Publications by authors named "Su Jin Jeong"

213 Publications

Risk factors for unfavorable clinical outcomes in patients with brain abscess in South Korea.

PLoS One 2021 20;16(9):e0257541. Epub 2021 Sep 20.

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.

Background: Brain abscess can be life-threatening and manifest various neurological findings, although the mortality rate has decreased recently. We investigated the risk factors for unfavorable outcomes of patients with brain abscess.

Methods: A retrospective cohort study examined patients with brain abscess seen from May 2005 to December 2018 in a tertiary care hospital in Seoul, South Korea. We reviewed the medical records for clinical findings, therapeutic modalities, and prognostic factors of brain abscess. Unfavorable clinical outcomes were defined as death, moderate to severe disability with neurological deficits, or vegetative state at 1 year or at the time of discharge from outpatient follow-up.

Results: The study enrolled 135 patients: 65.2% were males; the mean age was 56 years. 35.6% had unfavorable outcomes. In multivariate analysis, higher Sequential Organ Failure Assessment (SOFA) (p < 0.001), pre-existing hemiplegia (p = 0.049), and higher Charlson comorbidity index (CCI) (p = 0.028) were independently associated with unfavorable outcomes.

Conclusions: Higher SOFA, pre-existing hemiplegia and higher Charlson comorbidity index were significant risk factors for unfavorable clinical outcomes in patients with brain abscess.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257541PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8451987PMC
September 2021

The Prediction and Prognosis of Fungal Infection in Lung Transplant Recipients-A Retrospective Cohort Study in South Korea.

J Fungi (Basel) 2021 Aug 6;7(8). Epub 2021 Aug 6.

Division of Thoracic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.

(1) Background: Lung transplant recipients (LTRs) are at substantial risk of invasive fungal disease (IFD), although no consensus has been reached on the use of antifungal agents (AFAs) after lung transplantation (LTx). This study aimed to assess the risk factors and prognosis of fungal infection after LTx in a single tertiary center in South Korea. (2) Methods: The study population included all patients who underwent LTx between January 2012 and July 2019 at a tertiary hospital. It was a retrospective cohort study. Culture, bronchoscopy, and laboratory findings were reviewed during episodes of infection. (3) Results: Fungus-positive respiratory samples were predominant in the first 90 days and the overall cumulative incidence of spp. was approximately three times higher than that of spp. In the setting of itraconazole administration for 6 months post-LTx, accounted for 36.5% of all -positive respiratory samples. Underlying connective tissue disease-associated interstitial lung disease, use of AFAs before LTx, a longer length of hospital stay after LTx, and old age were associated with developing a fungal infection after LTx. IFD and fungal infection treatment failure significantly increased overall mortality. Host factors, antifungal drug resistance, and misdiagnosis of non- molds could attribute to the breakthrough fungal infections. (4) Conclusions: Careful bronchoscopy, prompt fungus culture, and appropriate use of antifungal therapies are recommended during the first year after LTx.
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http://dx.doi.org/10.3390/jof7080639DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8400395PMC
August 2021

Revised Korean Society of Infectious Diseases/National Evidence-based Healthcarea Collaborating Agency Guidelines on the Treatment of Patients with COVID-19.

Infect Chemother 2021 Mar;53(1):166-219

Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Despite the global effort to mitigate the spread, coronavirus disease 2019 (COVID-19) has become a pandemic that took more than 2 million lives. There are numerous ongoing clinical studies aiming to find treatment options and many are being published daily. Some effective treatment options, albeit of variable efficacy, have been discovered. Therefore, it is necessary to develop an evidence-based methodology, to continuously check for new evidence, and to update recommendations accordingly. Here we provide guidelines on pharmaceutical treatment for COVID-19 based on the latest evidence.
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http://dx.doi.org/10.3947/ic.2021.0303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032920PMC
March 2021

Trends of age-related non-communicable diseases in people living with HIV and comparison with uninfected controls: A nationwide population-based study in South Korea.

HIV Med 2021 Oct 14;22(9):824-833. Epub 2021 Jul 14.

Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.

Objectives: We aim to compare the trends of non-communicable diseases (NCDs) and death among people living with HIV (PLWH) and uninfected controls in South Korea.

Methods: We identified PLWH from a nationwide database of all Korean citizens enrolled from 1 January 2004 to 31 December 2016. A control cohort was randomly selected for PLWH by frequency matching for age and sex in a 20:1 ratio. To compare NCD trends between the groups, adjusted incidence rate ratios for outcomes across ages, calendar years and times after HIV diagnosis were calculated.

Results: We included 14 134 PLWH and 282 039 controls in this study; 58.5% of PLWH and 36.4% of the controls were diagnosed with at least one NCD. The incidence rates of cancers, chronic kidney disease, depression, osteoporosis, diabetes and dyslipidaemia were higher in PLWH than in the controls, whereas those of cardiovascular disease, heart failure, ischaemic stroke and hypertension were lower in PLWH. Relative risks (RRs) for NCDs in PLWH were higher than controls in younger age groups. Trends in the RRs of NCDs tended to increase with the calendar year for PLWH vs. controls and either stabilized or decreased with time after HIV diagnosis. The RR of death from PLWH has decreased with the calendar year, but showed a tendency to rise again after 2014 and was significant at the early stage of HIV diagnosis.

