Kosin Medical Journal

Volume 37(4); December 2022

Editorial

Which endoscopic treatment is effective for the treatment of benign esophageal stricture: balloon or incision?: Kyoungwon Jung; Kosin Med J. 2022;37(4):261-263. Published online December 20, 2022; DOI: https://doi.org/10.7180/kmj.22.143

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Review articles

Safety issues regarding melatonin use in child and adolescent patients with sleep problems: Eunsoo Moon, Jung Hyun Lee; Kosin Med J. 2022;37(4):264-270. Published online December 23, 2022; DOI: https://doi.org/10.7180/kmj.22.142

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Abstract PDF PubReader ePub Crossref - TDM: Several studies have reported that melatonin may be effective in treating sleep problems in children and adolescents. However, evidence regarding the safety of melatonin use in children and adolescents in their growth and developmental stages is warranted. Therefore, we aimed to summarize the literature on the safety of melatonin use in children and adolescents with insomnia and sleep disturbances. According to existing evidence, there are no serious adverse effects of long-term melatonin use in children and adolescents. The common adverse effects reported in long-term studies are fatigue, somnolence, and mood swings. In addition, there is no evidence that long-term use of melatonin inhibits the natural secretion of melatonin. It is necessary to monitor potential drug interactions with medications such as inhibitors and enhancers of cytochrome P450 1A2 (CYP1A2). Furthermore, low CYP1A2 expression in young children requires proper dose adjustment. Although sufficient experience of melatonin use in children and adolescents has yet to be attained, accumulating evidence suggests that the use of melatonin in children and adolescents with sleep problems might be effective and tolerable. Considering the abuse or overdose risk of hypnotics or benzodiazepines, melatonin supplements may be a good therapeutic alternative. Future studies on the long-term safety of melatonin for physiological and mental function in children and adolescents are required to establish certainty about melatonin use in children and adolescents.

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

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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.

Ethical issues in clinical research and publication: Hyoung Shin Lee; Kosin Med J. 2022;37(4):278-282. Published online December 15, 2022; DOI: https://doi.org/10.7180/kmj.22.132

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Abstract PDF PubReader ePub Crossref - TDM: Clinical research including human participants should be based on truth, demonstrate scientific integrity, and follow ethical standards and guidelines to protect study participants. The publication of clinical research should be transparent and adhere to strict criteria for authorship. A thorough understanding and knowledge of ethical issues will limit investigator misconduct in clinical research and publication. In this article, basic ethical issues in clinical research and publication are reviewed and summarized based on recent guidelines.

Original articles

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

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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.

Comparison of the efficacy and complications of endoscopic incisional therapy and balloon dilatation for benign esophageal strictures: Eun Jeong Choi, Sam Ryong Jee, Sang Heon Lee, Ji Hyun Kim, Jun Sik Yoon, Jae Hyuk Heo, Seung Jung Yu, Hee Won Baek, Hong Sub Lee; Kosin Med J. 2022;37(4):291-298. Published online November 16, 2022; DOI: https://doi.org/10.7180/kmj.22.128

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Abstract PDF PubReader ePub Crossref - TDM

Background
Benign esophageal strictures are treated endoscopically, often with balloon dilatation (BD) or bougie dilators. However, recurrent esophageal strictures have been reported after BD, and severe complications sometimes occur. The aim of this study was to compare the efficacy and complications of endoscopic incisional therapy (EIT) and BD for benign esophageal strictures.
Methods
We retrospectively reviewed patients who underwent BD or EIT as primary treatment for benign esophageal strictures between July 2014 and June 2021. Technical success was defined as restoration of the lumen diameter with <30% residual stenosis. Clinical success was defined as no recurrence of dysphagia within 1 month after BD or EIT and an increase of 1 grade or more on the Functional Oral Intake Scale.
Results
Thirty patients with benign esophageal stricture were enrolled. There were 16 patients in the BD group and 14 patients in the EIT group. No significant differences in technical and clinical success rates were found between the two groups. Furthermore, no significant differences in the re-stricture rate were observed between the groups. There was one complication in the EIT group and three complications in the BD group. Three patients who underwent BD had re-stricture and underwent EIT thereafter, and we regrouped patients who underwent EIT at least once. The clinical success rate was significantly higher in patients regrouped to the EIT group than in patients who underwent BD only.
Conclusions
EIT is not inferior to BD as the primary treatment for benign esophageal strictures, especially for recurrent cases.

