Kang-Moon Lee

Saint Vincent Hospital, Worcester, Massachusetts, United States

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Publications (65)193.13 Total impact

  • Seung-Woo Lee, Jeong-Seon Ji, Kang-Moon Lee
    Endoscopy 12/2014; 46(12):1124. · 5.74 Impact Factor
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    ABSTRACT: Several recent studies have reported that the early use of infliximab (IFX) improves the prognosis of Crohn's disease (CD). However, no data are available from Asian populations, as the forementioned studies have all been conducted in Western countries. The aim of the current study was to evaluate the impact of early use of IFX on the prognosis of Korean patients with CD.
    Intestinal research. 10/2014; 12(4):281-6.
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    Kang-Moon Lee, Ji Min Lee
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    ABSTRACT: The epidemiology, genetics, and clinical manifestations of Crohn's disease (CD) vary considerably among geographic areas and ethnic groups. Thus, identifying the characteristics of Korean CD is important for establishing management strategies appropriate for Korean patients. Since the mid-2000s, many studies have investigated the characteristic features of Korean CD. The incidence and prevalence rates of CD have been increasing rapidly in Korea, especially among the younger population. Unlike Western data, Korean CD shows a male predominance and a lower proportion of isolated colonic disease. Perianal lesions are more prevalent than in Western countries. Genome-wide association studies have confirmed that genetic variants in TNFSF15, IL-23R, and IRGM, but not ATG16L1, are associated with CD susceptibility in the Korean population. Studies of the associations between genetic mutations and the clinical course of CD are underway. Although it has been generally accepted that the clinical course of Korean CD is milder than that in Western countries, recent studies have shown a comparable rate of intestinal resection in Korean and Western CD patients. An ongoing nationwide, hospital-based cohort study is anticipated to provide valuable information on the natural history and prognosis of Korean CD in the near future.
    The Korean Journal of Internal Medicine 09/2014; 29(5):558-570.
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    ABSTRACT: Misoprostol is reported to prevent non-steroidal anti-inflammatory drug (NSAID)-associated gastroduodenal complications. There is, however, limited information regarding the efficacy of DA-9601 in this context. We performed a comparative study on the relative efficacy of DA-9601 and misoprostol for prevention of NSAID-associated complications. In this multicenter, double-blinded, active-controlled, stratified randomized, parallel group, non-inferiority trial, 520 patients who were to be treated with an NSAID (aceclofenac, 100 mg, twice daily) over a 4-week period were randomly assigned to groups for coincidental treatment with DA-9601 (60 mg, thrice daily) (236 patients for full analysis) or misoprostol (200 μg, thrice daily) (242 patients for full analysis). A total of 236 patients received DA-9601 and 242 received misoprostol. The primary endpoint was the gastric protection rate, and secondary endpoints were the duodenal protection rate and ulcer incidence rate. Endpoints were assessed by endoscopy after the 4-week treatment period. Drug-related adverse effects, including gastrointestinal (GI) symptoms, were also compared. At week 4, the gastric protection rates with DA-9601 and misoprostol were 81.4 % (192/236) and 89.3 % (216/242), respectively. The difference between the groups was -14.2 %, indicating non-inferiority of DA-9601 to misoprostol. Adverse event rates were not different between the two groups; however, the total scores for GI symptoms before and after administration were significantly lower in the DA-9601 group than in the misoprostol group (-0.2 ± 2.8 vs 1.2 ± 3.2; p < 0.0001). DA-9601 is as effective as misoprostol in preventing NSAID-associated gastroduodenal complications, and has a superior adverse GI effect profile.