Conclusions: Although the RR of each NCD in PLWH showed variable trends compared with that in controls, NCDs in PLWH have been increasingly prevalent.
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http://dx.doi.org/10.1111/hiv.13139DOI Listing
October 2021

24-Hour Multichannel Intraluminal Impedance-pH in Proton Pump Inhibitor Nonresponders vs Responders in Patients With Laryngopharyngeal Reflux.

Otolaryngol Head Neck Surg 2021 Jul 13:1945998211026843. Epub 2021 Jul 13.

Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea.

Objective: This study aimed to evaluate the characteristics of reflux in proton pump inhibitor (PPI) nonresponders vs responders in patients with laryngopharyngeal reflux (LPR) by using 24-hour multichannel intraluminal impedance-pH (MII-pH) monitoring.

Study Design: Prospective cohort study.

Setting: A tertiary care otolaryngology clinic.

Methods: Patients with typical LPR symptoms showing >1 proximal reflux episode were considered to have LPR and investigated prospectively. Patients were prescribed high-dose PPI twice daily and followed up for at least 2 months. Patients with LPR showing a ≥50% decrease in the follow-up reflux symptom index score during treatment periods as compared with pretreatment were defined as responders; others were defined as nonresponders. Various parameters in 24-hour MII-pH monitoring between nonresponders and responders with LPR were compared with Student's test and receiver operating characteristic curve.

Results: Eighty patients were diagnosed with LPR and categorized as nonresponders (n = 19) and responders (n = 61). Proximal all reflux time and proximal longest reflux time in various MII parameters were higher in responders than in nonresponders ( = .0040 and .0216, respectively). Proximal all reflux time >0.000517% was a better cutoff value to predict responders with LPR as compared with the proximal longest reflux time >0.61 minutes (sensitivity + specificity: 1.317 vs 1.291).

Conclusion: Proximal all reflux time in various 24-hour MII-pH monitoring parameters can be helpful to predict the response to PPI therapy in patients with LPR. These findings will help establish a personalized therapeutic scheme for patients with LPR.
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http://dx.doi.org/10.1177/01945998211026843DOI Listing
July 2021

Korean Society of Infectious Diseases/National Evidence-based Healthcare Collaborating Agency Recommendations for Anti-SARS-CoV-2 Monoclonal Antibody Treatment of Patients with COVID-19.

Infect Chemother 2021 Jun;53(2):395-403

Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Neutralizing antibodies targeted at the receptor-binding domain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein have been developed and now under evaluation in clinical trials. The US Food and Drug Administration currently issued emergency use authorizations for neutralizing monoclonal antibodies in non-hospitalized patients with mild to moderate coronavirus disease 2019 (COVID-19) who are at high risk for progressing to severe disease and/or hospitalization. In terms of this situation, there is an urgent need to investigate the clinical aspects and to develop strategies to deploy them effectively in clinical practice. Here we provide guidance for the use of anti-SARS-CoV-2 monoclonal antibodies for the treatment of COVID-19 based on the latest evidence.
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http://dx.doi.org/10.3947/ic.2021.0304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258293PMC
June 2021

Effects of early corticosteroid use in patients with severe coronavirus disease 2019.

BMC Infect Dis 2021 May 31;21(1):506. Epub 2021 May 31.

Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea.

Background: Coronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents for this disease. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes.

Methods: This was a retrospective cohort study including patients with severe COVID-19 who received corticosteroid treatment from March 2 to June 30, 2020 in seven tertiary hospitals in South Korea. We analyzed the patient demographics, characteristics, and clinical outcomes according to the timing of steroid use. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids.

Results: Of the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10 days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO/FiO ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08 days and the treatment duration was 14 days in the early use group, while those in the late use group were 12.80 days and 18.50 days, respectively. The PaO/FiO ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4 days vs. 60.0 days, P = 0.030), time from diagnosis to discharge (27.8 days vs. 57.4 days, P = 0.024), and hospital stay (26.0 days vs. 53.9 days, P = 0.033) were shortened.

Conclusions: Among patients with severe COVID-19, early use of corticosteroids showed favorable clinical outcomes which were related to a reduction in the length of hospital stay.
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http://dx.doi.org/10.1186/s12879-021-06221-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165348PMC
May 2021

Pharyngeal reflux episodes in patients with suspected laryngopharyngeal reflux versus healthy subjects: a prospective cohort study.

Eur Arch Otorhinolaryngol 2021 Sep 25;278(9):3387-3392. Epub 2021 May 25.

Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea.

Purpose: This study aimed to analyze pharyngeal reflux episodes in patients with suspected LPR versus healthy subjects using 24-h MII-pH monitoring.

Methods: One hundred twenty-one patients who visited our clinic with a chief complaint of LPR-related symptoms and underwent 24-h MII-pH monitoring were enrolled prospectively. Also, 27 healthy subjects were enrolled and underwent 24-h MII-pH monitoring during the same period. We analyzed sensitivity, specificity, and accuracy comprehensively to determine appropriate cut-off values of pharyngeal reflux episodes in 24-h MII-pH monitoring to diagnose patients with LPR.

Results: Twenty-nine of 121 patients with suspected LPR showed no pharyngeal reflux episodes, while 92 showed more than one pharyngeal reflux event. In contrast, the 22 healthy subjects showed no pharyngeal reflux episodes, three showed one reflux event, and two showed two reflux events. A cut-off value of ≥ 1 showed best accuracy reflected by combined sensitivity and specificity values, while ≥ 2 demonstrated better specificity with slight loss of sensitivity and slightly lower overall accuracy, suggesting cut-off value of ≥ 1 pharyngeal reflux episodes is a good clinical indicator.

