Kosin Medical Journal

Case report

Radiologic evolution of biopsy-proven acute interstitial nephritis: a multimodal imaging case report: Euljo Jeong, Bong Soo Park, Il Hwan Kim, Jung Hee Son, Kyung Han Nam, Yoon Ho Lee, Yoo Jin Lee; Kosin Med J. 2025;40(1):72-79. Published online March 27, 2025; DOI: https://doi.org/10.7180/kmj.25.104

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Abstract PDF PubReader ePub: This report presents radiologic changes after clinical improvement in a patient with acute interstitial nephritis (AIN). A 45-year-old female patient was referred for decreased renal function. Eight months prior, she had undergone hysterectomy and received chemotherapy. At the start of chemotherapy, her baseline creatinine level was 0.55 mg/dL, which rose to 1.46 mg/dL. Multiple imaging modalities performed when decreased renal function was observed revealed bilateral renal enlargement with increased cortical attenuation on computed tomography (CT), cortical hyperechogenicity on ultrasonography, and diffusion restriction in the renal cortices on magnetic resonance imaging. A renal biopsy was performed, and AIN was diagnosed. Follow-up laboratory tests showed that kidney function had improved to normal levels, and CT at that time showed a reduction in the size of both kidneys. Radiologic changes can serve as clues for the diagnosis of AIN. This is the first report to confirm radiological changes after the clinical improvement of AIN, thereby providing novel information about the course of AIN.

Editorial

Acute appendicitis surgery in the COVID-19 era: delays without deterioration of outcomes: Sang-Yong Son; Kosin Med J. 2025;40(1):1-3. Published online March 27, 2025; DOI: https://doi.org/10.7180/kmj.25.103

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Review article

Common statistical methods used in medical research: Hye Jin Yang, Hye Sun Lee; Kosin Med J. 2025;40(1):21-30. Published online March 27, 2025; DOI: https://doi.org/10.7180/kmj.24.160

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Abstract PDF PubReader ePub: This paper aims to review the statistical methods that are widely used in medical and clinical research. Statistical analysis is crucial for ensuring the reliability of research results; therefore, methods should be carefully tailored to research interests and objectives, depending on the type and characteristics of the data. This paper explains various types of data, discusses how to confirm whether the data satisfy these methods’ specific assumptions, and elucidates the meaning and interpretation of univariable and multivariable analysis. Finally, it presents corresponding examples to help other researchers understand how these methods are applied in real-world studies and select appropriate methods that ensure both research quality and reliability.

Case report

Retrocrural capillary hemangioma: a case report: Han Sol Lee, Tae-hong Yoon, Chul Ho Lee, Yun-Ho Jeon; Kosin Med J. 2025;40(1):80-83. Published online March 27, 2025; DOI: https://doi.org/10.7180/kmj.24.152

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Abstract PDF PubReader ePub: An enlarged retrocrural mass was incidentally discovered in a 79-year-old male patient. Preoperative chest computed tomography and thoracolumbar junction spine magnetic resonance imaging indicated the possibility of a paraganglioma, Castleman disease, or neurogenic tumor. Due to the large size of the tumor, malignancy could not be ruled out, and we decided to perform surgery for diagnostic and therapeutic purposes. Video-assisted thoracoscopic surgery was safely performed, and histopathological examination revealed a capillary hemangioma.

Original articles

The conservative management of ovarian endometrioma using cyst aspiration followed by dienogest medication: a pilot study: Ha Eun Jung, Eun Hee Yu, Hyun Joo Lee, Jong Kil Joo, Yong Jin Na; Received October 10, 2024 Accepted December 17, 2024 Published online March 27, 2025; DOI: https://doi.org/10.7180/kmj.24.149 [Epub ahead of print]

