Kosin Medical Journal

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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Original article

Efficacy of intravesical gemcitabine instillation compared with intravesical Bacillus Calmette-Guérin instillation for non-muscle invasive bladder cancer: Dong Ha Kim, Taek Sang Kim, Su Hwan Kang, Seong Bin Kim; Kosin Med J. 2024;39(4):254-258. Published online December 11, 2024; DOI: https://doi.org/10.7180/kmj.24.143

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Abstract PDF PubReader ePub: Background
Intravesical Bacillus Calmette-Guérin (BCG) instillation is the most effective treatment for reducing intravesical recurrence in non-muscle invasive bladder cancer (NMIBC). However, due to the recent global shortage of BCG, there is an increasing need for alternative treatments. This study aimed to retrospectively compare the outcomes of patients treated with intravesical gemcitabine instillation and BCG instillation as initial treatment options for NMIBC.
Methods
Seventy-eight patients with NMIBC who underwent transurethral resection of bladder tumors between January 2022 and September 2023 were reviewed. Of these, 42 patients received intravesical gemcitabine instillation, and 36 patients received BCG instillation. Recurrence-free survival (RFS) was analyzed, along with tumor multiplicity, grade, T stage, size, and bladder storage time after instillation, which could influence RFS.
Results
The mean follow-up period was 18.7 months for the gemcitabine group and 20.6 months for the BCG group. Recurrence occurred in 46.15% of patients (52.38% in the gemcitabine group and 38.92% in the BCG group). Tumor characteristics, including multiplicity, grade, stage, and size, were not significantly different between the two groups. The mean RFS was 15.92 months in the gemcitabine group and 19.84 months in the BCG group, with no statistically significant difference (p=0.397). However, gemcitabine instillation caused more severe bladder irritation, with shorter bladder storage time.
Conclusions
Intravesical gemcitabine and BCG instillation yielded comparable RFS outcomes. However, gemcitabine led to more severe bladder irritation, highlighting the need for further studies to optimize its application.

Review article

The ethics of using artificial intelligence in medical research: Shinae Yu, Sang-Shin Lee, Hyunyong Hwang; Kosin Med J. 2024;39(4):229-237. Published online December 6, 2024; DOI: https://doi.org/10.7180/kmj.24.140

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Abstract PDF PubReader ePub: The integration of artificial intelligence (AI) technologies into medical research introduces significant ethical challenges that necessitate the strengthening of ethical frameworks. This review highlights the issues of privacy, bias, accountability, informed consent, and regulatory compliance as central concerns. AI systems, particularly in medical research, may compromise patient data privacy, perpetuate biases if they are trained on nondiverse datasets, and obscure accountability owing to their “black box” nature. Furthermore, the complexity of the role of AI may affect patients’ informed consent, as they may not fully grasp the extent of AI involvement in their care. Compliance with regulations such as the Health Insurance Portability and Accountability Act and General Data Protection Regulation is essential, as they address liability in cases of AI errors. This review advocates a balanced approach to AI autonomy in clinical decisions, the rigorous validation of AI systems, ongoing monitoring, and robust data governance. Engaging diverse stakeholders is crucial for aligning AI development with ethical norms and addressing practical clinical needs. Ultimately, the proactive management of AI’s ethical implications is vital to ensure that its integration into healthcare improves patient outcomes without compromising ethical integrity.

Original article

Intracranial aneurysms in autosomal dominant polycystic kidney disease: Jung Hyun Park; Kosin Med J. 2024;39(4):281-289. Published online December 6, 2024; DOI: https://doi.org/10.7180/kmj.24.138

