Kosin Medical Journal

From articles published since 2023.

Review articles

The ethics of using artificial intelligence in medical research: Shinae Yu, Sang-Shin Lee, Hyunyong Hwang; Kosin Med J. 2024;39(4):229-237. Published online December 6, 2024; DOI: https://doi.org/10.7180/kmj.24.140

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The integration of artificial intelligence (AI) technologies into medical research introduces significant ethical challenges that necessitate the strengthening of ethical frameworks. This review highlights the issues of privacy, bias, accountability, informed consent, and regulatory compliance as central concerns. AI systems, particularly in medical research, may compromise patient data privacy, perpetuate biases if they are trained on nondiverse datasets, and obscure accountability owing to their “black box” nature. Furthermore, the complexity of the role of AI may affect patients’ informed consent, as they may not fully grasp the extent of AI involvement in their care. Compliance with regulations such as the Health Insurance Portability and Accountability Act and General Data Protection Regulation is essential, as they address liability in cases of AI errors. This review advocates a balanced approach to AI autonomy in clinical decisions, the rigorous validation of AI systems, ongoing monitoring, and robust data governance. Engaging diverse stakeholders is crucial for aligning AI development with ethical norms and addressing practical clinical needs. Ultimately, the proactive management of AI’s ethical implications is vital to ensure that its integration into healthcare improves patient outcomes without compromising ethical integrity.

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Integrating Artificial Intelligence in Orthopedic Care: Advancements in Bone Care and Future Directions
Rahul Kumar, Kyle Sporn, Joshua Ong, Ethan Waisberg, Phani Paladugu, Swapna Vaja, Tamer Hage, Tejas C. Sekhar, Amar S. Vadhera, Alex Ngo, Nasif Zaman, Alireza Tavakkoli, Mouayad Masalkhi
Bioengineering.2025; 12(5): 513. CrossRef

Non-pharmacological treatments for insomnia: a focus on components of cognitive behavioral therapy for insomnia: Soyoung Park, Eun Ji Lim, Dongyun Lee, Young-Ji Lee; Kosin Med J. 2024;39(4):238-245. Published online December 19, 2024; DOI: https://doi.org/10.7180/kmj.24.153

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Abstract PDF PubReader ePub: Insomnia is a prevalent disorder that affects 4% to 22% of the population in the United States. While cognitive behavioral therapy for insomnia (CBT-I) remains the gold standard for non-pharmacological treatment, accessibility barriers exist owing to a shortage of trained professionals and high costs. This review examines the efficacy of the individual components of CBT-I as stand-alone interventions to improve treatment accessibility, digital CBT-I, and other non-pharmacological interventions. Guidelines from organizations such as the American Academy of Sleep Medicine and, European Sleep Research Society, along with recent meta-analyses, support the effectiveness of these components as stand-alone treatments. Sleep restriction therapy and stimulus control therapy show promise as effective interventions. Although recommended by certain guidelines, relaxation therapy has yielded mixed results. Sleep hygiene education, a common component of CBT-I, has not demonstrated significant efficacy as a stand-alone treatment. Cognitive strategies have shown promise in recent studies. Sufficient clinical evidence supports the efficacy of digital CBT-I in treating insomnia. Internationally, various platforms for digital CBT-I have already been developed and are in use, and in South Korea, some digital CBT-I software programs have received digital therapeutic device approval in 2023. This review highlights the potential of individual components of CBT-I as effective stand-alone interventions for insomnia, as well as digital CBT-I, emphasizing their importance for improving the accessibility of non-pharmacological insomnia treatments in clinical settings where full CBT-I may not be available.

Prevention of myopia progression using orthokeratology: Stephanie Suzanne S. Garcia, Changzoo Kim; Kosin Med J. 2023;38(4):231-240. Published online December 26, 2023; DOI: https://doi.org/10.7180/kmj.23.141

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The prevalence of myopia in children and juveniles has increased significantly in Korea and worldwide; in particular, the rates of myopia and high myopia in East Asia have grown rapidly. Myopia is easily corrected with spectacles or contact lenses. However, as children grow and mature, myopia can progress irreversibly and lead to vision-threatening complications. Thus, the prevention of myopia progression is an essential treatment goal. Many treatment strategies are being employed, including atropine eyedrops, specialized glasses, and orthokeratology (Ortho-K) lenses. Ortho-K is an effective treatment in managing myopia progression by lowering the rate of increase in refractive error and axial length. In this article, we review Ortho-K as a treatment for myopia progression, its history, mechanism, treatment regimen, and safety profile.

