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Lactate: a multifunctional signaling molecule
Tae-Yoon Lee
Yeungnam Univ J Med. 2021;38(3):183-193.   Published online February 18, 2021
DOI: https://doi.org/10.12701/yujm.2020.00892
  • 20,494 View
  • 552 Download
  • 44 Crossref
AbstractAbstract PDF
Since its discovery in 1780, lactate has long been misunderstood as a waste by-product of anaerobic glycolysis with multiple deleterious effects. Owing to the lactate shuttle concept introduced in the early 1980s, a paradigm shift began to occur. Increasing evidence indicates that lactate is a coordinator of whole-body metabolism. Lactate is not only a readily accessible fuel that is shuttled throughout the body but also a metabolic buffer that bridges glycolysis and oxidative phosphorylation between cells and intracellular compartments. Lactate also acts as a multifunctional signaling molecule through receptors expressed in various cells and tissues, resulting in diverse biological consequences including decreased lipolysis, immune regulation, anti-inflammation, wound healing, and enhanced exercise performance in association with the gut microbiome. Furthermore, lactate contributes to epigenetic gene regulation by lactylating lysine residues of histones, accounting for its key role in immune modulation and maintenance of homeostasis.

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Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL)
Jun-Ho Lee
Yeungnam Univ J Med. 2021;38(3):175-182.   Published online January 19, 2021
DOI: https://doi.org/10.12701/yujm.2020.00801
  • 7,592 View
  • 178 Download
  • 9 Crossref
AbstractAbstract PDF
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare T-cell non-Hodgkin lymphoma characterized as CD30 positive and anaplastic lymphoma kinase (ALK) negative. In 2016, the World Health Organization declared BIA-ALCL as a new disease entity. The first case of BIA-ALCL was reported in 1997, and as of July 2019, the United States Food and Drug Administration had cited a total of 573 United States and global medical device reports of BIA-ALCL, including 33 deaths. In all clinical case reports, except for those with unknown clinical history, the patient had received at least one textured surface breast implant. Although the etiology is not yet clear, chronic inflammation has been proposed as a potential precursor to tumorigenesis. The most common presentation of BIA-ALCL is peri-implant fluid collection following aesthetic or reconstructive implantation with textured surface breast implants. It can be accompanied by breast swelling, asymmetry, pain, skin lesions, lymphadenopathy, and B-type symptoms. Most cases are detected on average 7 to 10 years after implantation. Diagnostic specimens can be obtained with fine-needle aspiration or biopsy. BIA-ALCL is CD30 positive, epithelial membrane antigen positive, and ALK negative. It can be cured with complete surgical excision at the T1–T3 stage.

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The role of microRNAs in cell death pathways
Ji Hoon Jang, Tae-Jin Lee
Yeungnam Univ J Med. 2021;38(2):107-117.   Published online January 13, 2021
DOI: https://doi.org/10.12701/yujm.2020.00836
  • 10,447 View
  • 212 Download
  • 16 Crossref
AbstractAbstract PDF
MicroRNAs (miRNAs) are a class of noncoding RNAs that negatively regulate target messenger RNAs. In multicellular eukaryotes, numerous miRNAs perform basic cellular functions, including cell proliferation, differentiation, and death. Abnormal expression of miRNAs weakens or modifies various apoptosis pathways, leading to the development of human cancer. Cell death occurs in an active manner that maintains tissue homeostasis and eliminates potentially harmful cells through regulated cell death processes, including apoptosis, autophagic cell death, and necroptosis. In this review, we discuss the involvement of miRNAs in regulating cell death pathways in cancers and the potential therapeutic functions of miRNAs in cancer treatment.

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F-18 fluorodeoxyglucose positron emission tomography/computed tomography in the infection of heart
Eunjung Kong
Yeungnam Univ J Med. 2021;38(2):95-106.   Published online October 15, 2020
DOI: https://doi.org/10.12701/yujm.2020.00479
  • 6,989 View
  • 111 Download
  • 2 Crossref
AbstractAbstract PDF
Infections involving the heart are becoming increasingly common, and a timely diagnosis of utmost importance, despite its challenges. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a recently introduced diagnostic tool in cardiology. This review focuses on the current evidence for the use of FDG PET/CT in the diagnosis of infective endocarditis, cardiac implantable device infection, left ventricular assist device infection, and secondary complications. The author discusses considerations when using FDG PET/CT in routine clinical practice, patient preparation for reducing physiologic myocardial uptake, acquisition of images, and interpretation of PET/CT findings. This review also functions to highlight the need for a standardized acquisition protocol.

