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1 우리들이잘알고있는의학분야의대표적인학술지 JAMA에가장먼저논문을수록한한국인이누구인지아십니까? 1930년 "Sarcoma of Ovary in a Child Eight Years Old" 라는제목으로논문을수록한서재필박사입니다. (JAMA 1930;95:1098-9) 물론국내의병원에서발표한연구결과는아니지만그당시우리의상황을생각해볼때대단한연구업적이아닐수없습니다. 그렇다면국내의의과대학 / 병원에서의연구결과를세계유수의학술지에발표한의료인들은누구일까요? JCR 상위 Ranking 저널에등재된국내의료진의연구실적을조사하였습니다. 1. 기준및조사대상 1) JCR 총170여개주제분야가운데임상의학관련주제분야 38개를선별하였고, 각주제분야마다 2002년도 JCR Impact Factor 5.0 이상혹은주제분야별상위 3위이내의학술지선정 ( 괄호안은해당주제분야대상저널종수임 ) Allergy(3) Infectious Diseases(3) Peripheral & Vascular Disease(7) Andrology(3) Medicine, General & Internal(8) Psychiatry(4) Anesthesiology(3) Multidisciplinary Sciences(2) Radiology(3) Cardiac & Cardiovascular Systems(4) Neuroimaging(3) Rehabilitation(3) Clinical Neurology(6) Neurosciences(25) Reproductive Biology(3) Critical Care Medicine(3) Nuclear Science(3) Respiratory System(3) Dermatology & Venereal Obstetrics & Diseases(3) Gynecology(3) Rheumatology(3) Emergency Medicine(3) Oncology(14) Sports Sciences(3) Endocrinology & Metabolism(15) Ophthalmology(3) Surgery(3) Gastroenterology & Hepatology(4) Orthopedics(3) Transplantation(3) Genetics& Heredity(21) Otolaryngology(3) Tropical Medicine(3) Geriatrics & Gerontology(3) Pathology(3) Urology & Nephrology(3) Hematology(19) Pediatrics(3) 삼성서울병원의학정보센터 1

2 2) 검색방법 Pubmed DB에서소속 (Affiliation) 에 "Korea" 를넣고검색한결과와조합하여검색 해당저널논문과 [ 입력예 ] (" "[is] AND korea[affiliation]) 3) 결과 38개주제분야총 207종 1,871개논문이검색되었고이중 1개이상논문이등재된저널은총 150종이며가장대표적저널등재내용은아래와같다, ( 참고로논문별서지사항과초록은의학정보센터홈페이지참조 ] Journal I/F Rank 편수 연구팀 1.NEJM 아산병원심장내과박승정교수팀 2.JAMA 연세대예방의학교실서일교수팀 3.Lancet 연세대예방의학교실서일교수팀연세대심장혈관병원하종원, 장병철교수팀 4.Archives of Internal Medicine 중앙의대내과학교실김치정유왕성교수팀 5.Medicine 아산병원내분비내과김기수교수팀 [ 별첨1] 대표적의학저널등재논문 [ 별첨 2] 주제분야별대상저널등재논문연도별건수 [ 별첨3] 상위Ranking별등재저널건수 삼성서울병원의학정보센터 2