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Abstract PDF PubReader ePub: Background
The aim of this study was to evaluate the efficacy of ultrasonography-guided cyst aspiration followed by dienogest medication in the management of endometriomas in selected patients.
Methods
This study included 38 female patients diagnosed with endometrioma via transvaginal ultrasonography or pelvic magnetic resonance imaging. We performed needle aspiration of the contents of endometrioma followed by the administration of dienogest (2 mg) daily orally, and assessed changes in endometrioma size, cancer antigen 125, anti-Müllerian hormone, and a visual analog scale score for dysmenorrhea before and 3 months after the procedure.
Results
The diameter of the ovarian cysts decreased from a maximum of 4.35 cm before the procedure to 2.37 cm on follow-up ultrasonography, and seven of 56 endometriomas in 38 patients resolved completely as evaluated on transvaginal ultrasonography. Malignant cells were not found in any of the cases upon a cytologic examination of endometriotic cyst fluid. The mean cancer antigen 125 level decreased from 86.69 U/mL before the procedure to approximately 37.28 U/mL. There was no statistically significant difference in anti-Müllerian hormone before and after the procedure. The visual analog scale score decreased from 3.58 to 0.97 after aspiration.
Conclusions
Ultrasonography-guided cyst aspiration followed by dienogest administration allows cytological confirmation through relatively low-burden procedures and may increase patient compliance due to the reduction in ovarian cyst size.

Cigarette smoking and acute eosinophilic pneumonia: insights from a case series of 17 patients: I Re Heo, Tae Hoon Kim, Kyung Nyeo Jeon, Ho Cheol Kim; Kosin Med J. 2025;40(1):41-48. Published online March 27, 2025; DOI: https://doi.org/10.7180/kmj.24.146

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Abstract PDF PubReader ePub: Background
Acute eosinophilic pneumonia (AEP) is a rare and severe lung condition characterized by a rapid accumulation of eosinophils in the alveoli, leading to respiratory distress. This study analyzed the clinical characteristics of affected patients, aiming to shed light on the relationship between cigarette smoking and AEP.
Methods
This retrospective study analyzed 17 cases of AEP, focusing on patients' smoking habits, clinical symptoms, diagnostic findings, and treatment outcomes. Data were collected from medical records, imaging studies, and bronchoalveolar lavage (BAL) findings.
Results
The study cohort consisted primarily of male military personnel (94.1%), with a mean age of 20.8 years. Symptoms generally appeared approximately 2.82 days prior to hospitalization, with a mean body temperature at admission of 37.6 °C. The mean initial peripheral blood white blood cell count was 15.3×103/μL, with eosinophil percentages starting at 0.2%, peaking at a mean of 16.1%, and reaching as high as 32.4%. BAL fluid analysis showed a mean eosinophil level of 46.6%±15.1% (range, 17%–67%). In most cases, radiological examinations revealed bilateral ground-glass opacities, interlobular septal thickening, various degrees of airspace consolidation, and bilateral pleural effusions. Steroid treatment was administered to 70.5% of patients, lasting a mean of 8.3 days and resulting in significant improvements.
Conclusions
These cases reinforce the strong link between cigarette smoking and AEP. Additionally, these cases demonstrate the importance of obtaining a detailed smoking history and thorough diagnostic assessments, including BAL, in order to facilitate a more rapid diagnosis and early initiation of corticosteroid treatment.

Early effects of PCSK9 inhibitors: evolocumab versus alirocumab: Su-Hyun Bae, Bong-Joon Kim, Soo-Jin Kim, Sung-Il Im, Hyun-Su Kim, Jung-Ho Heo; Kosin Med J. 2025;40(1):49-54. Published online March 27, 2025; DOI: https://doi.org/10.7180/kmj.24.145

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Abstract PDF PubReader ePub: Background
The significance of risk modification in patients with acute coronary syndrome (ACS) is well recognized; however, the optimal timing for adminstering PCSK9 inhibitors remains unclear. Additionally, the lipid-lowering efficacy of evolocumab and alirocumab has not been fully established. This study evaluated the lipid-lowering effects of these two PCSK9 inhibitors.
Methods
Patients diagnosed with ACS, including unstable angina, ST-segment elevation myocardial infarction, and non-ST-segment elevation myocardial infarction, who were treated with a PCSK9 inhibitor (evolocumab or alirocumab) during hospitalization for ACS between 2021 and 2023 were retrospectively analyzed. Baseline low-density lipoprotein cholesterol (LDL-C) levels were assessed, and changes in LDL-C levels during the acute and subacute phases after PCSK9 inhibitor administration were compared between the evolocumab and alirocumab groups.
Results
Among 80 patients diagnosed with ACS, 36 received evolocumab, while 44 were treated with alirocumab. The mean baseline LDL-C level was 123 mg/dL in the evolocumab group and 128 mg/dL in the alirocumab group (p=0.456). In the subacute phase, the mean follow-up LDL-C levels were 47.05 mg/dL in the evolocumab group and 49.5 mg/dL in the alirocumab group (p=0.585). The mean percentage reduction in LDL-C levels during the subacute phase was 60.41% in the evolocumab group and 58.51% in the alirocumab group (p=0.431). These differences were not statistically significant.
Conclusions
No significant differences were observed between evolocumab and alirocumab. LDL-C levels exhibited a similar trend, characterized by a rapid decline in the acute phase, followed by a slight rebound in the subacute phase.