Conclusion: A cut-off value of ≥ 1 in pharyngeal reflux episodes on 24-h MII-pH monitoring in patients with suspected LPR might be an acceptable diagnostic tool for LPR.
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http://dx.doi.org/10.1007/s00405-021-06865-8DOI Listing
September 2021

Splenic uptake on FDG PET/CT correlates with Kikuchi-Fujimoto disease severity.

Sci Rep 2021 May 25;11(1):10836. Epub 2021 May 25.

Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.

Kikuchi-Fujimoto disease (KFD) is usually self-limiting, but prolonged systemic symptoms often result in frequent hospital visits, long admission durations, or missed workdays. We investigated the role of fluorine-18 fluoro-2-deoxy-D-glucose (F-FDG) positron emission tomography/computed tomography (PET/CT) in assessing KFD severity. We reviewed the records of 31 adult patients with pathologically confirmed KFD who underwent F-FDG PET/CT between November 2007 and April 2018 at a tertiary-care referral hospital. Disease severity was assessed using criteria based on clinical manifestations of advanced KFD. Systemic activated lymph nodes and severity of splenic activation were determined using semi-quantitative and volumetric PET/CT parameters. The median of the mean splenic standardized uptake value (SUV) was higher in patients with severe KFD than those with mild KFD (2.38 ± 1.18 vs. 1.79 ± 0.99, p = 0.058). Patients with severe KFD had more systemically activated volume and glycolytic activity than those with mild KFD (total lesion glycolysis: 473.5 ± 504.4 vs. 201.6 ± 363.5, p = 0.024). Multivariate logistic regression showed that myalgia (odds ratio [OR] 0.035; 95% confidence interval [CI] 0.001-0.792; p = 0.035), total lymph node SUV (cutoff 9.27; OR 24.734; 95% CI 1.323-462.407; p = 0.032), and spleen SUV (cutoff 1.79; OR 37.770; 95% CI 1.769-806.583; p = 0.020) were significantly associated with severe KFD. F-FDG PET/CT could be useful in assessing KFD severity.
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http://dx.doi.org/10.1038/s41598-021-90350-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8149816PMC
May 2021

Barriers to initiating SGLT2 inhibitors in diabetic kidney disease: a real-world study.

BMC Nephrol 2021 May 14;22(1):177. Epub 2021 May 14.

Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.

Background: Sodium-glucose cotransporter 2 inhibitor (SGLT2i) should be considered for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) having estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m and urine albumin-to-creatinine ratio (UACR) > 30 mg/g. However, SGLT2i is currently underprescribed among eligible, at-risk patients for CKD progression. We analyzed prescription patterns and barriers to initiating SGLT2i in patients with T2D and CKD in real practice.

Methods: A total of 3,703 consecutive outpatients with T2D from four teaching hospitals during six months (2019 ~ 2020) were reviewed. Five eGFR categories (G1, ≥ 90; G2, 60-89; G3ab, 30-59; G4-5, < 30 mL/min/1.73 m) and three UACR categories (A1, < 30; A2, 30-300; A3, > 300 mg/g) were used to define CKD status.

Results: Overall, 25.8 % patients received SGLT2i in the following eGFR and albuminuria categories: G1 (A1, 31 %; A2, 48 %; A3, 45 %); G2 (A1, 18 %; A2, 24 %; A3, 30%); and G3 (A1, 9 %; A2, 7 %; A3, 13 %). Total prevalence estimate of CKD was 33.8 % (n = 1,253), of whom 25.6 % patients received SGLT2i. We defined eGFR ≥ 45 mL/min/1.73 m and UACR ≥ 30 mg/g as high-risk CKD group eligible for SGLT2i (n = 905), of whom 32.9 % patients were treated with an SGLT2i. In this high-risk group, SGLT2i initiation showed negative correlations with age ≥ 65 years and recent hospitalization. Conversely, HbA1c level, body mass index (BMI), presence of diabetic retinopathy, and previous heart failure events were positively correlated with SGLT2i initiation.

Conclusions: Only 32.9 % of T2D with CKD eligible for SGLT2i is currently treated with SGLT2i in real-world clinical practice. The older patient group and clinical inertia are the main barriers to initiate SGLT2i for eligible patients. Clinicians should change the glucocentric approach and focus on reducing renal events in T2D.
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http://dx.doi.org/10.1186/s12882-021-02381-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122538PMC
May 2021

Plasma amino acids and oxylipins as potential multi-biomarkers for predicting diabetic macular edema.

Sci Rep 2021 05 6;11(1):9727. Epub 2021 May 6.

Department of Systems Biotechnology, Konkuk University, Seoul, Republic of Korea.