3 [ 별첨 1] 대표적의학저널등재논문 1. New England Journal of Medicine(Impact Factor:31.736, Ranking:4 위 ) 임상분야최고학술지인 NEJM에국내최초로논문을수록한의료진은아산병원심장내과의박승정교수팀입니다. A paclitaxel-eluting stent for the prevention of coronary restenosis [N EnglJMed. 2003;348: ] Park SJ, Shim WH, Ho DS, Raizner AE, Park SW, Hong MK, Lee CW, Choi D, Jang Y, Lam R, Weissman NJ, Mintz GS. (Asan Medical Center, Seoul, South Korea.) BACKGROUND: Intimal hyperplasia and resulting restenosis limit the efficacy of coronary stenting. We studied a coronary stent coated with the antiproliferative agent paclitaxel as a means of preventing restenosis. METHODS: We conducted a multicenter, randomized, controlled, triple-blind study to evaluate the ability of a paclitaxel-eluting stent to inhibit restenosis. At three centers, 177 patients with discrete coronary lesions (<15 mm in length, 2.25 to 3.5 mm in diameter) underwent implantation of paclitaxel-eluting stents (low dose, 1.3 microg per square millimeter, or high dose, 3.1 microg per square millimeter) or control stents. Antiplatelet therapies included aspirin with ticlopidine (120 patients), clopidogrel (18 patients), or cilostazol (37 patients). Clinical follow-up was performed at one month and four to six months, and angiographic follow-up at four to six months. RESULTS: Technical success was achieved in 99 percent of the patients (176 of 177). At follow-up, the high-dose group, as compared with the control group, had significantly better results for the degree of stenosis (mean [+/-SD], 14+/-21 percent vs. 39+/-27 percent; P<0.001), late loss of luminal diameter (0.29+/-0.72 mm vs /-0.83 mm, P<0.001), and restenosis of more than 50 percent (4 percent vs. 27 percent, P<0.001). Intravascular ultrasound analysis demonstrated a dose-dependent reduction in the volume of intimal hyperplasia (31, 18, and 13 mm3, in the high-dose, low-dose, and control groups, respectively). There was a higher rate of major cardiac events in patients receiving cilostazol than in those receiving ticlopidine or clopidogrel. Among patients receiving ticlopidine or clopidogrel, event-free survival was 98 percent and 100 percent in the high-dose and control groups, respectively, at one month, and 96 percent in both at four to six months. CONCLUSIONS: Paclitaxel-eluting stents used with conventional antiplatelet therapy effectively inhibit restenosis and neointimal hyperplasia, with a safety profile similar to that of standard stents. ( 그런데유감스럽게도이논문은중복게재라는오명을남겼습니다.) 삼성서울병원의학정보센터 3

4 2. JAMA(Impact Factor:16.586, Ranking:27 위 ) JAMA에수록된최초의국내논문은연세의대예방의학교실의서일교수팀입니다. 이팀은 Lancet 에최초의논문을낸팀이기도합니다. Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea Medical Insurance Corporation Study [JAMA. 1999;282: ] Jee SH, Suh I, Kim IS, Appel LJ. (Department of Epidemiology and Disease Control, Graduate School of Health Science and Management, Yonsei University) CONTEXT: Few studies have examined the interactive effects of smoking and serum cholesterol level on morbidity and mortality from cardiovascular dieseases. In East Asia, where the prevalence of smoking is among the highest in the world, morbidity and mortality from ischemic heart disease (IHD) is rapidly escalating. OBJECTIVES: To determine whether cigarette smoking is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) in the Republic of Korea (South Korea), a population that has relatively low levels of serum cholesterol, and to determine whether serum cholesterol levels modify the risk relationship between smoking and ASCVD. DESIGN: Prospective cohort study with a follow-up period of 6 years ( ). SETTING AND SUBJECTS: A total of Korean men aged 35 to 59 years who received health insurancefrom the Korea Medical Insurance Corporation and who had biennial medical evaluations in 1990 and MAIN OUTCOME MEASURES: Hospital admissions and deaths from IHD, cerebrovascular disease (CVD), and total ASCVD. RESULTS: At baseline, (58%) were current cigarette smokers and (60%) had a total cholesterol level of less than 5.17 mmol/l (200 mg/dl). Between 1993 and 1998, 1006 IHD events (176 per person-years), 1364 CVD events (238 per person-years), and 716 other ASCVD events (125 per person-years) occurred. In multivariate Cox proportional hazard models controlling for age, hypertension, hypercholesterolemia, and diabetes, current smoking increased the risk of IHD (risk ratio [RR], 2.2; 95% confidence interval [CI], ), CVD (RR, 1.6; 95% CI, ), andtotalascvd(rr, 1.6; 95% CI, ). For each outcome, there were significant dose-response relationships with amount and duration of smoking. Throughout the range of serum cholesterol levels, current smoking significantly increased the risk of IHD and CVD. In the lowest quartile of serum cholesterol levels (<4.42 mmol/l [171 mg/dl]), the RR from current smoking was 3.3 (95% CI, ) for IHD and 1.6 (95% CI, ) for CVD. There was no evidence of an interaction between smoking and serum cholesterol (P for interaction =.75,.87, and.92 for IHD, CVD,andtotalASCVD, respectively). CONCLUSIONS: This study demonstrates that in Korea smoking is a major independent risk factor for IHD, CVD, and ASCVD and that a low cholesterol level confers no protective benefit against smoking-related ASCVD. 삼성서울병원의학정보센터 4

