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From articles published since 2020.

Review article
Psychosomatic Approach to Fibromyalgia Syndrome: Concept, Diagnosis and Treatment
Sang-Shin Lee
Kosin Med J. 2021;36(2):79-99.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.79
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Fibromyalgia syndrome (FMS) has chronic widespread pain (CWP) as a core symptom and a variety of associated somatic and psychological symptoms such as fatigue, sleep problems, cognitive disturbances, multiple somatic pain, and depression. FMS is the subject of considerable controversy in the realm of nosology, diagnosis, pathophysiology, and treatment. Moreover, the fact that FMS and mental illness are closely associated with each other might intensify the confusion for the distinction between FMS and mental disorders. This narrative literature review aims to provide the concept, diagnosis, and treatment of FMS from the integrative biopsychosocial and psychosomatic perspective. This article first explains the concepts of FMS as a disease entity of biopsychosocial model, and then summarizes the changes of diagnostic criteria over past three decades, differential diagnosis and comorbidity issue focused on mental illnesses. In addition, an overview of treatment of FMS is presented mainly by arranging the recommendations from the international guidelines which have been developed by four official academic associations.

Original article
Effects of White-coat Hypertension on Heart Rate Recovery and Blood Pressure Response during Exercise Test
Sol Jin, Jung Ho Heo, Bong Jun Kim
Kosin Med J. 2020;35(2):89-100.   Published online December 31, 2020
DOI: https://doi.org/10.7180/kmj.2020.35.2.89
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

White-coat hypertension is defined as high blood pressure (BP) on clinical assessment but normal BP elsewhere or on ambulatory measurement. Autonomic dysfunction may be one of the mechanisms causing white-coat hypertension. Slowed heart rate recovery and excessive BP response during exercise test are associated with autonomic dysfunction. The purpose of this study was to determine the association between white-coat hypertension and abnormal autonomic nervous system response.

Methods

We assessed 295 patients stratified into three groups via 24hr ambulatory BP monitoring, following 2017 ACC/AHA guidelines: normal BP group, white-coat hypertension group, and a hypertension group. We analyzed medical history, blood test, echocardiography, 24hr ambulatory BP monitoring, and exercise test data.

Results

There was no difference in basement characteristics and echocardiography among the groups. Blunted heart rate recovery of each group showed a significant difference. Control group had 0% blunted heart rate recovery, but 33.3% in white coat group and 27.6% in true hypertension group (P < 0.001). Also, in the control group, 4.5% showed excessive BP response, but 31.5% in the white coat hypertension group and 29.3% in the true hypertension group (P < 0.001). Excessive BP response during the exercise test or blunted heart rate recovery, which is an indicator of autonomic nervous system abnormality, was more common in the hypertensive group and white-coat hypertension group than in the normal BP group.

Conclusions

These results confirmed that white-coat hypertension has an autonomic nervous system risk. Therefore, white-coat hypertension can be a future cardiovascular risk factor.

Review articles
How to write an original article in medicine and medical science
Gwansuk Kang, Sung Eun Kim
Kosin Med J. 2022;37(2):96-101.   Published online June 24, 2022
DOI: https://doi.org/10.7180/kmj.22.105
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Excellent research in the fields of medicine and medical science can advance the field and contribute to human health improvement. In this aspect, research is important. However, if researchers do not publish their research, their efforts cannot benefit anyone. To make a difference, researchers must disseminate their results and communicate their opinions. One way to do this is by publishing their research. Therefore, academic writing is an essential skill for researchers. However, preparing a manuscript is not an easy task, and it is difficult to write well. Following a structure may be helpful for researchers. For example, the standard structure of medical and medical science articles includes the following sections: introduction, methods, results, and discussion (IMRAD). The purpose of this review is to present an introduction for researchers, especially novices, on how to write an original article in the field of medicine and medical science. Therefore, we discuss how to prepare and write a research manuscript for publication, using the IMRAD structure. We also included specific tips for writing manuscripts in medicine and medical science.
How to write case reports in medicine
Sung Il Im
Kosin Med J. 2022;37(2):102-106.   Published online June 24, 2022
DOI: https://doi.org/10.7180/kmj.22.109
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Medical research has become an important part of providing care to patients. Case reports published in medical journals can communicate information to the medical community about rare or unreported features, conditions, complications, or interventions. Case reports are generally short, focusing on key components such as a summary and introduction, case presentation, and discussion. Authors now have access to free, continuously updated case reports of different types from multiple journals. This review introduces the process and mechanisms for how and when to prepare a case report. We briefly review the editorial process of each of these complementary journals, along with author anecdotes, hoping to inspire authors to write and continue writing case reports; and discusses the essentials of a case report, aiming to provide guidelines for improving medical writing skills.
Original article
Antinociceptive Effect of BPC-157 in the Formalin-induced Pain Model
Sang Yoong Park, So Ron Choi, Jeong Ho Kim, Seung Cheol Lee, Seong Yeop Jeong, Joon Ho Jeong, Tae Young Lee
Kosin Med J. 2021;36(1):1-13.   Published online June 30, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.1.1
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

