronic urticaria (CU) is characterized by recurrent wheals and angioedema lasting longer than six weeks. It affects approximately 0.5-1.4% of the population and profoundly impairs the quality of life. The disease exhibits a variable course, with many patients experiencing symptoms for several years. Higher disease activity correlates with increased burden and delayed remission. Therefore, early and effective intervention is critical to improving patient outcomes. Current first-line therapies target histamine, the principal effector mediator released from activated mast cells, using non-sedating H1-antihistamines. However, mast cells secrete a wide array of additional mediators, including platelet-activating factor, leukotrienes, cytokines, and neuropeptides, all of which contribute to vasodilation, pruritus, and inflammatory cell recruitment. Therapies targeting these mediators provide adjunctive benefits but remain insufficient because they do not prevent mast cell activation. This limitation has prompted a paradigm shift toward upstream strategies designed to inhibit mast cell activation and degranulation. These strategies can be broadly divided into IgE-dependent approaches, targeting the cross-linking of the high-affinity IgE receptor, which include anti-IgE monoclonal antibodies, IgE traps, and Bruton's tyrosine kinase inhibitors, and non-IgE-mediated approaches, such as cytokine blockade (interleukin [IL]-4, IL-5, IL-17, and IL-33), complement inhibition, c-kit targeting, Siglec-8 modulation, MRGPRX2 antagonism, and alarmin-directed therapies. Collectively, these advances signify a shift in chronic spontaneous urticaria (CSU) management from symptomatic mediator blockade to mechanism-based and personalized therapy. The ultimate objective is not merely to control symptoms but also to achieve true disease modification by altering the natural course of CSU.","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 3","pages":"418-431"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13172814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934912","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

Comment on: "Comprehensive analysis of patients with rheumatoid arthritis-associated interstitial lung disease" by Kim et al. 评论：Kim等人的《类风湿关节炎相关间质性肺病患者的综合分析》。

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-05-01 Epub Date: 2025-12-23 DOI: 10.3904/kjim.2025.316

Umut Bakay

引用次数: 0

Association between remnant cholesterol and colorectal cancer risk in Korea: a nationwide population-based study. 残留胆固醇与韩国结直肠癌风险之间的关系：一项全国性的基于人群的研究

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-05-01 DOI: 10.3904/kjim.2025.350

Minkook Son, Jong Yoon Lee, Chi Hyeon Choi, Yeo Wool Kang, Sang Yi Moon, Myeonseok Koh

{"title":"Association between remnant cholesterol and colorectal cancer risk in Korea: a nationwide population-based study.","authors":"Minkook Son, Jong Yoon Lee, Chi Hyeon Choi, Yeo Wool Kang, Sang Yi Moon, Myeonseok Koh","doi":"10.3904/kjim.2025.350","DOIUrl":"10.3904/kjim.2025.350","url":null,"abstract":"Background/aims: Remnant cholesterol (RC) has emerged as a novel lipid marker with potential implications in cardiovascular and metabolic diseases. However, its association with colorectal cancer (CRC) remains unclear.Methods: We conducted a retrospective cohort study using data from 364,626 Korean adults who underwent a national health screening between 2012 and 2013. RC and other lipid parameters were categorized into quartiles. Participants were followed up until CRC diagnosis, death, or December 31, 2019. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) after controlling for demographic, clinical, and lifestyle factors.Results: CRC incidence increased from 1.75 to 2.25 per 1,000 person-years across the RC quartiles. When compared with Q1, adjusted HRs were 1.08 (95% CI, 0.96-1.21) in Q2, 1.13 (1.01-1.26) in Q3, and 1.21 (1.08-1.35) in Q4. A similar trend was observed for triglycerides but not for low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or total cholesterol. In the subgroup analyses, the association between RC and CRC was stronger in participants aged ≥ 65 years and those with a body mass index < 23 kg/m2.Conclusion: Elevated RC levels were independently associated with an increased risk of CRC. Thus, RC may serve as a useful biomarker for CRC risk stratification beyond traditional lipid parameters.","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 3","pages":"443-453"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13172798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934820","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

Germline DDX41 mutations in myeloid neoplasms: a comprehensive review. 髓系肿瘤中种系DDX41突变：全面回顾。

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-05-01 DOI: 10.3904/kjim.2025.356

Je-Hwan Lee, Eun-Hye Hur, Young-Uk Cho

{"title":"Germline DDX41 mutations in myeloid neoplasms: a comprehensive review.","authors":"Je-Hwan Lee, Eun-Hye Hur, Young-Uk Cho","doi":"10.3904/kjim.2025.356","DOIUrl":"10.3904/kjim.2025.356","url":null,"abstract":"DEAD-box helicase 41 (DDX41)-associated myeloid neoplasms represent a distinct hereditary cancer syndrome and have emerged as the most common form of genetic predisposition to adult-onset hematologic malignancies, accounting for 3-5% of adults with myelodysplastic syndrome and acute myeloid leukemia. DDX41 is a multifunctional DEAD-box RNA helicase that plays essential roles in pre-mRNA splicing, ribosome biogenesis, and innate immune regulation. Pathogenic germline variants predominantly cluster within the N-terminal region, whereas somatic second-hit mutations are concentrated in the C-terminal helicase domain. The characteristic \"two-hit\" model involves a germline loss-of-function mutation followed by a somatic variant-most commonly p.R525H-leading to malignant transformation. This process occurs through defective small nucleolar RNA processing, impaired ribosome assembly, erythropoietic abnormalities, and R-loop-mediated DNA damage. Clinically, the phenotype is consistent and characterized by late-onset disease in the sixth to seventh decades of life, a strong male predominance, hypocellular bone marrow, and normal cytogenetics. Despite these distinctive features, affected individuals generally exhibit favorable treatment responses and outcomes compared with sporadic cases. An important clinical consideration in DDX41-associated disease management is the planning of allogeneic hematopoietic cell transplantation, where genetic screening for DDX41 variants among potential related donors is essential. Future investigations should aim to elucidate the molecular mechanisms underlying DDX41-driven leukemogenesis, refine surveillance strategies, and develop targeted therapeutic approaches.","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 3","pages":"396-410"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13172803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934885","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

