Kosin Medical Journal

From articles published since 2020.

Case report

Scrub typhus with complications of acute myocarditis and cardiac tamponade in metropolitan areas: two case reports: Ki-Woon Kang, Wonho Kim; Kosin Med J. 2023;38(3):210-214. Published online June 9, 2023; DOI: https://doi.org/10.7180/kmj.23.111; Funded: National Research Foundation of Korea, Ministry of Education

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Abstract PDF PubReader ePub Crossref - TDM: Scrub typhus is known as one of the most common seasonal infections in endemic rural areas, but life-threatening cardiac complications in cases of scrub typhus are very infrequent. In addition, scrub typhus infection has been rarely reported among workers assembling pallets using manufactured wood in metropolitan areas. Herein, we present two cases involving myocarditis and cardiac tamponade as complications of scrub typhus. One patient died and the other patient survived. These cases indicate that scrub typhus infection could be an environmental hazard in metropolitan areas, especially in locations with poor hygiene, and highlight the need for timely diagnosis and proper management of severe scrub typhus infections. Therefore, we present these two informative fatal cases of scrub typhus infection presenting with myocarditis and cardiac tamponade as an environmental hazard in metropolitan areas.

Original articles

Omega-3 fatty acids upregulate Nrf2 expression and attenuate apoptosis, inflammation, and fibrosis in a rat model of cyclosporine-induced nephropathy: Ji Young Lee, Young Ki Son, Mi Hwa Lee, Su Mi Lee, Seong Eun Kim, Won Suk An; Kosin Med J. 2023;38(3):184-192. Published online July 26, 2023; DOI: https://doi.org/10.7180/kmj.23.112; Funded: Dong-A University Research Fund

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Abstract PDF PubReader ePub Crossref - TDM: Background
Cyclosporine A (CsA)-induced kidney injury is characterized by renal impairment with inflammatory cell infiltrations, apoptosis, fibrosis, and hypoxic injury. It is not clear whether omega-3 fatty acids (O-3 FAs), which have anti-inflammatory and antioxidant roles, affect nuclear factor erythroid 2-related factor 2 (Nrf2) expression. The aim of this study was to investigate whether O-3 FAs affect Nrf2 expression and exert anti-inflammatory, anti-apoptotic, and anti-fibrotic effects in CsA-induced nephropathy.
Methods
Male Sprague-Dawley rats were divided into control, CsA-treated, and CsA-treated with O-3 FA groups. Nrf2 expression was measured by Western blots and immunohistochemical staining.
Results
Kidney function was impaired in the CsA-treated rats compared to the controls. Caspase-3 and caspase-7 were activated in the CsA-treated group, and the Bax/Bcl2 ratio was higher. O-3 FAs attenuated these apoptosis-related changes. ED-1 and inhibition of kappa B (IĸB) protein expression were significantly upregulated in the CsA-treated group. Compared to the control group, O-3 FA supplementation attenuated the increased expression of ED-1 and IĸB related to inflammation. Smad2/3, Smad4, and transforming growth factor-β1 were activated in the CsA group, and O-3 FA treatment prevented these changes related to renal fibrosis. The expression of Nrf2 was reduced in CsA-treated rats, but Nrf-2 was increased by O-3 FA treatment.
Conclusions
We suggest that Nrf2 is a potential mediator induced by O-3 FA supplementation and that it attenuates pro-inflammatory pathways, fibrotic processes, and apoptosis. Further studies are needed to elucidate the crosstalk between Nrf2 expression and signals related to O-3 FA treatment.