    Archives of Pharmacal Research 05/2014; · 1.54 Impact Factor
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    ABSTRACT: Background and study aims: The effectiveness of the prophylactic clip for the prevention of postpolypectomy bleeding in pedunculated colonic polyps has not been confirmed. The aim of this prospective, randomized study was to compare the efficacy of prophylactic clip and endoloop application in the prevention of postpolypectomy bleeding in large pedunculated polyps. Patients and methods: A total of 195 patients who had pedunculated colorectal polyps, with heads ≥ 10 mm and stalks ≥ 5 mm in diameter, were included in the study between July 2010 and January 2013. Polyps were randomized to receive either clips or endoloops. Both devices were applied to the base of the stalk before conventional snare polypectomy. Bleeding complications were analyzed with a noninferiority margin of 5 %. Results: A total of 203 polyps were included in the study (98 in the clip group and 105 in the endoloop group). Bleeding occurred after five polypectomies in the clip group (5.1 %) and after six in the endoloop group (5.7 %) (P = 0.847). Noninferiority of the prophylactic clip to the endoloop could not be confirmed (absolute bleeding rate difference - 0.6 %, 95 % confidence interval - 5.6 % to 6.8 %) due to small sample size. Immediate bleeding episodes occurred in 4/5 polyps in the clip group and 5/6 polyps in the endoloop group. Delayed bleeding occurred in one polyp in each group. Conclusions: These results suggest that the application of a prophylactic clip is as effective and safe as an endoloop in the prevention of postpolypectomy bleeding in large pedunculated colonic polyps. Clinical trial registration: ClinicalTrials.gov (NCT01406379).
    Endoscopy 05/2014; · 5.74 Impact Factor
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    ABSTRACT: The natural history of Crohn's disease (CD) is characterized by a remitting and relapsing course and a considerable number of patients ultimately require bowel resection. Moreover, postoperative recurrence is very common. Relatively few studies have investigated the postoperative recurrence of CD in Korea. The aim of the current study was to assess postoperative recurrence rates - both clinical and endoscopic - in CD as well as factors influencing postoperative recurrence.
    Intestinal research. 04/2014; 12(2):117-23.
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    ABSTRACT: Background and AimAlthough differences in genetic susceptibility and the clinical features of Crohn's disease (CD) have been reported between Asian and Caucasian patients, the disease course and predictors of CD in Asians remains poorly defined. The study therefore aimed to investigate factors predictive of the clinical outcomes of patients with CD in a Korean population. Methods This retrospective multicenter cohort study included 728 Korean CD patients from 13 university hospitals. The first CD-related surgery or need for immunosuppressive or biological agents were regarded as the clinical outcomes of interest. ResultsA total of 126 (17.3%) CD patients underwent CD-related surgery, while 473 (65.0%) and 196 (26.9%) were prescribed thiopurine drugs and infliximab, respectively. Multivariate Cox regression analysis identified current (hazard ratio [HR] = 1.86; P = 0.018) and former smoking habits (HR = 1.78; P = 0.049), stricturing (HR = 2.24; P < 0.001), and penetrating disease behavior at diagnosis (HR = 3.07; P < 0.001) as independent predictors associated with the first CD-related surgery. With respect to immunosuppressive and biological agents, younger age (< 40 years) (HR = 2.17; P < 0.001 and HR = 2.10; P = 0.006, respectively), ileal involvement (HR = 1.36; P = 0.035 and HR = 2.17; P = 0.006, respectively), and perianal disease (HR = 1.42; P = 0.001 and HR = 1.38; P = 0.038, respectively) at diagnosis were significant predictors for the need of these medications. Conclusions In Korean patients with CD, stricturing, penetrating disease behavior, and smoking habits at the time of diagnosis are independent predictors for CD-related surgery. It was also identified that younger age (< 40 years), ileal involvement, and perianal disease at diagnosis are predictive of a need for immunosuppressive or biological agents.
    Journal of Gastroenterology and Hepatology 01/2014; 29(1). · 3.33 Impact Factor
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    ABSTRACT: Advancing age is a well-known risk factor for Clostridium difficile infection (CDI). However, age-specific clinical differences in CDI are uncertain. A retrospective comparative analysis was performed based on age in 1367 patients with CDI in Korea. Most clinical features were similar in the two age groups studied, however malignancy was more common in the older group (age ≥ 65 y) (p < 0.001), while chemotherapy and transplantation were more common in the younger group (age < 65 y) (p < 0.001). Endoscopic examinations were more commonly performed in the older group (p = 0.010), which had a high positive predictive value (88.3%). More patients recovered from CDI without specific antibiotic treatment in the younger group than in the older group (p < 0.001). Although advancing age is an important risk factor for CDI, the clinical features of younger patients are similar to those of the older patient population.