Opposing associations of muscle and fat mass changes on serum uric acid levels: a 2-year longitudinal cohort study. 肌肉和脂肪量变化与血清尿酸水平的相反关系：一项为期2年的纵向队列研究

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-05-01 DOI: 10.3904/kjim.2025.362

Jiwon Hwang, Mi Yeon Lee, Joong Kyong Ahn

{"title":"Opposing associations of muscle and fat mass changes on serum uric acid levels: a 2-year longitudinal cohort study.","authors":"Jiwon Hwang, Mi Yeon Lee, Joong Kyong Ahn","doi":"10.3904/kjim.2025.362","DOIUrl":"10.3904/kjim.2025.362","url":null,"abstract":"Background/aims: Obesity elevates serum uric acid (SUA) levels, but the influence of muscle mass remains unclear. As a major endogenous purine pool, skeletal muscle may affect SUA dynamics. We evaluated the impact of changes in body components, including skeletal muscle mass index (SMI), fat mass index (FMI), and waist-to-hip ratio (WHR), on SUA in a large cohort of healthy Koreans.Methods: We analyzed 39,505 adults (24,623 men; 14,180 premenopausal and 702 postmenopausal women) who underwent health checkups in 2015-2017. Body composition was assessed using bioimpedance analysis. Participants were categorized into seven groups based on 2-year changes in SMI, FMI, and WHR (tertiles of increase, decrease, and no change). Hyperuricemia was defined as SUA ≥ 7 mg/dL in men and ≥ 6 mg/dL in women. Odds ratios (ORs) for achieving optimal SUA levels (< 6 mg/dL) and regression coefficients for SUA changes were calculated.Results: Mean SUA levels were 6.25 ± 1.21 mg/dL in men, 4.23 ± 0.88 mg/dL in premenopausal women, and 4.34 ± 0.91 mg/dL in postmenopausal women. SUA changed dose-dependently with body component: SMI increases were associated with reduced SUA (OR [95% CI] for the highest tertile = 1.45 [1.32-1.59] in men; 1.48 [1.06-2.06] in premenopausal women), while FMI and WHR increases correlated positively with SUA.Conclusion: Two-year changes in body composition significantly influenced SUA levels, particularly in men and premenopausal women. Increasing muscle mass and reducing adiposity may be associated with improved urate control in individuals with hyperuricemia or those prone to gout.","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 3","pages":"537-554"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13172810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934883","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

Incidence and risk factors of rebleeding in Crohn's disease patients with acute lower gastrointestinal bleeding. 克罗恩病合并急性下消化道出血患者再出血的发生率及危险因素

IF 2.2 4区医学

Korean Journal of Internal Medicine Pub Date : 2026-05-01 DOI: 10.3904/kjim.2025.348

Gabin Moon, Kyeong Ok Kim, Sung Noh Hong, Seong Joon Koh, Sung Hoon Jung, Chang Hwan Choi, Eun Mi Song, Hong Sub Lee, Yoo Jin Lee, Ki Bae Bang

{"title":"Incidence and risk factors of rebleeding in Crohn's disease patients with acute lower gastrointestinal bleeding.","authors":"Gabin Moon, Kyeong Ok Kim, Sung Noh Hong, Seong Joon Koh, Sung Hoon Jung, Chang Hwan Choi, Eun Mi Song, Hong Sub Lee, Yoo Jin Lee, Ki Bae Bang","doi":"10.3904/kjim.2025.348","DOIUrl":"10.3904/kjim.2025.348","url":null,"abstract":"Background/aims: Acute lower gastrointestinal bleeding (LGIB) in Crohn's disease (CD) is a rare but potentially life-threatening complication. This study aimed to investigate the incidence and risk factors of rebleeding in CD patients with LGIB.Methods: We retrospectively analyzed 137 CD patients with acute LGIB from nine tertiary university hospitals in Korea from January 2000 to October 2020. Patient characteristics, disease features, and treatment modalities were assessed, and rebleeding incidence, clinical features, and risk factors were analyzed.Results: The median age of patients was 26.5 years, and the male-to-female ratio was 3.72:1. The median duration from diagnosis to first bleeding was 30.6 (0-243) months. Ileocolonic involvement (72 patients, 53%) and inflammatory phenotype (85, 62%) were most prevalent. During index bleeding, 20 and 40 patients were receiving biologics and azathioprine/6-mercaptopurine (AZA/6-MP), respectively. Bleeding focus was confirmed in 58 patients, primarily with endoscopy (33 cases). Management included conservative therapy (115 cases, 84%), endoscopic treatment (11, 8%), embolization (5, 3%), and surgery (6, 4%). After the index bleeding, 77 (56.2%) patients started or changed AZA/6-MP or biologics. Rebleeding occurred in 44 (32%) patients. The median time to recurrence was 13.0 (0.1-209) months. Transfusion requirement was significantly associated with rebleeding in univariate (hazard ratio [HR] = 3.124, 95% confidence interval [CI] = 1.502-6.494; p = 0.002) and multivariate (HR = 3.857, 95% CI = 1.678-8.867; p = 0.001) analyses.Conclusion: Rebleeding incidence in patients with CD experiencing acute LGIB was 32%. Transfusion requirement is a significant risk factor for rebleeding.","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 3","pages":"454-461"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13172793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934921","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