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Abstract PDF PubReader ePub: Background
The incidence of intracranial aneurysms (ICA) is high in patients with autosomal dominant polycystic kidney disease (ADPKD). However, little is known regarding the optimal screening and treatment methods for ICA.
Methods
This study investigated the characteristics of ADPKD patients with ICA, analyzing each variable according to whether the ICA ruptured, and examined the outcomes according to the treatment method. Specifically, a retrospective study was conducted on the treatment of ICA patients with ADPKD at a single institution for 10 years, from 2013 to 2022.
Results
The mean age of the 17 enrolled ADPKD patients with ICA was 57.4 years. Surgical and endovascular treatment methods were used in four and 13 patients. Eleven patients had unruptured ICAs, and the remaining six patients had suffered subarachnoid hemorrhage (SAH). Two patients experienced neurological deficits after discharge. All patients with unruptured ICAs were discharged without any complications, although one of them underwent additional treatment 5 years later. Four patients with SAH had known ADPKD at the time of diagnosis (67%). As for the treatment method, 13 patients were treated with coiling. In a comparison of variables between unruptured ICA and SAH patients, the location of the ICA showed a statistically significant difference (p<0.05).
Conclusions
In ADPKD patients, diagnostic screening for the detection of ICA is essential, and with appropriate management, interventional endovascular treatment may be a good treatment option.

Review article

Zonula occludens proteins and their impact on the cancer microenvironment: Min-Hye Kim, Hee-Jae Cha; Kosin Med J. 2024;39(4):246-253. Published online December 6, 2024; DOI: https://doi.org/10.7180/kmj.24.136

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Abstract PDF PubReader ePub: Zonula occludens (ZO) proteins serve as scaffolding proteins that provide structural support at cell junctions and the cytoplasmic surface, acting as bridges between integral membrane proteins and the cytoskeleton. In addition to their structural functions, they also regulate cell growth and proliferation. Recent studies have shown that ZO proteins are involved in various diseases, including cancer. Specifically, ZO proteins influence the growth and development of cancer cells in the tumor microenvironment. These proteins perform various functions in the tumor microenvironment through processes such as angiogenesis, inflammatory responses, epithelial-mesenchymal transition, and interactions with mesenchymal stem cells. The mechanisms of these actions may vary depending on the type of cancer and environmental conditions. Ongoing research explores several signaling pathways involving ZO proteins. These insights suggest that new therapeutic approaches may be considered to slow down cancer growth and development within the tumor microenvironment. Despite continuing research on the cellular and in vivo roles of ZO proteins, the current understanding of how these signaling mechanisms function within the tumor microenvironment in vivo remains limited. In this review, we introduce the characteristics and regulatory mechanisms of ZO proteins in the cancer microenvironment, explore their potential to suppress cancer cell environments, and examine their roles in vivo.

Corrigendum

Correction to “Traumatic neuroma of the right posterior hepatic duct with an anatomic variation masquerading as malignancy: a case report”: Jae Ryong Shim, Tae Beom Lee, Byung Hyun Choi, Je Ho Ryu, Jung Hee Lee, Kwangho Yang; Kosin Med J. 2024;39(4):299-299. Published online December 6, 2024; DOI: https://doi.org/10.7180/kmj.22.135.c1; Corrects: Kosin Med J 2023;38(1):66

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Original articles

Stereopsis and clinical features of esotropia patients accompanied by congenital mild ptosis: Heeyoung Choi, Su-Jin Kim, Seung Ahn Yang, Kwang Eon Han; Kosin Med J. 2024;39(4):259-264. Published online December 3, 2024; DOI: https://doi.org/10.7180/kmj.24.123

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Abstract PDF PubReader ePub: Background
To evaluate binocular function and clinical features in patients with esotropia (ET) accompanied by congenital ptosis.
Methods
Clinical records of 44 ET patients with congenital ptosis (ET-ptosis group) and 71 age-matched ET patients without ptosis (ET only group) who presented for eye examination between January 2016 and December 2021 were retrospectively reviewed. Best-corrected visual acuity (BCVA), magnitude of esodeviation and stereopsis at the first visit were reviewed. Stereopsis and other clinical features of the two groups were compared.
Results
The mean (±standard deviation) age of overall patients was 5.7 (±1.9) years. The margin reflex distance 1 (MRD1) of patients with ptosis was greater than 0 but less than or equal to 2, indicating that mild ptosis was included. There was no significant difference in the distribution of age, sex, spherical equivalent refractive errors, BCVA, or magnitude of ET (at distance or near) between the two groups (all p>0.05). Furthermore, stereopsis and the number of patients with amblyopia did not differ significantly between the two groups. The magnitudes of esodeviation, near stereopsis and BCVA did not differ significantly between the 0Conclusions
In patients with ET and congenital mild ptosis, stereopsis and visual acuity were not different from those in ET only patients. The presence of coexisting mild ptosis might not have a further deleterious impact on binocular function in ET patients.

