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Volume 37(3); September 2022
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Editorial
Is there enough evidence to recommend preoperative calcium and vitamin D in patients who undergo total thyroidectomy?
Hyoung Shin Lee
Kosin Med J. 2022;37(3):173-175.   Published online September 20, 2022
DOI: https://doi.org/10.7180/kmj.22.125
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Review articles
Mucinous carcinoma of the breast: distinctive histopathologic and genetic characteristics
Minjung Jung
Kosin Med J. 2022;37(3):176-186.   Published online August 25, 2022
DOI: https://doi.org/10.7180/kmj.22.022
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Mucinous carcinoma is a rare histologic type of breast cancer that, when classified with favorable histology, can be treated with different therapeutic options. This study reviews the histologic findings of mucinous carcinoma that support or exclude favorable histology and emphasizes the necessity of an appropriate gross examination with radiologic findings for an accurate diagnosis. In addition, unusual findings such as micropapillary arrangements and lobular differentiation in mucinous carcinoma and their implications for prognosis and treatment are reviewed. Mucinous carcinoma involves upregulation of MUC2, a mucus-associated gene common in mucinous carcinoma of the breast as well as various other organs. In mucinous carcinoma, the fraction of genome altered and tumor mutation burden are lower than those of invasive carcinoma of no special type, the most common histology of breast cancer. In addition, the genetic alterations found in mucinous carcinoma are diverse, unlike the pathognomonic genetic alterations observed in other histologic types of breast cancer. These genetic features support the importance of conventional microscopic evaluations for the pathologic differential diagnosis of mucinous carcinoma of the breast in routine practice. A variety of breast lesions, including mucinous cystadenocarcinoma and mucocele-like lesions, as well as mucinous carcinoma from other organs, can mimic mucinous carcinoma of the breast. In order to obtain an accurate pathologic diagnosis, careful evaluation of the overall histopathologic characteristics and ancillary testing are required to provide information on appropriate treatment and prognosis.
How to conduct well-designed clinical research
Da Jung Kim, Song Yi Kil, Jongwon Son, Ho Sup Lee
Kosin Med J. 2022;37(3):187-191.   Published online September 27, 2022
DOI: https://doi.org/10.7180/kmj.22.122
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Clinicians and healthcare decision-makers conduct their clinical practice based on the results of clinical trials. However, some health problems remain unresolved; in such cases, further research is required. To ensure reliable research results, it is important to understand the study design and conduct well-designed clinical trials. Many study designs can be chosen within the two broad categories of observational and interventional. Clinical studies have a variety of designs, including case series, case-control, cross-sectional, and prospective and retrospective cohort studies. Well-designed clinical studies can clarify important differences between treatment options and provide data on long-term drug efficacy and safety. Interpreting the results of clinical trials can be difficult because weaknesses in research design, data collection methods, analytic methods, and reporting can compromise their value and usefulness. However, although randomized controlled trials are limited owing to ethical and practical issues, they are optimal for investigating the effects of therapy and establishing causality. Here we present an overview of different clinical research designs and review their advantages and limitations.
Dignity therapy for effective palliative care: a literature review
Se-Ryun Park, Yu-Jung Cha
Kosin Med J. 2022;37(3):192-202.   Published online September 27, 2022
DOI: https://doi.org/10.7180/kmj.22.127
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Dignity therapy for terminally ill patients in end-of-life care helps improve their psychological and spiritual well-being. In this study, the effectiveness and feasibility of dignity therapy in terminally ill patients were analyzed by reviewing previous studies. The review’s findings show that dignity therapy alleviates psychological distress and improves patients' spiritual well-being and dignity. In addition, many patients and their families found emotional support in generativity documents created through dignity therapy. Finally, the possibility of applying dignity therapy to palliative care in Korea in the future was explored. The findings indicate the influence of Eastern culture on recognizing death in patients who receive dignity therapy. Thus, dignity therapy shows promise as a contribution to improving palliative care; however, additional studies are needed to implement effective dignity therapy in the Korean context.
Original articles
Identification of the transcriptome profile of Miamiensis avidus after mebendazole treatment
Hyunsu Kim, A-Reum Lee, Kyung-Yoon Jeon, Eun-Ji Ko, Hee-Jae Cha, Mee Sun Ock
Kosin Med J. 2022;37(3):203-212.   Published online May 16, 2022
DOI: https://doi.org/10.7180/kmj.22.003
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
The scuticociliate Miamiensis avidus is a major pathogenic agent that causes significant economic losses in the flounder aquaculture industry. Many different types of drugs are being tested to control this disease, including mebendazole, which is a broad-spectrum antiprotozoal agent. The purpose of this study was to determine whether mebendazole worked in vitro against M. avidus and to explore its mechanism of action.
