Kosin Medical Journal

Volume 38(1); March 2023

Editorial

What is the effect of deferred laser treatment on reactivated retinopathy of prematurity after anti-VEGF injection?: Ji Hye Jang; Kosin Med J. 2023;38(1):1-3. Published online March 17, 2023; DOI: https://doi.org/10.7180/kmj.23.108

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Review articles

Faculty development: the need to ensure educational excellence and health care quality: Hyekyung Shin, Min-Jeong Kim; Kosin Med J. 2023;38(1):4-11. Published online March 27, 2023; DOI: https://doi.org/10.7180/kmj.23.109

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Abstract PDF PubReader ePub: The definition of faculty development has been refined and expanded over the past few decades, and various definitions have been used in higher education. Initially, faculty development was defined as activities that help teachers improve teaching skills, design better curricula, and improve the organizational environment for education. Since then, as the focus of faculty development has shifted from individual professors to institutional needs, faculty development is now defined as the personal and professional development of professors, clinicians, researchers, and managers to meet institutional goals, visions, and missions in social terms and moral responsibility to the community. Faculty development in medical education is universally needed to recognize and cope with widespread changes in education, including the traditional role of professors, advances in pedagogical theory, changes in learning styles, innovative curriculum models, and evaluation philosophy. However, critics have pointed out that most universities could not actively implement faculty development or accept professors’ various demands. In this paper, various reports related to faculty development are reviewed to summarize how faculty development has progressed and present future directions for accepting various opinions to improve educational excellence and the quality of health care.

Future directions of online learning environment design at medical schools: a transition towards a post-pandemic context: Sejin Kim; Kosin Med J. 2023;38(1):12-20. Published online March 27, 2023; DOI: https://doi.org/10.7180/kmj.23.110

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Coronavirus disease 2019 (COVID-19) has had an extremely large impact on methods of teaching and learning, and the need for online learning has grown enormously during the COVID-19 pandemic. Because most professors and students adjusted their mode of teaching and learning to this new context, online learning seemed to be going well. The problem is that distance learning was abruptly adopted as an alternative method of classroom instruction. To increase the effectiveness of online learning, more consideration is needed to explore future directions of creating learning environments. Therefore, this study suggests seven design guidelines for designing learning environments at medical schools based on a theoretical background and experiences from the pandemic. Constructivism and situated learning theory are introduced as the theoretical background for learning environment design, and the basic principles of learning environment design with the paradigm shift to learner-centered classrooms and experiences using EdTech, including HyFlex learning, flipped learning, learning management systems, and interactive learning tools, were used to develop the design guidelines. Each design guideline is strategically matched with the basic principles: learner-centeredness, real-world tasks and contexts, problem-solving, new roles of professors as facilitators or tutors, collaboration, and new perspectives of evaluation and assessment.

Citations

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Do we need Moodle in medical education? A review of its impact and utility
Seri Jeong, Hyunyong Hwang
Kosin Medical Journal.2023; 38(3): 159. CrossRef

Remote health monitoring services in nursing homes: Jiwon Kim, Hyunsoo Kim, Sungil Im, Youngin Park, Hae-Young Lee, Sookyung Kwon, Youngsik Choi, Linda Sohn, Chulho Oak; Kosin Med J. 2023;38(1):21-27. Published online March 29, 2023; DOI: https://doi.org/10.7180/kmj.22.131

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Abstract PDF PubReader ePub: Aged people are challenged by serious complications from chronic diseases, such as mood disorder, diabetes, heart disease, and infectious diseases, which are also the most common causes of death in older people. Therefore, elderly care facilities are more important than ever. The most common causes of death in elderly care facilities were reported to be diabetes, cardiovascular disease, and pneumonia. Recently, the coronavirus disease 2019 (COVID-19) pandemic have a great impact on blind spots of safety where aged people were isolated from society. Elderly care facilities were one of the blind spots in the midst of the pandemic, where major casualties were reported from COVID-19 complications because most people had one or two mortality risk factors, such as diabetes or cardiovascular disease. Therefore, medical governance of public health center and hospital, and elderly care facility is becoming important issue of priority. Thus, remote health monitoring service by the Internet of Medical Things (IoMT) sensors is more important than ever. Recently, technological breakthroughs have enabled healthcare professionals to have easy access to patients in medical blind spots through the use of IoT sensors. These sensors can detect medically urgent situations in a timely fashion and make medical decisions for aged people in elderly care facilities. Real-time electrocardiograms and blood sugar monitoring sensors are approved by the medical insurance service. Real-time monitoring services in medical blind spots, such as elderly care facilities, has been suggested. Heart rhythm monitoring could play a role in detecting early cardiovascular disease events and monitoring blood glucose levels in the management of chronic diseases, such as diabetes, in aged people in elderly care facilities. This review presents the potential usefulness of remote monitoring with IoMT sensors in medical blind spots and clinical suggestions for applications.

