Kosin Medical Journal

Articles in E-pub version are posted online ahead of regular printed publication.

Review articles

The role of the interatrial shunt device in the treatment of patients with heart failure with preserved ejection fraction: experience from the REDUCE LAP-HF studies: Bong-Joon Kim; Received October 12, 2024 Accepted December 11, 2024 Published online February 17, 2025; DOI: https://doi.org/10.7180/kmj.24.150 [Epub ahead of print]

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Abstract PDF PubReader ePub: Heart failure with preserved ejection fraction (HFpEF) is characterized by increased left ventricular filling pressure and elevated left atrial pressure. Despite advances in medical treatments, the management of HFpEF patients is often challenging due to multiple comorbidities, leading to polypharmacy and associated side effects. Consequently, there is an increasing demand for procedural or device-based therapies in HFpEF management. Over the past decade, the transcatheter interatrial shunt device (IASD), designed to create a passage between the left atrium and the right atrium, has emerged as a novel therapeutic option. The IASD offers potential benefits by reducing left atrial pressure at rest and during exercise. The efficacy and safety of the IASD were demonstrated in the REDUCE LAP-HF (Reduce Left Atrial Pressure in Patients with Heart Failure) study series. Furthermore, IASD has been shown to support positive cardiac remodeling. With the availability of more data, appropriate indications for the use of IASDs are becoming more evident, and criteria for patient selection in future studies are needed.

Exploring the influence of olfactory receptors in metabolic diseases and cancers: beyond sensory functions: In-sun Yu, Jeong Sook Ye, Jaewon Shim; Received September 21, 2024 Accepted November 15, 2024 Published online February 17, 2025; DOI: https://doi.org/10.7180/kmj.24.142 [Epub ahead of print]

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Abstract PDF PubReader ePub: Olfactory receptors (ORs), which are primarily responsible for olfactory sensation in the nasal epithelium, constitute the largest family of genes in the human genome. The majority of ORs are orphan receptors with unknown ligands; however, recent studies have revealed their expression in non-olfactory tissues, implying that ORs may be involved in various physiological processes beyond olfaction. This review highlights recent findings on the roles of ORs in cancers, including prostate, breast, and lung cancer, as well as their involvement in other diseases, such as atherosclerosis, Alzheimer's disease, and viral infections. Additionally, we explore emerging knowledge about the role of ORs in metabolic regulation, focusing on their effect on triglyceride metabolism, glucagon-like peptide-1 secretion, and lipid accumulation. Advancements in technology, such as structural analysis, have accelerated research on OR ligands and their functions, potentially positioning ORs as novel therapeutic targets for various diseases. This review highlights the need for further research into the non-olfactory roles of ORs and their potential as targets for future therapeutic interventions.

Original article

Synergistic effects of drug and aerobic exercise on endothelial function and epicardial fat thickness in patients with hypertension and dyslipidemia: Eun-Ah Jo, Shan-Shan Wu, Hyung-Rae Han, Jung-Jun Park, Jung-Ho Heo; Received August 29, 2024 Accepted November 13, 2024 Published online February 17, 2025; DOI: https://doi.org/10.7180/kmj.24.137 [Epub ahead of print]

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Abstract PDF PubReader ePub: Background
Aerobic exercise training and drug therapy are well-established interventions for the prevention and treatment of hypertension and dyslipidemia. We investigated the synergistic effects of aerobic exercise and olmesartan/rosuvastatin on epicardial fat thickness (EFT) and endothelial function in patients with hypertension and dyslipidemia.
Methods
A sample of 75 participants with hypertension and dyslipidemia was evaluated for multifactorial cardiovascular risk at baseline and at 6 months of intervention according to anthropometric and hemodynamic components, lipid profile, glycemia, brachial artery flow-mediated dilation (FMD), and EFT. After 3 months of drug therapy only, participants were allocated to one of three conditions: treadmill (n=22), exergame (n=29), or control (n=24).
Results
After 12 weeks of drug therapy only, systolic and diastolic blood pressure (3% and 2%, both p<0.05), total cholesterol (6.3%, p<0.01), low-density lipoprotein cholesterol (4.9%, p<0.05), triglycerides (11.1%, p<0.05), fasting blood glucose (10.2%, p<0.01), and glycosylated hemoglobin (3%, p<0.01) were significantly reduced. After 12 weeks of combined aerobic exercise and drug therapy, both the treadmill and exergame groups showed a significant improvement in FMD (both p<0.001) and reduction in EFT (both p<0.001). Systolic and diastolic blood pressures decreased in the treadmill group only (1.9% and 2.7%, respectively, p<0.05).
Conclusions
Incorporating aerobic exercise into drug therapy regimens can yield synergistic effects, particularly in improving endothelial function and reducing EFT, providing a comprehensive approach to managing cardiovascular risk in patients with hypertension and dyslipidemia.