Methods
Transcriptome and gene ontology analyses were conducted to investigate the specifically expressed gene profile. We confirmed the cytotoxic effect of mebendazole against M. avidus when it was applied intermittently for a total of three times. We also identified differentially expressed genes using transcriptome analysis.
Results
Most of the upregulated genes were membrane transport-related genes, including Na+/K+-ATPase. Most of the downregulated genes were categorized into three groups: tubulin-related, metabolism-related, and transport-related genes. The expression levels of glucose uptake-related genes decreased due to the inhibition of tubulin polymerization, but this was not statistically significant.
Conclusions
Our results demonstrate that intermittent treatment with mebendazole has a significant cytotoxic effect on M. avidus. Furthermore, mebendazole induces downregulation of the tubulin-alpha chain and metabolism-related genes. It is presumed that this leads to a glucose shortage and the death of M. avidus. Transcriptome analysis will provide useful clues for further studies on mebendazole applications for scutica control.
Effectiveness of prophylactic calcium and vitamin D supplementation for preventing post-thyroidectomy hypocalcemia: a meta-analysis
Hyeyeon Moon, Ju Won Seok, Keunyoung Kim, Hye Young Kim, Mi Kyoung Park, In Joo Kim, Kyoungjune Pak, Sunghwan Suh
Kosin Med J. 2022;37(3):213-219.   Published online August 31, 2022
DOI: https://doi.org/10.7180/kmj.22.101
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
Postsurgical hypocalcemia is the most common and troublesome consequence of thyroidectomy. We investigated the potential role of routine calcium or vitamin D supplementation in preventing postsurgical hypocalcemia.
Methods
We searched MEDLINE and Embase for English-language publications using the keywords “calcium,” “vitamin D,” and “thyroid cancer.” The primary outcome was any postoperative hypocalcemia, and the secondary outcome was symptomatic hypocalcemia.
Results
Four studies that included 381 patients were eligible for this meta-analysis. A random-effects model showed no significant difference in the occurrence of hypocalcemia between calcium/vitamin D treatment and placebo/no treatment. However, the occurrence of symptomatic hypocalcemia was lower in patients with calcium/vitamin D treatment. In the combined results, preoperative calcium and vitamin D supplementation were associated with a reduced incidence of symptomatic hypocalcemia.
Conclusions
Our findings support the use of preoperative calcium and vitamin D supplementation in conjunction with routine postsurgical supplementation for patients after total thyroidectomy.

Citations

Citations to this article as recorded by  
  • Is there enough evidence to recommend preoperative calcium and vitamin D in patients who undergo total thyroidectomy?
    Hyoung Shin Lee
    Kosin Medical Journal.2022; 37(3): 173.     CrossRef
Clinical significance of copeptin as an early predictor of renal graft dysfunction in renal transplant recipients
Yoo Jin Lee, Chang Min Heo, Sihyung Park, Il Hwan Kim, Jin Han Park, Junghae Ko, Bong Soo Park, Yang Wook Kim
Kosin Med J. 2022;37(3):220-227.   Published online September 2, 2022
DOI: https://doi.org/10.7180/kmj.22.107
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
Copeptin is the carboxyl-terminal part of the vasopressin precursor protein, and its concentration is an independent predictor of the onset of chronic kidney disease and a rapid decline in the glomerular filtration rate. The glomerular filtration rate is regarded as the best indicator of kidney transplant function and is a predictor of graft and patient survival. We investigated the clinical significance of copeptin as an early predictor of renal graft dysfunction in renal transplant recipients.
Methods
We measured serum creatinine, cystatin C, and copeptin concentrations in renal transplant recipients on the day of their operation, as well as on postoperative days 3, 7, 30, and 365. Acute rejection was defined as a sudden decrease in renal function accompanied by histological changes.
Results
Eight renal transplant recipients were enrolled in the study from July 2018 to December 2019. Four patients experienced histologically confirmed transplant rejection. All four cases involved acute T-cell rejection. No significant correlation was found between the copeptin level and the presence or absence of rejection at any time point. In subgroup analyses, changes in creatinine, the estimated glomerular filtration rate, cystatin, and copeptin did not show statistical significance.
Conclusions
We anticipated that copeptin would be useful to identify individuals at high risk of transplant rejection; however, our study failed to show an association. Further research will be needed to overcome the limitations of this study.