Diagnostic significance of transcranial Doppler ultrasonography in patients with subarachnoid hemorrhage and cerebral vasospasm: Jung Hyun Park; Kosin Med J. 2024;39(4):265-271. Published online December 2, 2024; DOI: https://doi.org/10.7180/kmj.24.139

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Abstract PDF PubReader ePub: Background
This study investigated the accuracy and usefulness of transcranial Doppler (TCD) ultrasonography as a diagnostic method in patients with subarachnoid hemorrhage (SAH) and cerebral vasospasm.
Methods
This retrospective study collected data from January 2022 to December 2023 at our institution, targeting patients with SAH caused by rupture of a cerebral aneurysm. TCD and brain computed tomographic angiography (CTA) were performed to diagnose cerebral vasospasm. The vessel diameters on CTA at the time of SAH occurrence and CTA 1 to 2 weeks after the occurrence were compared, and TCD was performed on a daily basis from 3 to 14 days after the occurrence of ictus.
Results
Among 152 patients with non-traumatic SAH over a 2-year period, 143 patients with SAH caused by ruptured cerebral aneurysms were enrolled. The mean age was 59.28±13.27 years. The modified Fisher grade was a statistically significant predictor of cerebral vasospasm (p<0.05). In addition, the Hunt-Hess grade also showed statistical significance (p<0.05). TCD showed high accuracy in predicting vasospasm. The sensitivity was 0.93 (95% confidence interval [CI], 0.87–0.97), specificity was 0.89 (95% CI, 0.81–0.96), positive predictive value was 0.92 (95% CI, 0.85–0.96), and negative predictive value was 0.92 (95% CI, 0.84–0.95).
Conclusions
TCD showed high accuracy in predicting the diagnosis of cerebral vasospasm. TCD is considered an essential diagnostic tool in the neurological management of cerebral vasospasm, which is a potentially fatal complication in SAH patients.

Review article

Endoscopic diagnosis of Helicobacter pylori infection: Eun Jeong Gong, Kyoungwon Jung; Received July 12, 2024 Accepted September 16, 2024 Published online November 13, 2024; DOI: https://doi.org/10.7180/kmj.24.130 [Epub ahead of print]

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Abstract PDF PubReader ePub: Accurate prediction of Helicobacter pylori infection status based on endoscopic findings is essential for optimizing management. This review emphasizes the importance of accurate endoscopic diagnosis of H. pylori infection. The endoscopic findings categorized in the Kyoto classification provide valuable indicators of infection status. Specifically, findings such as atrophic gastritis, intestinal metaplasia, nodular gastritis, enlarged folds, sticky mucus, xanthoma, and map-like redness are associated with H. pylori infection. Regular arrangement of collecting venules and linear red streaks are reliable indicators of non-infection. Selective testing based on endoscopic findings can optimize diagnosis and treatment of H. pylori infection and, minimizing unnecessary procedures. However, some findings overlap and do not clearly distinguish between current and past infections, indicating a need for further research.

Case reports

Obstructive jaundice caused by tuberculous lymphadenitis accompanied by a mass in the pancreas: a case report: Jong In Jeon, Jung Wook Lee; Received March 11, 2024 Accepted September 4, 2024 Published online November 13, 2024; DOI: https://doi.org/10.7180/kmj.24.113 [Epub ahead of print]