Citations

Citations to this article as recorded by

Which endoscopic treatment is effective for the treatment of benign esophageal stricture: balloon or incision?
Kyoungwon Jung
Kosin Medical Journal.2022; 37(4): 261. CrossRef

Students’ perceptions of the learning environment at a medical school in Korea: comparisons of the most recent 4 years’ results using the Dundee Ready Education Environment Measure (DREEM): Sejin Kim; Kosin Med J. 2022;37(4):299-310. Published online December 7, 2022; DOI: https://doi.org/10.7180/kmj.22.129

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Abstract PDF PubReader ePub Crossref - TDM: Background
The learning environment is an essential factor influencing students’ educational processes and personal quality of life. The purpose of this study was to examine medical students’ perceptions of the learning environment at a medical school over the most recent 4 years and explore possibilities for learning environment reform and revision based on the results.
Methods
Participating students were asked about their perceptions of the learning environment using the Dundee Ready Education Environment Measure (DREEM) questionnaire, which was distributed to first-year, third-year, and fourth-year students, representing each learning period. In total, 349 students participated in this study. Analysis of variance was conducted to determine differences in DREEM scores among years and learning periods.
Results
There were no statistically significant differences in DREEM scores by year and learning period, except for students’ perceptions of teachers and students’ perceptions of atmosphere. However, in an analysis of differences in DREEM scores in the class of 2018 cohort by learning period, four domains of the DREEM (except for students’ academic self-perceptions) and the total DREEM score were found to be significantly different.
Conclusions
Students’ perceptions of the learning environment at Kosin University College of Medicine were relatively high. The total score increased from 2019 to 2022, except for 2021. Another significant result was that basic science students had the highest perceptions, whereas students in basic clinical science had the lowest perceptions. To improve the learning environment for medical students, continuing support for students’ emotional stability, learning motivation, physical environment, social relationships, and counseling is essential.

Risk factors for central and lateral lymph node metastasis in papillary thyroid carcinoma: Ji Hyun Ahn, Hee Kyung Chang; Kosin Med J. 2022;37(4):311-319. Published online December 19, 2022; DOI: https://doi.org/10.7180/kmj.22.136

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Abstract PDF PubReader ePub Crossref - TDM: Background
Lymph node metastasis (LNM) is commonly observed in papillary thyroid carcinoma. This study aimed to investigate the risk factors for LNM in patients with papillary thyroid carcinoma.
Methods
The clinicopathological factors of 417 patients were investigated, and differences according to the presence or absence of LNM were evaluated.
Results
LNM was associated with age <55 years, male sex, tumor size >10 mm, multiple and bilateral tumors, tumor involving the lower pole or entire lobe, lymphovascular invasion (LVI), perineural invasion (PNI), and extrathyroidal extension (ETE). Univariable and multivariable analyses showed that age <55 years, male sex, tumor size >10 mm, LVI, and ETE were related to central LNM. Male sex, tumor size >10 mm, and LVI were correlated with lateral LNM (p<0.05). Compared to central LNM, more lymph nodes were involved in metastases and the metastatic tumors were larger in lateral LNM. Extranodal extension (ENE) was more commonly observed in lateral LNM (p<0.001) and was associated with tumor size >10 mm, multifocality, PNI, ETE, and the absence of lymphocytic thyroiditis (p<0.05).
Conclusions
Younger age, male sex, tumor size >10 mm, LVI, and ETE were risk factors for central LNM, while male sex, tumor size >10 mm, and LVI were risk factors for lateral LNM. ENE was more commonly observed in lateral LNM, and tumor size >10 mm, multifocal tumors, PNI, ETE, and tumors unrelated to lymphocytic thyroiditis were risk factors for ENE.