5 3. Lancet(Impact Factor:15.397, Ranking:36 위 ) Lancet에등재된두편의논문모두연세의대에서등재한것입니다. JAMA에논문을수록한예방의학교실서일교수팀과심장혈관병원의하종원, 장병철교수팀의논문입니다. 3.1 Low serum cholesterol and haemorrhagic stroke in men: Korea Medical Insurance Corporation Study [Lancet 2001;357:922-5] Suh I, Jee SH, Kim HC, Nam CM, Kim IS, Appel LJ. (Department of Preventive Medicine and Public Health, Yonsei University College of Medicine) BACKGROUND: In some prospective studies, haemorrhagic stroke occurs more frequently in individuals with low serum cholesterol than in those with higher concentrations. We aimed to determine whether low total serum cholesterol is an independent risk factor for haemorrhagic stroke (intracerebral haemorrhage and subarachnoid haemorrhage) in South Korea, a country that has a population with relatively low concentrations of total serum cholesterol. METHODS: We measured total serum cholesterol and other cardiovascular risk factors in 114,793 Korean men, aged between years in 1990 and 1992, in a prospective observational study. We used data obtained in 1992 for smoking and alcohol consumption. We divided total serum cholesterol into quintiles (<4.31 mmol/l, 4.31-<4.74, 4.74-<5.16, 5.16-<5.69 and > or = 5.69). Our primary outcomes were hospital admissions and deaths from intracerebral and subarachnoid haemorrhage in a 6 year follow-up between 1993 and FINDINGS: 528 men had a haemorrhagic stroke--372 intracerebral and 98 subarachnoid haemorrhage--and 58 were unspecified strokes. The relative risks of intracerebral haemorrhage in each quintile of total serum cholesterol (lowest to highest were: 1.22 (95% CI ); 0.86 ( ); 1.08 ( ); and 1.03 ( ). The corresponding relative risks for subarachnoid haemorrhage were: 1.44 ( ); 1.13 ( ); 1.21 ( ); and 1.12 ( ). INTERPRETATION: Low total serum cholesterol is not an independent risk factor for either intracerebral or subarachnoid haemorrhagic stroke in Korean men. 3.2 Pulmonary tumour embolism.[lancet 2002;359:2158] Ha JW, Kim SK, Chang BC. (Department of Cardiothoracic Surgery, Yonsei University College of Medicine) 삼성서울병원의학정보센터 5