Did the COVID-19 pandemic impact the surgical treatment of febrile acute appendicitis at a single center in Korea, a country not under lockdown? Observational cohort study: Youngil Choi, Youngsik Kim; Kosin Med J. 2025;40(1):55-65. Published online March 27, 2025; DOI: https://doi.org/10.7180/kmj.24.125

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Background
This study analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on acute appendicitis (AA) treatment in Korea, a country that did not implement lockdown measures.
Methods
A retrospective analysis was conducted during two discretionary time periods: a pre COVID-19 period, and a COVID-19 period. This study included adult and pediatric patients diagnosed with AA who underwent surgical treatment. Clinical and laboratory parameters, changes in surgery timing, disease severity, and postoperative outcomes were compared between the pre and post pandemic periods.
Results
The study included a total of 221 patients, with 139 receiving appendectomy in the COVID-19 cohort and 82 in the control cohort. In patients without fever, operative time was significantly longer during the COVID-19 period (p<0.01). Among patients presenting with fever, the rate of complicated AA was higher during the COVID-19 period than in the control period (p<0.01). During the COVID-19 period, the diagnostic and preoperative delay times, as well as postoperative hospital stays, were longer (p<0.05), and the incidence of postoperative complications and other hospital diagnoses was higher (p<0.01) during the COVID-19 period than in the control period. Multivariate analysis showed that age (p=0.03) and the presence of fever (p<0.01) were independent risk factors for complicated AA.
Conclusions
Older patients and those with fever were at greater risk of severe AA. During outbreaks of infectious diseases like COVID-19, careful consideration is needed regarding surgical interventions in older patients with fever. Understanding vulnerabilities is crucial for disease management in the future.

Citations

Citations to this article as recorded by

Acute appendicitis surgery in the COVID-19 era: delays without deterioration of outcomes
Sang-Yong Son
Kosin Medical Journal.2025; 40(1): 1. CrossRef

Review articles

The role of the interatrial shunt device in the treatment of patients with heart failure with preserved ejection fraction: experience from the REDUCE LAP-HF studies: Bong-Joon Kim; Received October 12, 2024 Accepted December 11, 2024 Published online February 17, 2025; DOI: https://doi.org/10.7180/kmj.24.150 [Epub ahead of print]

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Abstract PDF PubReader ePub: Heart failure with preserved ejection fraction (HFpEF) is characterized by increased left ventricular filling pressure and elevated left atrial pressure. Despite advances in medical treatments, the management of HFpEF patients is often challenging due to multiple comorbidities, leading to polypharmacy and associated side effects. Consequently, there is an increasing demand for procedural or device-based therapies in HFpEF management. Over the past decade, the transcatheter interatrial shunt device (IASD), designed to create a passage between the left atrium and the right atrium, has emerged as a novel therapeutic option. The IASD offers potential benefits by reducing left atrial pressure at rest and during exercise. The efficacy and safety of the IASD were demonstrated in the REDUCE LAP-HF (Reduce Left Atrial Pressure in Patients with Heart Failure) study series. Furthermore, IASD has been shown to support positive cardiac remodeling. With the availability of more data, appropriate indications for the use of IASDs are becoming more evident, and criteria for patient selection in future studies are needed.