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Abstract PDF PubReader ePub: Abdominal tuberculous lymphadenopathy is a rare condition that can cause obstructive jaundice. The feature of tuberculosis lymphadenopathy may resemble those of cancer, metastasis, or lymphoma on computed tomography (CT) or magnetic resonance imaging; therefore, physicians must perform appropriate examinations, make correct diagnoses, and conduct suitable treatment. Herein, we report a case of obstructive jaundice caused by tuberculous lymphadenopathy. The patient was 27 years old, with an initial serum total bilirubin level of 6.76 mg/dL and a direct bilirubin level of 5.64 mg/dL. Aspartate transaminase and alanine transaminase levels were 466 and 801 IU/L, respectively. Abdominal CT revealed a mass-like effect and extraluminal compression accompanying bile duct obstruction. An abrupt bile duct stricture was observed on endoscopic retrograde cholangiopancreatography; thus, a biopsy was performed. However, the specimen which was taken by endoscopic retrograde cholangiopancreatography was confirmed to constitute superficially biopsied bile duct mucosa and benign-looking epithelial cell stripes. Positron emission tomography-CT showed a hypermetabolic lesion in the hepato-duodenal ligament with small lymph nodes in the aortocaval and retrocaval spaces. Additionally, it showed hypermetabolism of the neck lymph node at level II. The neck lymph node was biopsied. Granulomatous inflammation was observed and nested tuberculosis polymerase chain reaction was positive. The patient was treated with anti-tuberculosis medications and underwent endoscopic retrograde biliary drainage without surgery.

Sonozaki syndrome (pustulotic arthro-osteitis) causing anterior chest pain: a case report: Taek Yong Ko; Kosin Med J. 2024;39(4):290-293. Published online November 7, 2024; DOI: https://doi.org/10.7180/kmj.24.128

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Abstract PDF PubReader ePub: Sonozaki syndrome is an exceptionally rare chronic rheumatic disorder characterized by pustulosis on the palms and soles, as well as arthritis and osteitis. This syndrome belongs to the category of spondyloarthritis, which includes psoriatic arthritis. Pustules are concentrated on the palms and soles, whereas arthro-osteitis predominantly affects the sternoclavicular and costochondral joints. This report presents the case of a 32-year-old man with a 2-month history of worsening anterior chest wall pain and pustular eruptions on the palms and soles.

Review articles

Oncoplastic breast-conserving surgery: evolution, techniques, and the emerging role of acellular dermal matrix: Jun Ho Choi, Yoonsoo Kim; Kosin Med J. 2024;39(3):153-159. Published online September 26, 2024; DOI: https://doi.org/10.7180/kmj.24.129

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Abstract PDF PubReader ePub: Oncoplastic breast-conserving surgery (OBCS) has revolutionized breast cancer treatment, aiming to achieve optimal oncological outcomes while preserving an aesthetically favorable appearance. This review explores the evolution, techniques, and outcomes of OBCS, with a particular focus on the emerging role of acellular dermal matrix in volume replacement techniques. We conducted a comprehensive literature review using PubMed, Medline, and Cochrane databases, focusing on studies published between 2010 and 2024. OBCS demonstrates comparable oncological safety to traditional breast-conserving surgery, with local recurrence rates ranging from 2.7% to 5.7% at 5 years. Patient satisfaction rates are consistently high, with 85% to 95% reporting good to excellent aesthetic outcomes. Volume replacement techniques using acellular dermal matrix show promising results, with one study reporting that 94% of patients were highly satisfied with cosmetic outcomes. Although the current results are encouraging, future advancements in OBCS may require innovative approaches, including the integration of robotic surgery and artificial intelligence technologies.

Fat embolism syndrome: a review in cosmetic surgery: Hongil Kim, Bommie Florence Seo, Gregory Randolph Dean Evans; Kosin Med J. 2024;39(3):169-178. Published online September 25, 2024; DOI: https://doi.org/10.7180/kmj.24.126

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Abstract PDF PubReader ePub: The growing popularity of cosmetic procedures such as liposuction and fat grafting has been accompanied by a rise in associated side effects. Among these, fat embolism syndrome stands out as a potential complication that sometimes has critical consequences. It is important to recognize that fat embolism affects organs through distinct mechanisms from those involved with other types of embolisms. Early diagnosis is crucial. Unfortunately, no effective treatments have been established for this condition. Therefore, starting with a more detailed categorization of diagnoses, developing new treatment methods for each subtype is essential.

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