    Scandinavian Journal of Infectious Diseases 10/2013; · 1.71 Impact Factor
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    ABSTRACT: BACKGROUND:: Although infliximab is widely accepted as a therapeutic option for inflammatory bowel disease, its therapeutic efficacy for the treatment of intestinal Behçet's disease (BD) is unknown. We investigated the short-term and long-term response rates to infliximab in intestinal BD and predictive factors of sustained treatment response following infliximab treatment. METHODS:: This study was conducted using a retrospective noncontrolled review of medical records from 8 tertiary hospitals in Korea. We collected clinical, demographic, and laboratory data for patients with 28 patients with intestinal BD who received at least 1 dose of infliximab. Response rates of infliximab at 2, 4, 30, and 54 weeks for each patient and factors predictive of sustained response were investigated. Adverse events were also identified. RESULTS:: The median duration of follow-up after initial infliximab infusion was of 29.5 months. The clinical response rates at 2, 4, 30, and 54 weeks were 75%, 64.3%, 50%, and 39.1%, respectively, with clinical remission rates of 32.1%, 28.6%, 46.2%, and 39.1%, respectively. After multivariate analysis, older age at diagnosis (≥40 yr), female sex, a longer disease duration (≥5 yr), concomitant immunomodulator use, and achievement of remission at week 4 were found to be predictive factors of sustained response. There was 1 serious infection but no malignancies or deaths in this study. CONCLUSIONS:: Infliximab was a well-tolerated and effective therapy for patients with moderate-to-severe intestinal BD. Moreover, we found 5 predictive factors associated with sustained response, which might assist in optimal patient selection for infliximab treatment.
    Inflammatory Bowel Diseases 05/2013; · 5.12 Impact Factor
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    ABSTRACT: BACKGROUND:: Several recent studies have revealed that diagnostic imaging can result in exposure to potentially harmful levels of ionizing radiation in patients with inflammatory bowel disease (IBD). However, these studies have been conducted exclusively in Western countries, and no data are available in Asian populations. The aim of this study was to estimate the diagnostic radiation exposure in Korean patients with IBD and to determine the factors associated with high radiation exposure. METHODS:: Patients with an established diagnosis of IBD between July 1987 and January 2012 were investigated in 13 university hospitals in Korea. The cumulative effective dose (CED) was calculated retrospectively from standard tables. RESULTS:: A total of 777 patients with Crohn's disease (CD) and 1422 patients with ulcerative colitis (UC) were included in the study. The mean CED for CD and UC were 53.6 and 16.4 mSv, respectively (P < 0.001). CTof CD and UC accounted for 81.6% and 71.2% of total effective dose, respectively. Importantly, 34.7% of patients with CD and 8.4% of patients with UC were exposed to high levels of radiation (CED > 50 mSv) (P < 0.001). High radiation exposure was associated with long disease duration, ileocolonic disease, upper gastrointestinal tract involvement, surgical intervention, hospitalization, and the requirement for oral steroids in CD, and with surgical intervention, hospitalization, and the requirement for infliximab in UC. CONCLUSIONS:: A substantial proportion of patients with IBD, especially patients with CD, were exposed to significantly harmful amounts of diagnostic radiation, mainly as a result of CT examination. Given that IBD is a life-long illness, strategies to reduce radiation exposure from diagnostic imaging need to be considered.