Body protective compound-157 (BPC-157) is a stable gastric pentadecapeptide that has been effective in trials aiming to increase wound healing capabilities and decrease inflammatory cell influx, including studies on the healing of muscles and tendons. There are no studies about the effect of BPC-157 on pain transmission via nociception. This study examined the antinociceptive effects of BPC-157 using formalin tests and immunohistochemistry.

Methods

Rats were randomly divided into the control, morphine and BPC-157 groups. Pain behavior was quantified periodically at 5- and 35- min intervals (representative values of phases 1 and 2) by counting the number of flinches exhibited by the injected paw after injection. The dorsal root ganglia (DRG) and spinal cords (SC) were collected, and then, the number of cytokine-positive cells was determined via immunostaining.

Results

BPC-157 dose-dependently decreased the number of flinches during phase 1 but did not decrease the number of flinches during phase 2. During phase 1, interleukin-1β (IL-1β) in the DRG tissue was significantly different in the morphine, 10 μg/kg BPC-157, and 20 μg/kg BPC-157 groups. During phase 2, statistical significance was achieved in the DRG tissue in the morphine, 20 μg/kg BPC-157, and 40 μg/kg BPC-157 groups. During phase 1, interleukin-6 was significantly different in the DRG tissue in the morphine group and the SC tissue in the 10 μg/kg BPC-157 group. During phase 2, statistical significance was achieved in the morphine group and the BPC-157 20 μg/kg group in both the DRG and SC tissues. There were no significant differences in tumor necrosis factor-α between the DRG and SC tissues.

Conclusions

BPC-157 was effective during phase 1 but not during phase 2, as determined by the formalin test. BPC-157 decreased the expression of IL-1β in the DRG tissue in phases 1 and 2.

