Kosin Medical Journal

Review articles

Clinical readiness of artificial intelligence for treat-to-target management in inflammatory bowel disease: from scores to decisions: You Jin Choi, Seom Gim Kong, So Yoon Choi; Kosin Med J. 2026;41(3):185-202. Published online September 30, 2026; DOI: https://doi.org/10.7180/kmj.26.197

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Abstract PDF PubReader ePub: Artificial intelligence (AI) is increasingly used in inflammatory bowel disease (IBD), particularly for endoscopy, histology, transmural imaging, and prediction of treatment response. However, strong diagnostic or predictive performance does not necessarily confer clinical utility. This narrative review traces the development of AI in IBD from objective disease assessment and outcome prediction to therapeutic decision support within a treat-to-target framework. Endoscopic AI has the most mature evidence base, while applications in histology and transmural imaging are at earlier stages of clinical translation. Models of treatment response can stratify patients by the likelihood of response, remission, relapse, or treatment sustainability; most, however, remain prognostic rather than prescriptive. We therefore propose the clinical readiness of AI in IBD framework, comprising analytical validity, clinical validity, generalizability, workflow utility, decision utility, and clinical impact. The strongest evidence concerns disease measurement and prediction; evidence that AI-informed or AI-guided strategies improve treatment decisions and patient outcomes remains limited. Future research should prioritize external validation, prospective evaluation in clinical workflows, comparative trials of prespecified AI-informed or AI-guided treatment strategies, and patient-important outcomes.

Spatial omics: current advances, biomedical applications, and future perspectives: Min-Hye Kim, Hee-Jae Cha; Kosin Med J. 2026;41(2):94-100. Published online June 15, 2026; DOI: https://doi.org/10.7180/kmj.26.165

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Abstract PDF PubReader ePub: Spatial omics is an emerging analytical paradigm that addresses the loss of spatial context inherent in conventional single-cell omics by integrating molecular information with spatial coordinates in intact tissues. This review outlines the conceptual framework and technological evolution of spatial omics and systematically compares major platforms based on next-generation sequencing (NGS) and imaging technologies. Key differences in resolution, analytical scope, and data characteristics are discussed for representative NGS-based approaches, including Visium, high-definition Visium spatial transcriptomic technology (Visium HD), and Stereo-seq, and imaging-based methods, including Xenium, MERSCOPE, and CosMx Spatial Molecular Imager. Recent advances in spatial multi-omics are also highlighted, with emphasis on the integration of transcriptomic, proteomic, and epigenomic data within the same spatial framework. We further describe essential computational strategies, including cell segmentation, spatial domain identification, and inference of cell-cell interactions, and demonstrate how spatial omics data can be translated into biological insights. Applications in oncology and neuroscience are reviewed, illustrating how spatial omics enables characterization of tumor microenvironment heterogeneity, prediction of immunotherapy responses, and investigation of neurodegenerative disease progression. Finally, current challenges, including data complexity, lack of standardization, and high cost, are discussed, along with future perspectives such as integration with artificial intelligence, three-dimensional tissue reconstruction, and real-time in vivo analysis. This review provides a comprehensive foundation for applying spatial omics in precision medicine and next-generation pathology.

The onco-bariatric paradigm: a tri-phasic metabolic obesity framework for synergizing glucagon-like peptide-1 receptor agonists and metabolic bariatric surgery: Dong Jin Park, Yoonhong Kim, Dongjae Jeon, Young Suk Park, Kyung Won Seo, Ki Hyun Kim; Kosin Med J. 2026;41(1):3-8. Published online March 23, 2026; DOI: https://doi.org/10.7180/kmj.26.154

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Abstract PDF PubReader ePub: Obesity is a chronic, progressive neuroendocrine disease that warrants a shift toward an “onco-bariatric” treatment paradigm. This study introduces the tri-phasic metabolic obesity (TPMO) framework, which integrates glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with metabolic bariatric surgery (MBS). Recent clinical and economic evidence—including findings from the Indiana multicenter study and the Highmark Health analysis—was reviewed to evaluate the effectiveness of the TPMO model in improving surgical and metabolic outcomes. The TPMO framework streamlines the patient journey through three synergistic phases. In the neoadjuvant phase, a 4–8-week course of GLP-1 RAs reduces liver volume and visceral fat, thereby improving surgical access, provided that treatment is discontinued 1 week before surgery to mitigate aspiration risk. During the core surgery phase, MBS provides a definitive metabolic reset and remains the most cost-effective treatment, yielding an average savings of $11,689 per patient over 2 years compared with medication alone. In the adjuvant phase, pharmacotherapy—used by 17.2% of post-bariatric patients—counteracts metabolic adaptation and supports sustained weight loss, while a high-protein intake (≥1.2 g/kg/day) is essential for preserving lean body mass. The TPMO framework represents a precision-based, synergistic standard of care designed to promote durable, cost-effective long-term metabolic health within the onco-bariatric paradigm.