    Inflammatory Bowel Diseases 05/2013; · 5.12 Impact Factor
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    ABSTRACT: We aim to evaluate the association between promoter polymorphism of the clusters of differentiation 14 (CD14) gene and Helicobacter pylori-induced gastric mucosal inflammation in a healthy Korean population. The study population consisted of 267 healthy subjects who visited our hospital for free nationwide gastric cancer screening. Promoter polymorphism at -260 C/T of the CD14 gene was determined by polymerase chain reaction and restriction fragment length polymorphism analysis. The severity of gastric mucosal inflammation was estimated by a gastritis score based on the sum of the values of the grade and activity of the gastritis. Expression of soluble CD14 (sCD14) was assessed by quantitative sandwich ELISA. CD14 polymorphism was not associated with H. pylori infection. There were no significant differences in gastritis scores among the genotype subgroups, but subjects carrying the CD14 -260 CT/TT genotype had significantly higher sCD14 levels than those carrying the CC genotype. Subjects with the 260-T allele of the CD14 gene and H. pylori infection had significantly higher sCD14 levels than those with the same genotype but without infection. In individuals with the T allele at the -260 site of the promoter region of the CD14 gene, H. pylori infection accentuates gastric mucosal inflammation.
    Gut and liver 05/2013; 7(3):317-322. · 1.31 Impact Factor
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    ABSTRACT: OBJECTIVES: Methane (CH4)-producing intestinal bacteria might be related to constipation. This study was carried out to evaluate the association between breath CH4, colonic transit, and anorectal pressure in constipated patients. METHODS: A database of consecutive 62 constipated patients fulfilling the Rome III with the lactulose CH4 breath test (LMBT), a colon marker study, and anorectal manometry was studied. The profile of LMBT in patients was compared with 49 healthy controls. The positivity to LMBT (LMBT+) was defined as CH4 of at least 10 ppm in baseline or above baseline within 90 min. There were two types of constipation: normal and delayed transit. RESULTS: There were significant differences in the breath CH4 between patients with delayed transit and (a) normal transit from 0 to 135 min or (b) healthy controls from 0 to 180 min. The LMBT+ was higher in delayed transit patients than in healthy controls (58.8 vs.12.2%) or in normal transit patients (vs. 13.3%), respectively (P<0.01). The delayed transit was the only independent factor for LMBT+ [odds ratio (95% confidence interval), 27.8 (3.32-250.00), P<0.01]. The left and total colonic transit time were significantly increased in LMBT-positive than in LMBT-negative patients. Significant correlations were found between total CH4 and the time of left or total colonic transit. However, no difference was found in the parameters of manometry by LMBT status. CONCLUSION: A positive breath CH4 was associated with delayed colonic transit and left colon, and it could be a new therapeutic target for the management of constipated patients with delayed colonic transit.
    European journal of gastroenterology & hepatology 02/2013; · 1.66 Impact Factor
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    ABSTRACT: The endoscopic insertion of the self-expandable metal stent (SEMS) in benign biliary stricture has become an alternative to surgery. Fracture or migration of SEMS can occur rarely as complications. We report a case of fracture of SEMS during endoscopic retrieval in patients with chronic pancreatitis. In this case, broken stent was successfully removed with endoscopic ballooning of bile duct and with a snare device.
    Clinical endoscopy. 01/2013; 46(1):95-7.
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    ABSTRACT: Background and Aim. We aim to elucidate the association of risk factors for atherosclerosis and H. pylori infection according to the promotor polymorphism of the CD14 gene in healthy Korean population. Methods. The patients who visited our hospital for routine health examinations and 266 healthy adults (170 males and 96 females) were enrolled in this study. The promotor polymorphism at -159C/T of the CD14 gene was determined by PCR-restriction fragment length polymorphism analysis. According to genetic polymorphism and H. pylori infection, we analyzed the risk of atherosclerosis. Results. The genotype frequencies were CC 7.9%, CT 45.1%, and TT 47.0%, respectively. There were no differences between specific genotypes of CD14 gene and H. pylori infection rate. As for HDL cholesterol level, there were significant differences among the three genotypes (P < 0.01). In subjects with H. pylori infection, no significant differences were observed between specific genotypes of CD14 gene and the risk factors of atherosclerosis. Conclusion. The promotor polymorphism at -159C/T of the CD14 gene was associated with the risk factor of atherosclerosis in healthy Korean population. However, it was not associated with the rate of H. pylori infection and H. pylori induced atherosclerotic risk.