The COVID-19 pandemic's impact on prostate cancer screening and diagnosis in Korea: Byeong Jin Kang, Kyung Hwan Kim, Hong Koo Ha; Kosin Med J. 2023;38(3):193-200. Published online August 16, 2023; DOI: https://doi.org/10.7180/kmj.23.116; Funded: Pusan National University Hospital

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Abstract PDF PubReader ePub Crossref - TDM: Background
The global coronavirus disease 2019 (COVID-19) pandemic, which started in early 2020, has had multiple impacts on cancer care. This study assessed how the COVID-19 pandemic influenced prostate cancer (PCa) screening and diagnosis in South Korea.
Methods
Patients who visited the outpatient clinic at a single institution for PCa evaluation were included in this study and divided into a pre-COVID-19 group and a COVID-19 pandemic group, based on the start of the COVID-19 pandemic and social distancing policies on March 1, 2020. The number of prostate-specific antigen (PSA) tests, patients with elevated PSA levels, and prostate biopsy results were analyzed.
Results
In total, 8,926 PSA tests were administered during the COVID-19 pandemic, compared to 15,654 before the pandemic (p<0.05). Of 2,132 patients with high PSA levels, 1,055 (49.5%) received prostate biopsies before the pandemic and 1,077 (50.5%) did so during the COVID-19 pandemic. The COVID-19 pandemic group had a higher detection rate of PC, and increased rates of Gleason scores (GS) 7 and 9–10, while the rate of GS 6 decreased compared to the pre-COVID-19 group (p<0.05). The rate of clinically significant PCa (csPCa) was also higher during the pandemic (p<0.05). In both magnetic resonance imaging-guided and standard biopsies, the GS 6 rate decreased, and the csPCa rate increased during the COVID-19 pandemic (each, p<0.05).
Conclusions
During the COVID-19 pandemic, the detection rate of prostate biopsies and the rate of csPCa increased significantly. Thus, PCa was diagnosed at a more advanced state in Korea during the COVID-19 pandemic.

Review article

Application of Raman spectroscopy in breast cancer surgery: Yikeun Kim, Sung Ui Jung, Jinhyuk Choi; Kosin Med J. 2023;38(3):176-183. Published online September 14, 2023; DOI: https://doi.org/10.7180/kmj.23.129; Funded: National Research Foundation of Korea, Ministry of Education

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Abstract PDF PubReader ePub Crossref - TDM: The incidence of breast cancer is increasing worldwide. As cancer screening has become more widespread, the rate of early breast cancer detection has increased and treatment methods have changed. Partial mastectomy is performed more often than total mastectomy for the surgical treatment of early breast cancer, and sentinel lymph node biopsy plays an important role. A high level of accuracy is necessary for the intraoperative examination of surgical margins and sentinel lymph nodes to identify malignancies. Therefore, several examination techniques, including Raman spectroscopy, that replace or supplement the currently used frozen-section methods are being studied. Raman spectroscopy has the ability to diagnose cancer in normal tissue by providing in real time a chemical fingerprint that can be used to differentiate between cells and tissues. Numerous studies have investigated the utilization of Raman spectroscopy to identify cancer in the margins of resected tissues and sentinel lymph nodes during breast cancer surgery, showing the potential of this technique for clinical applications. This article introduces and reviews the research on Raman spectroscopy for breast cancer surgery.

Case report

Targeted temperature management in a patient with suspected hypoxic-ischemic brain injury after successful resuscitation from cardiac arrest: a case report: Christine Kang, Won Yong Lim, Young-hoon Jung, Jiseok Baik; Kosin Med J. 2023;38(2):144-150. Published online December 19, 2022; DOI: https://doi.org/10.7180/kmj.22.130; Funded: Pusan National University Hospital

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Abstract PDF PubReader ePub Crossref - TDM: Hypoxic-ischemic brain injury (HIBI) after cardiac arrest (CA) is a leading cause of mortality and long-term neurological disorders in survivors. Targeted temperature management (TTM) has been rigorously studied as a way to improve results compared to a normal body temperature for preventing secondary damage after HIBI. We report a case of successful TTM in a patient who was suspected to have HIBI after resuscitation from cardiovascular collapse due to respiratory failure during elective surgery under brachial plexus block with dexmedetomidine and remifentanil infusion. A 27-year-old male patient developed CA due to apnea during orthopedic surgery. TTM was performed in the surgical intensive care unit for 72 hours after resuscitation, and the patient recovered successfully. TTM application immediately after resuscitation from CA in patients with suspected HIBI may be an appropriate treatment.