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Macular Buckling for Myopic Traction Maculopathy: A Comprehensive Systematic Review and Meta-Analysis
Hashem Abu Serhan, Abdullah Ahmed, Mahrukh Chaudhry, Zain Ali Nadeem, Fakiha Ahmed, Usama Hussain Kamal, Ameen Alkhateeb, Ayman G. Elnahry
American Journal of Ophthalmology.2025; 270: 25. CrossRef

Endoscopic diagnosis of Helicobacter pylori infection: Eun Jeong Gong, Kyoungwon Jung; Kosin Med J. 2025;40(1):4-14. Published online November 13, 2024; DOI: https://doi.org/10.7180/kmj.24.130

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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.

Do we need Moodle in medical education? A review of its impact and utility: Seri Jeong, Hyunyong Hwang; Kosin Med J. 2023;38(3):159-168. Published online September 22, 2023; DOI: https://doi.org/10.7180/kmj.23.139

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Various learning management systems (LMSs) are available to facilitate the development, management, and distribution of digital resources for both face-to-face and online instruction. In recent decades, these methods have shown potential for greater efficiency compared to traditional "chalk and talk" approaches. Additionally, they have paved the way for the establishment of ubiquitous learning environments, marking a new era in education. In a trend accelerated by the coronavirus disease 2019 pandemic, LMSs have been increasingly adopted to overcome the restrictions inherent to in-person education. In medical education, LMSs such as Moodle, Canvas, Blackboard Learn, and others have been introduced and used to support teaching, learning, and assessment activities. Of these, Moodle stands out as the most popular choice for many medical schools and institutions, primarily due to its flexibility, functionality, and user-friendliness. The learning environment is gradually transforming from traditional in-person teaching to a hybrid educational approach, driven by the need to fulfill diverse educational demands. Numerous research studies have examined the usability of Moodle in medical education, demonstrating its effectiveness in addressing challenges related to adaptive personalized learning, collaborative learning, blended learning, and more. Consequently, Moodle has emerged as a valuable solution for medical educators seeking a versatile and robust platform to enhance their teaching methodologies. The present review focuses on the practical utilization of Moodle in medical education and the advantages it offers to this field.

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Technology-Enabled Institutional Readiness for Agile-Blended Learning: A Framework for Educational Innovation
Jessie Ming Sin Wong, Kam Cheong Li
SN Computer Science.2025;[Epub] CrossRef
Development of an LMS-based e-literacy management model for managing the junior high school literacy movement
Oliva Ike Kurniawati
Primary: Jurnal Pendidikan Guru Sekolah Dasar.2025; 14(1): 71. CrossRef
Exploring the Opportunities and Challenges of Healthcare Innovation in UK Higher Education: A Narrative Review
Renske Emicke, Ashley Shepherd, Dylan Powell
Nursing Reports.2025; 15(5): 171. CrossRef
Exploring structural equations modelling on the use of modified UTAUT model for evaluating online learning
Stephen Gbenga Fashoto, Yinusa Akintoye Faremi, Elliot Mbunge, Olumide Owolabi
Educational Technology Quarterly.2024; 2024(3): 319. CrossRef
Looking Back on Digital Medical Education Over the Last 25 Years and Looking to the Future: Narrative Review
Oluwadamilola Ogundiya, Thahmina Jasmine Rahman, Ioan Valnarov-Boulter, Tim Michael Young
Journal of Medical Internet Research.2024; 26: e60312. CrossRef
The effectiveness of Moodle's “Lesson” feature in pre-learning about arterial puncture and blood transfusion procedures
Haeyoung Lee, Sang-Shin Lee, Hyunyong Hwang
Kosin Medical Journal.2023; 38(4): 278. CrossRef

Faculty development: the need to ensure educational excellence and health care quality: Hyekyung Shin, Min-Jeong Kim; Kosin Med J. 2023;38(1):4-11. Published online March 27, 2023; DOI: https://doi.org/10.7180/kmj.23.109