To investigate the pathophysiologic characteristics of diabetic complications, we identified differences in plasma metabolites in subjects with type 2 diabetes (T2DM) with or without diabetic macular edema (DME) and a disease duration > 15 years. An cohort of older T2DM patients with prolonged disease duration was established, and clinical information and biospecimens were collected following the guidelines of the National Biobank of Korea. DME phenotypes were identified by ophthalmologic specialists. For metabolomics studies, propensity matched case and control samples were selected. To discover multi-biomarkers in plasma, non-targeted metabolite profiling and oxylipin profiling in the discovery cohort were validated in an extended cohort. From metabolomic studies, 5 amino acids (asparagine, aspartic acid, glutamic acid, cysteine, and lysine), 2 organic compounds (citric acid and uric acid) and 4 oxylipins (12-oxoETE, 15-oxoETE, 9-oxoODE, 20-carboxy leukotriene B4) were identified as candidate multi-biomarkers which can guide DME diagnosis among non-DME subjects. Receiver operating characteristic curves revealed high diagnostic value of the combined 5 amino acids and 2 organic compounds (AUC = 0.918), and of the 4 combined oxylipins (AUC = 0.957). Our study suggests that multi-biomarkers may be useful for predicting DME in older T2DM patients.
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http://dx.doi.org/10.1038/s41598-021-88104-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102569PMC
May 2021

Duration of culturable SARS-CoV-2 within different specimens among mild and severe COVID-19 patients: A longitudinal study.

J Infect 2021 07 28;83(1):e29-e31. Epub 2021 Apr 28.

Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea. Electronic address:

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http://dx.doi.org/10.1016/j.jinf.2021.04.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080513PMC
July 2021

The Growth Model of Forensically Important (Meigen) (Diptera: Calliphoridae) in South Korea.

Insects 2021 Apr 6;12(4). Epub 2021 Apr 6.

Department of Legal Medicine, Korea University College of Medicine, Seoul 02841, Korea.

Development of forensically important (Meigen) was analyzed in South Korea. Rearing was replicated five times at seven constant temperatures between 20-35 °C to elucidate changes in accumulated degree hours, based on developmental stage and body length, and 2673 individuals were statistically analyzed. The results indicated that the optimum temperature, the base temperature, and the overall thermal constant were 22.31 °C (±1.21 °C, 95% CI), 9.07 °C, and 232.81 ± 23 (mean ± SD) accumulated degree days, respectively. In the minimum ADH models of each development stage, nonlinear regression graphs were parallel at the immature stages. Based on the scatter plot ( = 973) of immature stages using ADH values and body length, the logarithmic model using LogADH as the dependent variable was identified as the best fitting regression model. Additionally, the adjusted value and mean square of error were 0.911 and 0.007, respectively. This is the first forensically focused study on the development of for the estimation of minimum postmortem interval in South Korea. In future studies, we intend to study the development of other necrophagous fly species and to identify parameters for the determination of age at post-feeding and pupal stages.
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http://dx.doi.org/10.3390/insects12040323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067387PMC
April 2021

Risk of cancer in patients with recurrent aphthous stomatitis in Korea: A nationwide population-based study.

Medicine (Baltimore) 2021 Apr;100(16):e25628

Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul.

Abstract: The relationship between recurrent aphthous stomatitis (RAS), a common mucosal lesion, and cancer has not been demonstrated. This study investigated the risk for developing cancer in patients with RAS, based on data from Korea's National Health Insurance Sharing Service (NHISS). Nationwide population-based cohort data from 2005 to 2009 provided by the NHISS was used. The group diagnosed with RAS for 5 years and an undiagnosed control group were constructed through 1:1 propensity score matching (PSM). The experimental design compared the incidence rate of a cancer diagnosis from 2010 to 2015 between these 2 groups. After identifying 13,808 people that met our inclusion criterion from a 1 million cohort group, 13,808 controls were included in the study through PSM. Among all cancers, pancreatic cancer had an adjusted hazard ratio of 1.26 (95% confidence interval: 1.01-1.57, P < .041). For the rest of the cancers, there was no significant incidence rate. RAS was associated with an increased risk of pancreatic cancer in the analysis using large population-based cohort data. Further long-term follow-up studies are needed.
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http://dx.doi.org/10.1097/MD.0000000000025628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078402PMC
April 2021

Efficacy and Safety of Biphenyl Dimethyl Dicarboxylate and Ursodeoxycholic Acid Combination in Chronic Hepatitis Related to Metabolic Syndrome Components.

Korean J Gastroenterol 2021 04;77(4):179-189

Division of Gastroenterology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Backgrounds/aims: Steatohepatitis related to metabolic syndrome is a chronic liver disease prevalent in patients not only with non-alcoholic steatohepatitis but also with alcoholic liver disease and chronic viral hepatitis. On the other hand, there is limited data on the effects of hepatotonic agents in these patients. Therefore, this study evaluated the efficacy of a combined hepatotonic agent in this population.

Methods: Thirty-three adults with chronic hepatitis and one or more components of metabolic syndrome were assigned randomly to receive biphenyl dimethyl dicarboxylate/ursodeoxycholic acid or a placebo for 24 weeks. The primary outcome was the normalization of ALT (≤40 U/L). The secondary outcomes were the change in controlled attenuation parameter, transient elastography, and Chronic Liver Disease Questionnaire score.

Results: The 33 patients were assigned randomly to two groups. Eight (50%) of 16 patients who received the intervention drug showed the normalization of ALT, whereas only one (6%) of 17 patients in the placebo group did so. In contrast, the change in controlled attenuation, transient elastography, and Chronic Liver Disease Questionnaire were similar in the two groups. ALT was changed significantly during the four assessment periods, and this change was affected by the group. The interaction between the group and time was also significant. AST was changed significantly during the same period. This change was not affected by the group.

