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Volume 37(1); March 2022
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Editorial
Is ketamine useful for pain management in patients with stage IV cancer?
Sung Eun Kim
Kosin Med J. 2022;37(1):1-3.   Published online March 15, 2022
DOI: https://doi.org/10.7180/kmj.22.007
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PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Review articles
Role of biomarkers in the heart failure clinic
Bong-Joon Kim, Jae-Hyeong Park
Kosin Med J. 2022;37(1):4-17.   Published online March 29, 2022
DOI: https://doi.org/10.7180/kmj.22.019
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Heart failure (HF) is a common cardiovascular disease that has a complex pathophysiology. Because it is the final stage of many cardiovascular diseases, proper diagnosis and treatment are crucial for prolonging patients’ survival and improving their well-being. Several biomarkers have been identified in HF, and their roles in diagnosis and prognostication have been widely investigated. Among them, natriuretic peptides are key for diagnosing HF, predicting its prognosis, and monitoring the effectiveness of HF treatment. Moreover, natriuretic peptides can also be used to treat HF. In addition to natriuretic peptides, several other biomarkers were included in the most recent HF management guidelines. Thus, we reviewed the role of the biomarkers included in these guidelines and discussed future perspectives.
Adverse events following vaccination against coronavirus disease 2019
Minji Jeon, Sol Jin, Jin-Young Lee
Kosin Med J. 2022;37(1):18-26.   Published online March 28, 2022
DOI: https://doi.org/10.7180/kmj.22.017
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
To overcome the coronavirus disease 2019 (COVID-19) pandemic, large-scale vaccination is proceeding worldwide. As of December 23, 2021, 10 novel vaccines against COVID-19 had been validated for use by the World Health Organization (WHO), including BNT162b2 (Pfizer/BioNTech), mRNA-1273 (Moderna), AZD1222 (AstraZeneca), and Ad26.COV2.S (Janssen). These novel vaccines against COVID-19 showed acceptable safety profiles in randomized clinical trials. Most adverse events following immunization (AEFIs) associated with these novel vaccines ranged from mild to moderate and improved within a few days after administration. However, serious adverse events associated with vaccines that were not observed in the clinical trials were reported in real-world data. Adverse events of special interest include not only anaphylaxis or neurologic disorders (such as Guillain-Barré syndrome, transverse myelitis, or seizure) but also myocarditis or pericarditis associated with the messenger RNA (mRNA) vaccines and thrombosis with thrombocytopenia syndrome associated with the adenovirus-vector vaccines. Although several fatal cases of serious AEFIs that may have been related to vaccination have been reported, it is recommended to continue vaccination because the benefits of vaccines’ preventive effects against COVID-19 outweigh the risks of rare serious adverse events. Long-term monitoring of various AEFIs and sharing of clinical experiences are necessary for safe and efficient large-scale vaccination.
Sleep and vaccine administration time as factors influencing vaccine immunogenicity
Eun Seok Kim, Chi Eun Oh
Kosin Med J. 2022;37(1):27-36.   Published online March 29, 2022
DOI: https://doi.org/10.7180/kmj.22.014
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
The immunogenicity of vaccines is affected by host, external, environmental, and vaccine factors; in addition, sleep or circadian rhythms may also have effects. With the use of vaccines to mitigate the coronavirus disease 2019 (COVID-19) pandemic, research is underway to clarify what time of the day is optimal for COVID-19 vaccination and how disturbances of circadian rhythms will affect the immunogenicity of the vaccine in shift workers. Studies on the relationship between sleep time and the immunogenicity of vaccines for influenza and hepatitis have demonstrated that less sleep time and sleep deprivation tended to adversely affect immunogenicity. In some studies, there were even sex differences in these effects. When comparing shift workers with disturbances in their circadian rhythms and those who only worked during the day, one study found less antibody formation in shift workers; however, further studies on the relationship between shift work and the immunogenicity of vaccines are needed. Studies on the relationship between vaccine administration time and immunogenicity have shown different results according to age and sex. Therefore, future studies on vaccine administration time and immunogenicity may require an individualized approach for each vaccine and each population to be vaccinated. There is accumulating evidence on the effects of sleep and vaccine administration time on the immunogenicity of vaccines. However, further studies are needed to determine whether the association between immunogenicity and circadian rhythms and vaccine administration time can be used as a basis to increase the immunogenicity for individual vaccines.