Editorial
Why should you not overlook the postoperative evaluation of steno-occlusive arterial disease for coronary artery bypass graft patients?
Jong Hyun Baek, Haeyoung Lee
Kosin Med J. 2022;37(2):93-95.   Published online June 24, 2022
DOI: https://doi.org/10.7180/kmj.22.115
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Original articles
Postoperative effects of bariatric surgery on heart rate recovery and heart rate variability
Han Su Park, Kyungwon Seo, Hyeon Soo Kim, Sung il Im, Bong Joon Kim, Bu Kyung Kim, Jung Ho Heo
Kosin Med J. 2022;37(2):119-126.   Published online June 27, 2022
DOI: https://doi.org/10.7180/kmj.22.020
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
Several studies have reported associations between obesity and autonomic dysfunction. However, little research has investigated the effect of bariatric surgery on heart rate recovery (HRR) in the treadmill test and heart rate variability (HRV) in 24-hour Holter monitoring. We investigated the effects of bariatric surgery on HRR and HRV, which are parameters related to autonomic dysfunction.
Methods
We retrospectively investigated patients who underwent bariatric surgery in 2019. The treadmill test, 24-hour Holter monitoring, and echocardiography were performed before and 6 months after surgery. We compared the changes in HRR in the treadmill test and HRV parameters such as the time domain and spectral domain in 24-hour Holter monitoring before and after surgery.
Results
Of the 40 patients who underwent bariatric surgery, 25 patients had the treadmill test or 24-hour Holter monitoring both before and after surgery. Body weight and body mass index significantly decreased after surgery (112.86±24.37 kg vs. 89.10±20.26 kg, p<0.001; 39.22±5.69 kg/m2 vs. 31.00±5.09 kg/m2, p<0.001, respectively). HRR significantly increased (n=23; 43.00±20.97 vs. 64.29±18.49, p=0.001). The time domain of HRV parameters increased (n=21; standard deviation of the N-N interval 123.57±28.05 vs. 152.57±39.49, p=0.002 and mean N-N interval 791.57±88.84 vs. 869.05±126.31, p=0.002).
Conclusions
Our data showed that HRR after exercise and HRV during 24-hour Holter monitoring improved after weight reduction with bariatric surgery through improved cardiac autonomic function.
Performance comparison between Elecsys Anti-SARS-CoV-2 and Anti-SARS-CoV-2 S and Atellica IM SARS-CoV-2 Total and SARS-CoV-2 IgG assays
Seri Jeong, Yoo Rha Hong, Hyunyong Hwang
Kosin Med J. 2022;37(2):154-162.   Published online June 27, 2022
DOI: https://doi.org/10.7180/kmj.22.114
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Abstract PDFPubReader   CrossRef-TDMCrossref - TDM
Background
Although serological severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests from several manufacturers have been introduced in South Korea and some are commercially available, the performance of these test kits has not yet been sufficiently validated. Therefore, we compared the performance of Elecsys Anti-SARS-CoV-2 (ACOV2) and Anti-SARS-CoV-2 S (ACOV2S) and Atellica IM SARS-CoV-2 Total (COV2T) and SARS-CoV-2 IgG (sCOVG) serological tests in this study.
Methods
A total of 186 patient samples were used. For each test, we analyzed the positive rate of serological antibody tests, precision, linearity, and agreement among the four assays.
Results
The positive rates of COV2T, sCOVG, and ACOV2S were high (81.7%–89.2%) in total, with those for ACOV2S being the highest, while those of ACOV2 were as low as 44.6%. This may be related to the high completion rate of vaccination in Korea. The repeatability and within-laboratory coefficients of variation were within the claimed allowable imprecision; however, further research is needed to establish an allowable imprecision at low concentrations. COV2T showed a linear fit, whereas sCOVG and ACOV2S were appropriately modeled with a nonlinear fit. Good agreement was found among COV2T, sCOVG, and ACOV2S; however, the agreement between ACOV2 and any one of the other methods was poor.
Conclusions
Considering the different antigens used in serological SARS-CoV-2 antibody assays, the performance of the tested assays is thought to show no significant difference for the qualitative detection of antibodies to SARS-CoV-2.
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.
Analysis of ultradian rest-activity rhythms using locomotor activity in mice
Jung Hyun Lee, Eunsoo Moon, Jeonghyun Park, Yoo Rha Hong, Min Yoon
Kosin Med J. 2022;37(2):127-133.   Published online June 24, 2022
DOI: https://doi.org/10.7180/kmj.22.023
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
Locomotor activity in mice may have an ultradian rest-activity rhythm. However, to date, no study has shown how locomotor activity can be explained statistically using fitted cosine curves. Therefore, this study explored whether the ultradian rhythm of locomotor activity in mice could be analyzed using cosine fitting analysis.
Methods
The locomotor activity of 20 male mice under a 12/12-hour dark/light cycle for 2 days was fitted to a cosine function to obtain the best fit. The mean absolute error (MAE) values were used to determine the explanatory power of the calculated cosine model for locomotor activity. The cosine fitting analysis was performed using R statistical software (version 4.1.1).
Results
The mean MAE was 0.2944, whereas the mean MAE for integrating the individual analyses in the two experimental groups was 0.3284. The periods of the estimated ultradian rest-activity rhythm ranged from 1.602 to 4.168 hours.
Conclusions