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The definition of faculty development has been refined and expanded over the past few decades, and various definitions have been used in higher education. Initially, faculty development was defined as activities that help teachers improve teaching skills, design better curricula, and improve the organizational environment for education. Since then, as the focus of faculty development has shifted from individual professors to institutional needs, faculty development is now defined as the personal and professional development of professors, clinicians, researchers, and managers to meet institutional goals, visions, and missions in social terms and moral responsibility to the community. Faculty development in medical education is universally needed to recognize and cope with widespread changes in education, including the traditional role of professors, advances in pedagogical theory, changes in learning styles, innovative curriculum models, and evaluation philosophy. However, critics have pointed out that most universities could not actively implement faculty development or accept professors’ various demands. In this paper, various reports related to faculty development are reviewed to summarize how faculty development has progressed and present future directions for accepting various opinions to improve educational excellence and the quality of health care.

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Needs and gaps of faculty development for medical schools
Ji Hyun Im, Wha Sun Kang, Seung Hee Lee, Dae Chul Jeong, Dae Hyun Kim, Man-Sup Lim, Miran Kim, Ji-Hyun Seo, Dong Hyeon Lee
Korean Journal of Medical Education.2024; 36(2): 189. CrossRef
Current status and challenges of faculty development in Korean medical education and strategies for advancement
Dong Hyeon Lee
Korean Journal of Medical Education.2024; 36(4): 415. CrossRef

Polycystic liver disease: an overview of clinical manifestations, diagnosis, and treatment: Joonho Jeong, Hyun Joon Park; Kosin Med J. 2023;38(2):75-86. Published online June 28, 2023; DOI: https://doi.org/10.7180/kmj.23.128

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Polycystic liver disease (PLD) is a hereditary disease characterized by the presence of 20 or more liver cysts. It is classified into three types: isolated autosomal dominant PLD, PLD with autosomal dominant polycystic kidney disease, and PLD with autosomal recessive polycystic kidney disease. Genetic alterations, ciliary dysfunction of the biliary epithelial cells, and aberrant cell signaling pathways are the main factors contributing to the pathophysiology of PLD; however, other complicated mechanisms are also involved. The Gigot and Schnelldorfer classifications are widely used in clinical practice. Most patients with PLD are asymptomatic; however, a few patients with advanced-stage disease may develop symptoms and complications that impair their quality of life and require treatment. The known treatment options for PLD are somatostatin analogues, aspiration with sclerotherapy, fenestration, hepatic resection, and liver transplantation. Although liver transplantation remains the only curative treatment for PLD, medical therapies are gradually being developed with the increasing knowledge of the disease’s pathophysiology. This review focuses on the clinical manifestations and diagnosis of PLD, as well as treatment strategies, to support clinicians regarding the clinical management of the disease.

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Predicting Safe Liver Resection Volume for Major Hepatectomy Using Artificial Intelligence
Chol Min Kang, Hyung June Ku, Hyung Hwan Moon, Seong-Eun Kim, Ji Hoon Jo, Young Il Choi, Dong Hoon Shin
Journal of Clinical Medicine.2024; 13(2): 381. CrossRef

Original article

Troponin I and D-dimer levels as triaging biomarkers to distinguish acute pulmonary thromboembolism from myocardial infarction: Soo-Jin Kim, Moo Hyun Kim, Kwang Min Lee, Jin Woo Lee, Young Shin Cha, Da Eun Koh, Joo Yeong Hwang, Jong Sung Park; Kosin Med J. 2023;38(4):252-258. Published online December 20, 2023; DOI: https://doi.org/10.7180/kmj.23.133

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Background
Acute pulmonary thromboembolism (APTE) is often confused with myocardial infarction. Previous studies have shown that patients with APTE exhibit lower initial and peak cardiac troponin I (CTI) levels, but higher D-dimer (DD) levels, than patients with myocardial infarction. The present study aimed to reaffirm the tree model algorithm using an entirely new set of data.
Methods
We reviewed retrospective clinical and laboratory data from patients who were diagnosed with APTE or non-ST-elevation myocardial infarction (NSTEMI) between 2015 and 2016. Subjects who were not classified with a diagnosis or did not have their CTI or DD levels assessed were excluded. We categorized patients according to the previous algorithm and compared the outcomes with the previous test dataset.
Results
The analysis involved data from 156 patients with APTE and 363 patients with NSTEMI. In the validation data set, the APTE group showed higher initial DD levels (9.80±10.84 μg/mL) and lower initial CTI levels (0.17±0.54 μg/mL) than the NSTEMI group. The accuracy rate for the test dataset and the validation set were similar. The test set accuracy rate was 91.0%, while the accuracy rate in the validation set improved to 88.6%.
Conclusions
Patients with APTE exhibited lower initial and peak CTI levels, but higher DD levels than NSTEMI patients. The accuracy rate estimates were similar between the test set obtained from the tree model algorithm and the validation set. The study findings demonstrate that the assessment of cardiac biomarkers can be useful for differentiating between APTE and NSTEMI.