Original articles
The effects of ketamine on pain control in stage IV cancer patients receiving palliative care
Seonghoon Kim, Jihun Kang, Jongsoon Choi, Eunhee Kong
Kosin Med J. 2022;37(1):37-45.   Published online March 14, 2022
DOI: https://doi.org/10.7180/kmj.21.003
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
We evaluated the effects of intravenous ketamine on cancer pain in stage IV cancer patients receiving palliative care.
Methods
In total, 253 stage IV cancer patients with cancer pain hospitalized at a single tertiary hospital palliative care unit were included. The ketamine group contained 112 patients receiving ketamine, and the control group comprised 141 non-ketamine users. To evaluate the odds ratios (ORs) for favorable pain control, optimal pain control, and opioid-sparing effect among ketamine users, we used multivariable logistic regression adjusted for age and objective prognosis score. Differences in the visual analog scale (VAS) score, oral morphine equivalents, inter-dose frequency, and inter-dose amount were compared between both groups at the time of ketamine introduction (T0), after 24 hours (T1), and after 48 hours (T2) using repeated-measures analysis of covariance.
Results
The ketamine group was more likely to show favorable pain control (OR, 3.84; 95% confidence interval [CI], 1.76–8.37) and an optimal response (OR, 3.99; 95% CI, 1.73–9.22) than the control group. Compared to the control group, the ketamine group showed a higher VAS score at T0, but a more evident VAS score reduction at T1 and T2 (pint<0.001). The ketamine group was less likely than the control group to experience depressive mood (OR, 0.31; 95% CI, 0.10–0.92), but had a higher risk of delirium (OR, 2.06; 95% CI, 1.12–3.91).
Conclusion
Our findings suggest that ketamine can effectively reduce refractory cancer pain in stage IV cancer patients.
Comparison of the radiation dose between dual-acquisition coronary computed tomography angiography and coronary angiography for coronary spasm
Soo-Jin Kim, Moo Hyun Kim, Eun-Ju Kang
Kosin Med J. 2022;37(1):46-51.   Published online March 16, 2022
DOI: https://doi.org/10.7180/kmj.21.035
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
Coronary computed tomography angiography (CCTA) is an imaging technique that can be used to evaluate and diagnose coronary artery stenosis. Dual-acquisition CCTA (DA-CCTA) with additional nitrate infusion is a promising alternative noninvasive diagnostic tool, as conventional CCTA has limitations in the diagnosis of variant angina compared to conventional angiographic coronary spasm tests. However, DA-CCTA may pose a potential risk due to radiation exposure. We compared the radiation dose between DA-CCTA and the coronary angiographic spasm provocation test.
Methods
Patients with clinically suspected variant angina at a single hospital between March 2013 and October 2018 were screened and underwent DA-CCTA or a coronary angiographic spasm provocation test. The effective radiation dose required for each approach was compared.
Results
In total, 211 suspected variant angina patients underwent DA-CCTA or the coronary angiographic spasm provocation test. Of these, 49 patients (mean age, 59.8 years; 67.3% men) received DA-CCTA and 162 patients (mean age, 60.5 years; 66.2% men) received a coronary angiographic spasm provocation test. There was a significant difference in the effective radiation dose, with a median dose of 5.1 mSv (interquartile range [IQR], 4.1–9.2 mSv) required for DA-CCTA and a median dose of 10.9 mSv (IQR, 8.4–15.2 mSv) for the coronary angiographic spasm provocation test (p<0.001).
Conclusion
DA-CCTA showed a significantly lower effective radiation dose than the coronary angiographic spasm provocation test required to diagnose variant angina.
Transcriptome analysis of the pathogenic ciliate Miamiensis avidus after hydrogen peroxide treatment
Hyunsu Kim, A-Reum Lee, Kyung-Yoon Jeon, Eun-Ji Ko, Hee-Jae Cha, Mee Sun Ock
Kosin Med J. 2022;37(1):52-60.   Published online March 11, 2022
DOI: https://doi.org/10.7180/kmj.21.040
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
The scuticociliate Miamiensis avidus is a highly pathogenic ciliate responsible for serious damage to various organs of aquaculture fish. In particular, the olive flounder aquaculture industry is suffering massive losses due to M. avidus infection. Hydrogen peroxide (H2O2) is one of the most widely used chemicals for scuticociliate treatment. Despite the superior killing effect of H2O2, studies on transcription levels and gene expression changes after H2O2 treatment are limited. We conducted an mRNA transcriptome analysis to compare the expressed gene (DEG) profiles between the ciliate and cyst-like stages of M. avidus after H2O2 treatment.