These results suggest that locomotor activity data reflect an ultradian rhythm better than a circadian rhythm. Locomotor activity can be statistically fitted to a cosine curve under well-controlled conditions. In the future, it will be necessary to explore whether this cosine-fitting analysis can be used to analyze ultradian rhythms under different experimental conditions.
Review article
Alcohol-related liver disease and liver transplantation
Musheer Shafqat, Ji Hoon Jo, Hyung Hwan Moon, Young Il Choi, Dong Hoon Shin
Kosin Med J. 2022;37(2):107-118.   Published online June 27, 2022
DOI: https://doi.org/10.7180/kmj.22.108
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Alcohol-related liver disease (ALD) has become the major cause of liver transplantation (LT) in Korea, and is currently the most common cause of LT in Europe and the United States. Although, ALD is one of the most common indications for LT, it is traditionally not considered as an option for patients with ALD due to organ shortages and concerns about relapse. To select patients with terminal liver disease due to ALD for transplants, most LT centers in the United States and European countries require a 6-month sober period before transplantation. However, Korea has a different social and cultural background than Western countries, and most organ transplants are made from living donors, who account for approximately twice as many procedures as deceased donors. Most LT centers in Korea do not require a specific period of sobriety before transplantation in patients with ALD. As per the literature, 8%–20% of patients resume alcohol consumption 1 year after LT, and this proportion increases to 30%–40% at 5 years post-LT, among which 10%–15% of patients resume heavy drinking. According to previous studies, the risk factors for alcohol relapse after LT are as follows: young age, poor familial and social support, family history of alcohol use disorder, previous history of alcohol-related treatment, shorter abstinence before LT, smoking, psychiatric disorders, irregular follow-up, and unemployment. Recognition of the risk factors, early detection of alcohol consumption after LT, and regular follow-up by a multidisciplinary team are important for improving the short- and long-term outcomes of LT patients with ALD.
Original article
Incidence of arterial steno-occlusive disease and related factors in patients undergoing coronary artery bypass graft surgery
Seong Gyu Kim, Geun Woo Lee, Chul Ho Lee
Kosin Med J. 2022;37(2):140-145.   Published online June 24, 2022
DOI: https://doi.org/10.7180/kmj.22.104
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
Patients who undergo coronary artery bypass graft (CABG) surgery receive regular physical examinations and medications on an outpatient basis. However, these patients are at risk of developing other vascular diseases, such as postoperative arterial steno-occlusive disease (SOD). This study investigated the incidence of SOD and related factors.
Methods
In total, 246 patients who underwent CABG surgery from January 1, 2017 to December 31, 2021 were investigated. The incidence and risk factors of vascular disease were analyzed by dividing the included patients into SOD and non-SOD groups. Laboratory tests, medical history, surgical information, and family history were investigated through an electronic chart review.
Results
Data from 193 patients who met the criteria were analyzed. SOD occurred in 19.1% of patients, and the cerebral artery (38%) was the most common artery involved, followed by the peripheral artery (32%), the coronary artery (22%), and the retinal artery (8%). Risk factors for the development of SOD included estimated glomerular filtration rate (eGFR; odds ratio [OR]=0.977, p=0.008), cholesterol (OR=1.020, p=0.001), and patients with diabetes complications (OR=5.077, p=0.010). The 3-year cumulative incidence rate was 21.6%, and the risk factors for cumulative occurrence were a low eGFR, elevated cholesterol, and complications of diabetes.
Conclusions
Low eGFR, high cholesterol, and the presence of diabetic complications before CABG surgery may be associated with postoperative vascular disease. In these cases, close monitoring, proper drug administration, and patient warnings may be required.
Review article
The Roles of Human Endogenous Retroviruses (HERVs) in Inflammation
Eun-Ji Ko, Hee-Jae Cha
Kosin Med J. 2021;36(2):69-78.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.69
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Human endogenous retroviruses (HERVs) are ancient, currently inactive, and non-infectious due to recombination, deletions, and mutations in the host genome. However, HERV-derived elements are involved in physiological phenomena including inflammatory response. In recent studies, HERV-derived elements were involved directly in various inflammatory diseases including autoimmune diseases such as rheumatoid arthritis (RA), multiple sclerosis, amyotrophic lateral sclerosis (ALS), and Sjogren’s syndrome. Regarding the involvement of HERV-derived elements in inflammation, two possible mechanisms have been proposed. First, HERV-derived elements cause nonspecific innate immune processes. Second, HERV-derived RNA or proteins might stimulate selective signaling mechanisms. However, it is unknown how silent HERV elements are activated in the inflammatory response and what factors and signaling mechanisms are involved with HERV-derived elements. In this review, we introduce HERV-related autoimmune diseases and propose the possible action mechanisms of HERV-derived elements in the inflammatory response at the molecular level.