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The old biomarkers you know are still useful: D-dimer and troponin I
Sanghyun Lee
Kosin Medical Journal.2023; 38(4): 229. CrossRef

Review articles

Fat embolism syndrome: a review in cosmetic surgery: Hongil Kim, Bommie Florence Seo, Gregory Randolph Dean Evans; Kosin Med J. 2024;39(3):169-178. Published online September 25, 2024; DOI: https://doi.org/10.7180/kmj.24.126

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Abstract PDF PubReader ePub: The growing popularity of cosmetic procedures such as liposuction and fat grafting has been accompanied by a rise in associated side effects. Among these, fat embolism syndrome stands out as a potential complication that sometimes has critical consequences. It is important to recognize that fat embolism affects organs through distinct mechanisms from those involved with other types of embolisms. Early diagnosis is crucial. Unfortunately, no effective treatments have been established for this condition. Therefore, starting with a more detailed categorization of diagnoses, developing new treatment methods for each subtype is essential.

Common statistical methods used in medical research: Hye Jin Yang, Hye Sun Lee; Kosin Med J. 2025;40(1):21-30. Published online March 27, 2025; DOI: https://doi.org/10.7180/kmj.24.160

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Abstract PDF PubReader ePub: This paper aims to review the statistical methods that are widely used in medical and clinical research. Statistical analysis is crucial for ensuring the reliability of research results; therefore, methods should be carefully tailored to research interests and objectives, depending on the type and characteristics of the data. This paper explains various types of data, discusses how to confirm whether the data satisfy these methods’ specific assumptions, and elucidates the meaning and interpretation of univariable and multivariable analysis. Finally, it presents corresponding examples to help other researchers understand how these methods are applied in real-world studies and select appropriate methods that ensure both research quality and reliability.

Current understanding of modulated electro-hyperthermia in cancer treatment: Sungmin Kim, Jesang Yu, Jihun Kang, Yunkyung Kim, Taek Yong Ko; Kosin Med J. 2024;39(3):160-168. Published online September 23, 2024; DOI: https://doi.org/10.7180/kmj.24.127

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Traditional hyperthermia involves increasing the temperature at the tumor site to above 39 ℃, inducing death in cancer cells. Although hyperthermia is an effective cancer treatment, its clinical application has decreased due to potential complications, including damage to surrounding normal tissue. In recent years, modulated electro-hyperthermia (mEHT) has emerged as an effective and safe treatment modality. mEHT selectively heats tumor cells to 42–43 °C, while reducing the average temperature in the treatment area, including the surrounding normal tissue, compared to conventional methods. Additionally, mEHT may be used in combination with systemic chemotherapy and radiation therapy in tumor treatment, providing a synergistic effect to increase efficacy. As chemotherapy and radiation therapy technologies advance, the application of combined mEHT may improve clinical outcomes. In this study, we review and discuss reports on the clinical outcomes of mEHT combined with chemotherapy and/or radiation therapy, which are established anticancer treatments.

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Advances and applications of hyperthermia in tumor therapy: Mechanisms, techniques, and clinical integration
Cuihua Gu, Jinzhong Zhang, Wenhua Gao, Jisong Wang, Kun Mou, Xuequn Zhang, Jiude Qi
International Communications in Heat and Mass Transfer.2025; 164: 108895. CrossRef

Original article

Comparison of the prevalence and histology between primary benign bladder tumors and recurrent benign lesions after transurethral resection of malignant bladder tumors: Jae Jin Baek, Yong Deuk Seo, Dong Ha Kim, Won Tae Seo, Su Hwan Kang, Taek Sang Kim, Bong Kwon Chun; Kosin Med J. 2023;38(1):43-49. Published online February 17, 2023; DOI: https://doi.org/10.7180/kmj.22.133