Conclusions: Biphenyl dimethyl dicarboxylate/ursodeoxycholic acid combination reduced ALT in chronic liver disease related to metabolic syndrome. On the other hand, there is no evidence that this leads to improved hepatic steatosis and fibrosis within 6 months.
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http://dx.doi.org/10.4166/kjg.2020.158DOI Listing
April 2021

Cap-assisted Endoscopic Mucosal Resection of Rectal Perineurioma Mimicking a Neuroendocrine Tumor.

Korean J Gastroenterol 2021 02;77(2):84-87

Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Colorectal perineuriomas are benign mucosal-based mesenchymal tumors composed of perineurial cells and show serrated or hyperplastic crypts in epithelium on histopathological evaluation. Most perineuriomas are usually presented as sessile polyps and often as subepithelial tumors. In this case, colonoscopy revealed a rectal subepithelial tumor (measuring approximately 7 mm) with yellowish- colored normal mucosa. A rectal neuroendocrine tumor was suspected, and cap-assisted endoscopic mucosal resection was performed. Histopathological examination of the resected specimen revealed bland spindle cells showing immunopositivity for CD34. The patient was finally diagnosed with rectal perineurioma.
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http://dx.doi.org/10.4166/kjg.2020.154DOI Listing
February 2021

A Proteomic Approach to Understand the Clinical Significance of Acute Myeloid Leukemia-Derived Extracellular Vesicles Reflecting Essential Characteristics of Leukemia.

Mol Cell Proteomics 2020 Dec 8;20:100017. Epub 2020 Dec 8.

Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea. Electronic address:

Extracellular vesicle (EV) proteins from acute myeloid leukemia (AML) cell lines were analyzed using mass spectrometry. The analyses identified 2450 proteins, including 461 differentially expressed proteins (290 upregulated and 171 downregulated). CD53 and CD47 were upregulated and were selected as candidate biomarkers. The association between survival of patients with AML and the expression levels of CD53 and CD47 at diagnosis was analyzed using mRNA expression data from The Cancer Genome Atlas database. Patients with higher expression levels showed significantly inferior survival than those with lower expression levels. ELISA results of the expression levels of CD53 and CD47 from EVs in the bone marrow of patients with AML at diagnosis and at the time of complete remission with induction chemotherapy revealed that patients with downregulated CD53 and CD47 expression appeared to relapse less frequently. Network model analysis of EV proteins revealed several upregulated kinases, including LYN, CSNK2A1, SYK, CSK, and PTK2B. The potential cytotoxicity of several clinically applicable drugs that inhibit these kinases was tested in AML cell lines. The drugs lowered the viability of AML cells. The collective data suggest that AML cell-derived EVs could reflect essential leukemia biology.
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http://dx.doi.org/10.1074/mcp.RA120.002169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7949255PMC
December 2020

Basiliximab Induction with Delayed Calcineurin Inhibitors for High-Risk Lung Transplant Candidates.

Yonsei Med J 2021 Feb;62(2):164-171

Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Purpose: Calcineurin inhibitor (CNI) use has improved lung transplantation outcomes. However, significant perioperative complications in patients receiving CNI can deteriorate the early course of lung transplantation. To date, there is no consensus regarding the optimal agent for the induction regimen after lung transplantation. We aimed to determine the efficacy of basiliximab induction with delayed CNI initiation in the prevention of acute complications without compromising immunosuppression in high-risk patients.

Materials And Methods: Between January 2013 and December 2019, 236 patients at a single lung transplant center were retrospectively reviewed. Forty-one patients (17.4%) received basiliximab induction, and 195 patients (82.6%) received a routine triple-drug regimen without induction. The primary endpoint was postoperative acute kidney injury with several other postoperative outcomes as secondary end-points.

Results: Preoperatively, the induction group had a higher proportion of patients who were admitted before transplantation (95.1% vs. 47.7%, <0.001) and received intensive unit care (90.2% vs. 33.8%, <0.001) and extracorporeal membrane oxygenation (ECMO) (87.8% vs. 20.0%, <0.001) compared to the non-induction group. No significant differences were observed in the incidence of acute rejection between groups (=0.657), although lower incidence of postoperative complications, including acute kidney injuries or culture-proven infections, were observed in the induction group. However, the differences were not statistically significant. A subgroup analysis of high-risk and preoperative ECMO support groups showed similar results.

Conclusion: Basiliximab induction with delayed CNI initiation for high-risk patients might decrease the incidence of perioperative complications, including acute renal failure, without increasing the risk of acute rejection.
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http://dx.doi.org/10.3349/ymj.2021.62.2.164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859690PMC
February 2021

Longitudinal study of meningococcal carriage rates in university entrants living in a dormitory in South Korea.

PLoS One 2021 28;16(1):e0244716. Epub 2021 Jan 28.

Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.