Methods
We applied differentially expressed gene profiling to identify DEGs during the ciliate and cyst-like stages of M. avidus.
Results
There were 5,967 DEGs among the 9,075 transcripts identified, and 50 of these DEGs were significantly different (p<0.05). Among these, 21 DEGs were upregulated and 29 were downregulated in the cyst-like stage. The most significantly upregulated genes during the change to the cyst-like stage were cytochrome c oxidase genes. Genes related to the calcium channel were also highly upregulated.
Conclusion
The significant upregulation of cytochrome c gene expression and cytosolic calcium ion channel-related gene expression after H2O2 treatment suggests that ciliate mortality occurred through apoptosis. The formation of the cyst-like stage is considered a temporary form during the process of apoptosis. Information on the gene expression profile of M. avidus in response to H2O2 is expected to contribute to the understanding of the mechanism of action of therapeutic agents against this pathogen.
Validation of the association of the cystic duct fibrosis score with surgical difficulty in laparoscopic cholecystectomy
Hyung Hwan Moon, Ji Hoon Jo, Young Il Choi, Dong Hoon Shin
Kosin Med J. 2022;37(1):61-67.   Published online March 25, 2022
DOI: https://doi.org/10.7180/kmj.21.049
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
The level of surgical difficulty in laparoscopic cholecystectomy might be predictable based on preoperative imaging and intraoperative findings indicative of cholecystitis severity. Several scales for laparoscopic cholecystectomy have been developed, but most are complex, unverified, and not widely adopted. This study evaluated the association of the cystic duct fibrosis score (range, 0–3) with surgical difficulty in laparoscopic cholecystectomy.
Methods
Between July 2018 and November 2018, 163 laparoscopic cholecystectomy cases were retrospectively reviewed at a single center. Patients’ demographics, preoperative laboratory data, operation time, complications, hospital stay, and cholecystitis severity grade were investigated. We also evaluated the associations of the Tokyo Guidelines 2018 and the Parkland grading scale with the cystic fibrosis score.
Results
The cystic duct fibrosis score was associated with preoperative white blood cells (p<0.001), preoperative platelet count (p=0.046), preoperative total bilirubin (p<0.004), preoperative C-reactive protein (p<0.001), operation time (p<0.001), cystic duct ligation time (p=0.002), estimated blood loss (p<0.001), postoperative complication (p=0.004), open conversion (p<0.001), and common bile duct injury (p=0.010). The cystic duct fibrosis score was also correlated with the Tokyo Guidelines 2018 and the Parkland grading scale (p<0.001). The cystic duct ligation time predicted the cystic duct fibrosis score and the Parkland grading scale, but not the Tokyo Guidelines 2018.
Conclusion
As a simple indicator of cholecystitis severity, the cystic duct fibrosis score can predict the surgical difficulty and outcomes of laparoscopic cholecystectomy.
Hepatic steatosis changes after early gastric cancer surgery
Ki Hyun Kim, Soyoung Ock, Dohyung Lee, Yoonhong Kim, Jihoon Jo, Kyungwon Seo, Kiyoung Yoon, Sukyoung Kwon, Youngsik Choi, Bukyung Kim
Kosin Med J. 2022;37(1):68-74.   Published online March 28, 2022
DOI: https://doi.org/10.7180/kmj.22.008
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
Nonalcoholic fatty liver disease dramatically improves after bariatric surgery, primarily due to improvements in hepatic insulin sensitivity. Since the procedure for gastric cancer surgery is very similar to that for bariatric surgery, we investigated changes in fatty liver following gastrectomy for gastric cancer according to the type of surgery.
Methods
We evaluated hepatic steatosis in 212 early gastric cancer patients using Hounsfield units (HUs) on non-contrast computed tomography preoperatively and 6, 12, and 24 months after surgery. We compared the preoperative and postoperative liver-to-spleen HU ratio according to the type of surgery: Billroth I, Billroth II, and total gastrectomy with Roux-en-Y reconstruction.