    Gastroenterology Research and Practice 01/2013; 2013:570597. · 1.62 Impact Factor
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    ABSTRACT: Background/aims The effect of immunosuppressants on the efficacy of a variety of vaccines is a controversial issue in patients with inflammatory bowel disease (IBD). In this study we determined whether specific immunosuppressants impair the serological response to the standard 23-valent pneumococcal polysaccharide vaccine (PPSV23) in a large cohort of patients with Crohn's disease (CD). Methods This was a multi-center, prospective observational study of adult patients with CD at 15 academic teaching hospitals in Korea. The study population received one intramuscular injection of PPSV23. Anti-pneumococcal IgG antibody titers were measured by immunoassay prior to and 4 weeks after vaccination. All vaccination-related adverse events and the effect of the vaccine on disease activity were also evaluated. Results The overall serological response rate was 67.5% (133/197). The serological response rate was significantly lower in patients on anti-tumor necrosis factor (anti-TNF) therapy (50.0% on anti-TNF alone; 58.0% on anti-TNF combined with an immunomodulator, IM) than patients on 5-aminosalicylate (78.4%; all P-values vs. 5-aminosalicylate < 0.05); 45.6% (41/90) of patients on anti-TNF therapy were not protected against PPSV23. IM did not affect the immunologic response to the vaccine. Female gender and anti-TNF therapy were significant predictors of non-response to the vaccine (odds ratio [OR] 2.316, P = 0.015; OR 2.582, P = 0.048, respectively). Vaccination was generally safe and tolerated by all patients. Conclusions Patients with CD on anti-TNF therapy are at significant risk of an inadequate response to PPSV23. The pneumococcal vaccination strategy should be optimized for patients with CD on anti-TNF therapy.
    Journal of Crohn s and Colitis 01/2013; · 3.39 Impact Factor
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    ABSTRACT: BACKGROUND: Gastric cancer is supposed to be a result of inflammation induced by Helicobacter pylori (H. pylori) infection. Nucleotide-binding oligomerization domain 1 (NOD 1) is required for the innate immune response to H. pylori. We aim to investigate whether single nucleotide polymorphism (SNP) in NOD 1 gene is associated with H. pylori-induced gastric mucosal inflammation in a healthy Korean population. METHODS: The study was conducted on 412 adults who visited two different healthcare centers for health examinations. The G796A (E266K) NOD 1 SNP was detected by using polymerase chain reaction/restriction fragment length polymorphism. A gastritis score was calculated by the summed values of the grade and the activity of gastritis scored according to the updated Sydney system. The expression of IL-8 and COX-2 mRNA was assessed by quantitative reverse transcription polymerase chain reaction. In the group with H. pylori infection, the complete screening of the genes comprising the cag PAI was performed. RESULTS: The genotype frequencies were 26.7% (AA type), 58.3% (GA), and 15.0% (GG). In H. pylori-positive patients, gastritis score of the AA genotype was significantly higher than those of the others (p = .04). Also, the IL-8 and COX-2 mRNA levels increased in the AA genotype. In the group with H. pylori infection, 31.9% were found to carry the complete cag PAI. When the subjects were infected with intact cag PAI, the IL-8 and COX-2 mRNA levels were significantly high in AA genotype. CONCLUSION: G796A (E266K) NOD 1 polymorphism is closely correlated with H. pylori-associated gastric mucosal inflammation in the Korean population.