Exploring the influence of olfactory receptors in metabolic diseases and cancers: beyond sensory functions: In-sun Yu, Jeong Sook Ye, Jaewon Shim; Kosin Med J. 2025;40(1):15-20. Published online February 17, 2025; DOI: https://doi.org/10.7180/kmj.24.142

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Abstract PDF PubReader ePub: Olfactory receptors (ORs), which are primarily responsible for olfactory sensation in the nasal epithelium, constitute the largest family of genes in the human genome. The majority of ORs are orphan receptors with unknown ligands; however, recent studies have revealed their expression in non-olfactory tissues, implying that ORs may be involved in various physiological processes beyond olfaction. This review highlights recent findings on the roles of ORs in cancers, including prostate, breast, and lung cancer, as well as their involvement in other diseases, such as atherosclerosis, Alzheimer's disease, and viral infections. Additionally, we explore emerging knowledge about the role of ORs in metabolic regulation, focusing on their effect on triglyceride metabolism, glucagon-like peptide-1 secretion, and lipid accumulation. Advancements in technology, such as structural analysis, have accelerated research on OR ligands and their functions, potentially positioning ORs as novel therapeutic targets for various diseases. This review highlights the need for further research into the non-olfactory roles of ORs and their potential as targets for future therapeutic interventions.

Original article

Synergistic effects of drug and aerobic exercise on endothelial function and epicardial fat thickness in patients with hypertension and dyslipidemia: Eun-Ah Jo, Shan-Shan Wu, Hyung-Rae Han, Jung-Jun Park, Jung-Ho Heo; Kosin Med J. 2025;40(1):31-40. Published online February 17, 2025; DOI: https://doi.org/10.7180/kmj.24.137

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Abstract PDF PubReader ePub: Background
Aerobic exercise training and drug therapy are well-established interventions for the prevention and treatment of hypertension and dyslipidemia. We investigated the synergistic effects of aerobic exercise and olmesartan/rosuvastatin on epicardial fat thickness (EFT) and endothelial function in patients with hypertension and dyslipidemia.
Methods
A sample of 75 participants with hypertension and dyslipidemia was evaluated for multifactorial cardiovascular risk at baseline and at 6 months of intervention according to anthropometric and hemodynamic components, lipid profile, glycemia, brachial artery flow-mediated dilation (FMD), and EFT. After 3 months of drug therapy only, participants were allocated to one of three conditions: treadmill (n=22), exergame (n=29), or control (n=24).
Results
After 12 weeks of drug therapy only, systolic and diastolic blood pressure (3% and 2%, both p<0.05), total cholesterol (6.3%, p<0.01), low-density lipoprotein cholesterol (4.9%, p<0.05), triglycerides (11.1%, p<0.05), fasting blood glucose (10.2%, p<0.01), and glycosylated hemoglobin (3%, p<0.01) were significantly reduced. After 12 weeks of combined aerobic exercise and drug therapy, both the treadmill and exergame groups showed a significant improvement in FMD (both p<0.001) and reduction in EFT (both p<0.001). Systolic and diastolic blood pressures decreased in the treadmill group only (1.9% and 2.7%, respectively, p<0.05).
Conclusions
Incorporating aerobic exercise into drug therapy regimens can yield synergistic effects, particularly in improving endothelial function and reducing EFT, providing a comprehensive approach to managing cardiovascular risk in patients with hypertension and dyslipidemia.

Case report

Idiopathic scoliosis with recurrent dyspnea and wheezing in an otherwise healthy female adolescent: a case report: Jin Ku Kim, Yoon Ha Hwang; Received August 20, 2024 Accepted October 23, 2024 Published online February 7, 2025; DOI: https://doi.org/10.7180/kmj.24.135 [Epub ahead of print]