University students, especially those living in dormitories, are known to have a high risk of invasive meningococcal disease. We performed a longitudinal study to investigate the change in Neisseria meningitidis carriage rates and identify the risk factors for carriage acquisition in university students in South Korea. We recruited university entrants who were admitted to a student dormitory. Pharyngeal swabs were taken from participants at baseline, 1 month, and 3 months, and the subjects completed a questionnaire. Culture and real-time polymerase chain reaction (PCR) for species-specific ctrA and sodC genes were performed. The cultured isolates or PCR-positive samples were further evaluated for epidemiologic characterization using serogrouping, PorA typing, FetA typing, and multilocus sequence typing (MLST). At the first visit, we enrolled 332 participants who were predominantly male (64.2%) with a median age of 19 years. Meningococcal carriage rates increased from 2.7% (95% confidence interval [CI] 0.9-4.4%) at baseline to 6.3% (95% CI 3.4-9.0%) at 1 month and 11.8% (95% CI 7.8-15.6%) at 3 months. Nongroupable isolates accounted for 50.0% of all isolates, with serogroup B being the next most prevalent (24.1%). In the study population, male sex (OR 2.613, 95% CI 1.145-5.961, p = 0.022) and frequent pub or club visits (OR 3.701, 95% CI 1.536-8.919, p = 0.004) were significantly associated with meningococcal carriage. Based on serotype and MLST analyses, six carriers transmitted meningococci to other study participants. N. meningitidis carriage rates among new university entrants who lived in a dormitory significantly increased within the first 3 months of dormitory stay, probably owing to the transmission of identical genotype among students. Based on the risk of meningococcal disease, meningococcal vaccination should be considered for students before dormitory admission.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244716PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7842983PMC
May 2021

Diabetes Fact Sheets in Korea, 2020: An Appraisal of Current Status.

Diabetes Metab J 2021 01 13;45(1):1-10. Epub 2021 Jan 13.

Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea.

Background: This study aimed to investigate the recent prevalence, management, and comorbidities of diabetes among Korean adults aged ≥30 years by analyzing nationally representative data.

Methods: This study used data from the Korea National Health and Nutrition Examination Survey from 2016 to 2018, and the percentage and total number of people ≥30 years of age with diabetes and impaired fasting glucose (IFG) were estimated.

Results: In 2018, 13.8% of Korean adults aged ≥30 years had diabetes, and adults aged ≥65 years showed a prevalence rate of 28%. The prevalence of IFG was 26.9% in adults aged ≥30 years. From 2016 to 2018, 35% of the subjects with diabetes were not aware of their condition. Regarding comorbidities, 53.2% and 61.3% were obese and hypertensive, respectively, and 72% had hypercholesterolemia as defined by low-density lipoprotein cholesterol (LDL-C) ≥100 mg/dL in people with diabetes. Of the subjects with diabetes, 43.7% had both hypertension and hypercholesterolemia. With regard to glycemic control, only 28.3% reached the target level of <6.5%. Moreover, only 11.5% of subjects with diabetes met all three targets of glycosylated hemoglobin, blood pressure, and LDL-C. The percentage of energy intake from carbohydrates was higher in diabetes patients than in those without diabetes, while that from protein and fat was lower in subjects with diabetes.

Conclusion: The high prevalence and low control rate of diabetes and its comorbidities in Korean adults were confirmed. More stringent efforts are needed to improve the comprehensive management of diabetes to reduce diabetes-related morbidity and mortality.
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http://dx.doi.org/10.4093/dmj.2020.0254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850879PMC
January 2021

Persistent Effort to Control Infection after Lung Transplantation in Korea.

Authors:
Su Jin Jeong

Infect Chemother 2020 Dec;52(4):644-646

Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.3947/ic.2020.52.4.644DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779979PMC
December 2020

Clinical Characteristics and Causative Pathogens of Infective Arthritis and Risk Factors for Gram-Negative Bacterial Infections.

Infect Chemother 2020 Dec;52(4):503-515

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Background: The aim of this study was to describe the clinical and microbiological characteristics of infective arthritis and to analyze risk factors for Gram-negative bacterial infections that cause infective arthritis.

Materials And Methods: Patients admitted between 2009 - 2018 with infective arthritis in a single-tertiary hospital were evaluated retrospectively.

Results: A total of 181 patients were enrolled in this study. Of them, 135 were native joint infection patients and 46 were prosthetic joint infection patients. The most common site of infective arthritis was the knee (63.6%), followed by the shoulder (17.7%), and the hip (9.9%). The most frequently identified microorganisms were (51.1%), followed by sp. (21.1%), (8.4%), and coagulase-negative- (CNS; 8.4%). Infections due to Gram-negative bacteria and fungi made up 13.7% and 3.2% of all cases, respectively. Additionally, 20% and 4.2% of the cases involved methicillin-resistant (MRSA) and MRCNS. We found that bacteriuria, infective arthritis in the hip, and steroid use at admission are independent risk factors for Gram-negative bacterial infections.

Conclusion: Infective arthritis with methicillin-resistant microorganisms reached up to about 25% in a single-tertiary hospital in Korea. In case of suspected urinary tract infection, infective arthritis of the hip joint, or steroid use at admission time among infective arthritis patients, empirical treatment covering Gram-negative microorganisms can be considered.
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http://dx.doi.org/10.3947/ic.2020.52.4.503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779980PMC
December 2020

Clinical characteristics and online mental health care of asymptomatic or mildly symptomatic patients with coronavirus disease 2019.

PLoS One 2020 23;15(11):e0242130. Epub 2020 Nov 23.

Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.