Original articles

Revascularization of immature retinas with retinopathy of prematurity using combination therapy of deferred laser treatment after a single intravitreal bevacizumab injection: Ju Seouk Lee, Ki Yup Nam, Ji Eun Lee, Joo Eun Lee, Sang Joon Lee; Kosin Med J. 2023;38(1):28-35. Published online March 28, 2023; DOI: https://doi.org/10.7180/kmj.22.145

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Background
This study aimed to observe the extent of retinal vascularization in patients with retinopathy of prematurity (ROP) who underwent deferred laser treatment (LT) after a single intravitreal bevacizumab injection (IVB).
Methods
This study retrospectively evaluated 40 consecutive eyes in 21 infants who received a single IVB or LT. Deferred LT was performed in cases of ROP recurrence after a single IVB. To assess the amount of retinal vascularization between the initial IVB and deferred LT, the cases were divided into three groups based on treatment: single IVB, deferred LT after a single IVB, and prompt LT. The growth and associated complications were compared between groups.
Results
There were 12, 16, and 12 eyes in the single IVB, deferred LT, and prompt LT groups, respectively. Deferred LT was performed at an average of 7.9 weeks after a single IVB. In the single IVB group, retinal vascularization proceeded to zone III, whereas the prompt LT group did not show any growth of vascularization beyond the laser scars. In the deferred LT group, during the window period before LT, retinal vascularization progressed from zone I to zone II posterior and from zone II posterior to zone II anterior, respectively, without further ROP recurrence.
Conclusions
Retinal vascularization progressed during the deferred window period, thereby reducing the area of the retina ablated by LT. A single IVB followed by deferred LT can be an alternative treatment option to prevent ablation of zone I or multiple IVBs.

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Comparison of different agents and doses of anti-vascular endothelial growth factors (aflibercept, bevacizumab, conbercept, ranibizumab) versus laser for retinopathy of prematurity: A network meta-analysis
Amparo Ortiz-Seller, Pablo Martorell, Honorio Barranco, Isabel Pascual-Camps, Esteban Morcillo, José L. Ortiz
Survey of Ophthalmology.2024;[Epub] CrossRef
What is the effect of deferred laser treatment on reactivated retinopathy of prematurity after anti-VEGF injection?
Ji Hye Jang
Kosin Medical Journal.2023; 38(1): 1. CrossRef

Comparison of circuit patency and exchange rates between the original and generic versions of nafamostat mesylate in critically ill adults receiving continuous renal replacement therapy: Sujung Heo, Yanghyeon Kim, Nagyeom Lee, Ye Na Kim, Ho Sik Shin, Yeonsoon Jung, Hark Rim; Kosin Med J. 2023;38(1):36-42. Published online March 20, 2023; DOI: https://doi.org/10.7180/kmj.22.137

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Abstract PDF PubReader ePub: Background
Nafamostat mesylate is widely used as an anticoagulant in continuous renal replacement therapy (CRRT). The generic versions of nafamostat mesylate have identical main components to the original product. However, it is questionable whether the generic versions have the same efficacy as the original. Therefore, we compared the circuit patency and exchange rates of the original nafamostat mesylate and a generic version to determine which is more efficient as an anticoagulant in CRRT.
Methods
This retrospective study enrolled 1,255 patients hospitalized to receive CRRT who received the original version of nafamostat mesylate or a generic version between January 2010 and July 2018. We evaluated the filter lifespan, number of filters used per day, mean blood flow, and transmembrane pressure (TMP).
Results
The mean filter lifespan was 36.3±15.1 hours in the original product group and 22.2±16.2 hours in the generic product group, which was not a statistically significant difference (p=0.060). The mean TMP was 62.2±47.3 mmHg in the original product group and 74.5±45.6 mmHg in the generic product group (p=0.045).
Conclusions
This retrospective study suggests no meaningful difference in filter lifespan between the original and generic versions of nafamostat mesylate. However, TMP was lower in the original product group than in the generic product group.