Original articles

Comparative evaluation of two automated immunoassays for serum thyroglobulin quantification: Kyoung Ho Roh, Hyunyong Hwang; Kosin Med J. 2025;40(3):213-220. Published online September 23, 2025; DOI: https://doi.org/10.7180/kmj.25.122

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Abstract PDF PubReader ePub: Background
We evaluated the clinical performance of in vitro diagnostic devices for quantifying thyroglobulin (Tg), which is a key marker for monitoring and treating thyroid dysfunction. The recently launched Siemens Atellica IM Tg assay was compared with the established Roche Elecsys Tg II assay using residual serum samples from routine testing.
Methods
The precision, linearity, limit of blank (LoB), limit of detection (LoD), limit of quantitation (LoQ), and reference ranges were assessed using the Siemens Atellica IM Tg assay. In total, 681 patient serum samples were analyzed to compare the results with those of the Roche Elecsys Tg II assay for correlation and concordance evaluations across the clinical ranges.
Results
The precision coefficients of variation, linearity, LoB, LoD, and LoQ for the Siemens Atellica IM Tg assay met the manufacturer’s specifications across all concentrations. All data points and confidence intervals were within the allowable deviation from linearity. The correlation between the assays was excellent (Pearson’s r=0.997). In the low range, concordance was 83%, whereas in the normal range, it reached 98%. In contrast, the highly abnormal range exhibited a concordance of 65%, resulting in an overall concordance rate of 88%. Weighted kappa values (κ=0.79–0.82) demonstrated moderate-to-strong agreement.
Conclusions
The Siemens Atellica IM Tg assay showed performance consistent with the precision, linearity, LoB, LoD, LoQ, and reference ranges claimed by the manufacturer. It demonstrated a strong correlation and good overall concordance with Roche Elecsys Tg II. Lower concordance in the highly abnormal range suggests a potential limitation.

Comparative analysis of Access PCT and Elecsys BRAHMS PCT assays for procalcitonin measurements: Hyunji Choi, Sang-Shin Lee, Hyunyong Hwang; Kosin Med J. 2024;39(4):272-280. Published online December 20, 2024; DOI: https://doi.org/10.7180/kmj.24.155

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Background
Procalcitonin (PCT) is a crucial biomarker for diagnosing sepsis and managing antibiotic therapy. This study evaluated the analytical performance and comparability of the Access PCT and Elecsys BRAHMS PCT assays.
Methods
The precision, detection capability, linearity, and reference range of both assays were assessed. A comparative analysis included 182 patient samples categorized into four risk groups to compare the results between Access PCT and Elecsys BRAHMS PCT assays.
Results
The Access PCT assay demonstrated precision within the manufacturer’s threshold, and its detection capabilities were verified. This assay exhibited excellent linearity and appropriate reference intervals. Comparative analysis indicated that the Access PCT assay reported higher overall PCT levels than the Elecsys BRAHMS assay, with high agreement between the assays (κ=0.941). However, the biases varied across different PCT concentration intervals.
Conclusions
Both the Access PCT and Elecsys BRAHMS PCT assays performed robustly with notable concordance but varying biases at different concentration intervals. The observed biases require careful consideration in clinical decision-making, especially when adopting novel assay systems. Standardizing the calibration across different platforms is recommended to improve assay comparability.

Citations

Citations to this article as recorded by

Procalcitonin measurement uncertainty around Sepsis-related decision thresholds: Monte Carlo modeling from a large-scale clinical laboratory dataset
Beyza Haytaç, Gamze Gök, Özcan Erel, Ceylan Bal
Clinica Chimica Acta.2027; 593: 121275. CrossRef
Comparative evaluation of multimodal point-of-care tests to differentiate gram-negative from gram-positive infections in critically ill adults: a diagnostic accuracy study
Weijia Huang, Ting Yang, Sinan Ma, Jiatian Wang, Huangxin Gong, Haitao Wang, Jingying Sun, Na Wang, Li Zhang, Yan Wang
Infection.2026; 54(2): 863. CrossRef
KInetics of Procalcitonin to Reduce Unnecessary aNtibiotic use (KIPRUN): protocol for a multicentre, randomised, superiority trial to compare the efficacy and safety of procalcitonin kinetics-guided and absolute procalcitonin value-guided antibiotic initi
Márton Papp, Caner Turan, Nikolett Kiss, László Zubek, Dilan Márk Karim, Péter Hegyi, Zsolt Molnár
BMJ Open.2026; 16(5): e115344. CrossRef
Comparative performance of automated immunoassay systems for procalcitonin measurement: Vidas B.R.A.H.M.S vs. Maglumi
Nuray Arı, Hatice Handan Akbulut
Turkish Journal of Biochemistry.2026;[Epub] CrossRef
Comparative evaluation of two automated immunoassays for serum thyroglobulin quantification
Kyoung Ho Roh, Hyunyong Hwang
Kosin Medical Journal.2025; 40(3): 213. CrossRef

Improvement of Precision in TL Response with an Automated TLD Reader: Soo kil Kim; Kosin Med J. 1999;14(1-2):113-122.

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