How does quiz activity affect summative assessment outcomes? An analysis of three consecutive years’ data on self-directed learning
Chi Eun Oh, Hyunyong Hwang
Kosin Med J. 2022;37(3):228-235.   Published online September 27, 2022
DOI: https://doi.org/10.7180/kmj.22.118
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
We investigated how quiz activities can improve summative assessment outcomes by analyzing the relationship between them.
Methods
We used 217 first-year medical students’ medical informatics data from 3 consecutive years. We analyzed summative assessment outcomes between quiz completion and incompletion groups, one-time and multiple-time quiz learning groups, and three combined comparisons between subgroups of quiz learning activity frequencies: 1 versus 2, 3, 4, and 6 (group 1), 1 and 2 versus 3, 4, and 6 (group 2), and 1, 2, and 3 versus 4 and 6 (group 3). We then analyzed correlations between the final quiz scores and summative assessment outcomes.
Results
The summative assessment means for students who completed quizzes and those who did not were 87.16±8.73 and 83.22±8.31, respectively (p=0.001). The means for the one-time and multiple-time quiz learning groups were 86.54±8.94 and 88.71±8.10, respectively (p=0.223). The means for combined subgroups were not significantly different between groups (p>0.05), although a statistically significant increasing trend was found from groups 1 to 3 (0.223>0.203>0.075 using the t-test and 0.225>0.150>0.067 using the Mann-Whitney test, respectively). Summative assessment scores were not significantly correlated with quiz scores (r=0.115, p=0.213).
Conclusions
Quizzes helped students who used self-directed learning obtain better summative assessment outcomes. Formative quizzes presumably did not provide students with direct knowledge, but showed them their weak points and motivated them to work on areas where their knowledge was insufficient.
A novel technique for transurethral vesicovaginal fistula tract resection followed by transvaginal fistula repair: a two-step procedure
Soodong Kim, Heejong Jeong, Wonyeol Cho
Kosin Med J. 2022;37(3):236-241.   Published online September 27, 2022
DOI: https://doi.org/10.7180/kmj.22.124
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
The principle of treatment for a vesicovaginal fistula (VVF) tract is complete removal of the fistula tract and surrounding scar tissue, followed by anastomosis without tension from surrounding healthy tissue. We present our novel two-step procedure for VVF repair.
Methods
We retrospectively analyzed 12 women, aged 14 to 67 years, who were treated between 2011 and December 2018. Conservative treatments failed, as these patients had complex VVFs. This technique consisted of two steps: first, transurethral resection of the fistula tract and surrounding scar tissue; second, transvaginal repair of the bladder mucosa, bladder muscle, and vaginal mucosa with tensionless anastomosis. If an interposition flap was needed, we used a Martius flap.
Results
The mean operation time was 186.3 minutes (range, 145–320 minutes), and the mean urethral catheter indwelling time was 10 days. Ten patients successfully underwent surgery through a transvaginal approach with no intraoperative or postoperative complications. However, one patient developed peritoneal perforation during transurethral resection of the fistula due to severe granulation tissue formation around the fistula, which prompted conversion to an abdominal approach. In two cases, we used a Martius flap because of the poor tissue condition due to previous radiation therapy and an inflammatory reaction. At a mean follow-up of 37 months (range, 16–51 months), no recurrence of VVF was observed in any patients.
Conclusions
This novel technique for transurethral VVF tract resection followed by transvaginal fistula repair was very safe and effective technique, and this straightforward technique is expected to reduce surgeons’ burden.
The clinical significance of circulating microRNA-21 in patients with IgA nephropathy
A Young Cho, Ju Hwan Oh, Kwang Young Lee, In O Sun
Kosin Med J. 2022;37(3):242-248.   Published online September 27, 2022
DOI: https://doi.org/10.7180/kmj.22.116
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
Urinary microRNA-21 (miR-21) has been reported to correlate with the histologic lesions of IgA nephropathy (IgAN). We investigated whether urinary or circulating miR-21 could serve as a biomarker for detecting the renal progression of IgAN.
Methods
Forty patients with biopsy-proven IgAN were enrolled in this study. Serum and urinary sediment miRs were extracted, and the expression of miR-21 was quantified by real-time quantitative polymerase chain reaction. Renal progression was defined as end-stage renal disease, a sustained doubling of serum creatinine, or a 50% decrease in estimated glomerular filtration rate (eGFR) from baseline.