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  • The Role of the 18F-FDG PET/CT in the Management of Patients Suspected of Cardiac Implantable Electronic Devices’ Infection
    Antonio Rosario Pisani, Dino Rubini, Corinna Altini, Rossella Ruta, Maria Gazzilli, Angela Sardaro, Francesca Iuele, Nicola Maggialetti, Giuseppe Rubini
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    Marine Germaini, Caroline Boursier, François Goehringer, Christine Selton-Suty, Benjamin Lefevre, Véronique Roch, Laetitia Imbert, Marine Claudin, Elodie Chevalier, Pierre-Yves Marie
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Can antioxidants be effective therapeutics for type 2 diabetes?
Soyoung Park, So-Young Park
Yeungnam Univ J Med. 2021;38(2):83-94.   Published online October 8, 2020
DOI: https://doi.org/10.12701/yujm.2020.00563
  • 10,879 View
  • 224 Download
  • 11 Crossref
AbstractAbstract PDF
The global obesity epidemic and the growing elderly population largely contribute to the increasing incidence of type 2 diabetes. Insulin resistance acts as a critical link between the present obesity pandemic and type 2 diabetes. Naturally occurring reactive oxygen species (ROS) regulate intracellular signaling and are kept in balance by the antioxidant system. However, the imbalance between ROS production and antioxidant capacity causes ROS accumulation and induces oxidative stress. Oxidative stress interrupts insulin-mediated intracellular signaling pathways, as supported by studies involving genetic modification of antioxidant enzymes in experimental rodents. In addition, a close association between oxidative stress and insulin resistance has been reported in numerous human studies. However, the controversial results with the use of antioxidants in type 2 diabetes raise the question of whether oxidative stress plays a critical role in insulin resistance. In this review article, we discuss the relevance of oxidative stress to insulin resistance based on genetically modified animal models and human trials.

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Pathophysiology and protective approaches of gut injury in critical illness
Chang Yeon Jung, Jung Min Bae
Yeungnam Univ J Med. 2021;38(1):27-33.   Published online September 23, 2020
DOI: https://doi.org/10.12701/yujm.2020.00703
  • 7,800 View
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AbstractAbstract PDF
The gut is a complex organ that has played an important role in digestion, absorption, endocrine functions, and immunity. The gut mucosal barriers consist of the immunologic barrier and nonimmunologic barrier. During critical illnesses, the gut is susceptible to injury due to the induction of intestinal hyperpermeability. Gut hyperpermeability and barrier dysfunction may lead to systemic inflammatory response syndrome. Additionally, gut microbiota are altered during critical illnesses. The etiology of such microbiome alterations in critical illnesses is multifactorial. The interaction or systemic host defense modulation between distant organs and the gut microbiome is increasingly studied in disease research. No treatment modality exists to significantly enhance the gut epithelial integrity, permeability, or mucus layer in critically ill patients. However, multiple helpful approaches including clinical and preclinical strategies exist. Enteral nutrition is associated with an increased mucosal barrier in animal and human studies. The trophic effects of enteral nutrition might help to maintain the intestinal physiology, prevent atrophy of gut villi, reduce intestinal permeability, and protect against ischemia-reperfusion injury. The microbiome approach such as the use of probiotics, fecal microbial transplantation, and selective decontamination of the digestive tract has been suggested. However, its evidence does not have a high quality. To promote rapid hypertrophy of the small bowel, various factors have been reported, including the epidermal growth factor, membrane permeant inhibitor of myosin light chain kinase, mucus surrogate, pharmacologic vagus nerve agonist, immune-enhancing diet, and glucagon-like peptide-2 as preclinical strategies. However, the evidence remains unclear.

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Updates on the treatment of adhesive capsulitis with hydraulic distension
Jang Hyuk Cho
Yeungnam Univ J Med. 2021;38(1):19-26.   Published online August 31, 2020
DOI: https://doi.org/10.12701/yujm.2020.00535
  • 9,591 View
  • 238 Download
  • 11 Crossref
AbstractAbstract PDF
Adhesive capsulitis of the shoulder joint is a common disease characterized by pain at the insertional area of the deltoid muscle and decreased range of motion. The pathophysiological process involves fibrous inflammation of the capsule and intraarticular adhesion of synovial folds leading to capsular thickening and contracture. Regarding the multidirectional limitation of motion, a limitation in external rotation is especially prominent, which is related to not only global fibrosis but also to a localized tightness of the anterior capsule. Ultrasound and magnetic resonance imaging studies can be applied to rule out other structural lesions in the diagnosis of adhesive capsulitis. Hydraulic distension of the shoulder joint capsule provides pain relief and an immediate improvement in range of motion by directly expanding the capsule along with the infusion of steroids. However, the optimal technique for hydraulic distension is still a matter of controversy, with regards to the infusion volume and rupture of the capsule. By monitoring the real-time pressure-volume profile during hydraulic distension, the largest possible fluid volume can be infused without rupturing the capsule. The improvement in clinical outcomes is shown to be greater in capsule-preserved hydraulic distension than in capsule-ruptured distension. Moreover, repeated distension is possible, which provides additional clinical improvement. Capsule-preserved hydraulic distension with maximal volume is suggested to be an efficacious treatment option for persistent adhesive capsulitis.