Comparison of the prevalence and histology between primary benign bladder tumors and recurrent benign lesions after transurethral resection of malignant bladder tumors: Jae Jin Baek, Yong Deuk Seo, Dong Ha Kim, Won Tae Seo, Su Hwan Kang, Taek Sang Kim, Bong Kwon Chun; Kosin Med J. 2023;38(1):43-49. Published online February 17, 2023; DOI: https://doi.org/10.7180/kmj.22.133

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Abstract PDF PubReader ePub: Background
Benign bladder tumors are rare disease entities, and insufficient studies have assessed their epidemiological characteristics. The authors investigated the prevalence of benign bladder tumors by retrospectively investigating pathology reports of transurethral resection of bladder tumor (TURBT) procedures over the past 20 years.
Methods
We analyzed 1,674 pathology reports of TURBT conducted in 1,160 patients from January 1, 2000, to April 30, 2022. The prevalence of benign tumors and histological classification according to the presence of primary (group 1) and recurrent (group 2) bladder lesions were retrospectively investigated.
Results
The mean age of patients was 65.2±11.5 years, and 1,284 cases (79.1%) were in men. Benign bladder tumors comprised 278 cases (248 patients) accounting for about 17.1% of the total TURBT cases (278/1,624). Furthermore, 184 patients (16.0%, 184/1,147) belonged to group 1 and 78 patients (27.4%, 78/285) belonged to group 2. Among all benign lesions that underwent TURBT, cystitis was the most common (41.0%, 114/278), and this rate was higher in group 2 (64/184 [34.8%] vs. 50/94 [53.2%], p<0.001). The prevalence of non-neoplastic lesions was higher in group 1 (44/184 [23.9] vs. 11/94 [11.7%], p<0.001). There was no difference in the prevalence of noninvasive urothelial neoplasms between the two groups (22/184 [12.0%] vs. 8/94 [8.5%], p=0.86).
Conclusions
The probability of benign lesions in TURBT was 17.1%, among which cystitis was the most common. When TURBT was performed for recurrent lesions, the frequency of benign tumors was higher than that of primary benign bladder tumors.

Case reports

Development of severe junctional bradycardia after dexmedetomidine infusion in a polypharmacy patient: a case report and literature review: Soeun Jeon, Eunsoo Kim, Sun Hack Lee, Sung In Paek, Hyun-Su Ri, Dowon Lee; Kosin Med J. 2023;38(1):50-55. Published online December 7, 2022; DOI: https://doi.org/10.7180/kmj.22.113

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Abstract PDF PubReader ePub: The authors report a case of newly manifested severe junctional bradycardia following dexmedetomidine administration during spinal anesthesia in a polypharmacy patient. A 77-year-old woman receiving multiple medications, including a beta-blocker and a calcium channel blocker, underwent right total knee arthroplasty. After spinal anesthesia, intravenous dexmedetomidine was initiated as a sedative; her heart rate decreased, followed by junctional bradycardia (heart rate, 37–41 beats/min). Dexmedetomidine was discontinued, and a dopamine infusion was initiated. Seven hours after surgery, junctional bradycardia persisted; a temporary transvenous pacemaker was inserted, and the beta-blocker and calcium channel blocker were discontinued. The patient was discharged on postoperative day 11 without any sequelae. Anesthesiologists should be aware of dexmedetomidine’s inhibitory effects on the cardiac conduction system, especially in geriatric patients taking medications with negative chronotropic effects and in combination with neuraxial anesthesia.