6 4. Archives of Internal Medicine(Impact Factor:6.749, Ranking:146 위 ) Archives of Internal Medicine에는총3편의논문이수록되어있습니다. 그러나 2003년강북병원박용우교수의논문 (The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, Arch Intern Med Feb 24;163(4):427-36) 은미국교수진들과함께한논문으로본자료에서대상으로하는국내의연구실적으로볼수없습니다. 따라서2편의논문이수록된것으로볼수있는데모두중앙의대내과의김치정유왕성교수팀의논문입니다. 4.1 Effect of hormone replacement therapy on lipoprotein(a) and lipid levels in postmenopausal women. Influence of various progestogens and duration of therapy. [Arch Intern Med 1996;156: ] Kim CJ, Min YK, Ryu WS, Kwak JW, Ryoo UH (Department of Internal Medicine, Chung-Ang University Medical Center) BACKGROUND: Estrogen replacement therapy in postmenopausal women reduces the risk of coronary artery disease. One of the possible mechanisms of this effect is the modification of lipid profiles. However, there is controversy concerning the effects on lipoprotein(a) [Lp (a)] and lipid levels of progestogens administered with estrogen. METHODS: Five hundred fifty-one postmenopausal women were divided into 5 groups: group 1, mg of conjugated equine estrogen (CEE) (n = 140); group 2, mg of CEE plus 5 mg of medroxyprogesterone acetate (MPA) (n = 97); group 3, mg of CEE plus 10 mg of MPA (n = 109); group 4, 2 mg of estradiol valerate plus 0.5 mg of norgestrel (n = 134); and group 5, control (n = 71). The Lp(a) and lipid levels were measured before and 2, 6, and 12 months after hormone replacement therapy. RESULTS: Estrogen replacement therapy for 12 months lowered the Lp(a) level by 37.1%. The addition of progestogen attenuated the Lp(a)-lowering effect of estrogen. The high-density lipoprotein cholesterol (HDL-C) level was markedly increased in group 1 (16.5%), was moderately increased in groups 2 (10.8%) and 3 (11.3%), and was not changed in group 4. The low-density lipoprotein cholesterol level was decreased by 10.9% to 17.6% in all the treatment groups. Estrogen replacement therapy for 2, 6, and 12 months raised the HDL-C level by 7.2%, 17.4%, and 17.8%, respectively. In the group with combined estradiol plus norgestrel therapy, the HDL-C level was decreased after 2 months and was not changed after 6 and 12 months. The groups that received CEE plus MPA showed intermediate effects between the group that received CEE only and the group that received estradiol plus norgestrel. CONCLUSIONS: Combined estrogenand progestogen therapy may have effects on the heart different from those of estrogen therapy alone because of adverse impact of progestogens on Lp(a) and HDL-C levels. The effects of progesterones were dependent on the androgenic potency of progestogen and the duration of therapy. 삼성서울병원의학정보센터 6

7 4.2 Changes in Lp(a) lipoprotein and lipid levels after cessation of female sex hormone production and estrogen replacement therapy. [Arch Intern Med. 1996;156:500-4] Kim CJ, Ryu WS, Kwak JW, Park CT, Ryoo UH.(Division of Cardiology, Department of Internal Medicine, Chung-Ang University Medical Center) OBJECTIVE: To investigate the serial changes in Lp(a) lipoprotein levels with the loss of female sex hormones by surgical menopause and with estrogen replacement therapy in the same woman. PATIENTS AND METHODS: Forty-four premenopausal women who underwent a transabdominal hysterectomy (TAH) because of benign gynecological disorders were divided into two groups: women who underwent a TAH and unilateral salpingo-oophorectomy (n=31) and womenwho underwent a TAH and bilateral salpingo-oophorectomy (n=13). In the group of women who underwent a TAH and bilateral salpingo-oophorectomy, mg of conjugated equine estrogen was given daily 2 months after the operation. The levels of Lp(a) lipoprotein and lipids were measured before and at 2 and 4 months after the operation. RESULTS: In the group of women who underwent a TAH and bilateral salpingo-oophorectomy, the mean (+/-SD) concentration of Lp(a) lipoprotein was increased by 24.5% from 0.48+/-0.47 mmol/l (18.4+/-18.3 mg/dl) to 0.59+/-0.54 mmol/l (22.9+/-21.0 mg/dl) after 2 months (P<.05), and it was reduced by 30.6% to 0.41+/-0.51 mmol/l (15.9+/-20.1 mg/dl)(p<.005) with therapy with conjugated equine estrogen (Premarin). The Lp(a) lipoprotein levels were not changed in the group of women who underwent a TAH and unilateral salpingo-oophorectomy. In the group of women who underwent a TAH and bilateral salpingo-oophorectomy, the high density lipoprotein cholesterol level showed a trend of increase after 2 months from 1.45+/-0.48 mmol/l (56.1+/-18.5 mg/dl) to 1.58+/ mmol/l (61.2+/-15.1 mg/dl) without statistical significance, and it revealed a significant elevation to 1.76+/-0.43 mmol/l (68.2+/-16.8 mg/dl) with therapy with conjugated equine estrogen (Premarin) compared with that of the basal level (P<.05). CONCLUSIONS: the Lp(a) lipoprotein levels appear to be closely associated with female sex hormones. This association might play a pivotal role in postmenopausal increases of atherosclerotic diseases and cardioprotective effect of estrogen in postmenopausal women. 삼성서울병원의학정보센터 7