The effects of rebamipide, sucralfate, and rifaximin against inflammation and apoptosis in radiation-induced murine intestinal injury: Won Moon, Sangwook Lim, Yeonsoon Jung, Yuk Moon Heo, Seun Ja Park, Moo In Park, Sung Eun Kim, Jae Hyun Kim, Kyoungwon Jung; Kosin Med J. 2022;37(4):320-341. Published online December 26, 2022; DOI: https://doi.org/10.7180/kmj.22.140

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Abstract PDF PubReader ePub Crossref - TDM: Background
Radiotherapy improves overall survival in patients with abdominopelvic malignancies. However, the toxic effects of radiation restrict the maximum dose that can be given, and there are no well-established preventive or therapeutic strategies. This study was conducted to evaluate whether rebamipide, sucralfate, and rifaximin have a suppressive effect on acute ionizing radiation (IR)-induced inflammation in the intestines of mice.
Methods
Thirty-six ICR mice were divided into a vehicle-treated group with sham irradiation; a vehicle-treated group with irradiation; rebamipide, sucralfate, or rifaximin-treated groups with irradiation; and a rebamipide-treated group with sham irradiation. The expression of proinflammatory, anti-inflammatory, proapoptotic, and antiapoptotic factors was investigated.
Results
The downregulated expression of nicotinamide phosphoribosyltransferase by IR was attenuated by all drugs (p<0.05). All drugs suppressed the IR-induced activation of NF-κB and phosphorylation of MAPKs (p<0.05) and attenuated the production of TNF-α, IL-1β, and IL-6 in response to IR (p<0.05). The administration of all drugs markedly attenuated IR-induced increases in iNOS, COX-2, and PGE2 (p<0.05), as well as [Ca2+] oscillations that were increased by IR. The expression of proapoptotic genes and antiapoptotic genes was suppressed and induced, respectively, by all drugs. IR treatment increased the release of cytochrome C, which was attenuated by all drugs (p<0.05). All drug treatments resulted in a significant decrease in the expression of caspase-3 and caspase-7 (p<0.05), which were both upregulated following IR treatment.
Conclusions
The administration of rebamipide, sucralfate, or rifaximin prior to radiation therapy may prevent or attenuate acute radiation-induced enterocolitis.

Evaluation of automated calibration and quality control processes using the Aptio total laboratory automation system: Namhee Kim, Yein Kim, Jeongeun Park, Jungsoo Choi, Hyunyong Hwang; Kosin Med J. 2022;37(4):342-353. Published online December 22, 2022; DOI: https://doi.org/10.7180/kmj.22.144

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Abstract PDF PubReader ePub Crossref - TDM: Background
The objective of this study was to determine whether manually performed calibration and quality control (QC) processes could be replaced with an automated laboratory system when installed analyzers fail to provide automated calibration and QC functions.
Methods
Alanine aminotransferase (ALT), total cholesterol (TC), creatinine (Cr), direct bilirubin (DB), and lipase (Lip) items were used as analytes. We prepared pooled serum samples at 10 levels for each test item and divided them into two groups; five for the analytical measurement range (AMR) group and five for the medical decision point (MDP) group. Calibration and QC processes were performed for five consecutive days, and ALT, TC, Cr, DB, and Lip levels were measured in the two groups using automated and manual methods. Precision and the mean difference between the calibration and QC methods were evaluated using the reported values of the test items in each group.
Results
Repeatability and within-laboratory coefficients of variation (CVs) between the automated system and the conventional manual system in the AMR group were similar. However, the mean reported values for test items were significantly different between the two systems. In the MDP group, repeatability and within-laboratory CVs were better with the automation system. All calibration and QC processes were successfully implemented with the Aptio total laboratory automation system.
Conclusion
The Aptio total laboratory automation system could be applied to routine practice to improve precision and efficiency.

Case reports

Chronic obstructive lung disease after ammonia inhalation burns: a report of two cases: Insu Kim, Heock Lee, Bo Hyoung Kang, Dong Hyun Lee, Young Hee Nam, Mee Sook Roh, Soo-Jung Um; Kosin Med J. 2022;37(4):354-360. Published online July 27, 2022; DOI: https://doi.org/10.7180/kmj.22.004

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Abstract PDF PubReader ePub Crossref - TDM: Anhydrous ammonia is a commonly used chemical in industry. Ammonia gas inhalation causes thermal injuries and alkali burns in the airway and lung parenchyma. Previous case reports have stated that respiratory sequelae after acute ammonia inhalation burns were associated with structural lung disease, such as bronchiectasis or interstitial lung disease. We herein report two cases of long-term sequelae with persistent airflow limitation after ammonia inhalation burns.

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

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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.

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