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From articles published since 2020.

Case report
Squamous cell carcinoma of the pancreas with a pancreatic intraductal papillary mucinous neoplasm: a case report
Nam Kyung Lee
Kosin Med J. 2024;39(1):71-74.   Published online August 17, 2023
DOI: https://doi.org/10.7180/kmj.23.123
Funded: Pusan National University Hospital
  • 1,570 View
  • 15 Download
Abstract PDFPubReader   ePub   
Squamous cell carcinoma (SCC) of the pancreas is very rare. No reports have described SCC accompanied by intraductal papillary mucinous neoplasm (IPMN) of the pancreas. This report presents the first known case of SCC with IPMN of the pancreas in a 71-year-old man, with a focus on radiologic findings. Here, the imaging features of SCC with IPMN of the pancreas were similar to those of IPMN of the pancreas with high-risk stigmata features.
Original articles
Effects of cholecalciferol and omega-3 fatty acids on hepcidin levels in 5/6 nephrectomy rats
Yu In Jeong, Hyo Jin Jung, Mi Hwa Lee, Young Ki Son, Seong Eun Kim, Won Suk An, Su Mi Lee
Kosin Med J. 2024;39(1):35-43.   Published online September 25, 2023
DOI: https://doi.org/10.7180/kmj.23.137
Funded: National Research Foundation of Korea
  • 2,156 View
  • 27 Download
Abstract PDFPubReader   ePub   
Background
Anemia is a common complication of chronic kidney disease (CKD). In patients with CKD-related anemia, an inverse relationship between vitamin D and hepcidin levels has been observed. Hepcidin is a key regulator of iron homeostasis, mediated via binding to ferroportin. The aim of this study was to investigate the effects of cholecalciferol and omega-3 fatty acids (FA) on hepcidin levels using 5/6 nephrectomized (Nx) rats.
Methods
Male Sprague-Dawley rats were divided into five groups: sham control, 5/6 Nx, 5/6 Nx treated with cholecalciferol, 5/6 Nx treated with omega-3 FA, and 5/6 Nx treated with both cholecalciferol and omega-3 FA. We measured the hepcidin and ferroportin levels in the kidney and liver by enzyme-linked immunosorbent assays and Western blots. We evaluated hepcidin expression in the kidney by immunohistochemical staining.
Results
Among the five groups, 5/6 Nx rats exhibited the worst kidney function. Compared with the sham controls, 5/6 Nx rats showed significantly increased serum hepcidin levels and decreased vitamin D levels. Supplementation with either omega-3 FA or cholecalciferol decreased hepcidin and increased vitamin D levels, with a concurrent improvement of anemia. Furthermore, 5/6 Nx rats treated with omega-3 FA/cholecalciferol showed decreased ferroportin and ferritin levels, while iron and total iron-binding capacity levels increased.
Conclusions
Treatment with a combination of cholecalciferol and omega-3 FA may improve anemia in a CKD rat model by decreasing hepcidin levels.
Clinical efficacy and safety of autologous serum intramuscular injection in patients with mild-to-moderate atopic dermatitis: a prospective, open-label, uncontrolled study
Gil-Soon Choi, Jong Bin Park, Young-Ho Kim, Hee-Kyoo Kim
Kosin Med J. 2024;39(1):51-59.   Published online March 19, 2024
DOI: https://doi.org/10.7180/kmj.24.101
Funded: Ministry of Health and Welfare
  • 1,394 View
  • 8 Download
  • 1 Citations
Abstract PDFPubReader   ePub   
Background
Autologous blood therapy (ABT) has been used to treat atopic dermatitis (AD) for over a century, even though evidence supporting its efficacy is lacking. We aimed to investigate the effectiveness and safety of autologous serum intramuscular injection (ASIM), which is a modified form of ABT, in treating mild-to-moderate AD.
Methods
This study was a 12-week, open-label, prospective, uncontrolled trial. Following a 4-week run-in period, 22 out of 25 screened patients received ASIM once a week for 4 weeks in conjunction with standard treatment. The primary outcome measure was the Eczema Area and Severity Index (EASI), while the secondary outcomes included the Scoring Atopic Dermatitis (SCORAD) score, Dermatologic Life Quality Index (DLQI), and patient ratings of pruritus, sleep difficulty, disease status, and treatment effectiveness. Safety parameters were also assessed.
Results
EASI scores showed a non-statistically significant trend toward improvement during ASIM intervention. Patients with at least a 50% improvement in the EASI score at 4 weeks were older and had lower peripheral eosinophil counts (p<0.05). Secondary endpoints, including the SCORAD score, pruritus, sleep difficulty, and DLQI, demonstrated statistically significant improvements at week 4 compared to baseline (p<0.05). No significant adverse reactions were observed.
Conclusions
This pioneering study suggests that repeated ASIM may improve the clinical symptoms of mild-to-moderate AD, particularly in terms of pruritus and overall quality of life. However, further research with a larger sample size is required to establish the clinical significance of these findings.