Comparing to data in patients with severe coronavirus diseases 2019 (COVID-19), there are few studies on the prevalence anxiety and/or depression in patients with asymptomatic or mildly symptomatic COVID-19. We investigated the clinical characteristics and the prevalence of anxiety and/or depression among asymptomatic or mildly symptomatic patients with COVID-19 and monitored their mental health using an online assessment. An online survey for monitoring and assessing the mental health of patients with COVID-19 using a mobile phone was conducted. We used the Hospital Anxiety and Depression Scale to measure anxiety and/or depression levels. Of the 234 patients, 66 patients were asymptomatic (28.2%), while the remaining 168 patients were mildly symptomatic. The prevalence of anosmia (p = 0.001) and ageusia (p = 0.008) significantly decreased with the increasing age. In addition, 19.8% and 14.0% patients had anxiety and/or depression in the first survey, and one week after the first survey, respectively. Compared to patients without anxiety and/or depression, those with anxiety and/or depression had a longer quarantine duration. We found that anomia and ageusia were relatively common in the young age group. Furthermore, one-fifth asymptomatic or mildly symptomatic patients with COVID-19 had anxiety and/or depression.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242130PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7682865PMC
December 2020

Profiles of Extrapulmonary Nontuberculous Mycobacteria Infections and Predictors for Species: A Multicenter Retrospective Study.

Pathogens 2020 Nov 14;9(11). Epub 2020 Nov 14.

Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea.

Extrapulmonary nontuberculous mycobacteria (NTM) infections contribute to morbidity and mortality worldwide. However, studies about extrapulmonary NTM infections have been limited. Therefore, we aim to describe the diversity of extrapulmonary NTM infections and identify predictors for species. Information regarding diversity of NTM isolates, antimicrobial susceptibility testing, treatment regimens, and outcomes were collected from four tertiary care centers in South Korea. Comparisons were made between patients with rapidly growing mycobacteria (RGM) and slowly growing mycobacteria (SGM) infections. A total of 117 patients (46 males vs. 71 females) were included. Skin and soft tissue infections (SSTIs) predominated (34.2%), followed by bone and joint infections (28.2%). In SSTIs, RGM species were predominantly identified (26/28, 92.9%), whereas SGM species were mainly identified in bone and joint infections (18/26, 69.2%), and the difference of isolated sites was verified by a post hoc test ( < 0.001). Multivariable regression analysis revealed that male sex (vs. female sex; OR 5.30, CI 1.35-24.26, = 0.020) and bone and joint infections (vs. SSTIs; OR 18.10, CI 3.28-157.07, = 0.002) were predictors of SGM infections, whereas the opposite was observed for RGM infections. Bone and joint infections and male sex were predictors for SGM infections, whereas SSTIs and female sex were predictors for RGM infections.
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http://dx.doi.org/10.3390/pathogens9110949DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7697751PMC
November 2020

A mathematical model of COVID-19 transmission in a tertiary hospital and assessment of the effects of different intervention strategies.

PLoS One 2020 26;15(10):e0241169. Epub 2020 Oct 26.

Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

Novel coronavirus (named SARS-CoV-2) can spread widely in confined settings including hospitals, cruise ships, prisons, and places of worship. In particular, a healthcare-associated outbreak could become the epicenter of coronavirus disease (COVID-19). This study aimed to evaluate the effects of different intervention strategies on the hospital outbreak within a tertiary hospital. A mathematical model was developed for the COVID-19 transmission within a 2500-bed tertiary hospital of South Korea. The SEIR (susceptible-exposed-infectious-recovered) model with a compartment of doctor, nurse, patient, and caregiver was constructed. The effects of different intervention strategies such as front door screening, quarantine unit for newly admitted patients, early testing of suspected infected people, and personal protective equipment for both medical staff and visitors were evaluated. The model suggested that the early testing (within eight hours) of infected cases and monitoring the quarantine ward for newly hospitalized patients are effective measures for decreasing the incidence of COVID-19 within a hospital (81.3% and 70% decrease of number of incident cases, respectively, during 60 days). Front door screening for detecting suspected cases had only 42% effectiveness. Screening for prohibiting the admission of COVID-19 patients was more effective than the measures for patients before emergency room or outpatient clinic. This model suggests that under the assumed conditions, some effective measures have a great influence on the incidence of COVID-19 within a hospital. The implementation of the preventive measures could reduce the size of a hospital outbreak.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241169PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588052PMC
November 2020

Relative Skeletal Muscle Mass Is an Important Factor in Non-Alcoholic Fatty Liver Disease in Non-Obese Children and Adolescents.

J Clin Med 2020 Oct 19;9(10). Epub 2020 Oct 19.

Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea.

Recently, sarcopenia was identified as a risk factor for non-alcoholic fatty liver disease (NAFLD) in adults. We here investigated the association between skeletal muscle mass (SMM) and NAFLD in non-obese children and adolescents. A retrospective medical chart review was performed for individuals aged 9-15 years diagnosed with NAFLD. Healthy volunteers aged 9-15 years were recruited as controls. Participants were subject to laboratory tests, abdominal sonography, and multi-frequency bioelectrical impedance analysis. SMM data were calculated as the skeletal muscle-to-body fat ratio (MFR), and the diagnosis of fatty liver was established by abdominal sonography. The control and NAFLD groups included 73 and 53 individuals, respectively. No significant difference was observed in gender and body mass index (BMI) distribution between the groups. Mean MFR was significantly lower in individuals with NAFLD than in those without (0.83 vs. 1.04, = 0.005). After adjusting for age, sex, BMI, and serum glucose, the risk of having NAFLD was significantly associated with a decreased MFR ( = 0.016). NAFLD is significantly associated with relatively low SMM in non-obese children and adolescents. Increasing SMM, such as weight training, can be suggested as one of the treatment strategies in pediatric NAFLD without obesity.
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http://dx.doi.org/10.3390/jcm9103355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588960PMC
October 2020

Nontuberculous mycobacterial infection after lung transplantation: A single-center experience in South Korea.