Bochdalek hernia presenting gastrointestinal symptoms in late childhood: a case report: Sang Seok Jeong; Kosin Med J. 2023;38(1):56-59. Published online February 21, 2023; DOI: https://doi.org/10.7180/kmj.22.134

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Abstract PDF PubReader ePub: Most cases of congenital diaphragmatic hernia (CDH) can be diagnosed based on symptoms of severe respiratory failure during the neonatal period or fetal ultrasonography. However, some rare cases are diagnosed in late childhood or adolescence. In this case report, I describe an 11-year-old male patient diagnosed with late-onset CDH presenting with acute abdominal pain. The patient had recently experienced anorexia, nausea, and vomiting after eating. However, he reported no abdominal pain or past history of trauma. The abdomen was generally convex. All laboratory data were within normal limits. A chest X-ray revealed elevation of the left diaphragm. Chest computed tomography showed a defect in the left diaphragm. Based on the above radiologic findings, emergency surgery was performed after the diagnosis of diaphragmatic hernia. A surgical incision was performed in the left subcostal area. Finally, late-presenting Bochdalek hernia was diagnosed. The operation was completed and no specific findings on chest X-ray were found after surgery. The patient was discharged on the fourth day after surgery. In conclusion, CDH in late childhood or adolescence is rare and has various clinical manifestations. To avoid complications such as strangulation and bowel perforation, emergency surgery may be required. Thus, it is necessary to suspect CDH in children with recurrent gastrointestinal or respiratory symptoms, based on which an accurate diagnosis can be made and successful surgical treatment can be performed.

A case report of successfully treated metachronous gastrointestinal stromal tumor and colon cancer: Young Jin Heo, Ji Young Lee; Kosin Med J. 2023;38(1):60-65. Published online March 8, 2023; DOI: https://doi.org/10.7180/kmj.22.138

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Abstract PDF PubReader ePub: The diagnosis of gastrointestinal stromal tumor (GIST) has become relatively common in recent years, but little is known about its association with other malignancies. We present a rare case of successfully treated metachronous GIST and colon cancer with concurrent FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) chemotherapy and imatinib. A 63-year-old man presented with abdominal pain that had started 2 weeks ago, and endoscopic ultrasonography showed masses that were compatible with GIST on the duodenum. He underwent Whipple surgery. One year after the GIST diagnosis, two liver masses were found on abdominal computed tomography images taken for surveillance. A liver biopsy showed metastatic adenocarcinoma, not GIST. Colonoscopy was then performed to identify the primary site of the metastatic adenocarcinoma in the liver, and sigmoid colon cancer was found. He received 12 cycles of adjuvant FOLFOX concurrently with adjuvant imatinib. There were no serious adverse events of grade 3 or higher from either imatinib or chemotherapy. He has completed adjuvant imatinib and FOLFOX chemotherapy and there is no evidence of disease recurrence. When a synchronous or metachronous tumor is found in a GIST patient, the clinician should keep in mind the possibility of another primary tumor of different histopathology, as well as GIST recurrence.

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. 2023;38(1):66-71. Published online January 18, 2023; DOI: https://doi.org/10.7180/kmj.22.135

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Abstract PDF PubReader ePub: Traumatic neuroma (TN), also known as amputation neuroma, is a reactive hyperplasia of nerve fibers and connective tissue arising from Schwann cells after trauma or surgery. TN of the bile duct is usually asymptomatic, but rarely can lead to right upper quadrant pain, biliary obstruction, and acute cholangitis. It is very difficult to discriminate TN from malignancy before surgery, although doing so could avoid an unnecessary radical resection of the lesion. In the course of surgery, TN can be caused by unintentional injury of a nerve fiber near the common bile duct (CBD) and heat damage to an artery, complete ligation of an artery, and excessive manipulation of the CBD. Therefore, to prevent TN after cholecystectomy, surgery should be performed carefully with appropriate consideration of anatomic variations, and a cystic duct should not be resected too close to the CBD. The possibility of TN should be considered if a patient who has undergone CBD resection with hepaticojejunostomy or cholecystectomy long ago experiences symptoms of jaundice, cholangitis, or obliteration of the CBD. In this report, we present a case of TN mimicking cholangiocarcinoma that emerged from a cystic duct stump after cholecystectomy.

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