Citations

Citations to this article as recorded by  
  • What are the clinical usefulness and scientific value of intramuscular injection of autologous serum (autologous serum therapy) in patients with atopic dermatitis?
    Dong-Ho Nahm
    Kosin Medical Journal.2024; 39(1): 1.     CrossRef
Review article
Clinical challenges and advancements in diagnosing Staphylococcus aureus-associated musculoskeletal infections
Irvin Oh
Kosin Med J. 2024;39(1):5-17.   Published online March 22, 2024
DOI: https://doi.org/10.7180/kmj.24.104
Funded: Orthopaedic Research and Education Foundation, National Institute of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases
  • 1,291 View
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Abstract PDFPubReader   ePub   
Musculoskeletal infections (MSKI) present a significant health challenge, with a rising incidence linked to the aging population and advancements in orthopedic surgical care. Staphylococcus aureus is the most prevalent pathogen associated with orthopedic infections. The conventional culture method for identification of pathogen frequently lacks accuracy and is challenged by false-positive or false-negative results. Inflammatory markers such as the erythrocyte sedimentation rate and C-reactive protein are not site-specific or accurate, as they can be confounded by other medical conditions. Identifying the dominant pathogen and monitoring treatment response following surgical debridement and antibiotics therapy continues to pose challenges. Understanding the pathogenesis of MSKI is crucial for the development of innovative diagnostics and alternative therapeutics. S. aureus immune evasion stands out as a key component of the pathogenic mechanism, complicating clinical decisions. Other unique mechanisms such as biofilm and abscess formation, as well as osteocyte-lacuno canalicular network invasion, underscore the need for aggressive debridement and the complete removal of infected implants and bone tissues. Ongoing efforts focus on exploring and developing innovative diagnostics, such as serum immunoassays, next-generation sequencing of infected tissue, transcriptomics of peripheral blood mononuclear cells, and serum proteomics. These endeavors offer promising avenues for improved diagnostics, medical management, and innovative therapeutics for MSKI.
Original article
Clinical outcomes of prostate artery embolization for management of benign prostate hyperplasia (prostate larger than 100 mL) with or without hematuria
Soodong Kim
Kosin Med J. 2023;38(4):259-266.   Published online November 7, 2023
DOI: https://doi.org/10.7180/kmj.23.122
Funded: National Research Foundation of Korea, Ministry of Science and ICT
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  • 13 Download
Abstract PDFPubReader   ePub   
Background
In this study, we report 1-year follow-up clinical results of prostate artery embolization (PAE) in patients with glandular hematuria or acute urinary retention caused by a large prostate (over 100 mL).
Methods
Twenty-one consecutive patients undergoing PAE from March 2018 to July 2020 were included in this retrospective study. Clinical follow-up was conducted for all patients 1, 3, 6, and 12 months after the procedure. The outcome measures included the International Prostate Symptom Score (IPSS), quality of life (QoL), peak urinary flow rate (Qmax), post-void residual (PVR), prostate volume, prostate-specific antigen, and complications. A p-value <0.05 was considered statistically significant.
Results
Twenty-one patients with severe benign prostatic hyperplasia (BPH) with acute urinary retention or prostatic hematuria were enrolled in this study. Technical success rate was 90.5% (19/21), and unilateral PAE was done in 2/21 (9.5%) patients by pelvic vascular obliteration. In all patients, the mean IPSS, QoL score, Qmax, and PVR were significantly improved at 12 months post-PAE. The mean IPSS decreased from 26.1 to 12.1 points (p<0.05), mean QoL score decreased from 4.6 to 2.9 points (p<0.05), mean Qmax increased from 2.1 to 9.4 mL/s (p<0.05), and mean PVR decreased from 300.0 to 70.7 mL (p<0.05). The catheter was successfully removed from 19/21 patients and clinical success rate was 90.5%.
Conclusions
PAE was an effective and safe treatment option for patients with BPH and very large prostates (>100 mL) and urinary retention or gross hematuria associated with BPH in men unfit for surgery.
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
  • 1,197 View
  • 25 Download
Abstract PDFPubReader   ePub   
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
  • 1,665 View
  • 37 Download
  • 1 Citations
Abstract PDFPubReader   ePub   
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.

Citations

Citations to this article as recorded by  
  • Omega-3 fatty acids: promising therapeutic agents for combating kidney injuries
    Hee-Jae Cha
    Kosin Medical Journal.2023; 38(3): 157.     CrossRef
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
  • 1,454 View
  • 16 Download
Abstract PDFPubReader   ePub   
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
  • 1,725 View
  • 38 Download
Abstract PDFPubReader   ePub   
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
  • 1,778 View
  • 23 Download
Abstract PDFPubReader   ePub   
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
  • 2,293 View
  • 43 Download
  • 1 Citations
Abstract PDFSupplementary MaterialPubReader   ePub   
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
  • 1,283 View
  • 16 Download
Abstract PDFPubReader   ePub   
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
  • 1,880 View
  • 45 Download
Abstract PDFPubReader   ePub   
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
  • 1,318 View
  • 16 Download
PDFPubReader   ePub   
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
  • 1,376 View
  • 50 Download
Abstract PDFPubReader   ePub   
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.

KMJ : Kosin Medical Journal