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Classification of endometriosis
Soo-Young Lee, Yu-Jin Koo, Dae-Hyung Lee
Yeungnam Univ J Med. 2021;38(1):10-18.   Published online August 7, 2020
DOI: https://doi.org/10.12701/yujm.2020.00444
  • 24,993 View
  • 782 Download
  • 57 Crossref
AbstractAbstract PDF
Endometriosis is a chronic disease associated with pelvic pain and infertility. Several classification systems for the severity of endometriosis have been proposed. Of these, the revised American Society for Reproductive Medicine classification is the most well-known. The ENZIAN classification was developed to classify deep infiltrating endometriosis and focused on the retroperitoneal structures. The endometriosis fertility index was developed to predict the fertility outcomes in patients who underwent surgery for endometriosis. Finally, the American Association of Gynecological Laparoscopists classification is currently being developed, for which 30 endometriosis experts are analyzing and researching data by assigning scores to categories considered important; however, it has not yet been fully validated and published. Currently, none of the classification systems are considered the gold standard. In this article, we review the classification systems, identify their pros and cons, and discuss what improvements need to be made to each system in the future.

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Gallbladder polyps: evolving approach to the diagnosis and management
Kook Hyun Kim
Yeungnam Univ J Med. 2021;38(1):1-9.   Published online May 15, 2020
DOI: https://doi.org/10.12701/yujm.2020.00213
  • 23,983 View
  • 493 Download
  • 6 Crossref
AbstractAbstract PDF
Gallbladder (GB) polyp is a mucosal projection into the GB lumen. With increasing health awareness, GB polyps are frequently found using ultrasonography during health screening. The prevalence of GB polyps ranges between 1.3% and 9.5%. Most patients are asymptomatic and have benign characteristics. Of the nonneoplastic polyps, cholesterol polyps are most common, accounting for 60%–70% of lesions. However, a few polyps have malignant potential. Currently, the guidelines recommend laparoscopic cholecystectomy for polyps larger than 1 cm in diameter due to their malignan potential. The treatment algorithm can be influenced by the size, shape, and numbers of polyps, old age (>50 years), the presence of primary sclerosing cholangitis, and gallstones. This review summarizes the commonly recognized concepts on GB polyps from diagnosis to an algorithm of treatment.

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Frailty and elderly in urology: implications for postoperative complications
Phil Hyun Song
Yeungnam Univ J Med. 2020;37(4):296-301.   Published online October 8, 2020
DOI: https://doi.org/10.12701/yujm.2020.00752
  • 5,374 View
  • 62 Download
AbstractAbstract PDF
The geriatric population is at a greater risk of postoperative complications than young adults. This risk is associated with the physiologic decline seen in this population known as frailty. Unlike fitter patients, frail patients who undergo operative treatment have a greater likelihood of developing postoperative complications and endure prolonged hospital stays. This circumstance is comparable to the urological status. Therefore, tolerable measurement of frailty as a domain of preoperative health status has been suggested to ascertain vulnerability in elderly patients. In this review, we will elaborate on the concept of frailty and examine its importance with respect to surgical complications, focusing on the urological status.
Current aspects and prospects of glass ionomer cements for clinical dentistry
Eun Young Park, Sohee Kang
Yeungnam Univ J Med. 2020;37(3):169-178.   Published online July 9, 2020
DOI: https://doi.org/10.12701/yujm.2020.00374
  • 16,172 View
  • 737 Download
  • 24 Crossref
AbstractAbstract PDF
Glass ionomer cement (GIC) is a tailor-made material that is used as a filling material in dentistry. GIC is cured by an acid-base reaction consisting of a glass filler and ionic polymers. When the glass filler and ionic polymers are mixed, ionic bonds of the material itself are formed. In addition, the extra polymer anion reacts with calcium in enamel or dentin to increase adhesion to the tooth tissue. GICs are widely used as adhesives for artificial crowns or orthodontic brackets, and are also used as tooth repair material, cavity liner, and filling materials. In this review, the current status of GIC research and development and its prospects for the future have been discussed in detail.