Original articles

Dietary education may reduce blood cadmium and mercury levels in chronic kidney disease patients with higher blood cadmium and mercury levels: Su Mi Lee, Young-Seoub Hong, Byoung-Gwon Kim, Jung-Yeon Kwon, Yongsoon Park, Seong Eun Kim, Won Suk An; Kosin Med J. 2023;38(2):107-116. Published online May 24, 2023; DOI: https://doi.org/10.7180/kmj.23.101; Funded: Ministry of Environment

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1 Citations

Abstract PDF Supplementary Material PubReader ePub Crossref - TDM

Background
Exposure to cadmium and mercury is associated with renal dysfunction. This study aimed to investigate the possible ability of dietary education to decrease blood cadmium and mercury levels in patients with chronic kidney disease (CKD).
Methods
Twenty-seven patients with CKD were enrolled in this prospective, single-arm pilot study. Patients with blood cadmium levels ≥1.4 μg/L were instructed to reduce their intake of shellfish, while those with blood mercury levels ≥5.0 μg/L were asked to reduce their intake of externally blue-colored fish.
Results
Seven dialysis patients and 15 pre-dialysis patients completed the study. Compared with baseline, the blood cadmium (2.0±0.7 μg/L vs. 1.8±0.7 μg/L, p=0.031) and mercury levels (4.4±2.6 μg/L vs. 3.5±1.9 μg/L, p=0.005) after 1 year significantly decreased, although the dietary intake was not significantly different in patients with blood cadmium levels ≥1.4 μg/L and blood mercury levels ≥5.0 μg/L. In pre-dialysis patients, kidney function worsened after 1 year compared with that at baseline despite the reduction in blood cadmium and mercury levels.
Conclusions
Reduction of food intake containing cadmium and mercury may lower the blood cadmium and mercury levels in CKD patients with higher cadmium and mercury levels. Higher blood cadmium levels may cause renal disease progression in pre-dialysis patients, and further studies are necessary to determine the underlying mechanisms.

Citations

Citations to this article as recorded by

Impact of dietary education on blood cadmium and mercury levels in chronic kidney disease: a path to renal health improvement
Ho Sik Shin
Kosin Medical Journal.2023; 38(2): 73. CrossRef

Intraoperative tumor localization using a titanium ring strip in totally laparoscopic distal gastrectomy for middle-third gastric cancer: Jae-Kyun Park, Chang-In Choi, Tae Yong Jeon, Hyuk Jae Jung, Si Hak Lee, Sun Hwi Hwang, Dae-Hwan Kim; Kosin Med J. 2023;38(2):126-133. Published online June 23, 2023; DOI: https://doi.org/10.7180/kmj.23.113; Funded: Pusan National University

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Abstract PDF PubReader ePub Crossref - TDM: Background
This study presents a novel technical tip for intraoperative tumor localization and determination of the proximal resection line using a titanium ring strip for totally laparoscopic distal gastrectomy in patients with middle-third gastric cancer and describes the short-term results of its application.
Methods
In total, 42 patients with middle-third gastric cancer who underwent intraoperative tumor localization using a titanium ring strip and determination of the proximal resection line through intraoperative radiography between January 2020 and December 2021 were enrolled in this study. We retrospectively analyzed patients’ prospectively collected clinical, pathological, and surgical data.
Results
Twenty-six men and 16 women with a mean age of 58.3±12.5 years were enrolled. The mean operation time and estimated blood loss were 212.6±43.0 minutes and 122.4±77.6 mL, respectively. The lengths of the proximal and distal resection margin were 2.0±0.4 cm (range, 0.8–3.7 cm) and 10.5±4.1 cm (range, 0.4–20.4 cm), respectively. Roux-en-Y anastomosis was performed in 30 patients, while Billroth II with Braun anastomosis was performed in 12 patients. There were no procedure-related complications, and the mean postoperative hospital stay was 7.2±1.9 days. For all patients, the negative proximal resection margin was confirmed by postoperative pathological examinations.
Conclusions
Intraoperative tumor localization and determination of the proximal resection line using a titanium ring strip is a useful alternative method that can be easily and safely performed. This method is especially useful for patients with middle-third gastric cancer requiring an appropriate proximal resection margin.