Results
Six patients experienced renal progression during the follow-up period. The baseline eGFR was lower in the progression group (49±11 mL/min/1.73 m2 vs. 90±23 mL/min/1.73 m2, p<0.05) than in the non-progression group. The level of circulating miR-21 on kidney biopsy was higher in the progression group than in the non-progression group (40.0±0.6 vs. 38.2±1.1 ΔCt value of miR-21, p<0.01), whereas there was no significant difference in urinary miR-21 (38.1±2.1 vs. 37.8±1.4 ΔCt value of miR-21, p=0.687) between the two groups. Receiver operating characteristic curve analysis demonstrated that circulating miR-21 had good discriminative power for diagnosing renal progression of IgAN, with an area under the curve of 0.975.
Conclusions
The level of circulating miR-21 was higher in the progression group than in the non-progression group at the time of kidney biopsy. Therefore, circulating miR-21 could be a surrogate marker of renal progression in patients with IgAN.
Case reports
A rare case of pure-type embryonal carcinoma in a 75-year-old woman mimicking epithelial ovarian carcinoma
Hyun Been Jo, Eun Taeg Kim, Nam Kyung Lee, Kyung Un Choi, Eon Jin Kim, Yun Joo Shin, Ki Hyung Kim, Dong Soo Suh
Kosin Med J. 2022;37(3):249-254.   Published online June 16, 2022
DOI: https://doi.org/10.7180/kmj.22.026
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Embryonal carcinoma, a very rare ovarian germ cell tumor, involves pure and mixed phenotypes. Pure-type embryonal carcinoma has never been reported in postmenopausal women. The current case was, thus, misdiagnosed as an epithelial ovarian carcinoma based on radiologic findings. Herein, we describe the case of ovarian embryonal carcinoma in a 75-year-old woman along with a literature review. Magnetic resonance imaging findings were suggestive of epithelial ovarian malignancy associated with endometrioma, including ureteral invasion. The patient underwent complete surgical staging, and a pathologic diagnosis of pure-type embryonal carcinoma was made. The patient’s postoperative course was uneventful, and adjuvant chemotherapy was administered. Embryonal carcinoma in the postmenopausal woman is a clinical challenge owing to the possibility of its misdiagnosis as epithelial ovarian carcinoma. To the best of our knowledge, this is the first report of pure-type ovarian embryonal carcinoma in a postmenopausal woman, with a description of the clinicopathologic characteristics and review of the relevant literature.
Secondary hyperparathyroidism due to multiple parathyroid carcinomas in a patient with chronic hemodialysis: a case report
Soree Ryang, Wook Yi, Mijin Kim, Sang Heon Song, Byung Joo Lee, Bo Hyun Kim
Kosin Med J. 2022;37(3):255-259.   Published online July 27, 2022
DOI: https://doi.org/10.7180/kmj.22.103
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Parathyroid carcinoma (PC) in cases of secondary or tertiary hyperparathyroidism is relatively uncommon, and only a few case reports have described this entity. Although some papers have reported patients with one or two parathyroid malignancies, multiple PC–especially three or more–have been even more rarely reported. Herein, we report a case of secondary hyperparathyroidism due to multiple PCs in a chronic hemodialysis patient. A 54-year-old man with end-stage kidney disease was referred for hyperparathyroidism. He had been diagnosed with chronic kidney disease in 2001 and had begun hemodialysis in 2009. In laboratory tests, intact parathyroid hormone (iPTH) was markedly elevated to 1,144.1 pg/mL (normal range: 15.0–68.3 pg/mL) and serum calcium was mildly elevated to 10.56 mg/dL (normal range: 8.5–10.3 mg/dL). Ultrasonography showed hypoechoic nodules in the posterior part of both thyroid glands. All three nodules showed increased uptake on a 99mTc sestamibi scan. The patient underwent total parathyroidectomy with autotransplantation to the right forearm. Histopathology findings showed three PCs with capsular invasion and one parathyroid hyperplasia. In the immediate postoperative period, the iPTH level dropped from 1,446.8 to 82.4 pg/dL and, after 1 month, to 4.0 pg/dL. This patient needed oral calcium carbonate and active vitamin D to maintain appropriate serum calcium levels. Although multiple PCs are rare, they can cause secondary hyperparathyroidism. Therefore, clinicians should suspect multiple PCs when patients’ serum iPTH levels are exceptionally high. Additionally, since PCs could occur in multiple glands, autotransplantation of the parathyroid gland after parathyroidectomy should be done carefully.

KMJ : Kosin Medical Journal