Results
The initial results (liver/spleen HUs and the liver-to-spleen HU ratio) did not significantly differ according to surgical group. After surgery, only patients who underwent total gastrectomy with Roux-en-Y exhibited significant changes in the liver-to-spleen HU ratio at 6 months. In 26 patients who had higher initial HU levels of the spleen than the liver, the liver-to-spleen HU ratio significantly increased from 0.836 to 1.115 at 6 months, 1.109 at 12 months, and 1.102 at 24 months (P<0.01).
Conclusion
Significant changes in hepatic steatosis were found in even normal patients (with higher liver than spleen HU values) who underwent total gastrectomy with Roux-en-Y. Patients who initially had fatty liver also showed a significant increase in the liver-to-spleen HU ratio. These results suggest that total gastrectomy with Roux-en-Y reconstruction can have a positive effect on the improvement of hepatic steatosis.
New approach to learning medical procedures using a smartphone and the Moodle platform to facilitate assessments and written feedback
Sang-Shin Lee, Haeyoung Lee, Hyunyong Hwang
Kosin Med J. 2022;37(1):75-82.   Published online March 25, 2022
DOI: https://doi.org/10.7180/kmj.22.010
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
To overcome communication obstacles between medical students and trainers, we designed serial learning activities utilizing a smartphone and web-based instruction (WBI) on the Moodle platform to provide clear and retrievable trainer feedback to students on an objective structured clinical examination (OSCE) item.
Methods
We evaluated students’ learning achievement and satisfaction with the new learning tool. A total of 80 fourth-year medical students participated. They installed the Moodle app (the WBI platform) on their smartphones and practiced an endotracheal suction procedure on a medical simulation mannequin while being evaluated by a trainer regarding competence in clinical skills on the smartphone app. Students’ competency was evaluated by comparing the scores between the formative assessment and the summative assessment. The degree of satisfaction and usefulness for the smartphone and WBI system were analyzed.
Results
The means (standard deviations, SDs) of the formative and summative assessments were 8.80 (2.53) and 14.24 (1.97) out of a total of 17 points, respectively, reflecting a statistically significant difference (P<0.05). The degree of satisfaction and perceived usefulness of the smartphone app and WBI system were excellent, with means (SDs) of 4.60 (0.58), and 4.60 (0.65), respectively.
Conclusion
We believe that the learning process using a smartphone and the Moodle platform offers good guidance for OSCE skill development because trainers’ written feedback is recorded online and is retrievable at all times, enabling students to build and maintain competency through frequent feedback review.
Case reports
Metastatic ameloblastoma with postoperative accelerated tumor growth treated with carboplatin and paclitaxel: a case report
Joo Un Park, Jae Wan Jung
Kosin Med J. 2022;37(1):83-88.   Published online March 23, 2022
DOI: https://doi.org/10.7180/kmj.21.030
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Ameloblastoma is a histologically benign odontogenic epithelial tumor that rarely metastasizes. However, metastasis to the lungs can occur, usually years after the development of the primary tumor. Here, we present the case of a 63-year-old woman with metastatic ameloblastoma in the lungs that developed 12 years after surgery for the primary lesion. As is typical for metastatic ameloblastomas, the tumor was incidentally found on radiography and surgically removed. However, the tumor exhibited accelerated progression with pleural metastasis after surgical removal, which is unusual in metastatic ameloblastoma. The patient was successfully treated with carboplatin/paclitaxel and showed a partial response to tumor progression, implying that this approach can be safely used in the absence of a standard treatment regimen.
Emergency rescue stent grafting for a ruptured degenerated graft that bypassed coarctation of the aorta: a case report
Jin Ho Choi, Min Suk Choi, Haeyoung Lee
Kosin Med J. 2022;37(1):89-92.   Published online March 17, 2022
DOI: https://doi.org/10.7180/kmj.21.047
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
A 33-year-old man who had undergone bypass from the distal aortic arch to the proximal descending thoracic aorta with a Dacron graft to treat coarctation of the aorta 20 years prior presented to the emergency department with massive hemoptysis. He was diagnosed with a graft-to-bronchial fistula. After thoracic endovascular aneurysm repair through the coarctation, aortic replacement was performed 3 weeks later. Therefore, emergency-rescue thoracic endovascular aneurysm repair can be considered for preventing aortic rupture.

KMJ : Kosin Medical Journal