Review article

Revolutionizing gut health: exploring the role of gut microbiota and the potential of microbiome-based therapies in lower gastrointestinal diseases: Yong Eun Park, Jae Hyun Kim; Kosin Med J. 2023;38(2):98-106. Published online June 23, 2023; DOI: https://doi.org/10.7180/kmj.23.115; Funded: National Research Foundation of Korea

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Abstract PDF PubReader ePub Crossref - TDM: The gut microbiota comprises a collection of microorganisms residing in the human digestive system, including bacteria, viruses, and fungi. These microbes have critical roles in food breakdown, immune system regulation, and the production of essential nutrients. Several lower gastrointestinal (GI) diseases, including inflammatory bowel disease, irritable bowel syndrome, and colorectal cancer, have been associated with dysbiosis, which refers to an imbalance in the gut microbiota. Additionally, the gut microbiome and its microbial compounds affect disease development and the host’s immune response. Alterations in the gut-brain axis microbiome are also implicated in lower GI diseases. Therefore, microbiome-based therapies that regulate the gut microbiota (e.g., fecal microbiota transplantation and probiotics) are essential for the prevention and treatment of these diseases. This review aims to highlight the significance of gut microbiota and microbiome-based therapies in managing lower GI diseases.

Editorial

Impact of dietary education on blood cadmium and mercury levels in chronic kidney disease: a path to renal health improvement: Ho Sik Shin; Kosin Med J. 2023;38(2):73-74. Published online June 26, 2023; DOI: https://doi.org/10.7180/kmj.23.130; Funded: SK Chemical, National Research Foundation of Korea, Ministry of Education

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PDF PubReader ePub Crossref - TDM

Case report

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; Funded: Pusan National University Hospital

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Abstract PDF PubReader ePub Crossref - TDM: 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.

Original article

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; Funded: National Research Foundation of Korea, Ministry of Education

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Abstract PDF PubReader ePub Crossref - TDM: 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.

Review article

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; Funded: Korea Health Industry Development Institute

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Abstract PDF PubReader ePub Crossref - TDM: 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.

Case report

Multiple extraintestinal manifestations in a patient with acute severe ulcerative colitis: a case report: Eun Young Park, Dong Hoon Baek, Seung Min Hong, Geun Am Song; Kosin Med J. 2022;37(4):361-366. Published online July 27, 2022; DOI: https://doi.org/10.7180/kmj.22.027; Funded: Pusan National University Hospital

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Abstract PDF PubReader ePub Crossref - TDM: Patients with inflammatory bowel disease (IBD) are at risk for extraintestinal manifestations (EIM) over the course of their disease. As EIMs can involve nearly every organ, and strongly influence the quality of life, early recognition and adequate treatment are necessary to prevent severe morbidity and mortality in affected patients. Pyoderma gangrenosum is a highly severe and debilitating skin condition that occurs in 1% to 10% of ulcerative colitis (UC) patients. Thromboembolic events are also serious EIMs and usually present as deep vein thromboses in the legs or as pulmonary embolisms. A 19-year-old woman presented with bloody diarrhea lasting for 3 months and deep ulceration on the right foot. She was diagnosed with UC. The patient's skin lesions did not improve with intravenous corticosteroids and oral mesalazine. After she was started on infliximab, we observed rapid resolution of the skin lesions. She continued to complain of mild dyspnea while in the hospital. Computed tomography performed using the thromboembolism protocol revealed pulmonary thromboembolism and deep venous thrombosis. The patient underwent anticoagulant therapy with low-molecular-weight heparin, and her dyspnea gradually improved. Anticoagulation was continued with warfarin. It is rare for IBD patients to have multiple EIMs; however, this case demonstrates that multiple EIMs are a possible presentation in UC and underscores the importance of a meticulous clinical examination and adequate evaluation in the management of IBD patients presenting with EIMs.