    Helicobacter 11/2012; · 3.51 Impact Factor
  • Gastrointestinal endoscopy 09/2012; 76(5):1047-8. · 6.71 Impact Factor
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    ABSTRACT: PURPOSE: We investigated the relationships between biomarkers related to anaerobic glycolytic metabolism (GLUT1, LDH5, PDK1, and HIF-1α proteins), pathologic response, and prognosis. METHODS: All stage II and stage III rectal cancer patients had 50.4 Gy (1.8 Gy/day in 28 fractions) over 5.5 weeks, plus 5-fluorouracil (425 mg/m(2)/day) and leucovorin (20 mg/m(2)/day) bolus on days 1 to 5 and 29 to 33, and surgery was performed at 7 to 10 weeks after completion of all therapies. Expression of GLUT1, LDH5, PDK1, and HIF-1α proteins was determined by immunohistochemistry and was assessed in 104 patients with rectal cancer treated with neoadjuvant chemoradiotherapy. RESULTS: This study included stage II and III rectal cancer patients, and each stage accounted for each 50 % of the total cases. A high expression of GLUT1 protein was associated with a significantly lower rate of ypCR compared with low expression of GLUT1 protein (4.0 % vs. 27.8 %, respectively; p = 0.012). GLUT1 expression was also significantly higher in the poor response group (Grade 0, 1) than in the good response group (Grade 2, 3) (34.0 % vs. 14.8 %, respectively; p = 0.022). In recurrence analysis, the expression of GLUT1 protein demonstrated a significant correlation with time to recurrence, based on a log-rank method (p = 0.016). When analyzed by multiple Cox regression, the positive expression of GLUT1 was the most significant and independent unfavorable prognostic factor (p = 0.004). CONCLUSIONS: GLUT1 expression is a predictive and prognostic factor for pathologic complete response and recurrence in rectal cancer patients treated with 5-flurouracil and leucovorin neo-adjuvant chemoradiotherapy.
    International Journal of Colorectal Disease 07/2012; · 2.24 Impact Factor
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    ABSTRACT: To determine the precise incidence and clinical features of endoscopic ulcers following gastrectomy. A consecutive series of patients who underwent endoscopic examination following gastrectomy between 2005 and 2010 was retrospectively analyzed. A total of 78 patients with endoscopic ulcers and 759 without ulcers following gastrectomy were enrolled. We analyzed differences in patient age, sex, size of the lesions, method of operation, indications for gastric resection, and infection rates of Helicobacter pylori (H. pylori) between the nonulcer and ulcer groups. The incidence of endoscopic ulcers after gastrectomy was 9.3% and that of marginal ulcers was 8.6%. Ulcers were more common in patients with Billroth II anastomosis and pre-existing conditions for peptic ulcer disease (PUD). Infection rates of H. pyloridid not differ significantly between the two groups. The patients who underwent operations to treat PUD had lower initial levels of hemoglobin and higher rates of hospital admission. H. pylori was not an important factor in ulcerogenesis following gastrectomy. For patients who underwent surgery for PUD, clinical course of marginal ulcers was more severe.
    World Journal of Gastroenterology 07/2012; 18(25):3260-6. · 2.55 Impact Factor
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    ABSTRACT: Portal vein thrombus has been detected in patients with liver cirrhosis, pancreatitis, ulcerative colitis, septicemia, myeloproliferative disorder, and neoplasm. The formation of portal tumor thrombus by hepatocellular carcinoma is well recognized, because of its high incidence, and subsequent development of portal hypertension such as rupture of varices, ascites and liver failure indicates the poor prognosis. In gastric cancer, portal hypertension as an initial presentation is extremely rare. Herein we report a case presenting as portal hypertension caused by tumor thrombus without invasion of liver parenchyma. It is presumed to be intraluminal tumor thrombus originating from primary foci of gastric adenocarcinoma. Tumor thrombus in the portal vein is demonstrated on the PET-CT.
    The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 07/2012; 60(1):42-6.

Publication Stats

168 Citations
193.13 Total Impact Points

Institutions

  • 2008–2014
    • Saint Vincent Hospital
      Worcester, Massachusetts, United States
  • 2004–2014
    • Catholic University of Korea
      • • Department of Internal Medicine
      • • College of Medicine
      Sŏul, Seoul, South Korea