Original article
A prospective study of the correlation between hepatic fibrosis and noninvasively measured fibrosis markers including serum M2BPGi and acoustic radiation force impulse elastography
Kwang Il Seo, Hyunyong Hwang, Byung Cheol Yun, Hyung Hwan Moon, Young Il Choi, Dong Hoon Shin, Myunghee Yoon
Kosin Med J. 2022;37(2):146-153.   Published online June 24, 2022
DOI: https://doi.org/10.7180/kmj.22.110
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
Mac-2 binding protein glycosylation isomer (M2BPGi) was introduced as a noninvasively measurable serologic marker for liver fibrosis. Acoustic radiation force impulse imaging (ARFI) elastography is another noninvasive method of measuring hepatic fibrosis. There are limited data about the correlations between histologic fibrosis grade and noninvasively measured markers, including M2BPGi and ARFI.
Methods
This prospective study was conducted among patients admitted consecutively for liver resection, cholecystectomy, or liver biopsy. ARFI elastography, serum M2BPGi levels, and the AST to Platelet Ratio Index (APRI) score were evaluated before histologic evaluation. Histologic interpretation was performed by a single pathologist using the METAVIR scoring system.
Results
In patients with high METAVIR scores, M2BPGi levels and ARFI values showed statistically significant differences between patients with fibrosis and those without fibrosis. In 41 patients with hepatocellular carcinoma, as METAVIR scores increased, M2BPGi levels also tended to increase (p=0.161). ARFI values changed significantly as METAVIR scores increased (p=0.039). In 33 patients without hepatocellular carcinoma, as METAVIR scores increased, M2BPGi levels significantly increased (p=0.040). ARFI values also changed significantly as METAVIR scores increased (p=0.033). M2BPGi levels were significantly correlated with ARFI values (r=0.604, p<0.001), and APRI values (r=0.704, p<0.001), respectively.
Conclusions
Serum M2BPGi levels increased with liver fibrosis severity and could be a good marker for diagnosing advanced hepatic fibrosis regardless of the cause of liver disease.
Case report
Overcoming high pre-transplant isoagglutinin titers using high-dose intravenous immunoglobulin, salvage plasmapheresis, and booster rituximab without splenectomy in ABO-incompatible living donor liver transplantation: a case report
Hyung Hwan Moon
Kosin Med J. 2022;37(2):163-168.   Published online March 29, 2022
DOI: https://doi.org/10.7180/kmj.21.036
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
High pre-transplant isoagglutinin is a risk factor for antibody-mediated rejection in ABO-incompatible living donor liver transplantation. A 55-year-old man with alcoholic liver cirrhosis underwent ABO-incompatible living donor liver transplantation. The initial isoagglutinin immunoglobulin G titer was 1:1,024. Despite five sessions of plasmapheresis, the isoagglutinin titer was not significantly reduced (from 1:1,024 to 1:512). We decided to perform 11 plasmaphereses and proceed with liver transplantation regardless of the isoagglutinin titer (1:128 at transplantation day). Instead, we planned to administer 0.5 g/kg intravenous immunoglobulin and booster rituximab (200 mg) after transplant. On postoperative day 6, the isoagglutinin titer increased from 1:32 to 1:64, and the patient received plasmapheresis twice. The patient maintained stable liver function without evidence of further complications or rejection. The high-dose intravenous immunoglobulin, salvage plasmapheresis, and booster rituximab protocol might be able to overcome a pre-transplant high isoagglutinin titer in ABO-incompatible living donor liver transplantation without splenectomy.

KMJ : Kosin Medical Journal