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김광실,박중현,원종철 대한내분비학회 2019 Endocrinology and metabolism Vol.34 No.2
The prevalence of type 2 diabetes mellitus (T2DM), which is associated with cardiovascular morbidity and mortality, is increasing worldwide. Although there have been advances in diabetes treatments that reduce microvascular complications (nephropathy, neuropathy, retinopathy), many clinical studies have found that conventional oral hypoglycemic agents and glucose control alone failed to reduce cardiovascular disease. Thus, incretin-based therapies including glucagon-like peptide 1 (GLP-1) receptor agonists (RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT-2Is) represent a new area of research, and may serve as novel therapeutics for treating hyperglycemia and modifying other cardiovascular risk factors. Recently, it has been confirmed that several drugs in these classes, including canagliflozin, empagliflozin, semaglutide, and liraglutide, are safe and possess cardioprotective effects. We review the most recent cardiovascular outcome trials on GLP-1RAs and SGLT-2Is, and discuss their implications for treating patients with T2DM in terms of protective effects against cardiovascular disease.
김광실,서종권,김병규,진무년,이혜영,김병옥,변영섭 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.4
Purpose: Only a few Asian studies have discussed the impact of statin intensity on clinical outcomes in patients with peripheralartery disease (PAD). We aimed to investigate the clinical impact of statin intensity in patients with PAD after endovascular revascularization. Materials and Methods: From April 2009 to June 2019, 376 patients with lower extremity PAD treated with endovascular revascularizationwere enrolled. They were classified into three groups according to statin intensity: no-statin, low-to-moderate intensity(LMI), and high-intensity (HI). The primary outcomes were major adverse cardiovascular events (MACE) and major adverselimb events (MALE). Results: During the 40-month follow-up, MACE occurred less frequently in the HI and LMI groups than the no-statin group(11.4% vs. 16.0% vs. 39%, p<0.001). In adjusted Cox models, the HI group had the fewest MACE [hazard ratio (HR): 0.447; 95%confidence interval (CI): 0.244–0.834; p=0.018] and MALE (HR: 0.360; 95% CI: 0.129–1.006; p=0.051) events, while the LMI grouphad fewer MACE (HR: 0.571; 95% CI: 0.326–1.0; p=0.050) events than the no-statin group. HI statin therapy was associated withbetter outcomes in terms of MALE (HR: 0.432; 95% CI: 0.223–0.837; p=0.003) than LMI statin therapy after inverse probabilitytreatment weighting analysis. Conclusion: HI and LMI statin use is associated with a significant reduction in MACE events than no-statin use. HI statin use wasassociated with better MALE outcomes than no-statin or LMI statin use.
위와 공장에서 점막하 종양 양상을 보인위로 전이된 공장 점액성 선암 1예
김광실,전태주,오태훈,신원창,최원충,신은아,김정연,김홍주 대한소화기내시경학회 2008 Clinical Endoscopy Vol.37 No.3
소장의 길이는 약 6 m로 전 위장관 길이의 75%, 점막표면의 90%를 차지하지만, 악성 종양 발생 비율은 2%로 매우 낮다. 점액성 선암은 선암 형태이면서 종양 내부 세포외 점액량이 50% 이상일 때로 정의하며, 소장 원발성 점액성 선암은 매우 드물어 현재까지 발생률, 호발 부위나 전이 장소 등에 대한 보고가 거의 없다. 국내에서도 위, 대장 또는 췌장에 발생한 점액성 선암에 대한 증례 보고는 있었지만, 소장에서 원발한 점액성 선암에 대한 증례는 없었다. 또한 점액성 선암이 위나 소장에서 점막하 종양의 형태로 나타나는 경우도 매우 드물다. 저자들은 점막하 종양의 양상을 보이며 복막과 위로 전이된 원발성 공장 점액성 선암 1예를 경험하였기에 문헌 고찰과 함께 보고한다.
강건희,김광실,이효락,유영진,김성록 대한암학회 2008 Cancer Research and Treatment Vol.40 No.3
Purpose: We wanted to assess the effectiveness and safety of combination chemotherapy with paclitaxel, 5-fluorouracil (5-FU) and cisplatin for treating advanced gastric cancer. Materials and Methods: Patients with metastatic or recurrent gastric cancer were entered into this study. Paclitaxel at a dose of 135 mg/m² on day 1, 5-FU 1 g/m²/ day in a 24 hour continuous infusion from day 1 to day 4 and cisplatin 60 mg/m² on day 1 were administered. This regimen was repeated every 3 weeks. Results: A total of 34 patients were enrolled in this study. Among them, 33 patients were finally evaluable for their response. 17 (51.5%) patients had a partial response (95% CI: 26.0∼77.0%). The median duration of overall survival was 13.2 months. Grade 3 or 4 neutropenia and thrombocytopenia were observed in 15.2% and 1.1% of all the cycles, respectively. Grade 3 stomatitis and neurotoxicity were observed in 20.6% and 1.1% of all patients, respectively. Grade 4 non-hematologic toxicity was not observed. Conclusions: The regimen of paclitaxel, 5-FU and cisplatin demonstrated activity and accepatable toxicity for treating metastatic gastric cancer.
서종권,김광실,이혜영,변영섭,정인현,이건주,김병옥 연세대학교의과대학 2019 Yonsei medical journal Vol.60 No.6
Purpose: The prevalence and clinical outcomes of asymptomatic carotid artery stenosis (CAS) in patients with coronary arterydisease (CAD) have not been thoroughly studied. We examined the prevalence and predictors of asymptomatic CAS detected bycarotid angiography and determined the impact of concomitant CAS on prognosis in patients undergoing coronary angiography(CAG) due to CAD. Materials and Methods: Between January 2013 and July 2015, 395 patients who underwent carotid digital subtraction angiographyto screen for CAS during CAG were analyzed. The presence of CAS was defined as angiographically significant stenosis(≥50%). Major adverse cardiac and cerebrovascular event (MACCE) rates were compared between patients with and withoutCAS. MACCEs included a composite of cardiac death, cerebrovascular death, acute myocardial infarction, and stroke. Results: Of the 395 patients, 101 (25.5%) patients had significant CAS. The independent predictors of CAS were age, male sex, hypertension,diabetes, and multi-vessel disease. In patients with CAD, the presence of CAS was as an independent predictor forMACCEs after adjusting for confounding factors (hazard ratio 2.47, 95% confidence interval 1.16–5.24, p=0.018). Conclusion: Asymptomatic CAS was documented in up to 25% of patients with CAD. The presence of CAS in patients with CADwas associated with a higher rate of MACCEs. Therefore, detection of CAS by carotid angiography during CAG may be importantfor risk stratification for CAD patients, particularly those with multi-vessel disease.