Original article

Correlation of long interspersed element-1 open reading frame 1 and c-Met proto-oncogene protein expression in primary and recurrent colorectal cancers: Kyung-Yoon Jeon, Eun-Ji Ko, Hee-Kyung Chang, Seung-Hyun Lee, Byung-Kwon Ahn, Mee Sun Ock, Hee-Jae Cha; Kosin Med J. 2022;37(4):283-290. Published online December 22, 2022; DOI: https://doi.org/10.7180/kmj.22.106; Funded: National Research Foundation of Korea

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Abstract PDF PubReader ePub Crossref - TDM: Background
Colorectal cancer is one of the most common cancers worldwide. Colorectal cancer that has recurred and metastasized to other organs also has a very poor prognosis. According to recent studies, the long interspersed element-1 (LINE-1) retrotransposon open reading frame (ORF) is located in the intron of the c-Met proto-oncogene, which is involved in cancer progression and metastasis, and regulates its expression. However, no study has compared the expression patterns of LINE-1 ORF1 and c-Met, which are closely related to cancer progression and metastasis, and their correlation in primary and recurrent cancers.
Methods
In the present study, we compared the expression patterns of LINE-1 ORF1 and c-Met in both primary and recurrent colorectal cancer tissues from 10 patients. Expression patterns and correlations between LINE-1 ORF1 and c-Met proto-oncogene proteins were analyzed by immunofluorescence staining using both LINE-1 ORF1 and c-Met antibodies.
Results
The expression patterns of LINE-1 ORF1 and c-Met showed significant individual differences, and the expression of both proteins was correlated in all colorectal cancer patients. However, the expression levels of LINE-1 ORF1 and c-Met were not significantly different between primary and recurrent colorectal cancers.
Conclusions
The protein expression levels of LINE-1 ORF1 and c-Met were correlated, but did not change significantly in cases of recurrent colorectal cancer in the same patient.

Review article

Considerations for experimental animal ethics in the research planning and evaluation process: Jaewon Shim, Jeongtae Kim; Kosin Med J. 2022;37(4):271-277. Published online December 22, 2022; DOI: https://doi.org/10.7180/kmj.22.139; Funded: Kosin University College of Medicine, National Research Foundation of Korea

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Abstract PDF PubReader ePub Crossref - TDM: Research using experimental animals has substantially contributed to advances in science and medicine. Animal experiments are nearly essential for biomedical research and development efforts. Because many animals are sacrificed, researchers should consider the welfare of experimental animals and related ethical issues, along with the successful results of their experiments. This review introduces the criteria that should be considered in terms of experimental animal ethics, based on the principles of the 3 R’s: replacement, representing careful consideration of the need for animal experiments; reduction, representing the use of the minimal number of animals to obtain meaningful experimental results; and refinement, representing continuous effects to find alternative methods to reduce pain and distress in experimental animals. Based on these principles, the following points should be considered when planning experiments: the necessity of animal experiments; alternatives to animal experiments; the relevance of the species and numbers of experimental animals; appropriate assessment and management of pain; the proper usage of sedatives, painkillers, and anesthesia; and valid timing for humane endpoints and euthanasia. These criteria are beneficial for both experimental animals and researchers because careful handling to ensure experimental animal welfare guarantees that scientific research will yield convincing, repeatable, and accurate results.

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Funded articles