J Microbiol Immunol Infect 2020 Oct 7. Epub 2020 Oct 7.

Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address:

Purpose: Nontuberculous mycobacteria (NTM) infection is an important issue after lung transplantation. However, a large-scale epidemiological study on this issue in Korea is lacking. We aimed to evaluate the epidemiology of NTM infection after lung transplant surgery in Korea.

Methods: Between October 2012 and December 2018, we retrospectively evaluated lung transplant recipients in a referral hospital in South Korea. A total of 215 recipients were enrolled. The median age at transplantation was 56 years (range, 17-75), and 62% were men. Bronchoscopy was performed according to the surveillance protocol and clinical indications. A diagnosis of NTM infection was defined as a positive NTM culture from a bronchial washing, bronchoalveolar lavage sample, or two separate sputum samples. We determined NTM pulmonary disease (NTM-PD) according to the American Thoracic Society/Infectious Disease Society of America 2007 guidelines. The Kaplan-Meier method and log-rank test were used for conditional survival analysis in patients with follow-up of ≥12 months.

Results: Fourteen patients (6.5%) were diagnosed with NTM infection at a median of 11.8 months (range, 0.3-51.4) after transplantation. Nine patients (4.2%) were diagnosed with NTM-PD, and the incidence rate was 1980/100,000 person-years. Mycobacterium abscessus was the most common species causing NTM-PD (66%), followed by M. avium complex (33%). The presence of NTM infection did not influence all-cause mortality among those who underwent follow-up for ≥12 months (N = 133, log-rank P = 0.816).

Conclusion: The incidence of NTM-PD was considerably high among lung-transplant recipients. M. abscessus was the most common causative species of NTM-PD after lung transplantation.
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http://dx.doi.org/10.1016/j.jmii.2020.08.021DOI Listing
October 2020

Serum YKL-40 Levels Are Associated with the Atherogenic Index of Plasma in Children.

Mediators Inflamm 2020 26;2020:8713908. Epub 2020 Sep 26.

Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea.

YKL-40, also known as chitinase-3-like protein 1, is an inflammatory glycoprotein that is secreted by various cell types under acute, chronic, and subclinical inflammation conditions. Elevated serum YKL-40 levels are reportedly independently related to diabetes mellitus, coronary artery disease, acute myocardial infarction, and cardiovascular mortality in adults. Therefore, we aimed to investigate the relationship between serum YKL-40 levels, lipid abnormalities, and the atherogenic index of plasma (AIP) in children. We enrolled 479 children aged 10-12 years (mean age: 11.52) in this general population-based, cross-sectional study. All subjects completed questionnaires and were subjected to multifrequency bioelectrical impedance analysis (BIA) to measure their height, weight, and body mass index (BMI). We collected serum samples from all participants to measure YKL-40, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels. Mean serum YKL-40 levels were significantly higher in the low-HDL-C ( = 0.017) and high-TG ( = 0.010) groups but were not related to TC and LDL-C levels. YKL-40 levels were also higher in the high AIP group ( = 0.007). After adjusting for age, gender, and BMI -score, the associations between serum YKL-40 levels and TG levels ( = 0.003), the TG-to-HDL-C ratio ( = 0.019), and the AIP value ( = 0.012) remained significant. Based on these findings, we suggest that serum YKL-40 may be a useful initial screening tool or follow-up risk indicator for lipid abnormalities, atherosclerosis, and cardiovascular disease in children and adolescents with risk factors, regardless of obesity.
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http://dx.doi.org/10.1155/2020/8713908DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533750PMC
August 2021

Risk of autoimmune diseases in recurrent aphthous ulcer patients: A nationwide population study.

Oral Dis 2021 Sep 30;27(6):1443-1450. Epub 2020 Dec 30.

Department of Preventive Medicine, Kyung Hee University School of Medicine, Seoul, Korea.

Objective: To estimate the risk of developing autoimmune disease in patients diagnosed having recurrent aphthous stomatitis (RAS) through a nationwide population-based cohort study.

Methods: This study included two group of patients who had three or more episodes with aphthae diagnosed from their physician (RAS group) and a similar matched group of patients without aphthae (control group). Both groups were collected within the period of 2005-2007 from the Korean National Health Insurances claims database. Non-RAS cohort was matched after frequency matching. The final enrolled subjects were observed during a follow-up period from 2008 to 2015 and those who received autoimmune diseases diagnoses during follow-up were identified. The hazard ratio (HR) for developing autoimmune diseases was estimated.

Results: A total of 4,637 patients with RAS and 4,637 controls were included. The risk of overall autoimmune diseases was significantly increased in the RAS group (adjusted HR [aHR)], 1.19). With regard to each disease entity, patients with RAS showed an increased risk of Behcet's disease (31.16), systemic lupus erythematous (SLE) (1.74), ankylosing spondylitis (AS) (1.47), gout (1.47), Hashimoto thyroiditis (1.42), Graves' disease (1.37), and rheumatoid arthritis (RA) (1.19).

Conclusion: RAS-like lesion may be an early sign of systemic autoimmune disease, as it was associated with an increased risk of Graves' disease, Hashimoto thyroiditis, SLE, AS, gout, RA, and Behcet's disease from real-world data.
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http://dx.doi.org/10.1111/odi.13659DOI Listing
September 2021
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