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Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging
Sung Mee Jung
Yeungnam Univ J Med. 2020;37(3):159-168.   Published online April 17, 2020
DOI: https://doi.org/10.12701/yujm.2020.00171
  • 12,646 View
  • 397 Download
  • 23 Crossref
AbstractAbstract PDF
The demand for drug-induced sedation for magnetic resonance imaging (MRI) scans have substantially increased in response to increases in MRI utilization and growing interest in anxiety in children. Understanding the pharmacologic options for deep sedation and general anesthesia in an MRI environment is essential to achieve immobility for the successful completion of the procedure and ensure rapid and safe discharge of children undergoing ambulatory MRI. For painless diagnostic MRI, a single sedative/anesthetic agent without analgesia is safer than a combination of multiple sedatives. The traditional drugs, such as chloral hydrate, pentobarbital, midazolam, and ketamine, are still used due to the ease of administration despite low sedation success rate, prolonged recovery, and significant adverse events. Currently, dexmedetomidine, with respiratory drive preservation, and propofol, with high effectiveness and rapid recovery, are preferred for children undergoing ambulatory MRI. General anesthesia using propofol or sevoflurane can also provide predictable rapid time to readiness and scan times in infant or children with comorbidities. The selection of appropriate drugs as well as sufficient monitoring equipment are vital for effective and safe sedation and anesthesia for ambulatory pediatric MRI.

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Current perspectives in stem cell therapies for osteoarthritis of the knee
Gi Beom Kim, Oog-Jin Shon
Yeungnam Univ J Med. 2020;37(3):149-158.   Published online April 13, 2020
DOI: https://doi.org/10.12701/yujm.2020.00157
  • 10,884 View
  • 310 Download
  • 9 Crossref
AbstractAbstract PDF
Mesenchymal stem cells (MSCs) are emerging as an attractive option for osteoarthritis (OA) of the knee joint, due to their marked disease-modifying ability and chondrogenic potential. MSCs can be isolated from various organ tissues, such as bone marrow, adipose tissue, synovium, umbilical cord blood, and articular cartilage with similar phenotypic characteristics but different proliferation and differentiation potentials. They can be differentiated into a variety of connective tissues such as bone, adipose tissue, cartilage, intervertebral discs, ligaments, and muscles. Although several studies have reported on the clinical efficacy of MSCs in knee OA, the results lack consistency. Furthermore, there is no consensus regarding the proper cell dosage and application method to achieve the optimal effect of stem cells. Therefore, the purpose of this study is to review the characteristics of various type of stem cells in knee OA, especially MSCs. Moreover, we summarize the clinical issues faced during the application of MSCs.

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Effectiveness of orthoses for treatment in patients with spinal pain
Yoo Jin Choo, Min Cheol Chang
Yeungnam Univ J Med. 2020;37(2):84-89.   Published online March 24, 2020
DOI: https://doi.org/10.12701/yujm.2020.00150
  • 8,692 View
  • 176 Download
  • 12 Crossref
AbstractAbstract PDF
Spinal pain is a common patient complaint in clinical practice. Conservative treatment methods include oral medication, physical therapy, injections, and spinal orthoses. The clinical application of orthoses is debated because of potential complications associated with long-term use, such as muscle weakness and joint contracture. We reviewed the orthoses most frequently used to manage spinal pain. We review the use of soft cervical and Philadelphia collars, lumbosacral corsets, and thoracolumbosacral orthosis to manage spinal pain. Spinal orthoses can help reduce pain by protecting the muscles and joints of the injured spinal region, preventing or correcting malformations, and limiting trunk flexion, extension, lateral flexion, and rotation. The short-term use of spinal orthoses is known to improve pain and disability during the treatment period without significant adverse effects. Spinal orthoses are expected to alleviate pain and improve patients’ lifestyle.

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Creativity in medical education: concepts related to creative capacity
Yura Kim, Young Hwan Lee
Yeungnam Univ J Med. 2020;37(2):79-83.   Published online March 9, 2020
DOI: https://doi.org/10.12701/yujm.2019.00458
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AbstractAbstract PDF
In the 21st-century postmodernism era, which represents diversity and relativity, one of the most essential elements in the field of education is to strengthen individual human values. Accordingly, we must focus on developing capacity in order to adapt to change. It is clear that the medical field maximizes the need for new judgments to solve life-related problems constantly, and this problem-solving capacity is an essential skill for a physician. Problem-solving capacity can be achieved simultaneously with creativity to apply them in an appropriate manner based on standardized expertise and well-trained skills. Creativity is also a key element that medical education is currently pursuing. Many studies on creativity have resulted in confusion and misunderstandings on the concept of creativity due to similar terms and varied definitions, such as creation, innovation, etc. In this study, we attempt to identify the importance of creativity in medical education by comparing and organizing concepts related to creative capacity.

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JYMS : Journal of Yeungnam Medical Science
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