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Abstract PDF PubReader ePub: Background
Benign bladder tumors are rare disease entities, and insufficient studies have assessed their epidemiological characteristics. The authors investigated the prevalence of benign bladder tumors by retrospectively investigating pathology reports of transurethral resection of bladder tumor (TURBT) procedures over the past 20 years.
Methods
We analyzed 1,674 pathology reports of TURBT conducted in 1,160 patients from January 1, 2000, to April 30, 2022. The prevalence of benign tumors and histological classification according to the presence of primary (group 1) and recurrent (group 2) bladder lesions were retrospectively investigated.
Results
The mean age of patients was 65.2±11.5 years, and 1,284 cases (79.1%) were in men. Benign bladder tumors comprised 278 cases (248 patients) accounting for about 17.1% of the total TURBT cases (278/1,624). Furthermore, 184 patients (16.0%, 184/1,147) belonged to group 1 and 78 patients (27.4%, 78/285) belonged to group 2. Among all benign lesions that underwent TURBT, cystitis was the most common (41.0%, 114/278), and this rate was higher in group 2 (64/184 [34.8%] vs. 50/94 [53.2%], p<0.001). The prevalence of non-neoplastic lesions was higher in group 1 (44/184 [23.9] vs. 11/94 [11.7%], p<0.001). There was no difference in the prevalence of noninvasive urothelial neoplasms between the two groups (22/184 [12.0%] vs. 8/94 [8.5%], p=0.86).
Conclusions
The probability of benign lesions in TURBT was 17.1%, among which cystitis was the most common. When TURBT was performed for recurrent lesions, the frequency of benign tumors was higher than that of primary benign bladder tumors.

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

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Abstract PDF PubReader 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.

Review article

Bone-modifying agents for bone metastasis in patients with breast cancer: Lee Chun Park, Eun Mi Lee; Kosin Med J. 2024;39(2):83-88. Published online June 28, 2024; DOI: https://doi.org/10.7180/kmj.24.121

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Abstract PDF PubReader ePub: The bone is the most common location of breast cancer metastasis. Bone metastasis causes pain and skeletal-related events (SREs), and affects the quality of life and survival of breast cancer patients. Bone-modifying agents, including bisphosphonates and denosumab, reduce the risk of SREs in these patients. Among bisphosphonates, zoledronic acid is preferred due to its higher efficacy. Denosumab is marginally more effective than zoledronic acid in reducing the frequency of SREs. Patients with renal impairment should receive zoledronic acid with caution due to nephrotoxicity, and denosumab is an alternative option in these patients. Osteonecrosis of the jaw is a rare but severe complication of both zoledronic acid and denosumab, and all patients should undergo dental examinations before and during treatment. Although these drugs can reduce the risk of SREs in bone metastasis, no significant improvement in survival has been noted. This study reviews the effects and adverse events of bone-modifying agents for the treatment of bone metastasis from breast cancer.

Case report

Sigmoid colon plexiform neurofibroma as a colonic subepithelial mass: a case report: Hee Won Baek, Eun Jeong Choi, Seung Jung Yu, Myeongpyo Kim, Sang Heon Lee, Sam Ryong Jee, Hyungjoo Baik, Hong Sub Lee; Kosin Med J. 2023;38(2):138-143. Published online November 9, 2022; DOI: https://doi.org/10.7180/kmj.22.123

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Abstract PDF PubReader ePub: Plexiform neurofibroma (PN) is an uncommon benign tumor, usually associated with neurofibromatosis type 1. As most PNs involve the craniomaxillofacial region, PN of the colon is very rare. Here we present a case of PN involving the sigmoid colon. A 43-year-old male patient presented to the outpatient clinic for the evaluation of an incidentally discovered sigmoid colon mass. A colonoscopic biopsy was performed for the mass, and the result revealed neuronal proliferation. The patient visited the outpatient clinic a year later with symptoms of abdominal pain and stool caliber change. Biopsy was repeated for the sigmoid colon mass, and the results showed mucosal Schwann cell proliferation and S-100 immunostaining positivity. Computed tomography and magnetic resonance imaging were performed for further evaluation, and neurofibroma or schwannoma was suspected based on the imaging studies. For an accurate diagnosis, the patient underwent surgery to remove the sigmoid colon mass. The final diagnosis of the mass was confirmed as PN. We hereby report a rare case of PN involving the sigmoid colon that could not be diagnosed before surgery.

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