8 5. Medicine(Impact Factor:5.188, Ranking:240 위 ) Medicine 에는아산병원내분비내과김기수교수팀의논문이수록되어있습니다. Paget bone disease involving young adults in 3 generations of a Korean family [Medicine (Baltimore). 1997;76:157-69] Kim GS, Kim SH, Cho JK, Park JY, Shin MJ, Shong YK, Lee KU, Han H, Kim TG, Teitelbaum SL, Reinus WR, Whyte MP (Dept of Medicine, Asan Medical Center, Univ of Ulsan) Although the etiology of Paget bone disease (PBD) is unknown, increasing evidence implicates a "slow virus" infection of the skeleton, perhaps in genetically predisposed individuals. PBD is rare in Asia. We describe a Korean family with PBD. The propositus noticed bowed limbs at approximately 25 years of age. Radiologic studies made when he was 55 years old revealed essentially panostotic PBD. Serum alkaline phosphatase (ALP) activity and osteocalcin (OC) levels were markedly elevated. An iliac crest specimen showed classic histopathologic changes of PBD. Additionally, palpable swellings were first observed at age 45 years at his occiput, pubic ramus, ileum, and facial bones. They contained numerous multinucleated cells and were originally diagnosed as giant cell tumors. However, we found that, like osteoclasts, these cells expressed considerable tartrate-resistant acid phosphatase activity. These "extraskeletal osteoclastomas" resolved rapidly with dexamethasone treatment. Two daughters, 20- and 24-years-of-age, were discovered by study of his 5 children to have elevated serum ALP activity and OC levels and widespread PBD. Both women, however, are without palpable masses and are asymptomatic. The propositus' father, who died at age 55 years, had similar skeletal deformities beginning at age 20 years, but was not examined. Leukocytopenia was found in the 3 living family memberswithpbd. There was no evidence for linkage of the PBD to HLA loci. The condition appears to be transmitted as an autosomal dominant trait and is manifest in young adult life. Multicentric extraskeletal osteoclastomas with remarkable sensitivity to dexamethasone treatment appear to be another unusual feature of this family's disorder. In this family, the stimulus for PBD is so great that the PBD is apparent at an early age, affects essentially the entire skeleton, and leads to the formation or extension of osteoclast-like cells into nonosseous tissues (extraskeletal osteoclastomas). This 3-generation kindred in Korea, where PBD is rare, shows a strong clustering of PBD compatible with autosomal dominant inheritance. Leukocytopenia appears to distinguish affected family members, but any role for this abnormality in the pathogenesis of PBD is unclear. Our findings support a heritable diathesis for PBD, perhaps mediated by an immune deficiency. 삼성서울병원의학정보센터 8

Treatment and Role of Hormaonal Replaement Therapy

Treatment and Role of Hormaonal Replaement Therapy Treatment and Role of Hormone Replacement Therapy Chung-Ang University Hospital Chee Jeong Kim 7.2 5.3 6.4 5.6 7.3 5.5 1 1 2 3 4 10 11 7 34 49 122 123 1.0 - - 10. 2001 1998 1998 Improvement of postmenopausal