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Abstract PDF PubReader ePub: A 15-year-old female visited our hospital’s outpatient and emergency department several times due to recurrent paroxysmal dyspnea for 6 months. Based on the clinical symptoms, the researchers diagnosed the patient with bronchial asthma and treated her with oral steroids and inhaled corticosteroid agents, but her patients did not significantly improve. At that time, thoracic scoliosis was observed in previous chest X-ray images. Previous records showed that the scoliosis had progressed during the rapid growth period in 2018 (patient age 10 years) and 2023 (patient age 15 years). As the symptoms did not improve despite medication, a further evaluation was performed. Contrast-enhanced chest computed tomography revealed the T8 vertebral body compressing the right bronchus intermedius. The patient rarely wore an existing brace due to discomfort, but a new custom brace was prescribed after confirmation using chest computed tomography. Since then, the patient's compliance with treatment has improved, and she has gradually increased the amount of time she wears the brace. In addition, her Cobb’s angle and pulmonary function tests have improved in outpatient follow-up. The researchers initially considered the patient's recurrent dyspnea and wheezing to be an asthma exacerbation and treated her with medication, but the symptoms did not improve. Therefore, when a patient does not respond well to asthma medications, the possibility of dyspnea or wheezing due to causes other than asthma should not be ruled out. Evaluation for scoliosis should also not be neglected, especially in growing adolescents.

Original article

Comparative analysis of Access PCT and Elecsys BRAHMS PCT assays for procalcitonin measurements: Hyunji Choi, Sang-Shin Lee, Hyunyong Hwang; Kosin Med J. 2024;39(4):272-280. Published online December 20, 2024; DOI: https://doi.org/10.7180/kmj.24.155

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Abstract PDF PubReader ePub: Background
Procalcitonin (PCT) is a crucial biomarker for diagnosing sepsis and managing antibiotic therapy. This study evaluated the analytical performance and comparability of the Access PCT and Elecsys BRAHMS PCT assays.
Methods
The precision, detection capability, linearity, and reference range of both assays were assessed. A comparative analysis included 182 patient samples categorized into four risk groups to compare the results between Access PCT and Elecsys BRAHMS PCT assays.
Results
The Access PCT assay demonstrated precision within the manufacturer’s threshold, and its detection capabilities were verified. This assay exhibited excellent linearity and appropriate reference intervals. Comparative analysis indicated that the Access PCT assay reported higher overall PCT levels than the Elecsys BRAHMS assay, with high agreement between the assays (κ=0.941). However, the biases varied across different PCT concentration intervals.
Conclusions
Both the Access PCT and Elecsys BRAHMS PCT assays performed robustly with notable concordance but varying biases at different concentration intervals. The observed biases require careful consideration in clinical decision-making, especially when adopting novel assay systems. Standardizing the calibration across different platforms is recommended to improve assay comparability.

Review article

Non-pharmacological treatments for insomnia: a focus on components of cognitive behavioral therapy for insomnia: Soyoung Park, Eun Ji Lim, Dongyun Lee, Young-Ji Lee; Kosin Med J. 2024;39(4):238-245. Published online December 19, 2024; DOI: https://doi.org/10.7180/kmj.24.153

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Abstract PDF PubReader ePub: Insomnia is a prevalent disorder that affects 4% to 22% of the population in the United States. While cognitive behavioral therapy for insomnia (CBT-I) remains the gold standard for non-pharmacological treatment, accessibility barriers exist owing to a shortage of trained professionals and high costs. This review examines the efficacy of the individual components of CBT-I as stand-alone interventions to improve treatment accessibility, digital CBT-I, and other non-pharmacological interventions. Guidelines from organizations such as the American Academy of Sleep Medicine and, European Sleep Research Society, along with recent meta-analyses, support the effectiveness of these components as stand-alone treatments. Sleep restriction therapy and stimulus control therapy show promise as effective interventions. Although recommended by certain guidelines, relaxation therapy has yielded mixed results. Sleep hygiene education, a common component of CBT-I, has not demonstrated significant efficacy as a stand-alone treatment. Cognitive strategies have shown promise in recent studies. Sufficient clinical evidence supports the efficacy of digital CBT-I in treating insomnia. Internationally, various platforms for digital CBT-I have already been developed and are in use, and in South Korea, some digital CBT-I software programs have received digital therapeutic device approval in 2023. This review highlights the potential of individual components of CBT-I as effective stand-alone interventions for insomnia, as well as digital CBT-I, emphasizing their importance for improving the accessibility of non-pharmacological insomnia treatments in clinical settings where full CBT-I may not be available.

Editorial

Congenital mild ptosis might not influence visual function in esotropia patients: Chang Zoo Kim; Kosin Med J. 2024;39(4):227-228. Published online December 11, 2024; DOI: https://doi.org/10.7180/kmj.24.144

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