Case report

Idiopathic scoliosis with recurrent dyspnea and wheezing in an otherwise healthy female adolescent: a case report: Jin Ku Kim, Yoon Ha Hwang; Received August 20, 2024 Accepted October 23, 2024 Published online February 7, 2025; DOI: https://doi.org/10.7180/kmj.24.135 [Epub ahead of print]

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Abstract PDF PubReader ePub: A 15-year-old female visited our hospital’s outpatient and emergency department several times due to recurrent paroxysmal dyspnea for 6 months. Based on the clinical symptoms, the researchers diagnosed the patient with bronchial asthma and treated her with oral steroids and inhaled corticosteroid agents, but her patients did not significantly improve. At that time, thoracic scoliosis was observed in previous chest X-ray images. Previous records showed that the scoliosis had progressed during the rapid growth period in 2018 (patient age 10 years) and 2023 (patient age 15 years). As the symptoms did not improve despite medication, a further evaluation was performed. Contrast-enhanced chest computed tomography revealed the T8 vertebral body compressing the right bronchus intermedius. The patient rarely wore an existing brace due to discomfort, but a new custom brace was prescribed after confirmation using chest computed tomography. Since then, the patient's compliance with treatment has improved, and she has gradually increased the amount of time she wears the brace. In addition, her Cobb’s angle and pulmonary function tests have improved in outpatient follow-up. The researchers initially considered the patient's recurrent dyspnea and wheezing to be an asthma exacerbation and treated her with medication, but the symptoms did not improve. Therefore, when a patient does not respond well to asthma medications, the possibility of dyspnea or wheezing due to causes other than asthma should not be ruled out. Evaluation for scoliosis should also not be neglected, especially in growing adolescents.

Review article

Endoscopic diagnosis of Helicobacter pylori infection: Eun Jeong Gong, Kyoungwon Jung; Received July 12, 2024 Accepted September 16, 2024 Published online November 13, 2024; DOI: https://doi.org/10.7180/kmj.24.130 [Epub ahead of print]

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Abstract PDF PubReader ePub: Accurate prediction of Helicobacter pylori infection status based on endoscopic findings is essential for optimizing management. This review emphasizes the importance of accurate endoscopic diagnosis of H. pylori infection. The endoscopic findings categorized in the Kyoto classification provide valuable indicators of infection status. Specifically, findings such as atrophic gastritis, intestinal metaplasia, nodular gastritis, enlarged folds, sticky mucus, xanthoma, and map-like redness are associated with H. pylori infection. Regular arrangement of collecting venules and linear red streaks are reliable indicators of non-infection. Selective testing based on endoscopic findings can optimize diagnosis and treatment of H. pylori infection and, minimizing unnecessary procedures. However, some findings overlap and do not clearly distinguish between current and past infections, indicating a need for further research.

Case report

Obstructive jaundice caused by tuberculous lymphadenitis accompanied by a mass in the pancreas: a case report: Jong In Jeon, Jung Wook Lee; Received March 11, 2024 Accepted September 4, 2024 Published online November 13, 2024; DOI: https://doi.org/10.7180/kmj.24.113 [Epub ahead of print]

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Abstract PDF PubReader ePub: Abdominal tuberculous lymphadenopathy is a rare condition that can cause obstructive jaundice. The feature of tuberculosis lymphadenopathy may resemble those of cancer, metastasis, or lymphoma on computed tomography (CT) or magnetic resonance imaging; therefore, physicians must perform appropriate examinations, make correct diagnoses, and conduct suitable treatment. Herein, we report a case of obstructive jaundice caused by tuberculous lymphadenopathy. The patient was 27 years old, with an initial serum total bilirubin level of 6.76 mg/dL and a direct bilirubin level of 5.64 mg/dL. Aspartate transaminase and alanine transaminase levels were 466 and 801 IU/L, respectively. Abdominal CT revealed a mass-like effect and extraluminal compression accompanying bile duct obstruction. An abrupt bile duct stricture was observed on endoscopic retrograde cholangiopancreatography; thus, a biopsy was performed. However, the specimen which was taken by endoscopic retrograde cholangiopancreatography was confirmed to constitute superficially biopsied bile duct mucosa and benign-looking epithelial cell stripes. Positron emission tomography-CT showed a hypermetabolic lesion in the hepato-duodenal ligament with small lymph nodes in the aortocaval and retrocaval spaces. Additionally, it showed hypermetabolism of the neck lymph node at level II. The neck lymph node was biopsied. Granulomatous inflammation was observed and nested tuberculosis polymerase chain reaction was positive. The patient was treated with anti-tuberculosis medications and underwent endoscopic retrograde biliary drainage without surgery.

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